Table of Content

20 May 2021 Volume 35 Issue 3

  

Category and disease classification of voice medicine

HUANG Yongwang, FU Dehui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  1-4.  doi:10.6040/j.issn.1673-3770.1.2020.120

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With the improvement in living standards, the demand for voice has also increased. This sets higher requirements for voice science practitioners. However, at present, there is still a certain degree of confusion in the definition of voice science and the classification of voice disorders, which also leads to difficulties in clinical practice. In view of this situation, we define the category of voice science in this study. In addition, the classification of voice diseases is proposed, based on the previous classification of voice disorders and our understanding of voice diseases. Further, this paper lists the important roles played by academic societies related to voice science. We hope that some of the concepts in this paper will be beneficial for the standardization of the diagnosis, treatment, and classification of voice disorders in the future.

Hormones and voice

ZHUANG Peiyun, LIU Yunyi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  5-9.  doi:10.6040/j.issn.1673-3770.1.2020.117

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There is a close relationship between the endocrine system and the voice, and fluctuations in hormone levels have an impact on the shape and structure of the human vocal system, which in turn leads to voice changes. The larynx contains a large number of receptors for sex hormones and thyroid hormones, so sex hormones and thyroid hormones are the two most important hormones that cause voice disorders. Sex hormones have dynamic changes at different stages of human life, which can cause voice changes, which are most obvious in adolescence and old age. Mutational falsetto, also known as puberphonia, is very sensitive to voice training therapy, so it is necessary to be cautious when choosing surgical treatment. Furthermore, the hormone-related drugs has a significant and even irreversible impact on the voice, so caution should be used when using them. In addition, laryngeal mucosa and vocal cord edema caused by hypothyroidism can easily be misdiagnosed as Reinke's edema, which requires attention to distinguish. Finally, otolaryngologists should deepen their understanding of the endocrine problems behind voice disorders in order to more clearly identify the primary disease.

Clinical characteristics of functional dysphonia secondary to inadequate voice rest

CHENG Liyu, XU Wen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  10-13.  doi:10.6040/j.issn.1673-3770.1.2021.001

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The etiology and pathogenesis of spasmodic dysphonia

YU Ping, QU Ge

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  14-19.  doi:10.6040/j.issn.1673-3770.1.2020.119

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Objective To retrospectively analyze the demographic characteristics, occurrence background, characteristics of voice disorders, and effects of different treatment methods in patients with adduction spasmodic dysphonia(SD), as well as to explore the etiology and pathogenesis of SD. Methods Sixty eight SD patients aged 5 months to 8 years were enrolled, including 62 women and 6 men. We investigated the patient's occupation, education, family or/and work status, background, onset mode and course of disease, manifestation of voice disorder, and others. The recorded text was a short poem and long vowel ［a:］. It was produced in three different ways: normal speech, whispering, and high-pitched voice. The anatomical morphology of the bilateral vocal cords was normal on electronic laryngoscopy. According to the patient's age, degree of voice disorder, course of disease, and willingness to choose the treatment: injection of Botox, voice training and/or self-regulating relaxation therapy, music therapy, and anti-anxiety drugs. Results The age range of the SD patients was 30-49 years, and the number of females was significantly higher than that of males, with a sex ratio of 1:10.3. Voice disorders occurred in 29 cases of important difficult periods, 15 cases of mental trauma, 5 cases of adverse events, and 19 cases of no clear psychological background. Therapeutic effect: Among the 22 patients who received botulinum toxin treatment 1-5 times, 1 case was cured, 14 cases were relieved, and 7 cases were invalid; 4 cases were treated with music therapy, of which 1 case was cured and 3 cases were relieved; 23 cases were treated with vocal training, of which 8 cases were relieved and 15 cases were invalid; 12 cases were treated with oral anti-anxiety drugs, of which 2 cases were relieved and 10 cases were invalid; and 7 cases were treated with self-relaxation training, of which 4 cases were cured and 3 cases were invalid. Conclusion The diversity of therapeutic methods resulted in different therapeutic effects, suggesting a multidimensional etiology and the complexity of the pathogenesis of SD. Unhealthy living events or long-term mental stress are highly correlated with the occurrence of SD, suggesting that it is an important factor affecting SD patients.

Phonological assessment and analysis of voice patterns after thyroidectomy

LIANG Chengcheng, LEI Dapeng, WANG Xin, HOU Bo, LI Mei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  20-27.  doi:10.6040/j.issn.1673-3770.1.2020.110

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Objective To investigate and analyze the voice changes in patients with thyroid nodules before and after surgery. Methods A total of 64 patients who underwent thyroidectomy between July 14, 2020, and September 1, 2020, were grouped according to the type of surgery and sex as follows: female patients with total thyroidectomy(group 1,18 cases), female patients with partial thyroidectomy(group 2, 28 cases), male patients with thyroidectomy(Group 3, 6 cases), and male patients with partial thyroidectomy(Group 4, 12 cases). Electronic nasopharyngolaryngoscopy, dynamic laryngoscopy, VHI-10, GRBAS, and voice acoustic analysis were performed preoperatively and on the third day and after 1 month postoperatively. Results The recurrent laryngeal nerve(RLN)was exposed during the surgery. All cases had RLN signals. Regarding VHI-10 and GRBAS, there was no significant difference between the preoperative and postoperative values of groups 3 and 4(P>0.05). The score of Asthenia(A)for group 1 and the scores of Physiology(P), total Hoarseness(G), and Roughness(R)for group 2 preoperatively and on the third day postoperatively were statistically significant(P<0.05). However, there was no statistically significant difference 1 month postoperatively(P>0.05). On the third postoperative day, the shimmer(group 4)increased(P<0.05)and the MPT(group 1, group 4), SPLmax(group 1, group 2, group3, group 4), and DSI(groups 1, 2, and 3)decreased(P<0.05). All the voice indicators returned to or became better than the preoperative levels 1 month postoperatively: the F0(group 4), MPT(group 1), and DSI(group1, group 2)increased(P<0.05), and the jitter(group1, group 4)and shimmer(group 4)decreased(P<0.05). Conclusion The abnormal voice of patients after thyroidectomy may be related to gender, psychological factors, tumor range, and recurrent laryngeal nerve exposure. The abnormal voice in patients without recurrent laryngeal nerve paralysis is reversible.

Voice changes after parathyroidectomy in patients with secondary hyperparathyroidism

DENG Minxin, OU Weijian, LIU Shuangxin, REN Qingyi, YAN Peikai, WU Jiahui, KANG Jing, ZHANG Siyi,

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  28-30.  doi:10.6040/j.issn.1673-3770.1.2021.002

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Objective To investigate the changes in voice after parathyroidectomy in patients with secondary hyperparathyroidism. Method This study involved 29 patients, including 11 women(mean age, 50±12 years)and 18 men(mean age, 43±12 years). All patients underwent computerized voice analysis for F₀, jitter, shimmer, and harmony-to-noise ratio(HNR)and maximum phonation time(MPT)and serum calcium concentration assessment preoperatively and 5 days postoperatively. The serum parathyroid hormone concentration was measured pre- and post-operatively. Results There was no difference between the pre- and post-operative F₀, jitter, shimmer, and HNR. The MPT decreased after parathyroidectomy(P<0.05). Conclusion The MPT decreased significantly after parathyroidectomy remaining serum calcium concentration on secondary hyperparathyroidism. However, no changes were observed in F₀, jitter, shimmer, and HNR.

Narrow band imaging might contribute to the diagnosis of laryngopharyngeal reflux

WU Dipanpan, CUI Xinhua, GUO Ying, GENG Bo, GAO Fangfang, LIANG Hui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  31-36.  doi:10.6040/j.issn.1673-3770.1.2020.108

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Objective To explore the possible role of narrow band imaging(NBI)in the diagnosis of laryngopharyngeal reflux(LPR). Methods According to the Chinese domestic expert consensus on the diagnosis and treatment of laryngopharyngeal reflux(LPR), we recruited 39 LPR patients who visited our outpatient department. All patients were assessed using the reflux symptom index(RSI)and questionnaires on the reflux finding score(RFS)and NBI endoscopy before and after treatment. At the same time, we selected 19 symptom-negative controls and completed the above examinations. Results Initially, we recruited 39 LPR-positive patients, although two were lost. Compared with the consensus standard, the sensitivity of NBI was 94.6%, its specificity was 78.9%,(Kappa=0.755, P<0.001). Before treatment: According to NBI, the positivity rate was 94.6%. In the control group, the positivity rate was 21.1%. The positivity rates based on RSI and RFS were 24.3% and 94.6%, respectively. The results showed that NBI was as effective as RFS(P=0.003), and the consistency between NBI and RSI was poor(P=0.040). The positivity rate of the study group was significantly different from that of the control group(P<0.001). After treatment, only 21 patients with LPR agreed to undergo post-treatment. The positivity rate of NBI was 71.4%, while that of RSI was 9.5%, indicating poor consistency(P<0.001). The positivity rate of RFS was 61.9%, which was relatively better than that of NBI(Kappa=0.576, P=0.007), showing statistical significance. Compared with the pre-study, the positive rate dropped from 90.5% to 71.4%, although the difference was not statistically significant(P=0.119). Conclusion NBI is valuable for LPR diagnosis.

Evaluation of voice and mental state in patients with functional dysphonia

ZHANG Kaiting, LIU Jie, XU Zhenju, ZHANG Xiaoxue, CAO Songli, HAN Min

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  37-41.  doi:10.6040/j.issn.1673-3770.1.2020.114

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Objective We aimed to explore the clinical importance of voice and mental state assessment in the diagnosis and treatment of functional speech disorders. Methods We selected 72 patients with functional dysphonia(experimental group)and 40 individuals without dysphonia(control group)from the Department of Otolaryngology, Affiliated Hospital of Qingdao University, from August 2017 to October 2020. In the functional dysphonia group, 50 individuals had enhanced dysphonia and 22 had diminished dysphonia. All patients underwent voice assessment, evaluation using the Grade, Roughness, Breathiness, Asthenia, Strain(GRBAS)scale and voice handicap index(VHI)scale, dynamic laryngoscopy, and evaluation of anxiety(Self-Rating Anxiety Scale, SAS)and depression(Self-Rating Depression Scale, SDS). We compared evaluation results of the various indicators between the two groups. Results In the experimental group, the GRBAS score was 1.92±1.03 and the VHI score was 58.43±23.17. Vocal cord closure, mucosal wave, symmetry, and periodicity scores in the experimental group were significantly different from those of the control group, in stroboscopic examination. In computer voice evaluation, the frequency perturbation, amplitude perturbation, and maximum sound time in the experimental group were significantly different from these values of the control group. We found significant differences in SAS and SDS scores between the experimental and control groups. Conclusion Voice and mental state assessment are important for guiding the diagnosis and treatment of patients with functional phonation disorder.

Preliminary observation of the immediate curative effect of unilateral idiopathic vocal cord palsy after electrical stimulation of the nerve

YAN Jing, REN Xiaoyong, XIANG Li, DU Xiaoying, LI Na, LIU Xiaohong, HOU Jin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  42-46.  doi:10.6040/j.issn.1673-3770.0.2020.451

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Objective To explore the effects of idiopathic vocal cord paralysis on subjective sound changes, acoustic parameters, and dynamic laryngoscope observations immediately after electrical stimulation of the recurrent laryngeal nerve/supralaryngeal nerve. Methods The records of patients who were diagnosed with unilateral idiopathic vocal cord paralysis at the Throat Clinic of the Second Affiliated Hospital of Xi'an Jiaotong University from March 2018 to April 2020 before and after undergoing laryngeal EMG examination and concurrent neuroelectric stimulation treatment were reviewed. The stroboscopic laryngoscopy and voice analysis results, subjective voice changes before and after examination and treatment, acoustic parameters(jitter, shimmer, MPT), and dynamic laryngoscope observation results were assessed. Results A total of 43 patients with unilateral idiopathic vocal cord paralysis met the inclusion criteria: 4 had recurrent laryngeal nerve damage of the superior laryngeal nerve, 1 had superior laryngeal nerve damage, and 38 had recurrent laryngeal nerve damage. After laryngeal electromyography and nerve electrical stimulation treatment, the patients felt that their speech was more relaxed than before. Stroboscopic laryngoscopy immediately after treatment revealed that 5 patients(11.6%)had closed vocal cords. There was no significant change. In 38 cases(88.4%), the glottis was significantly smaller after than before the examination, and the fundamental frequency and mucosal waves could be collected. The changes in acoustic parameters did not significantly differ after treatment: MPT(6.58±2.75 vs 10.3±5.18, P<0.000 1), DSI(-3.79±6.7vs -0.11±1.68, P=0.002), jitter and shimmer(P>0.05). Conclusion Patients with idiopathic vocal cord palsy receiving early laryngeal electromyography and nerve electrical stimulation intervention can improve hoarseness, significantly extend the longest pronunciation time, improve the severity index of voice disorders, and significantly improve the degree of glottis closure. The recovery of the nerve function has a positive effect.

Mastery and demand regarding vocal hygiene knowledge among music, teacher education, and medical undergraduates

ZENG Bin, XU Ting, YU Lingyu, MAO Minzi, REN Jia, ZHU Jiao, YANG Hui, CHEN Qian, LÜ Dan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  47-53.  doi:10.6040/j.issn.1673-3770.1.2020.109

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Objective This study aimed to investigate the mastery and demand regarding vocal hygiene knowledge among music, teacher education, and medical undergraduates at Chinese universities, in order to provide a basis for promoting vocal hygiene knowledge among professional vocal practitioners. Methods A questionnaire was distributed online through WJX.cn to undergraduates of related majors, and the data were analyzed statistically. Results A total of 444 participants were enrolled in the study. In terms of daily habits and customs, the majority of the undergraduates reported “liking spicy and stimulating food”(50.5%, n=224), and 40.5%(n=180)had not heard of vocal hygiene knowledge. The awareness rates of the behavior habits that are associated with voice damage or voice protection ranged from 55.0% to 84.2% and from 71.9% to 91.0%,respectively. In addition, 85.1%(n=378)of undergraduates wanted to learn more about vocal hygiene,especially the prevention of voice diseases(83.3%, n=370). The network platform(62.6%, n=278)was the most popular method of obtaining information. Conclusion Undergraduates of music, teacher education and medical department lack knowledge on vocal hygiene, and there is a need for vocal hygiene. However, personalized vocal hygiene programs should be formulated according to different gender, grade and major vocal hygiene mastery and demand degree.

Evaluation of the effect of voice training on vocal cord polyp surgery

MA Yifei, YU Guodong, XIAN Zhipeng, HE Xingchen, GU Ping, CHEN Zili

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  54-58.  doi:10.6040/j.issn.1673-3770.0.2020.407

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Objective To explore the effect of voice training on vocal cord polyps after surgery. Methods Ninety-two patients who had undergone vocal polypectomy in the department of otolaryngology of the Affiliated Hospital of Guizhou Medical University between September 2019 and March 2020 were selected as the research subjects. All the subjects were randomly allocated to the experimental(n=46)and control (n=46)groups. Laryngeal microvocal polypectomy was performed in both groups. The patients in the control group received oral treatment with Jinsang Sanjiewan for 4 weeks after surgery. The experimental group received a combination treatment, including voice training for 3 weeks after 1 week after surgery. The treatments were completed simultaneously in both groups 4 weeks after surgery. The VHI score and voice acoustic parameters of the two groups before and after treatment were compared. Results Six patients did not complete the study; 86 did. There were no significant differences between the VHI scores and voice acoustic parameters of the experimental and control groups before treatment(P>0.05). The VHI scores and the voice acoustic parameters of the two groups improved after treatment(P<0.001). After treatment, the VHI scores and voice acoustic parameters of the experimental group significantly improved compared with those of the control group. Conclusion Voice training can significantly promote functional recovery after vocal cord surgery and voice quality.

Application of the Chinese version of the vocal fatigue index scale to self-assessment of vocal fatigue of professional voice users

XING Dongsheng, DI Quanhong, YIN Youliang, XIU Shiguo, ZHANG Minglong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  59-64.  doi:10.6040/j.issn.1673-3770.0.2020.467

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Objective To explore the application of the Chinese version of the vocal fatigue index(VFI)to the self-assessment of vocal fatigue in professional voice users. Methods The observation group consisted of 120 professional voice users who were treated in our department due to voice fatigue(VF). The patients were examined using NBI, and they filled the Chinese version of the VFI. According to the findings of NBI examination under electronic laryngoscopy, the observation group was divided into the chronic laryngitis group(group A), vocal cord nodule group(group B), and the vocal cord polyp group(group C). The control group consisted of 20 occupational voice users who were examined using an electronic laryngoscope NBI and self-reported without voice diseases. Observation groups A and B were treated with atomization inhalation for one week, sound rest, 10 mL Lanqin oral liquid three times a day, and symptomatic treatment for one month, followed by electronic laryngoscope NBI examination and filling of the Chinese version of the VFI scale. The observation group C underwent vocal cord tumor resection, and the specimens were used for pathological examination. Based on the pathological results, the group was subdivided into the C1 benign tumor group, C2 malignant tumor group, postoperative atomization inhalation for 1 week, sound rest, Lanqin oral liquid 10 mL, three times a day, and symptomatic treatment for 1 month. The results were statistically analyzed. Results 1. The age and sex composition ratios of each of the observation and control groups were compared(P>0.05); the difference was not statistically significant. 2. Compared with the control group, the VFI scores of the observation group were higher than those of the control group in Part 1 and Part 2, and lower in Part 3(P<0.001); the difference was statistically significant. 3. The scores of group A and group B in Parts 1, 2, and 3 and C1 and C2 in the observation group were compared (P=0.125,P=0.492); the difference was not statistically significant. The scores of group A and group B were lower than those in group C1 in Part 1. The scores of group A and group B were lower than those in group C1 and group C2 in part 2. The scores of group A and group B were higher than those in group C1 and group C2 in part 3(P<0.005); the difference was statistically significant. The score of group A was lower than that in group C2 in Part 1(P=0.012), and the difference was statistically significant. The score of group B was lower than that of group C2 in Part 1(P=0.056), and the difference was not statistically significant. 4. After treatment, the VFI scores of observation groups A, B, and C1 decreased in Part 1 and Part 2, and the scores of Part 3 increased(P<0.001); the difference was statistically significant. The VFI scores of observation group C2 in Part 1 and Part 2 decreased, and the scores of Part 3 increased(P=0.102); the difference was not statistically significant. Conclusion The Chinese version of the VFI scale can provide accurate quantitative indicators for VF patients in three aspects: pronunciation fatigue and avoidance, pronunciation discomfort, sound rest, and improvement of symptoms. It can be used for the subjective evaluation of the VF of professional voice users.

Phenotypic characteristics of a new X-linked deafness syndrome

LAN Shipeng, CHEN Zhibin, CAO Xin, XING Guangqian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  65-69.  doi:10.6040/j.issn.1673-3770.0.2020.382

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Therapeutic and anti-allergic effects of probiotics on allergic rhinitis: a meta-analysis

LIN Xiaoyan, LI Jing, MA Zhiqi, LI Yilin, GAO Xinyi, LI Yong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  70-80.  doi:10.6040/j.issn.1673-3770.0.2020.374

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Objective To systemically review the therapeutic and anti-allergic effects of probiotics on allergic rhinitis(AR). Methods Publications from PubMed, the Cochrane Library, Embase, CNKI, WanFang, and VIP databases were searched from inception to February 2020. Two reviewers extracted the data and performed literature evaluation. Revman 5.3 software was used for meta-analysis. Results A total of 27 randomized controlled trials comprising 2 147 patients(1 106 patients in the probiotics group and 1 041 patients in the placebo group)were included. The results of meta-analysis showed that probiotics reduced serum total IgE ［SMD=-0.22, 95%CI(-0.42, -0.02), P=0.03<0.05］ and eosinophil level ［SMD=-0.38, 95%CI(-0.69, -0.08), P=0.01<0.05］. Rhinoconjunctivitis quality of life questionnaire(RQLQ)nose symptoms ［MD=-0.78, 95%CI(-0.96, -0.61), P<0.001］, RQLQ eye symptoms ［MD=-0.78, 95%CI(-0.96, -0.61), P<0.000 01］, the total nasal symptom score ［MD=-1.54, 95%CI(-1.77, -1.31), P<0.001］, and medication scores ［SMD=-0.43, 95%CI(-0.64, -0.22), P<0.001］ were significantly lower in the placebo group. However, specific IgE ［SMD=0.08, 95%CI(-0.11, 0.26), P=0.42］ and Th1/Th2 ratio ［SMD=0.40,95%CI(-1.20, 1.99), P=0.63］ were not statistically different between the groups. Conclusion Probiotics effectively reduced symptom scores of patients with AR compared with placebo. Although short-term use of probiotics showed no significant preventive effects on AR, their long-term use reduced serum total IgE level and eosinophil count. Taken together, probiotics can be suggested as an effective treatment for AR.

Analysis of the relationship between miR-429 and miR-200C expression and prognosis in patients with nasopharyngeal carcinoma

WANG Zhongwei, YANG Lin, GUO Ya, SUN Bin, WANG Yali, MA Xiulong, REN Hongtao, BAO Xing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  81-86.  doi:10.6040/j.issn.1673-3770.0.2020.016

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Objective To investigate the relationship between the expression of miR-429, miR-200C and prognosis in patients with nasopharyngeal carcinoma. Methods 80 patients with nasopharyngeal carcinoma who received treatment between January 2016 and May 2017 were selected Tissue puncture samples were subjected to qRT-PCR detection to analyze the offset expression of miR-429 and miR-200C, and three treatments were performed. The Efficacy will be evaluated in the coming months. After discharge from the hospital, follow-up was conducted by telephone and outpatient follow-up, and the survival time of the patient was recorded. Results The relative expression levels of miR-429 and miR-200C in patients with different pathological stages, T stages, N stages and clinical stages were statistically significantly different, and the expression levels decreased with the increase of severity(P<0.05). After three months of treatment, the overall effective rate of 80 patients was 100%, of which 71 were CR(88.75%)and 9 were PR(11.25%). Fifty-five patients with death, recurrence or metastasis belonged to the poor prognosis group, and 18 patients with tumor-free survival belonged to the good prognosis group. The relative expression levels of miR-429 and miR-200C in the good prognosis group were higher than those in the poor prognosis group(P<0.05). The relative expression of miR-429 has a predictive cut-off value of 1.36 for the poor prognosis of nasopharyngeal carcinoma. The AUC was 0.723, 95% CI of 0.547 to 0.898, sensitivity of 82.15%, and the specificity was 81.72%; relative expression of miR-200C The predictive cut-off value of poor prognosis for nasopharyngeal carcinoma was 0.53, the AUC was 0.713, 95%CI was 0.562-0.865, the sensitivity was 82.01%, and the specificity was 79.61%. The average survival time of the miR-429 high expression group(miR-429 relative expression level ≥ 1.36)was 39.07±1.59 months, with a 95%CI: of 35.95-42.19; miR-429 in the low expression group(miR-429 relative expression level < 1.36). The average survival time was 23.57±1.02 months, with a 95%CI of 21.57-25.58(P<0.05). The average survival time of the miR-200C high expression group(miR-200C relative expression ≥0.53)was(38.28±1.71)months the 95%CI was 34.94-41.63; and the miR was-200C in the low expression group(miR-200C relative expression <0.53 )The average survival time was 23.52±1.07 months, 95%CI: 21.42-25.62(P<0.05). Conclusion The relative expression levels of miR-429 and miR-200C in nasopharyngeal carcinoma patients at different pathological stages, T stages, N stages and clinical stages were different, and the expression levels of miR-429 and miR-200C decreased as the severity of the disease increased. The survival time of nasopharyngeal carcinoma patients decreased when the relative expression of miR-429 was <1.36 and the relative expression of miR-200C was <0.53.

Application of the ROE scale to the evaluation of the quality of life of patients with external nose deformity and nasal septum deviation before and after surgery

SUN Xiaohan, LI Na, CHEN Kaixuan, CHEN Min, YAN Shu, CHE Fei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  87-91.  doi:10.6040/j.issn.1673-3770.0.2021.098

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Objective To investigate the improvement in the quality of life of patients with external nose deformity and nasal septum deviation after nasal endoscopy assisted functional rhinoplasty. Methods The reliability and validity of the rhinoplasty outcome assessment scale(ROE)were analyzed. The outcomes of the patients with external nasal deformity and nasal septum deviation, who received functional rhinoplasty assisted by nasal endoscopy before and after surgery, were compared using the Chinese translated ROE. Results The ROE scores before and after surgery were 38.622±18.136 and 76.603±6.761, respectively. The difference was statistically significant(t=14.478, P<0.001). Conclusion Using ROE for the evaluation, nasal endoscopy assisted functional rhinoplasty can improve the quality of life of patients with external nasal deformity and nasal septum deviation.

Application of hysteroscopy during surgery for difficult glottis exposure in patients with laryngeal lesions

SUN Hao,ZHANG Jie, YANG Yang, NI Shuren, WU Yuhua, LIU Yuanhu, NI Xin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  92-95.  doi:10.6040/j.issn.1673-3770.0.2020.492

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Objective To investigate the usefulness of hysteroscopy during surgery for difficult laryngeal exposure and compare its visual field with that of microscopy. Methods Based on the Yamamoto grading method, 45 patients with difficult laryngeal exposure were selected. The visual field images were obtained using hysteroscopy and microscopy during the surgery. The niduses of 38 patients were removed using hysteroscopy during the surgery. Results Thirty-eight patients were successfully treated with hysteroscopy guidance. Hysteroscopy has more advantages related to the operating visual field than microscopy. Conclusion Hysteroscopy can be used forvisual guidance during interventions for difficult laryngeal exposure, and it has more advantages related to the operating visual field than microscopy.

Clinical application of the ultra-widefield laser ophthalmoscope to the preoperative examination of patients with rhegmatogenous retinal detachment

ZHOU Huaisheng, LIANG Wanling, LANG Haibo, XIAN Zhilin, YAN Shigang, Kong Xiangbin, SHEN Peiyang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  96-99.  doi:10.6040/j.issn.1673-3770.0.2020.378

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Objective To compare the usefulness of the ultra-widefield laser ophthalmoscope(Daytona)and the three-mirror contact lens for detecting preoperative retinal breaks in a patient with rhegmatogenous retinal detachment, evaluate their consistency, and analyze their related factors. Methods One hundred and eleven eyes of patients with rhegmatogenous retinal detachment were retrospectively reviewed. Retinal images of the patients were obtained with the Optomap ultra-widefield laser ophthalmoscope imaging system and their fundi were examined with a three-mirror contact lens by ophthalmologists. All patients had undergone vitrectomy. The findings from the Optomap retinal images and the three-mirror contact lens examination were compared with the findings of the pars plana vitrectomy(PPV). Results The consistency of the two methods was moderate for detecting rhegmatogenous retinal detachment(Kappa=0.447). The number of different types of retinal holes detected by the two methods was different. The detection of the round hole demonstrated the most significant difference. Few other types of holes were missed for the two methods. Conclusion The ultra-wide-angle laser scanning ophthalmoscope fundus examination system is moderately consistent with the three-mirror contact lens for the preoperative examination of rhegmatogenous retinal detachment, and it may miss more peripheral retinal tears and macular holes, especially peripheral round retinal holes.

Research progress on short lingual frenulum and obstructive sleep apnea in children

YANG Mu,XIAO Xuping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  100-105.  doi:10.6040/j.issn.1673-3770.0.2020.148

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Short lingual frenula and obstructive sleep apnea are common disorders in children. Studies have shown that a short lingual frenulum is a risk factor for sleep apnea, and it can cause early oral development disorders in children, lead to dental and maxillofacial deformities, and increase the risk of upper airway collapse during sleep. Short lingual frenula should be detected and treated early in children to prevent more severe complications. In clinical practice, the correlation between sleep apnea and a short lingual frenulum should always be considered. This article systematically reviews the correlation between a short lingual frenulum and obstructive sleep apnea in children.

Galectin-10 and chronic rhinosinusitis with nasal polyps

LI Chunhua, LIU Xiao,LIU Hongbing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  106-111.  doi:10.6040/j.issn.1673-3770.0.2020.163

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Galectin-10(CLC, Charcot-Leyden crystal)was discovered a long ago, but until recently, few studies have explored its role in pathophysiology. In recent years, galectin-10 has received considerable attention, especially for its role in airway eosinophil diseases. Here, we provide a brief historical review of galectin-10 and related research focused on chronic rhinosinusitis. Galectin-10 is a biomarker for chronic rhinosinusitis with nasal polyps characterized by a type 2 inflammatory response and may play an important role in its pathogenesis. Thus, it is a promising potential drug target for this type of CRSwNP.

Endoscopic surgery for skull base lesions in pediatric patients

WU Zebin,QIU Qianhui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  112-117.  doi:10.6040/j.issn.1673-3770.0.2020.233

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Transnasal endoscopic approaches have been more frequently employed for navigating the natural orifice; this can optimally widen the operative field and, consequently, reduce brain tissue traction and improve surgical efficacy. Surgical interventions of skull base lesions require extensive training and experience, which is usually gained through cadaveric dissection or surgery in adults. Endoscopic surgery for skull base lesions in pediatric patients can be safe but challenging due to the sinonasal and skull base embryology, developmental anatomies, and invasion of critical structures. This review facilitates a better understanding of age-dependent endoscopic surgery by discussing pediatric skull base anatomies and lesions, endoscopic approaches, management complications, skull base reconstruction, and selected pathologies and conditions, among others.

Progress in chemotherapy and targeted drug therapy for locally advanced head and neck squamous cell carcinoma

WEI Ya'nan,CHEN Xi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  118-124.  doi:10.6040/j.issn.1673-3770.0.2020.276

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Surgery in combination with chemotherapy and radiotherapy is the mainstay of treatment for locally advanced head and neck squamous cell carcinoma(LAHNSCC). However the organ preservation rate and 5-year survival rate have not significantly improved. In the late 1970s, cisplatin-based chemotherapeutic drugs began to be used in the treatment of LAHNSCC. Studies have shown a significant laryngeal preservation benefit of PF. With the application of paclitaxel, studies have confirmed that the TPF regimen has significant advantages in terms of local control and progression-free survival compared with PF. Therefore, it became the first choice for induction chemotherapy. In the early 1990s, concurrent chemoradiotherapy(CCRT)became a new method of non-surgical treatment and laryngeal protection. CCRT has clear advantages in terms of overall survival, laryngeal preservation, and local control and has been the standard non-surgical treatment for LAHNSCC. In 2006, cetuximab(CET)was approved by the US Food and Drug Administration for clinical use. Because of its advantages in terms of prognosis and less side effects, CET offers a new alternative for patients who cannot tolerate chemotherapy. This article reviews the progress in chemotherapy and targeted drug therapy for locally advanced head and neck squamous cell carcinoma.

Recent research advances in the role of glutaredoxin in oculopathy

FU Yihao, XU Yixuan,YAN Hong, ZHANG Jie

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(3):  125-130.  doi:10.6040/j.issn.1673-3770.0.2020.191

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Glutaredoxin(Grx)is animportant member of the thiol disulfide oxidoreductase protein family. The primary function is to dethiolate glutathionylated proteins, thus maintaining cellular redox homeostasis. Grx is expressed in many tissues throughout the body. In recent years, the protective function of Grx in oculopathy and its synergistic effect with other antioxidative enzymes have been increasingly elucidated, leading to a better understanding of this protein. This review summarizes the latest research on the role of Grx in oculopathy.