Table of Content

20 July 2022 Volume 36 Issue 4

  

Cervical vertebral osteomyelitis secondary to necrotizing otitis externa:a case report and review of literature

TIAN Jun, LIU Liangfa, BAI Jiaqi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  1-5.  doi:10.6040/j.issn.1673-3770.0.2022.174

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Objective To outline and analyze the clinical features and treatment option of cervical osteomyelitis secondary to necrotizing otitis externa. Methods We performed a retrospective review, along with literature review, of a case of C2-C6 osteomyelitis secondary to a necrotizing otitis externa in a diabetic patient, in order to outline its clinical manifestation, diagnosis, treatment option and prognosis. Results A total of five relevant studies published in Chinese and English from 2005 to 2022 were reviewed, and four cases(including the case presented in this study)were analyzed. The four cases involved three men and one woman(age range: 54-72 years). Only one patient had a history of head and neck radiotherapy, the remaining three were known diabetic patients. The lesions were extensive, involving two to five vertebral bodies. The causative pathogens isolated were all bacteria; however, the strains varied among the cases. After a systematic treatment, three patients(75%)succumbed to the disease as a result of bacterial resistance, poor compliance to medications, and severe comorbidity. Conclusion The lesions of necrotizing otitis externa can extend from the skull base to the cervical vertebrae, causing cervical osteomyelitis: a life-threatening condition that requires an aggressive treatment.

Comparative study of ototoxicity between kanamycin and 2-hydroxypropyl-β-cyclodextrin

YANG Kun, CHEN Lijuan, HE Xiaodan, LIU Zhiqi, SHA Suhua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  6-11.  doi:10.6040/j.issn.1673-3770.0.2021.195

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Objective This study aimed to investigate the effects of ototoxic injury induced by kanamycin and 2-hydroxypropyl-β-cyclodextrin(HPβCD)in CBA/J mice. Methods Male CBA/J mice were intraperitoneally administered kanamycin for 15 days at the optimal dosage of 700 mg/kg and were subcutaneously administered HPβCD at the optimal dosage of 8 000 mg/kg. The control group was administered 0.9 % sterile sodium chloride. Auditory brainstem response tests were performed. Cochlear preparations and diaminobenzidine staining were used for hair cell observation. Data were analyzed using the statistical software GraphPad Prism 13 for Windows. Results In the control group, at 8 kHz, 16 kHz, and 32 kHz, the thresholds were 21±2.24 dB, 21±2.24 dB, and 21±2.24 dB, respectively. After kanamycin treatment, the thresholds were 22±2.74 dB(t=0.632 5, P=0.544 7), 67± 4.47 dB(t=20.571 8, P<0.001), and 77±4.47 dB(t=25.044 0, P<0.001), respectively. After 6 hours, the thresholds in the HPβCD group were 29±4.18 dB, 30±4.47 dB, and 37±2.74 dB, respectively. After 7 hours, the thresholds were 65±3.54 dB, 71±2.24 dB, and 80±3.54 dB, and after 8 hours, the thresholds were 70±3.54 dB, 78±5.70 dB, and 85±5.00 dB, respectively. Comparison of the data revealed significant differences(F=20.590, P<0.001). Prolonging HPβCD treatment resulted in hearing loss being gradually aggravated at all frequencies. In the kanamycin group, outer hair cell(OHC)loss from the top to the base was significantly different(F=7.840, P=0.000 3), with 9.17±6.03% at 2.0 mm, 89.76±3.12% at 2.5 mm, and 100% at 4.0 mm. Inner hair cell(IHC)loss was also significantly different(F=3.549, P<0.05), with values of 0.71±0.00%, 6.79±6.01%, and 20.71±6.00% being recorded. Six hours of HPβCD treatment resulted in obvious damage to OHCs of the cochlea. Damage occurred at the apex, the middle, and the base of the basement membrane. After 7 to 8 hours, the IHCs and OHCs had practically disappeared. After 8 hours, no IHCs were found. Conclusion Kanamycin and HPβCD induced hearing loss and hair cell damage in mice. OHC damage occurred earlier than the IHC damage, with the degree of damage being dependent on the time and concentration of treatment.The difference is that Kanamycin damaged hearing at the onset of high frequencies, while HPβCD starts from full frequency.

Bilateral ossification of the auricular cartilage: a case report and literature review

LIU Bo, XIAO Xuping, LI Yunqiu, ZHOU En, GUO Renbin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  12-16.  doi:10.6040/j.issn.1673-3770.0.2021.234

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Objective The study aimed to explore the pathogenesis, clinical manifestations, diagnostic basis, differential diagnoses, and treatment methods of auricular cartilage ossification. Methods The clinical data of a patient with auricular cartilage ossification was retrospectively analyzed. A review of related literature was included for summary. Results The pathogenesis of auricular cartilage ossification is yet to be elucidated. Obvious discomfort is not a common finding; however, a few cases may present with local pain, hearing loss, and other symptoms. Computerized tomography of the temporal bone aids in diagnosis, but histopathological examination dictates the final diagnosis. Patients with no obvious symptoms may opt for temporary observation. However, surgical management is the treatment of choice if quality of life and function are affected. Conclusion Auricular cartilage ossification is relatively uncommon in clinical practice, and currently, no treatments have been developed to reverse its course. Active risk identification and early intervention are key to prevent disease progression.

Short-term and long-term outcomes of endolymphatic sac decompression with instillation of local steroids for intractable Meniere's disease

XU Jia, LI Xin, CHEN Wenjing, GAO Juanjuan, LU Xingxing, YI Haijin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  17-21.  doi:10.6040/j.issn.1673-3770.0.2021.272

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Objective To investigate the short-term and long-term effects of endolymphatic sac decompression with instillation of local steroids for intractable Meniere's disease. Methods Twenty-three patients who underwent surgery for intractable Meniere's disease were enrolled. The surgical strategy included traditional endolymphatic sac decompression, opening of the facial recess, placement of gelatin sponge around the round window, and injection of steroids into the tympanic cavity and onto the surface of the endolymphatic sac. Frequency of vertigo episodes and hearing function(pure tone averages)were compared before surgery, 6~12 months after surgery, and 18~24 months after surgery. Results Twenty-three patients completed the short-term effect evaluation at 12 months after surgery. The frequency of vertigo episodes decreased from(5.7±5.9)to(0.4±1.0)times. The vertigo control rate was 87.0%, while the hearing maintenance rate was 95.7%. Thirteen patients completed the long-term effect evaluation at 24 months after surgery. The frequency of vertigo episodes decreased from(4.2±2.6)to(0.1±0.3)times. The vertigo control rate was 92.3%, while the hearing maintenance rate was 100%. Conclusion Endolymphatic sac decompression with instillation of local steroids for the treatment of intractable Meniere's disease had favorable effects on vertigo control and the maintenance of hearing function.

A study on the relationship between mastoid pneumatization degree and endolymphatic sac development based on a propensity score matching analysis

HAN Shuhui, FAN Xintai, WANG Na, WANG Zhe, HOU Lingxiao, XU Anting

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  22-26.  doi:10.6040/j.issn.1673-3770.0.2021.369

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Objective To explore the relationship between the degree of mastoid pneumatization and the development of the endolymphatic sac. Methods A retrospective study of 145 patients(290 ears)who underwent temporal bone CT examination from January 2019 to May 2021 in the Department of Otolaryngology. After screening, the patients were divided into the well- pneumatized and the poorly-pneumatized groups, according to the degree of mastoid pneumatization. The 1∶1 closest match was adopted. The propensity score(PS)was set at 0.02. The propensity score matching(PSM)analysis was performed on covariates based on age and otitis media. The analysis produced 58 sets of paired data. The shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface(P-P value)was used to indirectly reflect the development of the endolymphatic sac. The shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface(P-P value)of different degrees of pneumatization was analyzed statistically. Results The median(interquartile range)of the shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface(P-P value)was 2.26(1.49, 3.08)mm. The difference between the degree of mastoid pneumatization and the shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface(P-P value)was not statistically significant. That is, the degree of mastoid pneumatization was not associated with the development of the endolymphatic sac. There were no statistically significant differences in the general data processed after PSM in the two mastoid pneumatization groups. That is, the propensity score matching was effective in managing the selection deviation of non-random experimental data in clinical research. There was a statistically significant difference in the degree of mastoid pneumatization and otitis media; in the group with good mastoid pneumatization, the incidence of otitis media is lower. Conclusion There is no correlation between the degree of mastoid pneumatization and the development of the endolymphatic sac.

Clinical application of target gene panel testing in genetic diagnosis of deafness

ZHANG Yanhong, LI Juanjuan, ZENG Xianhai, GOU Lingshan, WANG Zhaoxia, WEI Jianfang, MA Fang, QIU Shuqi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  27-34.  doi:10.6040/j.issn.1673-3770.0.2022.190

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Objective This study aimed to explore the application of the deafness gene panel in the genetic analysis of patients with hearing loss. Methods The combination of real-time polymerase chain reaction(PCR)and Sanger sequencing was used to identify the 25 mutations of four common deafness genes in 40 deaf patients. Patients with heterozygous mutations, detected via deafness gene sequencing, underwent further single deafness gene sequencing or target gene panel testing. Those with negative real-time PCR results underwent target gene panel testing. The parents of the 16 patients underwent genetic analysis to identify inherited mutations. Results Among the 40 patients, there were eight patients with a homozygous or compound heterozygous mutation in the GJB2 gene and two patients with a single heterozygous mutation, according to the deafness genetic screening. Moreover, one patient had a homozygous mutation, while two had a single heterozygous mutation in the SLC26A4 gene. The four patients with single heterozygous mutations underwent further single deafness gene sequencing or target gene panel testing. Two patients had the compound heterozygous mutation, GJB2 c.235delC/c.610delC or c.235delC/c.109G>A. Meanwhile, two patients had SLC26A4 c.919-2A>G/c.1548_1549insC. Among the 27 patients with negative real-time PCR results, there were four patients with the homozygous mutation, GJB2 c.109G>A, one patient with c.571T>C/c.G109A, one patient with MYO7A c.397dupC/c.3484A>T, one patient with MYO15A c.4779+2T>C/c.5008-2A>G, and one patient with the heterozygous mutation, ACTG1 c.118C>T, based on target gene panel testing. Additionally, there were two patients with the compound heterozygous mutations, CDH23 c.1765G>A/c.6504T>A and c.6049G>A/c.7225-1G>A, respectively. Among the 16 patients, 15 inherited the deafness genetic mutations from their parents, according to the genetic analysis. Conclusion The deafness gene panel improved the genetic diagnostic rate among deaf patients with negative results of hotspot deafness gene mutations.

Correlation between sinonasal inverted papilloma and peripheral inflammatory blood markers

MA Jingyuan, WU Tianyi, SUN Zhanwei, WANG Weiwei, LI Shichao, WANG Guangke

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  35-39.  doi:10.6040/j.issn.1673-3770.0.2021.264

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Objective To investigate the correlation between sinonasal inverted papilloma(SNIP)and peripheral inflammatory blood markers. Methods 62 patients with SNIP who received endoscopic sinus surgery in the Department of Otolaryngology of Henan People's Hospital from February 2019 to March 2021 were selected as the research objects. 62 age-and-sex-mached healthy controls were included in the study. The number of various peripheral blood cells and inflammatory blood markers such as neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR)of the patient and control groups were compared. According to whether with malignant transformation and recurrence patients, the research groups were further divided into the SNIP group(38 cases), the recurrence group(14 cases)and the cancer group(10 cases). Multiple comparative analysis were performed on the three sets of data. Results There were statistically significant differences between the patients and controls for neutrophil(P<0.001), eosinophil counts(P<0.001), NLR(P=0.016)and PLR(P=0.005). Logistic regression analysis model showed that the increase of NLR(P<0.001), decrease of PLR(P=0.002)and increase of eosinophil counts(P=0.013)were statistically significant. Further multiple comparative analysis showed that the basophil count in the experimental group was statistically different among the three groups. There was statistically significant difference in the basophil count between SNIP and recurrence group(P=0.045), canceration and recurrence group(P=0.017). Conclusion The peripheral blood eosinophil, neutrophil counts, NLR and PLR are correlated with SNIP, and can be used as peripheral blood inflammation markers of SNIP. The increase of NLR、eosinophil counts, and decrease of PLR may be the risk factors of SNIP.

Research in the field of olfactory disorders in China—An analysis based on Citespace

LI Dan, CHEN Tengyu, HUANG Yanfen, ZHOU Min, ZHOU Yixing, RUAN Yan, YAN Yajie

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  40-48.  doi:10.6040/j.issn.1673-3770.0.2021.349

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Objective To visually analyze and evaluate olfactory disorders in domestic research, in an attempt to provide scholars with current research trends and possible future areas of investigation in this field. Methods “Olfactory disorder” was selected as the subject term, academic papers from the China National Knowledge Infrastructure(CNKI)database were explored, with a time-frame from the present to October 20, 2020. Articles were screened according to the inclusion criteria, Citespace software was then used to screen for authors, journals/units and subject headings by means of graphs. Results It was found that the amount of literature published on “olfactory disorders” has increased rapidly. The top authors with the highest number of publications are Wei Yongxiang, Ni Daofeng, Liu Gang, Hang Wei, Yao Linyin, Han Demin, and Liu Jianfeng. The journals ranked 1-3 regarding “olfactory research” are: Journal of Clinical Otorhinolaryngology Head & Neck Surgery; International Journal of Otorhinolaryngology Head & Neck Surgery; and the Chinese Journal of Otorhinolaryngology Head & Neck Surgery. The high-yield cooperative and influential institutions are Beijing An Zhen Hospital of the Capital University of Medical Sciences and Peking Union Medical College Hospital et al. The subject heading cluster analysis showed 7 clusters: chronic rhinosinusitis, Parkinson's disease, Kallmann's Syndrome, rhinitis, Corona Virus Disease 2019(COVID-19), ultrastructure and acupuncture. Conclusion In the field of olfactory disorders, early domestic authors such as Han Demin and Li Zhichun conducted in-depth research. In recent years, authors such as Wei Yongxiang and Ni Daofeng studied the detection methods, etiology, and pathogenesis of olfactory disorders. Although the core authors conducted combinations of research and inductive classifications of olfactory dysfunction in recent years, the central mediation value was less than 0.1, indicating that their relationship was a short liaison. It is recommended that should be strengthened in the service of forming an academic community with which to increase the overall influence of research findings. According to cluster analysis, the current research hotspots of “olfactory disorders” are mainly focused on: The associations between olfactory and chronic rhinosinusitis, Parkinson's disease, novel coronavirus pneumonia(COVID-19), nasal polyps and other primary diseases, and explorations of their pathogenesis. Clinical characteristics and epidemiological investigations of different types of olfactory disorders. Explorations of the efficacy of different treatments, such as endoscopic sinus surgery and acupuncture, on olfactory disorders. It is considered that the above seven clustering research areas may continue to be important hotspots in this field. Among them, chronic rhinosinusitis has been a topic of interest from ancient times to the present, and COVID-19 will become a great source of research work in the next 5 to 10 years. Furthermore, it is possible olfactory disorders caused by COVID-19 may be related to nasal inflammation, and the correlation between them will become a target of future research on olfactory disorders.

Prevalence and prognostic nomogram for IVc stage hypopharyngeal carcinoma patients: a SEER population-based analysis

JIANG Chao, ZHOU Xuanchen, HAN Jie, YUE Zhiyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  49-54.  doi:10.6040/j.issn.1673-3770.0.2021.278

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Objective Hypopharyngeal carcinoma patients in IVc stage are always associated with poor prognosis and prognostic factors for these patients are largely unknown. We aimed to characterize the prevalence of metastases, and establish a prognostic nomogram for survival prediction. Methods Hypopharyngeal carcinoma patients with IVc stage were collected from surveillance, epidemiology and End Results(SEER)database. Chi-square test was used to analyze the related risk factors of different sites of metastases. Univariate and multivariate Cox regression analyses were performed to analyze the prognostic factors of cancer-specific survival(CSS)in IVc stage patients. The nomogram based on multivariate Cox analysis was then established and validated. Results A total of 283 IVc stage hypopharyngeal carcinoma patients were included in this study. Majority of patients were diagnosed with single metastasis, and lung(53. 7%)was the most common metastasis site. Patients with tumor in pyriform sinus(P=0.029)and high-grade tumors(P=0.010)were more likely to develop lung metastasis. Multivariate Cox analysis showed that bone metastasis(HR=2.239, P<0.001), liver metastasis (HR=1.880, P=0.003), surgical therapy(HR=0.311, P=0.003)and chemotherapy(HR=0.494, P<0.001)were independent prognostic factors for CSS. Independent prognostic factors were integrated into nomogram for CSS prediction, and the C-index was 0.686(95%CI 0.649-0.723). Conclusion Lung metastasis is the most common in IVc stage hypopharyngeal carcinoma patients. For hypopharyngeal carcinoma patients in IVc stage, surgical therapy, chemotherapy, without bone and liver metastases are associated with superior survival outcome. The proposed nomogram has a good predictive ability and may be practical for clinical decision-making.

Newborn with Kasabach-Merritt phenomenon in parapharyngeal space:a case report and literature review

ZHU Jing, ZHANG Rui, ZHAO Yuan, LI Yang, ZHAO Yu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  55-59.  doi:10.6040/j.issn.1673-3770.0.2021.410

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Objective We aimed to evaluate - the clinical characteristics,the diagnosis,and treatment of Kasabach-Merritt phenomenon(KMP)in newborns. Methods We retrospectively analyzed a case of new born with KMP in parapharyngeal space,along with a review of the related literature. Results In this case, oral administration of Prednisone and Propranolol was ineffective.As such,a combined solution of bleomycin and dexamethasone was injected into the tumor, and the treatment was completed in two stages, with an interval of one month.The tumor eventually resolved,and laboratory examinations were found to be normal. The patient was followed up for 2 years who showed good recovery without adverse reactions or sequelae. Conclusion KMP is a rare but greatharmful disease among in fants, especially rare in the parapharyngeal space. As there is no unified treatment at presen,there is a need for effective individualized management. This particular case shows that local injection of bleomycin and dexame thasone may be a safe and effective treatment in neonates with difficult surgical resection who are resistant to systemic medication.

Retrospective analysis of 67 cases of primary parapharyngeal space tumors

GONG Xiaoyang, LI Wang, CHEN Xi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  60-65.  doi:10.6040/j.issn.1673-3770.0.2021.429

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Objective To analyze the clinical characteristics and surgical approaches of parapharyngeal space tumors and to explore the advantages, disadvantages, and prognosis of surgical approaches. Methods The data of 67 patients with parapharyngeal space tumor admitted to the First Affiliated Hospital from January 2010 to June 2019 were analyzed retrospectively. All patients were examined using CT and /or MRI before operation. Forty-five cases were operated by lateral transcervical approach, 20 cases by trans-oral approach, and two cases by cervical-transparotid approach. All patients were followed up closely after operation. The follow-up time was from 8 months to 110 months(median: 45 months). Results A total of 59 cases(88.1%)were pathological benign tumors, eight cases(11.9%)were malignant tumors, and 24 cases(35.8%)had postoperative complications. Twenty cases underwent lateral transcervical approach(29.9%), three patients(4.5%)had transoral approach, and one patient(1.5%)had cervical-transparotid approach. Seven patients(10.4%)improved after follow-up, and seven patients(10.4%)had relapse. Four patients(6.0%)underwent lateral transcervical approach, and three patients(4.5%)underwent transoral approach. Conclusion Parapharyngeal space tumors are mainly benign, with a complex anatomy and various pathological types. Surgical resection serves as the main treatment. According to the results of the imaging examination, tumor size and anatomical relationship determine the approach prior to surgery. The lateral transcervical approach is still the preferred method for resection of parapharyngeal space tumors, but in patients with benign tumors with a maximum tumor diameter of <6 cm and located medical to the artery, the transoral approach can be considered.

Perioperative management of children with mild bleeding disorders undergoing adenotonsillectomy procedures

ZHANG Fengzhen, WANG Guixiang, WEI Yunyun, ZHANG Yamei, ZHAO Jing, WANG Hua, LI Hongbin, LI Xiaodan, ZHANG Jie

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  66-72.  doi:10.6040/j.issn.1673-3770.0.2020.263

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Objective To explore the perioperative management of children with mild bleeding disorders who underwent tonsil and/or adenoid surgery, and to improve the perioperative safety of such cases in the future. Methods We conducted a retrospective analysis of six children with bleeding disorders who underwent tonsil and/or adenoid surgery in our hospital. We collected information on their diagnosis and treatment plans, bleeding risk assessments, surgical plans, and perioperative bleeding control strategies. We also analyzed the key points of diagnosis and treatment of such cases through a literature review. Results The results for the hemagglutination test of the six children were as follows: hemophilia A FVIII: C 4.8%; APTT 57.7 s, hemophilia B FIX: C 4.2%; APTT 59.3 s, hemophilia B FIX: C 5.9%; APTT 57.2 s, FIX: C 64.3%; APTT 52.3 s, FVII: C 73.3%; FX: C 66.2%; FIX: C 58.4%; APTT 44 s, APTT 35s; PLT 102×10⁹/L. The children with hemophilia were treated with factor replacement and antifibrinolytic therapy, while the two children with coagulopathies were treated with fresh frozen plasma. There was no specific treatment for the child with immune-mediated thrombocytopenia. All six children completed tonsil and/or adenoid surgery successfully with the close cooperation of the hematology, anesthesiology, and blood supply departments. The mean operation time and average bleeding volume were 63.3 min and 16.7 mL for the hemophilia cases, 47.5 min and 10 mL for the coagulopathy cases, and 15 min and 5 mL for the child with platelet reduction. During the perioperative period the coagulation function, coagulation factor activity, inhibitor concentration, and platelet function were monitored. Different replacement treatments and anti-fibrinolytic therapies were given for different reasons. Two patients with hemophilia(33.3%)had mild tonsil hemorrhage during the first 4-7 days of their postoperative hospitalization stay. And no bleeding occurred after the transfusion of fresh frozen plasma. However, the remaining children did not show bleeding. The average length of hospitalization for children with hemophilia was 13.3 days, while the other children were hospitalized for 6 days. The patients all healed well and were discharged, and no bleeding was noted during the 1-month follow-up period. Conclusion Children with mild bleeding disorders who need to undergo tonsil and/or adenoid surgery require multi-disciplinary cooperation, and good bleeding control strategies during the perioperative period. The operation is safe and feasible for these cases. However, perioperative antifibrinolytic therapy should be continued for at least 7-14 days. The hospital stay should also be extended to 1 week for children with mild coagulation dysfunction and up to 2 weeks for cases of hemophilia to ensure the wounds are fully healed.

The utility of different values of average oxygen saturation and minimum oxygen saturation between different sleep stages for predicting the uvulopalatopharyngoplastysurgery effect

HAN Jibo, DONG Jie, MING Wei, WANG Yan, LUO Zhihong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  73-78.  doi:10.6040/j.issn.1673-3770.0.2021.180

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Objective The objective of this study was to explore whether the difference in average blood oxygen saturation and lowest oxygen saturation between different sleep stages could predict the effect of uvulopalatopharyngoplasty(UPPP)surgery. Methods Preoperative and postoperative PSG data from 117 patients(113 men and 4 women)with OSA admitted to our hospital between May 2015 and June 2018 were retrospectively analyzed. After computing the average oxygen saturation difference value(ΔAvSaO₂)and the lowest oxygen saturation difference value(ΔLSaO₂)between the REM and NREM sleep stages in preoperative patients, a linear correlation analysis was conducted with the postoperative AHI drop ratio(ΔAHI%). Using ΔAHI %≥50% as an effective operation, we drew the receiver operating characteristic(ROC)curves for ΔAvSaO₂ and ΔLSaO₂.We then calculated the cutoff value to determine the optimal threshold for predicting the operation effect, and also conducted further unconditionallogistic regression analyses on the predictors. Results The preoperative ΔAvSaO₂、ΔLSaO₂ between REM and NREM sleep stages were negatively correlated with ΔAHI% and had Pearson correlation coefficients of r=0.881 and 0.849, respectively(P<0.001), indicating the possibility of that both as the prediction index for the effect of UPPP surgery. The ΔAvSaO₂ area under the curve was 0.888, 95% CI: 0.830-0.945(P<0.001), and ΔAvSaO₂=3.25 was the best threshold for predicting the UPPP surgery effect. Its sensitivity, specificity, positive predictive value, and negative predictive value were 0.836, 0.804, 0.822, and 0.818, respectively. The ΔLSaO₂ area under the curve was 0.931, 95% CI:0.889-0.973(P<0.001), and ΔLSaO₂=8.75 was the best threshold for predicting the UPPP surgery effect. Its sensitivity, specificity, positive predictive value, and negative predictive values were 0.836, 0.875, 0.879, and0.831, respectively. Unconditional logistic regression analysis showed that patients with OSA with smaller preoperative oxygen saturation difference values between REM and NREM sleep stages may have more effective outcomes with UPPP surgery. The prediction accuracy was 84.6% for a combination of both predictors for the UPPP surgery effect. Conclusion The difference in oxygen saturation between REM and NREM in patients with OSA can be used as a good index to predict the outcome of UPPP surgery.

Forty cases of early glottic cancer treated by CO₂ laser surgery combined with radiofrequency ablation

LI Lijie, TIAN Xiufen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  79-85.  doi:10.6040/j.issn.1673-3770.0.2021.188

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Objective To explore the clinical efficacy of endoscopic CO₂ laser surgery combined with low-temperature plasma radiofrequency ablation(LTP-RFA). Methods We retrospectively analyzed the clinical data of 40 patients with early glottic cancer treated by endoscopic CO₂ laser surgery combined with LTP-RFA. Results All patients initially underwent endoscopic CO₂ laser surgery combined with LTP-RFA. The patients were followed up for 4.2-32.0(18.6)months; none were lost to follow-up. Three cases experienced recurrence once and two cases, twice. The recurrence rate was 12.5%. Total laryngectomy was performed in two cases, vertical partial laryngectomy in one case, selective neck dissection in one case, and combined surgery with tracheotomy in one case. One patient who experienced recurrence after total laryngectomy received chemoradiotherapy and interventional therapy, but the therapeutic effect was poor. One patient with recurrence after vertical partial laryngectomy, with an otherwise good general condition, opted for radiotherapy. The other three patients recovered well after their last surgery. Granulation tissue was observed in nine cases postoperatively and healed completely after 1-6 months. Mild vocal cord adhesion was observed in four patients. Postoperative vocal function was good in 36 patients, poor in 2 patients, and lost in 2 patients after total laryngectomy. Conclusion Endoscopic CO₂ laser surgery combined with LTP-RFA for the treatment of early glottic cancer helps overcome the limitations of the two methods when used alone and helps improve surgical efficiency. It is an effective and feasible surgery.

Factors affecting flap neurosis and other postoperative flap-related complications after free-flap reconstruction of head and neck tumors

ZHANG Lijun, XU Ran, LUO Jifang, LIU Guoqi, HE Qian, LI Wei, JIANG Zhenhua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  86-90.  doi:10.6040/j.issn.1673-3770.0.2021.375

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Objective This study aimed to explore the factors affecting flap neurosis and other postoperative flap-related complications. Methods Patients who underwent free-flap reconstruction of head and neck tumors were examined. Factors such as of age, sex, operation duration, smoking, alcohol consumption, hypertension, diabetes, preoperative radiotherapy, vascular anastomosis skill on flap neurosis, and flap-related complications were analyzed. Results We observed that age, sex, operation duration, smoking, alcohol consumption, preoperative radiotherapy, and vascular anastomosis skill were not risk factors for flap neurosis and flap-related complications after free flap reconstruction in patients with head and neck tumors; Diabetes was observed to be a risk factor for flap failure after free-flap reconstruction in patients with head and neck tumors(P=0.006), whereas hypertension(P=0.040)and diabetes(P=0.024)were independent risk factors for flap-related complications. Conclusion Individualized reconstruction methods should be used in patients with head and neck tumors who are suffering from diabetes and are candidates for free-flap reconstruction.

Acute maxillary osteomyelitis complicated with nasal septal abscess in an infant: a case report and literature review

WANG Juan, SONG Yingluan, GENG Jiangqiao, WEN Xin, SHI Yanan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  91-96.  doi:10.6040/j.issn.1673-3770.0.2021.402

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Objective To investigate the clinical manifestations, diagnostic reasoning, treatment, and prognosis of infant maxillary osteomyelitis complicated with nasal septal abscess. Methods The clinical data of one child with acute maxillary osteomyelitis complicated with septal abscess were retrospectively analyzed. Relevant studies from the literature published in China and overseas from 1956 to 2021 were retrieved and analyzed. In total, the published studies reported on 84 patients. The clinical manifestations, treatment methods, and prognosis, were summarized. Results Of the 84 patients with acute maxillary osteomyelitis, 53 were male, 29 were female, and the sex of 2 was unknown. The key presenting symptoms included nasal obstruction, facial swelling, and fever. The diagnosis was confirmed based on the imaging features of maxillary bone destruction, bone hyperplasia, and sclerosis, as well as the clinical manifestations of the children. Staphylococcus aureus was the most common pathogen identified. Staphylococcus epidermidis, Streptococcus, and Acinetobacter calcoaceticus were also detected. Maxillary osteomyelitis frequently co-occurs with orbital abscess or maxillary alveolar abscess. However, maxillary osteomyelitis with septal abscess in children is rare. In the literature, only one 14-year-old patient with maxillary osteomyelitis complicated with nasal septal abscess and previous relevant dental history has been reported. Treatment with intravenous broad-spectrum antibiotics and incisional drainage of the localized abscess can lead to a positive therapeutic outcome. Conclusion Staphylococcus aureus is the main pathogen associated with acute maxillary osteomyelitis in infants. Early administration of antibiotics to control the infection is recommended. For localized abscesses in the eyes, oral cavity, maxillary alveolar cavity, or nasal cavity, timely detection and early incisional drainage should be performed to minimize the destruction caused by inflammation and infection, leading to necrosis of the maxillary bone, arrested tooth development, or nasal septum cartilage necrosis leading to external nasal collapse.

A clinical study on the effect of phacoemulsification on the retinal structure in the macular region of senile cataract

YANG Ru, ZHANG Yuguang, XU Xianghui, WU Xuelian, TAO Yuan, TAN Yue

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  97-102.  doi:10.6040/j.issn.1673-3770.0.2022.020

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Objective Optical coherence tomography angiography(OCTA)is used to observe the changes of blood flow density, retinal thickness, and foveal avascular zone(FAZ)in the macular region after phacoemulsification in patients with senile cataract. The objective of this study is to explore the influence of intraoperative parameters on the structural changes of the macular area and to explore the factors affecting postoperative visual acuity. Methods This is a prospective observational study. Patients with senile cataract who underwent phacoemulsification before operation, and 1 day, 1 week, 1 month, and 3 months after operation, underwent imaging of the macular area using the 3×3 mm OCTA scan to obtain the macular blood flow density, thickness of the retina, and the area of FAZ. Cumulative release energy(CDE)and effective phacoemulsification time(EPT)were recorded, and their correlation with the changes of macular retinal structure was analyzed. Using binary logistic regression analysis to explore the factors affecting postoperative visual acuity. Results Forty-one cases(41 eyes)were included in the final analysis. Compared with those before operation, the linear density and perfusion density of the macular area increased at 1 day, 1 week, 1 month, and 3 months after operation(P<0.05), and the FAZ area decreased(P<0.001); the retinal thickness in the macular increased at 1 month and 3 months after operation compared with preoperative(P<0.05). There was no correlation between CDE and EPT and macular retinal structural changes(P>0.05), and postoperative best corrected visual acuity(BCVA)had no correlation with macular blood flow density, retinal thickness, FAZ area, CDE and EPT(P>0.05). Conclusion After phacoemulsification, the blood flow density and retinal thickness in the macular increased, and the FAZ area decreased. The surgical parameters were not the main factors that caused changes of the postoperative retinal structure. The changes in surgical parameters and retinal structure had no effect on postoperative visual acuity. We should further explore the reasons for the changes of postoperative retinal structure in the macular region and the factors affecting the recovery of postoperative visual acuity.

Analysis of a therapeutic modality for sudden deafness utilizing neck acupuncture comprising seven lines of treatment

SHI Anni, ZHANG Jiajia, BAI Peng, ZHANG Chongyang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  103-107.  doi:10.6040/j.issn.1673-3770.0.2021.412

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The efficacy of acupuncture in the treatment of sudden deafness is well substantiated. However, it is necessary to assess traditional methods in order to identify the most efficient acupuncture treatment modalities. This article links an exposition of “sudden deafness” in Huangdi Neijing, with an illustration of the mechanism of treatment of sudden deafness by modern doctors using acupoints on the neck. It further presents a discussion and summary of the theoretical source of the application of neck acupoints, and explains the basis of the seven-line neck method in treating sudden deafness. In comparison to traditional methods, our treatment combines a consideration of the characteristics of acupoints, with their respective tissue structures, providing a new approach to the clinical treatment of sudden deafness, in the hope of improving the efficacy of this modality.

Research progress on the pathogenesis and clinical characteristics of BPPV secondary to inner ear diseases

HUANG Lan, GAO WeiOverview,CHEN GanggangGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  108-113.  doi:10.6040/j.issn.1673-3770.0.2021.445

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Benign paroxysmal positional vertigo(BPPV)is one of the most common peripheral vestibular dysfunction diseases, which can be divided into idiopathic and secondary BPPV. Exogenous disease is considered to be the most important risk factor for secondary BPPV. In addition to history of ear trauma and inner ear surgery, common inner ear diseases, including Meniere's disease, sudden sensorineural hearing loss, vestibular neuritis, and vestibular migraine, may also result in secondary BPPV. Moreover, secondary BPPV can occur at any stage of inner ear disease with similar clinical manifestations. Therefore, this paper aimed to systematically review relevant national and international literature, as well as summarize and analyze the pathogenesis and clinical characteristics of BPPV secondary to common inner ear diseases, as a reference for clinical diagnosis and treatment.

Research advances in neuroendocrine carcinoma of the larynx

MAO ZefanOverview,CHEN Xi, CHENG LeiGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  114-119.  doi:10.6040/j.issn.1673-3770.1.2021.152

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Neuroendocrine carcinoma of the larynx is a rare malignant tumor of the larynx that originates from epithelial neuroendocrine cells. Based on the degree of differentiation and cell type, it can be divided into four histological subtypes: typical carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma, and large cell neuroendocrine carcinoma. Despite the substantial differences across these subtypes, an accurate description of their differences has been impeded by the overly low incidence. A number of studies reported are frequently contradictory due to too few cases reported or the inability to collect a sufficient sample size, making it difficult to reach a consensus. This paper reviews the recent literature reports on the clinical behavior, characteristics, diagnosis, treatment, and prognosis of neuroendocrine carcinoma of the larynx, to provide an evidence for clinicians to broaden their understanding and optimize the diagnosis and treatment protocol for this disease.

Laryngeal cancer stem cells: potential therapeutic targets for overcoming multidrug resistance

WANG MeiOverview,LI ZhihaiGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(4):  120-128.  doi:10.6040/j.issn.1673-3770.0.2021.388

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Laryngeal cancer is a common malignancy in the head and neck. Although, detection and treatment of laryngeal cancer advances have increased the possibility of early diagnosis and treatment, most patients eventually die due to drug resistance and recurrence. Therefore, drug resistance and metastasis are the major challenges in laryngeal cancer treatment. As research progresses, the existence of tumor stem cells was proven to be closely associated with tumorigenesis and treatment resistance. The early diagnosis and treatment of laryngeal cancer depend on the detection and identification of the tumor stem cell markers, which have far-reaching implications for targeted therapy of laryngeal cancer. This study reviewed the current research on laryngeal cancer stem cells at home and abroad, its origin, and possible drug resistance mechanism of laryngeal cancer stem cells. Additionally, this study reviewed the surface markers that maintain the stemness of laryngeal cancer and progress of targeted therapy for laryngeal cancer, which aims to provide new directions and targets for clinical treatment of laryngeal cancer.