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Table of Content

    10 January 2022 Volume 36 Issue 1
      
    Progress on diagnosis and treatment of middle ear cholesteatoma in children
    YANG Yang, WANG Xiaoxu, ZHANG Jie
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  1-6.  doi:10.6040/j.issn.1673-3770.0.2021.503
    Abstract ( 1002 )   PDF (701KB) ( 412 )   Save
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    Middle ear cholesteatoma in children has population specificity in terms of prevalence, pathogenesis, and clinical manifestations. Due to its gradual onset, early diagnosis and treatment have become difficult clinically. With the improvement and popularization of middle ear cholesteatoma in children, this disease is becoming of increasing interest. The application of clinical staging and the accuracy of surgical treatment have greatly improved. The long-term prognosis management of middle ear cholesteatoma in children with cleft palate, Turner syndrome, Down syndrome, and other special populations has also been given importance.
    Analysis of the efficacy of balloon eustachian tuboplasty combined with adenoidectomy in the treatment of otitis media with effusion in children
    GAO Xinzhong, LING Zongtong, SHEN Ling, LIU Pingfang, LIN Xin, XU Yangyang
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  7-12.  doi:10.6040/j.issn.1673-3770.0.2021.506
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    Objective To investigate the medium-and short-term efficacy and safety of Eustachian tube balloon dilatation combined with adenoidectomy in the treatment of secretory otitis media in children. Methods Sixty-six children with secretory otitis media and adenoid hypertrophy in our department from July 2020 to February 2021 were analyzed retrospectively. Among them, 35 cases were treated with Eustachian tube balloon dilatation combined with adenoidectomy as the treatment group, and 31 cases with simple adenoidectomy as the control group. The postoperative curative effect and the proportion of complications were compared between the two groups. Results The curative effects at 1 month and 3 months after the operation in the treatment group were significantly better than those in the control group(all P<0.05), with the best curative effect observed at 3 months after the operation in the treatment group, which was significantly better than that at 1 month post-operation(P<0.05). There was no significant difference in the curative effects 6 months after the operation(P>0.05)and in intraoperative blood loss and postoperative complications between the two groups(all P>0.05). Conclusion Eustachian tube balloon dilatation combined with adenoidectomy can improve the curative effect in the short term, and it is minimally invasive and safe, with no obvious complications.
    Clinical characteristics and management of pediatric temporal bone fractures
    MA Ning, CHEN Min, LIU Wei, YANG Yang, SHAO Jianbo, HAO Jinsheng, LIU Bing, ZHANG Xiao, DUAN Xiaomin, ZHANG Qifeng, ZHANG Jie
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  13-19.  doi:10.6040/j.issn.1673-3770.0.2021.436
    Abstract ( 747 )   PDF (4697KB) ( 74 )   Save
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    Objective To summarize the clinical characteristics and treatment strategies of temporal bone fracture in children. Methods Medical records of 477 children under 18 years old who were diagnosed with temporal bone fracture in Beijing Children's Hospital from July 2014 to July 2021 were retrospectively analyzed. Including age, gender, injury causes, imaging, facial nerve and audiological assessment, complications, treatment and prognosis. Results 483 sides of 477 children,6 of which were bilateral. The age range was from birth to 18 years old, the median age was 9 years old, and the male to female ratio was 3.01∶1. Traffic accidents were the main cause of injuries, accounting for 57.23%, followed by falls, accounting for 23.69%. The most common clinical symptoms are tympanema and ear hemorrhage, which usually disappear from 3 weeks to 1 month. Longitudinal fracture accounted for 52.38%, transverse fracture 35, 7.25%; 48 cases of mixed fracture, accounting for 9.93%, and 147 cases, accounting for 30.43%, which could not be classified, were presented as minor fracture lines.372 cases(77.02%)had hearing impairment. Facial nerve injury occurred in 28 cases(5.80%), including 8 cases of internal auditory canal injury. Cerebrospinal fluid otorrhea(CSF)was found in 47 cases(9.73%). Tympanic membrane perforation occurred in 15 cases(3.11%). 6.35% with intracranial injury. 3.98% complicated with multiple fractures or multiple organ injuries. There were 10 cases of immediate facial paralysis, 1 case recovered well, accounting for 10.00%, and 18 cases of delayed facial paralysis, 15 cases recovered well, accounting for 83.33%. 10 cases were treated by operation, including 8 cases of tympanum exploration and ossicular chain reconstruction. Facial nerve HB Ⅴ was recovered to HB Ⅱafter decompression in 2 cases. Conclusion Temporal bone fracture in children is most common in boys, and the most common cause of injury is traffic accident. Tympanic hemorrhage, tympanic membrane perforation, cerebrospinal fluid otorrhea and conductive deafness can be cured by conservative treatment. Trauma caused ossicular chain fracture or dislocation has a good prognosis by surgical treatment. Trauma caused internal auditory canal fracture can cause extremely severe sensorineural deafness and complete facial paralysis with poor prognosis.
    The correlation between arterial blood gas analysis and hearing screening results in neonates
    PAN Linlin, FANG Xuhua, ZHAI Feng, GUI Yiding, BIAN Zhouliang, CHEN Jie
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  20-24.  doi:10.6040/j.issn.1673-3770.0.2021.350
    Abstract ( 754 )   PDF (543KB) ( 180 )   Save
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    Objective This study aimed to examine the relationship between arterial blood gas and hearing screening test in neonates. Methods The results of hearing screening test and arterial blood gas analysis of 496 newborns in the Neonatal Department of Shanghai Children's Medical Center were retrospectively analyzed. Results The pass rate of automated auditory brainstem response(AABR), distortion product otoacoustic emissions(DPOAE)and acoustic immittance is 61.9%(307/496), 61.3%(304/496), 90.1%(447/496)and 56.7%(281/496)respectively. There were significant differences in the pass rates of the three hearing screening methods(χ2=131.00, P<0.001). The pass rate of AABR was in extremely strong consistency with that of DPOAE(Kappa=0.817, P<0.001), while the pass rate of both AABR and DPOAE were in very weak consistency with that of acoustic immittance(Kappa=0.262 and 0.256, respectively. all P<0.001). Univariate Logistic regression analysis showed that the failure of hearing screening was correlated with increased lactic acid(OR=0.544, P=0.001), increased partial pressure of carbon dioxide(OR=1.917, P=0.009)and decreased pH value(OR=1.692, P=0.021). Multivariate Logistic regression analysis showed that failed hearing screening results were correlated with increased lactic acid(OR=0.627, P=0.018)and decreased partial oxygen pressure(OR=1.493, P=0.047). No significant correlations were found between hearing screening and the results of partial pressure of carbon dioxide, pH and blood oxygen saturation(P>0.05). Conclusion Neonatal hypoxia and the accompanying change of blood gas might have an impact on hearing screening results.
    A clinical observation on effect of auricle deformity type and age on outcomes of auricle correction in 1-year-old infants
    MA Xiaobao, LI Yue, SHEN Jiali, SUN Jin, CHEN Xiangping, YANG Jun, CHEN Jianyong
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  25-30.  doi:10.6040/j.issn.1673-3770.0.2021.401
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    Objective To explore the influence of auricle deformity type and age at the time of correction on the outcomes in order to provide references for clinical non-surgical correction of the auricle. Methods Infants with auricle deformity diagnosed in the ENT department between September 2017 and September 2019 were selected as the subjects. They were divided into two groups based on the age within 1 year. Infants less than 42 days were in the younger group, and infants more than 42 days were in the older group. The type of auricle deformity was divided into prominent ears, cup ears, lop ears, and cryptotia. The modified visual analogue scale in non-surgical auricle correction(MVAS-NAC)was used to evaluate the outcomes. Results The outcomes of the younger group were better than those of the older group(P<0.05). The relationship between the age at correction and the outcome was generally negative(P<0.05). The difference in the duration of treatment between the younger group and the older group was not statistically significant(P>0.05). No significant difference was found in the outcome among the different type of deformity groups (P>0.05). No statistical difference was seen between parents' score and doctor's score(P>0.05). The Spearman rank correlation coefficient between the parents and the doctor was 0.810. The incidence of skin complications in the younger group was lower than that in the older group(P<0.05). Conclusion The age of correction is the main factor affecting the effect of correction. Infants with age above 6 months must not be recommended for auricle correction; for infants with cryptotia, the age limitation can be relaxed. MVAS-NAC can initially be used to evaluate the effect of non-invasive correction of auricle deformities in infants.
    Analysis of audiological and imaging characteristics of 149 children with unilateral sensorineural hearing loss
    HU Chunyan, DANG Panhong, ZHANG Rui, FAN Mengyun
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  31-36.  doi:10.6040/j.issn.1673-3770.0.2021.418
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    Objective To analyze the clinical audiological data and imaging manifestations of unilateral sensorineural hearing loss(USHL)in children, and explore its etiology. Methods A total of 149 patients with USHL, aged from one month to 14 years, were analyzed retrospectively. Results 95.97% of the analyzed patients had severe or extremely severe hearing loss, namely single-sided deafness. 38.26% of the patients with USHL were detected through hearing examinations after their hearing screenings were not passed suffered from unilateral hearing loss as per the findings 20.13% children were found by perceiving unicat eral hearing loss. No obvious imaging abnormalities were found in 47 patients. Among the other 102 patients with imaging abnormalities, one had complete dysplasia(Michel malformation), one had dysplasia of the cochlea, and three had common cavity malformation. Two patients had dysplasia of the cochlea and seven patients had dysplasia of the cochlea. These included four patients with IP-Ⅰ malformation, two with IP-Ⅱ malformation, and one with IP-Ⅲ malformation. Seven patients had vestibular aqueduct enlargement, while 28 patients had bony internal auditory canal stenosis or cochlear foramina stenosis. One patient had internal auditory canal enlargement, while 46 patients had cochlear dysplasia, including 10 patients with cochlear nerve absence and 26 with cochlear nerve tenaciousness. Conclusion Most children with USHL experience severe and extremely severe deafness. The proportion of cochlear neurodysplasia and cochlear dysplasia are high in children with USHL. It is also closely related to congenital dysplasia. Therefore, routine temporal bone imaging examinations should be performed for children with USHL.
    Clinical analysis of facial nerve decompression via an external transmastoid-subtemporal labyrinth approach in eight children
    DANG Panhong, ZHANG Rui, HU Chunyan, WANG Jie, FAN Mengyun
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  37-42.  doi:10.6040/j.issn.1673-3770.0.2021.405
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    Objective To explore the curative effect of the external transmastoid-subtemporal labyrinth approach for facial nerve decompression in children with traumatic facial paralysis. Methods Eight cases of traumatic facial paralysis that were treated by facial nerve decompression with an external transmastoid-subtemporal labyrinth approach within 1 month between January 2014 and July 2019 were retrospectively analyzed. Some cases underwent ossicular chain reconstruction at the same time. Patients were followed up for 1 to 2 years, and the degree of hearing and facial nerve function(House-Brackmann, H-B)were assessed. Results There were seven cases of H-B grade V and one case of grade Ⅳ preoperatively, which reduced to five cases of grade I and three cases of grade Ⅱ postoperatively; Two cases had severe conductive hearing loss preoperatively, which returned to normal and mild postoperatively; One case had normal hearing preoperatively with no hearing loss postoperatively; The remaining five cases had severe or profound sensorineural hearing loss preoperatively. Conclusions Facial nerve function and hearing can be satisfactorily recovered by facial nerve decompression via an external transmastoid-subtemporal labyrinth approach within 1 month of temporal bone fracture.
    Application of 1 000 Hz acoustic immittance in hearing screenings of high-risk newborns
    NI Kun, SUN Shibing, LI Xiaoyan
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  43-47.  doi:10.6040/j.issn.1673-3770.0.2021.378
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    Objective To explore the significance of the 1 000 Hz acoustic immittance test combined with automatic auditory brainstem response(AABR)and distortion product otoacoustic emission(DPOAE)in hearing screenings of high-risk newborns. Methods A total of 318 high-risk newborns(636 ears)were included as the research subjects. The triple hearing screening scheme of AABR + DPOAE + 1 000 Hz acoustic immittance was adopted. The newborns who failed the screening test were examined for diagnostic hearing at 3 months of age, and the sensitivity, specificity, missed diagnosis rate, false diagnosis rate, and accuracy of the triple screening results were calculated. In this study, the normal triple screening results included AABR(-)DPOAE(+)acoustic immittance(+), AABR(-)DPOAE(-)acoustic immittance(+), and AABR(-)DPOAE(-)acoustic immittance(-). The abnormal triple screening results include AABR(+)DPOAE(+)acoustic immittance(+), AABR(+)DPOAE(+)acoustic immittance(-), AABR(+)DPOAE(-), AABR(-)DPOAE(+)acoustic immittance(-), and AABR(+)DPOAE(-)acoustic immittance(-). Results A total of 318 high-risk newborns(636 ears)were included. The sensitivity of triple screening(96.77%)was higher than that of the AABR-only screening method(80.64%)and DPOAE-only screening method(83.87%), which was consistent with that of the double AABR + OAE screening method(96.77%). The specificity of triple screening(91.24%)was higher than that of AABR + OAE double screening(87.44%). Triple screening can further reduce the false-positive rate of double screening and is suitable for high-risk neonatal screening. Conclusion Triple screening has high sensitivity and a low missed diagnosis rate for hearing screening of high-risk newborns. Triple hearing examinations can be applied to hearing screening of high-risk newborns. Some false-positive infants with simple middle-ear dysfunction can be screened out in the early stage, which can alleviate parental anxiety.
    Hearing loss in children after bacterial meningitis: a systematic review and meta-analysis
    LIU Shanshan, HAN Shujing, WANG Xiaoxu, LI Yanhong, NI Xin, ZHANG Jie
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  48-54.  doi:10.6040/j.issn.1673-3770.0.2021.260
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    Objective To systematically evaluate the risk factors for hearing loss after bacterial meningitis in children. Methods Electronic databases including PubMed, EMbase, Web of Science, CNKI, Sinomed, Wanfang data, and VIP were searched from inception to September 20, 2021 to gather studies published on hearing loss in children after bacterial meningitis. Two authors independently assessed the quality of the studies using the NOS Scale, and a meta-analysis was performed using Stata 16.0 software. Results Twelve studies(3 cohort and 9 case-control studies)measured hearing in a total of 2041 children with bacterial meningitis among whom 301 children suffered sensorineural hearing loss. Meta-analysis was performed for a total of 4 risk factors. Results showed that Streptococcus pneumoniae infection [OR=2.70, 95%CI(1.89, 3.87), P<0.001] and seizures [OR=2.31, 95%CI(1.29, 4.14), P=0.005] were risk factors for hearing loss after bacterial meningitis; age ≤ 1 year old [OR=1.00, 95%CI(0.34, 2.97), P=0.998] and sex [OR=1.06, 95%CI(0.70, 1.58), P=0.794] were not associated with hearing loss. Conclusion Current evidence shows that Streptococcus pneumoniae infection and seizures are risk factors for hearing loss after bacterial meningitis. For children with the above risk factors, special attention should be paid to their hearing, and follow-up should be strengthened.
    A case of an infant with embryonal rhabdomyosarcoma in the middle ear and literature review
    LI Ling, LI Cong, SUN Yan, CHEN Liang
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  55-59.  doi:10.6040/j.issn.1673-3770.0.2021.409
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    Objective Raising awareness of otolaryngologists on embryonal rhabdomyosarcoma disease. Methods The clinical data of an infant with embryonal rhabdomyosarcoma in the middle ear were analyzed, and related literatures were reviewed. Results The patient was a 10-month-old female with a bleeding mass in the left external auditory canal. Computed tomography and magnetic resonance imaging revealed soft tissue density shadows in the left external auditory meatus, tympanum, and mastoid sinus that were accompanied with an enlarged lymph node in the parapharyngeal, neck and bilateral axilla. Moreover, the diagnosis of RMS was confirmed by postoperative pathological and immunohistochemical examination after biopsy. The patient died of brain metastasis four months after the end of radiation and chemotherapy. Conclusion RMS in the middle ear is rare. Due to its obscure location and lack of typical clinical manifestations in the early stage, RMS is difficult to detect and prone to misdiagnosis. The malignant degree of this disease is high. Thus, the early detection, diagnosis, and treatment of this disease should be further studied to improve the survival rate of patients.
    Effect of tympanic membrane insertion on the function of eustachian tube in children with secretory otitis media
    JIAO Xuemei, YANG Yang, LI Chunfeng, ZHANG Xiaolin
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  60-63.  doi:10.6040/j.issn.1673-3770.0.2020.476
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    Objective To analyze the effect of tympanic tube placement on the function of the Eustachian tube in children with secretory otitis media. Methods The study included 26 children with secretory otitis media admitted to our hospital from January 2019 to June 2019. All children underwent tympanic tube insertion. The statistics were collected before operation, 3 months after operation, half a year after operation, and 1 year follow-up. Eustachian tube function. Results After the treatment of the left ear canal of the 26 children in this group, the Eustachian tube pressure measurement under different pressures showed that the test results of the children were significantly higher at 3, 6 months, and 1 year after the operation(P<0.05); and the Valsalva method test showed that the children were higher than before the operation at 3 months, 6 months and 1 year after the operation(P<0.05); the evaluation of swallowing function at different times before and after the treatment(P>0.05); The total ETS scores of the eustachian tube function evaluation of the children in this group were significantly higher than those before the operation at 3 months, 6 months, and 1 year after operation(P<0.05). In this group of children with right ear canal at different times after 3 months, 6 months, and 1 year, the R values of 30 mbar, 40 mbar, and 50 mbar lower eustachian tube pressure of the children showed a significant increase, compared with preoperative(P<0.05); And the children's Valsalva test results and the total ETS score of Eustachian tube function were significantly increased, compared with preoperatively(P<0.05); while swallowing function was compared before and after surgery(P>0.05). In this group of 26 children, the treatment results showed that 20 cases were cured, 6 cases were effective, and 0 cases were ineffective. the complication rate was 3.85%. Conclusion Children with secretory otitis media in the case of failure of conservative treatment, tympanoplasty is a relatively reliable measure considering the particularity of growth and development of children, which has a positive effect on improving the function of eustachian tube
    Four cases of open rhinoplasty approach for congenital nasal dermoid and sinus cysts in children and literature review
    WANG Pengpeng, GE Wentong, TANG Lixing, YANG Xiaojian, ZHANG Wei, XIAO Xiao, HAN Yang
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  64-69.  doi:10.6040/j.issn.1673-3770.0.2021.419
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    Objective To evaluate the outcomes and indications of open rhinoplasty to treat congenital nasal dermoid and sinus cysts in children. Methods We retrospectively analyzed the clinical data of 4 children with congenital nasal dermoid and sinus cysts(3 males and 1 female)aged from 2 to 6 years at the time of surgery(average age: 4 years). All patients underwent open rhinoplasty approach for treatment. Postoperative follow-up was performed regularly. Follow-up parameters included recurrent lesions, incision scars, and nasal tip shape. Results Four children received an open rhinoplasty treatment. The fistulas were located between the middle part of the nasal bridge and the tip of the nose. All patients underwent preoperative CT and MRI to confirm the diagnosis and plan surgery. Intraoperative procedure using an open rhinoplasty approach for infectious lesions was performed under general anesthesia. Regular follow-up was conducted at 19-24 months after the operation. There were no reports of postoperative complications or recurrence, and follow-up examinations showed that the nasal incision scar recovered well; the shape of the nasal tip was normal in all cases. Conclusion Open rhinoplasty successfully treated congenital nasal dermoid and sinus cysts located in the lower third of the nose bridge to the tip, and the fistula path was longer than 1 cm without intracranial components. It can fully expose the lesion range while providing a perfect cosmetic outcome. It is safe in the pediatric population, with no significant effect on subsequent nasal growth during short-term follow-ups.
    Short-term effect of Dermatophagoides farinae specific sublingual immunotherapy for children with allergic rhinitis
    PANG Chong, BIAN Sainan, ZHANG Bing, YIN Xu, LU Yingxia, YE Pengfei, WANG Zhan, ZHAO Jing, GAO Yan, GUAN Kai
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  70-74.  doi:10.6040/j.issn.1673-3770.0.2021.117
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    Objective To evaluate the short-term effect of Dermatophagoides farinae specific sublingual immunotherapy for children with allergic rhinitis. Methods Children attended in the department of otorhinolaryngology head and neck surgery, Capital Institute of Pediatrics affiliated Children's Hospital and received Dermatophagoides farinae specific sublingual immunotherapy for 6 months were enrolled from 2019 to 2020. Visual analogue scale(VAS), total nasal symptoms score(TNSS), total medication score(TMS), and combined symptom and medication score(CSMS)before and after immunotherapy were collected. Results In total 50 children with allergic rhinitis were enrolled, with an average age of(7.7±2.7)years old. Before immunotherapy, VAS, TNSS, TMS and CSMS was(5.5±1.6)score,(5.5±2.2)score,(3.0±0.1)score,(4.3±0.6)score, respectively. And after immunotherapy for 6 months, VAS, TNSS, TMS and CSMS was(2.5±1.4)score,(2.2±1.6)score,(0.6±1.1)score,(1.2±1.2)score, respectively. The scores were all decreased significantly after immunotherapy(P<0.05). Conclusion Short term efficacy of Dermatophagoides farinae specific sublingual immunotherapy is good for children with allergic rhinitis.
    Clinical research of subcutaneous immunotherapy on children with allergic asthma caused by dust mites and combined with mold allergen
    LI Menghui, ZHI Lili, QI Kaiwen, WANG Shanshan, GAO Qian, BU Meiling,
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  75-80.  doi:10.6040/j.issn.1673-3770.0.2021.028
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    Objective To evaluate the efficacy of subcutaneous immunotherapy(SCIT)on children with allergic asthma caused by single dust mite and dust mite with mold respectively. Methods Children aged 6-14 years with allergic asthma were divided into single dust mite allergy group or dust mite with mold allergy group according to allergen species and given SCIT. ACQ score, drug score, lung function indicators(FEV1%, FEF50%, FEF75% and MMEF%)were compared after 12,24 months of treatment within and between groups, respectively. Results A total of 118 asthmatic children were included: 57 in the dust mite group and 61 in the dust mite with mold group. After 12 months of treatment, ACQ score, drug score, FEF50%, FEF75% and MMEF% were significantly improved compared with that before treatment in both groups(all P<0.05). While the FEV1% in both groups were improved compared with that before treatment, but there was no statistical significance(P>0.05). After 24 months of treatment, both groups of ACQ score, drug score, FEV1%,FEF50%,FEF75% and MMEF% have improved significantly of that after 12 months of treatment(all P<0.05). At 12 and 24 months of treatment, there were no significant differences of degree of improvement in ACQ score, drug score, FEV1%, FEF50%, FEF75% and MMEF%(all P>0.05)between two groups. Conclusion The SCIT can significantly improve the clinical symptoms, reduce the use of symptomatic drugs, improve lung function in children with allergic asthma. SCIT not only has a significant effect on single dust mite, but also on dust mite with mold allergen.
    Clinical diagnosis and treatment of congenital nasal sinus mass in children
    CHEN Kun, LU Hui, HUANG Qi, LI Lei, MENG Guozhen, YANG Jun, HOU Dongming
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  81-85.  doi:10.6040/j.issn.1673-3770.0.2021.150
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    Objective To explore the safety and effectiveness of diagnosis and endoscopic surgical treatment of congenital nasal sinus masses in children. Methods A retrospective analysis of the clinical data of 24 congenital nasal sinus mass cases in children admitted to the Xinhua Hospital, which is affiliated with the Shanghai Jiao Tong University School of Medicine. Preoperative nasal endoscopy, sinus CT, and MRI examination were performed, and all patients underwent endoscopic mass resection, with follow-up of surgical outcomes. Results Of the 24 cases, 17 were benign, consisting of 8 meningocele cases, 3 ossifying fibroma cases, 2 nasal chondromesenchymal hamartoma cases, 1 case of poor bone fiber structure, 1 myofibroma case, 1 teratoma case, and 1 capillary hemangioma case. Meanwhile, the remaining 7 cases were malignant, consisting of 2 B-cell lymphoma cases, 2 embryonal rhabdomyosarcoma cases, 1 mesenchymal chondrosarcoma case, 1 olfactory neuroblastoma case, and 1 mucoepidermoid carcinoma case. Aside from the two embryonal rhabdomyosarcoma cases, the one mesenchymal chondrosarcoma case and the one olfactory neuroblastoma case had passed away; thus, only the remaining 20 of the 24 cases were completely resected. No recurrence was observed in 1.5-7.5 years in the remaining cases. Conclusion There were more benign nasal sinus mass cases in children, which were usually resolved with complete surgical resection. Preoperative endoscopic examination, thin-layer CT, and MRI examination were found to be necessary for diagnosis, surgical procedure formulation, and risk assessment. Moreover, nasal endoscopic surgery can completely remove most of these lesions, with the advantages of small trauma, clear vision, and good clinical results.
    Clinical characteristics and outcomes of neonates with bilateral vocal cord paralysis
    ZHANG Fengzhen, WANG Guixiang, ZHAO Jing, WANG Hua, DUAN Qingchuan, LI Hongbin, HEI Mingyan, WENG Jingwen, ZHANG Jie
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  86-90.  doi:10.6040/j.issn.1673-3770.0.2021.435
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    Objective The objective of this study is to investigate the etiology, clinical characteristics, treatment, and outcomes of bilateral vocal cord paralysis(BVCP)in neonates. Methods We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP by endoscopy at the Department of Neonatal Center between January 2016 and December 2020. We collected the information, etiology, treatment, and outcomes of the children. Follow-up sessions were conducted in the clinic or by telephone, and relevant information were recorded. Results This study included a total of 28 patients consisting of 18 males and 10 females. Their ages ranged from one to 24 days, with a median age of 3.5 days. The main findings can be summarized into three points. First, 92.9% of the neonates were full-term and 53.6% were born by caesarean delivery. The most common clinical symptoms were inspiratory stridor and dyspnea, present in 78.6% of patients. This was followed by aspiration and vomiting, which were present in 14.3% of patients. Second, the etiology was congenital in 82.1% and acquired in 17.9% of the infants. In the congenital BVCP cases, there were seven cases of congenital central nervous system diseases, six(21.4%)of congenital heart diseases, six(21.4%)of laryngotracheal diseases, and two(7.1%)of gastroesophageal reflux diseases. Most of the acquired factors were secondary to postoperative esophageal and tracheal diseases(75%). Third, among all the patients, eight(28.6%)underwent tracheotomy. Of the eight cases, one died, one(14.3%)was successfully extubated at the age of 12 months, one had the trachea blocked, and the remaining five cases have not recovered even after conducting follow-up sessions for 16-47 months. Among the remaining 20 patients waiting for observation, three cases died. Of the remaining 17 cases, 11(64.7%)cases recovered within 1-38 months of late follow-up, and six cases(35.3%)had improved vocal cord activity within 5-17 months of late follow-up. All in all, the follow-up time ranged from one month to four years, and four patients died. Conclusion BVCP in neonates is most commonly congenital in nature and has many comorbidity factors. Most of the clinical manifestations we observed were stridor, dyspnea, and occasionally, dysphagia. Tracheotomy is generally not necessary in treating neonatal BVCP. Most children with BVCP can recover by themselves and have good prognoses, so surgical intervention should not be done too early.
    Application of rigid bronchoscope combined with fiberoptic bronchoscope in the treatment of a bronchial foreign body in the infantile lung segment
    HUANG Guiliang, SUN Changzhi, RUO Renzhong, XIE Zhiwei, TOHG Zhijie, LIU Shaofeng
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  91-95.  doi:10.6040/j.issn.1673-3770.0.2021.406
    Abstract ( 857 )   PDF (376KB) ( 98 )   Save
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    Objective To investigate the application value of rigid bronchoscope combined with fiberoptic bronchoscope in the treatment of a bronchial foreign body in the infantile lung segment(and its subsegment). Methods Clinical data of 42 patients with a bronchial foreign body in the lung segment(grade III and sub-segment)were analyzed retrospectively. Results Foreign bodies in all 42 cases were successfully removed simultaneously, without any intraoperative complications such as asphyxia, bleeding, and pneumothorax. The average operation time was 15±3 min, postoperative recovery was smooth transferred to the general ward, with five cases of mild hoarseness and no dyspnea. Conclusion Rigid bronchoscope combined with a fiberoptic bronchoscope is an effective and safe alternative for the treatment of the bronchial foreign body in the pulmonary segment(and its sub-segment), which can shorten the operation time, reduce the incidence of complications, and improve the prognosis of the operation.
    Application of laryngeal microsurgery in severe neonatal upper airway obstruction
    ZENG Bin, LÜ Dan, REN Jia, HU Juanjuan, YU Lingyu, LU Huan, YANG Hui
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  95-99.  doi:10.6040/j.issn.1673-3770.0.2021.259
    Abstract ( 741 )   PDF (2541KB) ( 137 )   Save
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    Objective The aim of this study was to explore the etiology, clinical features, and the microsurgery efficacy of severe neonatal upper airway obstruction, to achieve better diagnosis and treatment of neonatal obstructive dyspnea. Methods An observative research was conducted enrolling 16 neonates with severe throat-related upper airway obstruction. Results A total of 16 neonates(9 males and 7 females)were registered, whose clinical symptoms appeared 7-28 days after birth and included inspiratory dyspnea, stridor, and the three-concave sign. Patients were classified as follows: 6 cases of congenital laryngomalacia; 3 hypopharynx and tongue root cysts; 2 laryngeal hemangiomas; 1 laryngeal entrance teratoma; 1 congenital laryngeal webbing; 1 bilateral vocal cord paralysis; 1 secondary subglottic stricture; 1 laryngeal adhesion after intubation. All 16 neonates were treated with appropriate microsurgery, and all operations went smoothly. Altogether, 15 neonates were extubated smoothly, except for 1 case of laryngomalacia in which a tracheotomy was performed. Conclusion Severe neonatal upper airway obstruction is mostly frequently related to laryngopharynx lesions. Early local and systemic examinations are required to confirm the cause and diagnosis. Timely minimally invasive surgery for patients with surgical indications can achieve satisfactory results and save their lives.
    Clinical application analysis of endoscope in the operation of infantile tongue base cyst
    HUANG Guiliang, SUN Changzhi, LUO Renzhong, CHEN Yanqiu, LIU Shaofeng, XU Jiajian
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  100-105.  doi:10.6040/j.issn.1673-3770.0.2021.265
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    Objective To investigate the clinical value and effect of the endoscope in the treatment of infantile tongue base cyst. Methods The clinical data of 65 infants with tongue base cyst were retrospectively analyzed. A total of 39 patients underwent plasma ablation of tongue base cyst under prop laryngoscopy with the endoscope and 26 patients underwent the same procedure with the naked eye. The differences between endoscopic and naked eye surgeries in the surgical treatment of infantile tongue cyst regarding surgical effects, postoperative extubation time, and recurrence were analyzed. Results Ten cases(3 cases in the endoscope group and 7 cases in the naked eye group)were transferred to the intensive care unit for delayed extubation. In the endoscopic group, 2 patients had delayed extubation for 1 day and 1 patient had delayed extubation for 3 days, while in the naked eye group, 3, 2, and 2 patients had delayed extubation for 1, 2, and 3 days, respectively. In the endoscopic group, incomplete septa were found in the cyst wall in 3 cases and the bottom of the cyst wall reached the hyoid bone in 13 cases. The endoscopic group had no recurrence within 3 years, and the naked eye group had 3 recurrences. Conclusion Endoscopic surgery in the treatment of infant tongue base cyst has a clearer surgical field, smaller scope of trauma, more complete ablation of cyst wall, significantly reduced postoperative edema, shortened time of extubation, and reduced recurrence rate.
    Application of visual laryngoscope in surgical anesthesia of children with congenital tongue base cyst
    ZHAO Haitao, WANG Yafang, HE LI, CHEN Wenjing, XING Minzhe, ZHENG Wenjuan, YAN Yuyan, LIU Xiaofeng
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  106-110.  doi:10.6040/j.issn.1673-3770.0.2021.056
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    Objective To explore the clinical effect and safety of visual laryngoscope and traditional laryngoscope in tracheal intubation in children with congenital tongue base cyst. Methods Seventy-two children(dyspnea grade I-II)scheduled for resection of tongue base cyst were randomly divided into two groups: traditional laryngoscope group(group M)and visual laryngoscope group(group G). The intubation time, success rate of intubation, failure rate of intubation, glottic exposure and airway injury were recorded. The saturation of pulse oxygen(SpO2), heart rate(HR)and mean arterial pressure(MAP)before and during intubation were observed. Results The tracheal intubation time of group G was shorter than that of group M, the success rate of one-time intubation was higher than that of group M, the intubation failure rate and airway injury of group G were lower than those of group M(P<0.05); HR and MAP increased significantly during intubation, especially in group M. Conclusion For children with Ⅰ-Ⅱ mild dyspnea caused by congenital tongue base cyst,the application of video laryngoscope in endotracheal intubation can shorten the time of endotracheal intubation, improve glottic exposure level, improve the success rate of one-time intubation, and ensure the safety of children to the greatest extent. It was worthy of clinical application.
    A case of sleep disordered breathing is the first performance of Chiari deformity in young children report and literature revier
    ZHENG Li, XU Zhifei
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  111-115.  doi:10.6040/j.issn.1673-3770.0.2021.443
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    Objective To understand the characteristics of central sleep apnea and the clinical characteristics of the disease, and to improve the understanding of Chiari malformation combined with central sleep apnea. Methods The clinical data of a patient with Chiari malformation were retrospectively analyzed, and the characteristics of Chiari malformation combined with central sleep apnea were discussed combined with literature review. Results The child confirmed the characteristics of Chiari malformation type I combined with central sleep apnea by imaging and polysomnography. Review and summarize literatures related to Chiari malformation, together with this case, a total of 32 cases(1 adult male, 4 adult female, 12 young and young male, 15 young female)were reported. In 22 patients with sleep respiratory disorders, 13 were mainly obstructive pause, 5 were mainly central pause, one was central hypoventilation, and three showed both central and obstructive forms.Except for one patient with obstructive suspension, all the other patients underwent surgical treatment. Conclusion The problem of Chiari malformation causing sleep breathing disorder cannot be ignored. Polysomnography can help to make objective evaluation and preliminary diagnosis, and offer more information on characteristics of sleep and breathing before clinical treatment decision is made.
    Multidisciplinary diagnosis and treatment of a child with severe obstructive sleep apnea syndrome complicated by pulmonary hypertension
    SHI Xiaoli, MU Hong
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  116-119.  doi:10.6040/j.issn.1673-3770.0.2021.417
    Abstract ( 818 )   PDF (382KB) ( 74 )   Save
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    Objective To investigate the pathogenesis, diagnosis, treatment and perioperative management of children with severe obstructive sleep apnea(OSA)complicated by pulmonary hypertension. Methods A retrospective review of one child with OSA complicated by pulmonary hypertension is analyzed. Results Pulmonary hypertension can cause by severe OSA in children. Multidisciplinary diagnosis and treatment should be conducted for children with severe OSA complicated by pulmonary hypertension to exclude other factors that may lead to pulmonary hypertension. Surgical treatment could be chosen for children with severe OSA with mild hypertrophy of tonsil and adenoid after other obstruction factors were excluded. Perioperative CPAP therapy can rapidly correct pulmonary hypertension and reduce perioperative risk. Conclusion Operation combined with perioperative CPAP therapy is an effective treatment for severe OSA complicated by pulmonary hypertension. Polysomnography monitoring is an important means to judge the severity of children's disease and evaluate the efficacy of surgery.
    Primary large B-cell lymphoma of tonsil in children: a case report and document review
    ZHAO Xinghe, FAN Mingyue, DOU Xunwu, JIA Guangbiao
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  120-124.  doi:10.6040/j.issn.1673-3770.0.2021.366
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    Objective To investigate the clinical manifestations, diagnostic strategy, pathological examination and immunohistochemical characteristics of primary large B-cell lymphoma of tonsil in children. Methods The clinical data of a child with primary large B-cell lymphoma of the tonsil admitted to our hospital in January 2021 were reviewed. Relevant domestic literatures on primary malignant B-cell lymphoma of the tonsil in children were searched through CNKI and Wanfang database, and the data were analyzed. Results Children Male, April 10, may because of the pharynx ministry unwell, January admission with the soft palate of ulcer, perfect relevant inspection after admission, the pharynx and neck lesions after biopsy and pathology report shows:(neck lump, tonsil)combined with HE and immunohistochemical markers, consider B cell lymphoma that tends to diffuse large B cell lymphoma. Then transferred to the tumor surgery department of our hospital for 5 times of CCCG-BNHL-2015 chemotherapy regimen.After that, the stability was recovered, and the left neck lymph node enlargement and tonsil enlargement were examined again. The left tonsil biopsy suggested chronic hypertrophic tonsillitis..Follow-up observation is currently under way.Reviewing this case and 10 cases of primary malignant B lymphoma of tonsil reported in the literature with detailed clinical data, most of them were characterized by pharyngeal discomfort, tonsil enlargement, sleep snoring and other symptoms, with or without cervical lymph node enlargement.Pathological examination indicated malignant B-cell lymphoma with immunohistochemical expression of CD20, MUM1, Bcl-6 and Bcl-2, and chemotherapy was performed after surgery. with followed up for a long time. Conclusion Primary large B-cell lymphoma of the tonsil in children is rare. Preoperative symptoms are mostly tonsil enlargement and cervical lymph node enlargement, accompanied by nasopharyngeal discomfort and other symptoms. It is easy to be misdiagnosed, and a definite diagnosis should be made by pathological examination and immunohistochemistry. Early diagnosis and multidisciplinary comprehensive treatment can improve the clinical treatment rate.
    A clinical analysis on children with congenital pyriform sinus fistula treated through microscopic laryngoscopy with CO2 laser cauterization
    LONG Ting, LIU Yuwei, WANG Shengcai, ZHANG Jie, LI Yanzhen, ZHANG Xuexi, LIU Qiaoyin, LIU Zhiyong, SUN Nian, NI Xin
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  125-130.  doi:10.6040/j.issn.1673-3770.0.2021.444
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    Objective The objective of this study is to explore the clinical characteristics of children with congenital pyriform sinus fistula(CPSF). It also aims to standardize its diagnosis and serve as a reference for the treatment of children with CPSF through microscopic laryngoscopy with CO2 laser cauterization. Methods A retrospective, single-center study was conducted by analyzing the clinical data of children diagnosed with CPSF in Beijing Children's Hospital(BCH)from 2014 to 2021. Microscopic laryngoscopy involving CO2 single-laser cauterization was performed on children with CPSF until the internal fistula completely closed after one or two procedures. Results A total of 273 patients(6.28±3.33 years)were enrolled in this study. Preoperative examination showed a positive predictive value(PPV)of 91.2% when ultrasonography was used, and 82.8% when enhanced magnetic resonance imaging(MRI)was used. All patients were treated with a standardized procedure of CO2 laser cauterization in our center, with 173(63.0%)of the patients undergoing only one operation and 61(22.3%)of the patients undergoing two procedures until the internal fistulas completely closed. Multivariate logistic regression analysis showed that a history of open neck surgery was not related to the number of times the procedure was done. In contrast, the age at the first CO2 laser cauterization surgery was an independent risk factor for the number of procedures needed for the internal fistula to close. All patients did not suffer severe postoperative complications. Conclusion Our study revealed that CO2 laser cauterization is a therapeutic strategy that is effective, safe, and has repeatable results. This method can be the preferred treatment for pediatric CPSF.
    Research progress on auditory risk factors and hearing screening methods among neonates
    PAN Linlin, KONG LingyiOverview,ZHAI Feng, CHEN JieGuidance
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  131-137.  doi:10.6040/j.issn.1673-3770.0.2021.080
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    Newborn hearing loss results in not only delayed language and speech development but also poor social, recognitional, and educational performance. Several factors have an impact on neonatal hearing. However, the pathogenesis and characteristics of the factors vary based on the type of factor contributing to hearing impairment in neonates. Non-genetic factors mainly include preterm birth, low birth weight, neonatal hyperbilirubinemia, newborn hypoxia, infection, and ototoxic medication, whereas genetic factors mainly include GJB2, GJB3, SLC26A4, and mitochondrially encoded MT-RNR1 variation. Combined application of otoacoustic emission, automatic auditory brainstem response, and acoustic immittance test can effectively improve the accuracy of neonatal hearing impairment screening, which is helpful for early diagnosis and intervention.
    Advances in the treatment of congenital choanal atresia
    LU XiaoyanOverview,WEN ShuxinGuidance
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  138-142.  doi:10.6040/j.issn.1673-3770.0.2020.457
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    Congenital choanal atresia(CCA)refers to the anatomical closure of the posterior nostril, which is clinically characterized by no nasal respiratory airflow. The typical manifestations of CT are thickening of the bone of the posterior vomer, pterygoid plate, and closure of the choana with bony/and or membranous plate. According to the extent of the lesion, it can be divided into bilateral atresia and unilateral atresia, and the former often needs timely treatment. Transnasal endoscopic surgery is the first choice of surgery, and its safety and effectiveness have been certified in the past decade. However, postoperative stenosis is still the most important complication. It has been controversial whether the application of traditional stent and mitomycin C is beneficial to avoid postoperative stenosis. At present, some new methods to prevent postoperative stenosis(steroid-eluting stent, and balloon dilatation, and local application of the carboxymethyl cellulose gel-sodium salt)are still emerging, Which may offer promising prospects for the treatment of choanal atresia.
    Advances on the effect of OSAHS on pulmonary function in children
    YUAN Chenyang, LIU YanOverview, FANG ZhenshengGuidance
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):  143-148.  doi:10.6040/j.issn.1673-3770.0.2020.386
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    The incidence of obstructive sleep apnea-hypopnea syndrome in children is gradually increasing. OSAHS not only affects the sleep quality of children; it also leads to the impairment of cardiopulmonary and multi-system function and affects their growth and development. The pulmonary function test, as a non-invasive examination modality, can detect the effect of OSAHS on small airways at an early stage. In this review, the author evaluated recently published literature on the relationships between pediatric OSAHS and pulmonary function and changes after treatment.