Table of Content

20 January 2023 Volume 37 Issue 1

  

Preliminary analysis of the position and related factors of titanium ossicular prostheses during mastoid and tympanic revision surgeries

LI Xiaoyu, ZHAO Danheng, LIU Ya, LIU Yang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  1-5.  doi:10.6040/j.issn.1673-3770.0.2021.459

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Objective To evaluate the position, clinical characteristics, and related factors affecting implanted titanium ossicular prostheses during middle ear revision surgeries, in order to provide a clinical experience and guidelines for ossicular chain reconstruction. Methods We recruited cases of revision surgeries performed at least 6 months after implantation of titanium ossicles during mastoid tympanoplasties, between 2013 and 2020. We retrospectively analyzed data regarding the positions of the titanium ossicle, the causes of abnormal ossicle position, and the treatment methods. Results Among the 485 cases of tympanoplasty with titanium ossicle hearing reconstruction, 30 cases were reoperated. The prosthesis position was good in nine cases, tympanic membrane(TM)atelectasis and prosthesis protrusion occurred in two cases, TM perforation and prosthesis ejection in seven cases, detachment or angular inclination of the TM in six cases, and detachment of the stapes in six cases. The indications of reoperation included postoperative infection(eight cases), recurrence(fifteen cases), and pure hearing loss(seven cases). The postoperative infections occurred within a month after surgery, but the median times of onset of recurrence and pure hearing loss were 19 months(5-54 months)and 30 months(4-49 months), respectively, following the initial surgery. The position of the ossicular prosthesis was good in 1/3 and 1/2 of the recurrence and infection cases respectively; however, the positions in isolated hearing loss cases were all abnormal. Conclusion Titanium prosthesis osteoplasty is a safe and effective reconstruction method with a low reoperation rate. Poor Eustachian tube function and TM atelectasis are the main causes of prosthesis abnormalities during reoperation. Failure of the previous prosthesis implantations could be the result of dislocation, lodging, protrusion, shedding, foreign body stimulus, and granulation wrapping during reoperation.

Granulomatosis with polyangiitis with initial otological symptoms combined with a nasopharynx lesion: a case report with literature review

ZHONG Jiake, WANG Baiyang, YI Haijin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  6-14.  doi:10.6040/j.issn.1673-3770.0.2021.526

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Objective To explore the clinical characteristics, laboratory examination, pathological features, diagnosis, and treatment of a rare case of granulomatosis with polyangiitis(GPA)with initial otological symptoms combined with a nasopharynx lesion. Methods This article retrospectively analyzed the clinical case, summarized its characteristics, and reviewed related literature at home and abroad. Results This patient's earliest clinical symptoms included otitis media, labyrinthitis, and a nasopharynx lesion. Then came the facial paralysis, and the trigeminal nerve stimulation symptoms worsened gradually. Only acute and chronic infiltrating inflammatory cells were found in the middle ear and nasopharynx lesion biopsies. The antibiotics were then modified, and the mastoidectomy surgery was performed to avoid petrosal bone and cerebral invasion. Despite improvements in the local inflammation of the middle ear, the earache, facial palsy, and other symptoms did not improve. Glucocorticoid therapy, on the other hand, appeared to be helpful. As a result, we completed appropriate autoimmune disease examinations and had another nasopharynx biopsy. Finally, the GPA diagnosis was confirmed. Glucocorticoid and immunosuppressive treatments alleviated symptoms. For three months following surgery, there was no obvious evidence of lung or renal invasion. Conclusion In clinical practice, the diagnosis of GPA should be considered when certain atypical otitis media is repeatedly unhealed after conventional treatment but sensitive to glucocorticoids, along with nasopharynx lesions, sinusitis, lung or kidney involvement, and gradual invasion of the inner ear and cranial nerve manifesting as vertigo attacks and facial palsy. When repeated pathological biopsies fail to reveal specific diagnostic evidence, dynamic monitoring of anti-neutrophil cytoplasmic antibody, erythrocyte sedimentation rate, urine occult blood, chest CT, and serum creatinine are also important.

Effect of great auricular nerve block on emergence delirium in children undergoing cochlear implantation

FENG Yanyan, ZHANG Danxu, ZHANG Kangda, WANG Linyu, WANG Huanliang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  15-19.  doi:10.6040/j.issn.1673-3770.0.2021.538

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Objective To evaluate the effect of great auricular nerve block on emergence delirium(ED)in children undergoing cochlear implantation with sevoflurane general anesthesia. Methods We enrolled 80 children(0-6 years)with American Society of Anesthesiologists status Ⅰ or Ⅱ who were scheduled for unilateral cochlear implantation under sevoflurane general anesthesia. The patients were randomly assigned to the great auricular nerve block group(group A)or the control group(group B). After the induction of anesthesia, 1 mL of 0.2% ropivacaine was injected around the auricular nerve under ultrasound guidance in group A, while 2 mL of 2% lidocaine was injected around the incision in group B. General anesthesia was maintained with sevoflurane. The incidence of ED was assessed using the pediatric anesthesia acute delirium scale(PAED), while postoperative pain was assessed using the face, legs, activity, cry and consolability(FLACC)scale. Patients with a PAED≥13 or FLACC≥4 were given fentanyl 0.5 μg/kg intravenously. Average sevoflurane dosage, ED duration, extubation time, duration of post-anesthesia care unit(PACU)stay, total fentanyl dosage, nurse satisfaction score, and incidence of adverse reactions within 24 hours postoperative were recorded. Results The incidence of ED(P=0.036)and PAED(P=0.024)score were significantly decreased in group A versus B, FLACC score(P=0.008)and the incidence of FLACC≥4(P=0.006)were significantly decreased, the incidence of analgesia with fentanyl(P=0.011)was significantly decreased, duration of PACU(P=0.040)residence was significantly shortened, and nurse satisfaction(P=0.021)was significantly improved(all P<0.05). No significant change was found in group A in the incidence of PAED≥13(P=0.289), ED duration(P=0.962), extubation time(P=0.913), and the incidence of postoperative adverse reactions(P_Vomit=0.737;P_choking=0.487;P_hypoxia=1.000)(all P>0.05). Conclusion A great auricular nerve block can reduce the incidence of ED and postoperative pain in children under sevoflurane general anesthesia without increasing the incidence of postoperative adverse events.

Analysis of postoperative efficacy of middle ear cholesteatoma complicated with facial paralysis

ZHAI Guanhong, YU Sihan, ZHANG Zhiqiang, YU Changxu, CUI Zhezhu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  20-25.  doi:10.6040/j.issn.1673-3770.0.2022.045

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Objective This study aimed to investigate the efficacy of open mastoidectomy or complete wall tympanotomy, combined with facial nerve decompression, in improving facial paralysis among patients with middle ear cholesteatoma. Methods The facial nerve House-Brackmann classification system was used. There were 9 grade Ⅲ cases, 11 grade Ⅳ cases, and 5 grade Ⅴ cases. Among them, two patients presented with lower eyelid eversion. The patients were grouped according to the time interval between the onset of facial paralysis and the operation. Group 1 consisted of 13 patients who underwent surgery within 30 days after developing facial paralysis. There were seven grade Ⅲ cases, five grade Ⅳ cases, and one grade Ⅴ case in this group. Group 2 consisted of eight patients who underwent surgery within 30 to 60 days after developing facial paralysis. This group had two grade Ⅲ cases, five grade Ⅳ cases, and one grade Ⅴ case. Group 3 consisted of four patients who underwent surgery 60 to 90 days after developing facial paralysis. The group included one grade Ⅳ case and three grade Ⅴ cases. All patients were evaluated three and six months postoperatively. Results All 25 patients had successful surgeries with significant improvement noted three months postoperatively. There were seven grade Ⅰ cases, six grade Ⅱ cases, nine grade Ⅲ cases, and three grade Ⅳ cases(P<0.001). Further improvement was noted six months postoperatively with 17 grade I cases, three grade Ⅱ cases, and five grade Ⅲ cases(P<0.001). However, the improvement from the third postoperative month to the sixth postoperative month was insignificant(P=0.076). The treatment effect of group 1 was better than those of groups 2 and 3. No significant improvement in facial paralysis was observed three months after the operation in groups 2 and 3. However, a significant improvement was noted during the sixth postoperative month for these groups(P<0.001). The improvement from the third postoperative month to the sixth postoperative month was insignificant (P=0.223). Conclusion Surgery within 30 days from the onset of facial paralysis resulted in the most favorable outcomes in patients with middle ear cholesteatoma, complicated with facial paralysis. The treatment effect peaked within 30-90 days postoperatively. However, the improvement was gradual, and a drastic improvement was noted six months postoperatively. Favorable outcomes were still achieved within three months postoperatively among surgically treated patients with middle ear cholesteatoma.

Application effect and safety evaluation of inhalation anesthesia in children's electronic rhinopharyngeal endoscopy

YI Tongying, WANG Xueni, HAN Xudong, BAI Caiying, WU Qizhen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  26-29.  doi:10.6040/j.issn.1673-3770.0.2021.214

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Objective This study aimed to compare the application effects of sevoflurane inhalation anesthesia and topical local anesthesia in electronic rhinopharyngeal endoscopy. Methods A total of 1 006 children who underwent electronic rhinopharyngeal endoscopy were selected. The participants were divided into two groups depending on the type of anesthesia(inhalational vs. local)they received. Next, a random number table was created, with 503 participants added in each group. The FLACC pain score, the incidence of mucosal injury, the incidence of adverse reactions, the doctor's experience score, the time needed to complete the examination and the rate of second entry were compared between the two groups. Results The incidence of pain and iatrogenic injury among the children in the inhalation anesthesia group was significantly lower than that in the local anesthesia group(P=0.002,P<0.001). No severe adverse reactions were noted in both groups. Additionally, the doctor's experience and examination time in the inhalation anesthesia group were significantly better than those in the local anesthesia group(P=0.042,P=0.026). Conclusion For children undergoing electronic rhinopharyngeal endoscopy, inhalation anesthesia is more beneficial than local anesthesia.

Respiratory epithelial adenomatoid hamartoma in the nasal cavity: a case report and literature review

CEN Yanfang, WU Yingfang, HU Yuying, KONG Zhe, LIANG Yan, LI Xingya, XIA Jiyan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  30-34.  doi:10.6040/j.issn.1673-3770.0.2021.464

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Objective To explore the clinical, imaging, pathological features and treatment of nasal respiratory epithelial adenomatous hamartoma(REAH). Methods We report the case of a patient with REAH in the nasal cavity and review prior cases of REAH in the nasal cavity published in the literature. Results The most frequent symptoms of REAH in the nasal cavity are nasal obstruction and olfactory impairment. In terms of imaging, olfactory cleft widening greater than 10 mm on computed tomography is characteristic of REAH. The diagnosis of REAH relies mainly on pathology; this malformationis characterized by a prominent glandular proliferation lined by ciliated respiratory epithelial cells. Conclusion The clinical symptoms of REAH are nonspecific. Therefore,imaging and histopathological examinations are especially important for its early diagnosis. Endoscopic resection is the treatment of choice for REAH.

The bacteriological characteristics and drug sensitivity of the oropharyngeal region in children and adults with OSAHS

ZHANG Xiaoxue, WANG Wei, LIU Jie, XU Zhenju, QIAN Yongheng, HAN Min

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  35-40.  doi:10.6040/j.issn.1673-3770.0.2021.494

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Objective To analyze the difference of oropharyngeal flora between children and adults with obstructive sleep apnea hypopnea syndrome(OSAHS)and the results of drug sensitivity, so as to provide reference basis for rational selection of antibiotics in OSAHS patients after surgery. Methods OSAHS patients diagnosed by polysleep monitoring and treated by surgery in the Department of Otolaryngology Head and Neck Surgery of the Affiliated Hospital of Qingdao University from January 2018 to October 2021 were selected as the research objects. They were divided into children group and adults group according to age. After admission, some oropharyngeal secretions of the two groups were timely sent for bacterial culture and drug sensitivity analysis, to compare the oropharyngeal flora and drug sensitivity between children with OSAHS and adults with OSAHS. Results A total of 78 strains of pathogenic bacteria were isolated and cultured in 66 of 211 patients, with a positive rate of 31.28%, including 55 strains of Gram-positive cocci(70.51%), 29 strains of Staphylococcus aureus(37.18%)and 18 strains of Streptococcus pneumoniae(23.08%)were the main strains; there were 19 strains of Gram-negative bacilli(24.36%), mainly 15 strains of Haemophilus influenzae(19.23%). There was significant difference in detection rate of pathogenic bacteria between children group and adults group. There was significant difference in Streptococcus pneumoniae between the two groups, the detection rate of Streptococcus pneumoniae in children group was higher than that in adults group; there was no significant difference between Staphylococcus aureus and Haemophilus influenzae in the two groups. Streptococcus pneumoniae had high resistance rate to tetracycline, clindamycin and erythromycin. The resistance rate of Staphylococcus aureus to penicillin was high, and the drug resistance rates of Haemophilus influenzae to ampicillin, cefaclor, cotrimoxazole and cefuroxime were high. Conclusion The empirical application of antibiotics to prevent and treat infection after OSAHS surgery should be treated differently between children and adults patients, and the antimicrobial regimen should be adjusted according to the drug sensitivity results to slow down the production of drug-resistant bacteria.

Expression and clinical significance of miR-181b-5P and EPB41L3 protein in laryngeal squamous cell carcinoma

HUANG Hengfeng, MA Kunpeng, YANG Di, ZHANG Lijun, ZHANG Shenglin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  41-46.  doi:10.6040/j.issn.1673-3770.0.2021.502

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Objective Currently, the expression relationship and mechanism of miR-181b-5P and Erythrocyte Membrane Protein Band 4.1-like 3(EPB41L3)in laryngeal cancer are still unclear. This paper mainly studied the expression levels of miR-181b-5P and EPB41L3 protein in laryngeal squamous cell carcinoma tissues and adjacent normal tissues, and than conducted correlation analysis. To explore the effects of miR-181b-5P targeted regulation of EPB41L3 on the proliferation, invasion and metastasis of laryngeal neoplasms. Methods Using bioinformatics databases predicted the expression of miR-181b-5P in laryngeal cancer, and quantitative real-time PCR was used to determine the expression of miR-181b-5P in laryngeal squamous cell carcinoma and adjacent normal tissues. The target genes of miR-181b-5P were predicted and analyzed by bioinformatics. The relative expression of EPB41L3 protein was detected by immunohistochemistry. Results The expression of miR-181b-5P in laryngeal carcinoma tissues was significantly higher than that in adjacent normal tissues(P<0.001), and there was significant difference in laryngeal carcinoma tissues with or without lymph node metastasis(P=0.027 3).The expression of EPB41L3 protein in laryngeal carcinoma tissues was significantly lower than that in adjacent normal tissues(P<0.001).The positive expression rate of EPB41L3 protein was obviously different in different pathological differentiation degrees, clinical stages and lymph node metastasis(P<0.05). The expressions of miR-181b-5p and EPB41L3 protein in laryngeal carcinoma tissues were negatively correlated(r=-0.420 8, P=0.002 3). Conclusion miR-181b-5p may negatively regulate the expression of EPB41L3 and than affect the proliferation, invasion and metastasis of laryngeal cancer. This study maybe provide new ideas for clinical targeted therapy of laryngeal cancer.

Bioinformatics analysis of key molecular markers for malignant transformation of laryngeal papilloma

WANG Lingwa, WANG Ru, FANG Jugao

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  47-55.  doi:10.6040/j.issn.1673-3770.0.2022.012

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Objective To screen for molecular markers affecting malignant transformation and prognosis of laryngeal papilloma using bioinformatics analysis. Methods The GSE10935 gene expression profile of adult laryngeal papilloma was downloaded from the Gene Expression Omnibus database, and the transcriptome data for laryngeal squamous cell carcinoma were downloaded from The Cancer Genome Atlas. Differentially expressed genes(DEGs)in each dataset were identified using limma and DESeq2 R package. Venn diagrams analysis was conducted for identifying common DEGs. Survival analysis was performed by plotting the Kaplan-Meier curves in the Gene Expression Profiling Interactive Analysis(GEPIA)database to screen for candidate genes. Protein expression in the Human Protein Atlas database was analyzed to identify key genes. Univariate/multivariate Cox regression analysis and functional enrichment analyses were performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes. Results A total of 112 DEGs were related to the occurrence and development of laryngeal papilloma, and 1817 DEGs were related to laryngeal squamous cell carcinoma. Twenty-four common DEGs were identified using Venn diagram analysis. GEPIA revealed that the expression of FSCN1, MMP1, and IFI27 was upregulated, while that of ALDH3A1, HLF, and MMRN1 was downregulated in head and neck squamous cell carcinoma(HNSCC)samples compared with that in normal tissue samples; all differences were significant(FSCN1:P=0.002 9, MMP1:P=0.047, IFI27:P=0.035, ALDH3A1:P=0.024, HLF:P=0.008, MMRN1:P=0.036). Survival analysis revealed that the overexpression of FSCN1, MMP1, and IFI27 and low expression of ALDH3A1, HLF, and MMRN1 affected overall survival. Immunohistochemical analysis showed high FSCN1 expression and low ALDH3A1 expression in HNSCC samples. Further survival analysis showed that the expression levels of FSCN1 and ALDH3A1 were independent risk factors affecting the prognosis of human papillomavirus-related HNSCC. Conclusion FSCN1 and ALDH3A1 are plausible key genes in the malignant transformation of laryngeal papilloma. High FSCN1 expression and low ALDH3A1 expression affect the prognosis of human papillomavirus-related HNSCC and are potential molecular targets for suppressing malignant transformation.

Diagnosis and management of fishbone foreign body in the deep neck: three case reports and literature review

ZHANG Jin, ZHANG Hui, DING Detao, ZHANG Yonghong, LI Xiaoying, SUO Anqi, LI Xiaoyu, WU Yungang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  56-58.  doi:10.6040/j.issn.1673-3770.0.2021.440

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Objective To investigate the clinical manifestation, diagnosis, treatment, and operation of fishbone foreign body in deep neck. Methods A retrospective review of three patients who were treated for a fishbone foreign body in the deep neck. The relevant literature were reviewed to summarize their diagnosis and treatment experiences. Results A fishbone is one of the most common foreign bodies found in the upper gastrointestinal tract. Pharyngeal and esophageal foreign bodies are the most common emergency in the otorhinolaryngology(ear nose and throat(ENT))department. Sharp foreign bodies or foreign bodies with long residence time can often cause pharyngeal and esophageal mucosal damage and secondary infection. If they are not treated properly or not treated in time, foreign bodies can lead to serious complications. Therefore, it is very important to remove the foreign bodies as soon as possible. Conclusion We must be alert to the possibility of a fishbone foreign body entering the deep soft tissue of the neck, and appropriate imaging methods for the diagnosis and location of the foreign body must be selected. Surgery is the first choice of treatment for removing the fishbone foreign body.

Clinical and survival analysis of primary squamous cell carcinoma of the thyroid 12 cases

LI Zhilin, ZHENG Zhou, AN Wei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  59-63.  doi:10.6040/j.issn.1673-3770.0.2021.439

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Objective This study aimed to investigate the clinical characteristics, survival analysis, and factors affecting the prognosis of primary squamous cell carcinoma of the thyroid(PSCCT). Methods The preoperative clinical manifestations, thyroid ultrasound features, surgical methods and postoperative pathology of 12 patients with PSCCT admitted to the Department of Head and Neck Surgery in the hospital from January 2012 to December 2019 were retrospectively analyzed, including the immunohistochemical results, comprehensive treatment methods and prognosis. The Kaplan-Meier method, Log-rank test and Cox proportional hazard regression model were used for survival analysis. Results Univariate analysis showed that combined papillary carcinoma was associated with the overall survival(OS)in patients with PSCCT. Multivariate analysis revealed that the absence of the papillary carcinoma was a risk factor for OS. Conclusion PSCCT is a rare malignant thyroid tumor with a high degree of malignancy, rapid development and poor prognosis. If diagnosing PSCCT clinically, it is necessary to determine whether it is associated with papillary carcinoma and selecting the appropriate treatment is the key to improve the survival rate.

A clinical study on prophylactic central lymph node dissection in early cN0 papillary thyroid carcinoma

XIAO Fuliang, LIN Yun, PAN Xinliang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  64-71.  doi:10.6040/j.issn.1673-3770.0.2021.462

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Objective In this study, we explore the risk factors and construct a predictive model for the occult central lymph node metastasis in early cN0 papillary thyroid carcinoma(PTC), combining with the complication rate of prophylactic central lymph node dissection(PCLND), to provide its decision basis. Methods Clinical data of 454 early cN0 PTC patients was retrospectively analyzed. And the incidence of complications was collected. Results Male, age ≤45, diameter>1 cm, and formation of microcalcifications were independent risk factors for occult central lymph node metastasis. A prediction model for occult lymph node metastasis in the central region was established: Logit(P)=-1.735-0.717×gender +0.442×age +1.245×tumor diameter +1.349×microcalcifications. And our PCLND did not increase the incidence of complications. Conclusion The model should be used to calculate the probability of occult central lymph node metastasis before surgery. The larger the P-value is, the higher the risk of lymph node metastasis will be, and PCLND should be performed for these patients. The incidence of temporary postoperative complications in our study is lower than other studies, which showing surgery with good skills will not increase the complication incidence after PCLND. Thus, for the possibility of occult central lymph node metastasis(33% in our study), PCLND should be actively performed in all patients with early cN0 PTC to remove possible occult malignant lymph nodes.

The methodology of tracheobronchial metallic stents removal and influential factors analysis

WANG Xiaodong, PENG Jingyuan, AN Xiaoqing, JIANG Yingxiao, XU Li, WANG Xiaoping, QU Yiqing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  72-79.  doi:10.6040/j.issn.1673-3770.0.2022.419

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Objective The study aimed to investigate the methodology of tracheobronchial metallic stent removal and to analyze the influencing factors by statistical methods. Methods A total of 64 patients, who underwent tracheobronchial metallic stent removal, were included in this case-control study. The patients were divided into two groups: ≤3 types of stent removal methods(n=40)and >3 types of stent removal methods(n=24). The study aimed to compare the demographic characteristics, type of tracheobronchial metallic stents, duration of stent retention, stent-related complications, and other relevant factors between the two groups. Results There were 40 patients, who underwent at most three types of stent removal methods. Meanwhile, there were 24 patients, who underwent more than three types of stent removal methods. No significant statistical differences were observed between the two groups in terms of gender, age, etiology of stent implantation, duration of stent retention, and structural integrity of the stent. There were statistically significant differences between the two groups in terms of the coverage of the stent, stent migration, the stent-related granulation tissue or tumor tissue formation score, and the stent-related cicatricial tissue score. Based on the multivariate analysis, the stent-related cicatricial tissue score(OR=1.354, 95%CI:1.100-1.667, P=0.004)significantly influenced the number of tracheobronchial metallic stent removal methods. Conclusion In this study, the stent-related cicatricial tissue score significantly influenced the number of tracheobronchial metallic stent removal methods, and is the positive correlation relationship.

Two methods of vitreous silicone oil extraction with self-made simple devices

LUAN Guogang, CHEN Jinjin, YAN Tao

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  80-84.  doi:10.6040/j.issn.1673-3770.0.2021.455

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Objective This study aimed to investigate the feasibility of using two simple devices for vitreous silicone oil extraction. Methods Overall, 200 eyes of 200 patients with rhegmatogenous retinal detachment and stable retinal attachment after silicone oil filling for 3-6 months were selected. The patients were randomly divided into two groups. Group one composed of 102 patients who were treated with 20G Y intravenous indwelling trocar to make a simple oil-extracting device to get silicone oil by 20G channel. Subsequently, a 20G flute needle was used for gas-liquid exchange to remove residual silicone oil. Group two composed of 98 patients. The two ends of the straight blood transfusion tube were vertically cut with a retention length of 5 mm. One end was set on the 23G oil extraction cannulas and the other end was connected with a 20 mL syringe for oil extraction. The 23G flute needle was used for gas-liquid exchange to remove residual silicone oil. Results There was no significant difference in the removal time between groups one and two(［4.65±1.52］ min vs ［4.85±2.02］ min, T=1.38, P=0.14). There was a significant difference for the gas-liquid exchange time between groups one and two(［1.25±0.51］ min vs ［2.16±1.24］ min, T=8.34, P=0.003). There was no significant difference in the intraocular pressure between the two groups preoperatively and postoperatively for 1 day, 4 days, 1 week, and 1 month(P>0.05). There were no significant differences in the infection rate, bleeding rate, and recurrence rate for retinal detachment between the two groups(P>0.05). The silicone oil residual rate in group one was lower than that in group two and was statistically different(5.10% vs 19.61%, P=0.002). Conclusion The two methods are safe and effective for silicone oil extraction. However, 20G Y vein indent needle combined with 20G flute needle is more advantageous in terms of the gas-liquid exchange time and silicone oil residual rate.

Comparative observation of Trans-PRK, FS-LASIK, and SMILE for myopia with astigmatism

ZHOU Qiliang, ZHOU Yuehua, ZHOU Chunyang, YU Jia, LI Chen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  85-93.  doi:10.6040/j.issn.1673-3770.0.2021.465

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Objective This paper was aimed to investigate the clinical effect of Trans-PRK, conventional FS-LASIK, and SMILE for the correction of myopia and astigmatism. Methods In this retrospective study, we evaluated 54 eyes in the Trans-PRK group, 55 eyes in the FS-LASIK group, and 56 eyes in the SMILE group. ALL eyes follow-up period was 6 months. The visual acuity, diopters, and higher-order aberrations of the three groups were compared before and after surgery, and the safety and effectiveness of the three different methods were evaluated. Results (1)There was no significant difference in the preoperative baseline data among the three groups(P=0.148, 0.148, 0.31, 0.285, 0.283, 0.901). (2)There was also no significant difference in uncorrected visual acuity among the three groups at 1, 3, and 6 months after surgery(P=0.902). In the intra-group comparison, the UCVA at 6 months after surgery in the Trans-PRK group was higher than that at 1 month after surgery(χ2= 0.571, P=0.014). (3)The power of the cylinder among the three groups differed only at 1 month after the operation(χ2= 9.411, P=0.009). The degree of the cylinder in the FS-LASIK group was statistically significantly less than that in the SMILE group at 1-month post-operatively(χ2=24.400, P=0.004), while there was no significant difference among the three groups at 3 and 6 months after surgery(P=0.159, 0.106). (4)There was no significant difference in spherical equivalent among the three groups at 1, 3, and 6 months after the operation(P=0.132, 0.299, 0.643). (5)There was a significant difference in coma among the three groups at 1, 3, and 6 months post-operatively(χ2=20.939, 20.129, 19.208, all P<0.001), and the coma of the Trans-PRK group being statistically significantly less than that of the other two groups(P=0.008, 0.019, 0.034, <0.001, <0.001, <0.001). In the intra-group comparison, the coma of the Trans-PRK and FS-LASIK groups at 3 and 6 months after surgery were significantly higher than that before surgery(P=0.003, <0.001). The coma of the SMILE group at 1, 3, and 6 months postoperatively was significantly higher than that before surgery(all P<0.001). (6)There was a significant difference in spherical aberration difference among the three groups at 1, 3, and 6 months after surgery(χ2=47.363, 24.167, 22.913, all P<0.001). The spherical aberration at 1, 3, and 6 months after surgery was higher in the FS-LASIK group than in the Trans-PRK and SMILE groups(P<0.001, <0.001, 0.005, <0.001, 0.007, <0.001). In the intra-group comparison, the spherical aberration of the Trans-PRK group and FS-LASIK group at 1, 3, and 6 months after surgery was higher than that before surgery(all P<0.001). The spherical aberrations in smile group were higher than those before operation at 3 and 6 months after operation, and the difference was statistically significant(χ2=-1.726,-1.858, all P<0.001). The spherical aberration in the SMILE group was statistically significantly lower than that at 3 and 6 months after the operation, and the difference was statistically significant(χ2=-1.085,-1.217, all P<0.001). (7)There was a significant difference in higher-order aberrations among the three groups at 1, 3, and 6 months after surgery(χ2=14.267, 25.460, 13.210, and P=0.001, <0.001, 0.001, respectively). The total number of higher-order aberrations in the Trans-PRK group was lower than those in the FS-LASIK group at 1, 3, and 6 months after the operation(P=0.004, <0.001, 0.001). The total number of higher-order aberrations in the FS-LASIK group was greater than that in the SMILE group at 3 months post-operatively(P=0.009). The total number of higher-order aberrations in the SMILE group at 6 months was significantly higher than those before surgery(all P<0.001). (8)There was no significant difference in efficacy and safety among the three groups at 6 months after surgery(χ2=0.851, 0.893, and P=0.653, 0.640, respectively). Conclusion Trans-PRK, conventional FS-LASIK, and SMILE are safe and effective in correcting myopia astigmatism. Higher-order aberrations were introduced to varying degrees postoperatively. The coma in the Trans-PRK group was smaller than that in the conventional FS-LASIK and SMILE groups. The spherical aberration of the conventional FS-LASIK group was significantly higher than those of the Trans-PRK and SMILE groups. The total number of higher-order aberrations of the conventional FS-LASIK group was significantly higher than that in the Trans-PRK and SMILE groups.

Analysis of the effect of berberine on diabetic retinopathy in the immune microenvironment based on network pharmacology and experimental verification

LIU Tong, LIN Wei, FENG Meng, YANG Yi, LIU Tingting, ZHANG Min

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  94-104.  doi:10.6040/j.issn.1673-3770.0.2021.481

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Objective To study the immune mechanism of berberine(BBR)in the treatment of diabetic retinopathy(DR)using network pharmacology and animal model experiments. Methods Chemical constituents and potential BBR targets were obtained from a traditional Chinese medicine database(HERB), target genes related to DR pathogenesis were identified in the DisGeNET and GeneCards databases, and the protein interaction network was drawn using a combination of the String database and Cytoscape software. The BBR target(s)acting on DR were screened out by network topology analysis and the GO cell composition, biological processes, molecular function, and KEGG pathways of these targets were analyzed using the Metascape bioinformatics database. Following this, a BBR “target-path” network diagram was constructed and analyzed with Cytoscape, the molecular docking ability of drug ligands and targets was predicted with Pymol, and, finally, a diabetic mouse model was established, treated with BBR 100 mg/(kg·d)for 8 weeks, and then had retinal tissue sections taken and stained to detect the degree of pathological change. The proportion of CD4⁺ and IL-17⁺ T cells in the eyes and lymph nodes of diabetic mice was determined by flow cytometry. Results 67 common BBR and DR targets were screened from the traditional Chinese medicine database, including INS, IL-6, CASP3, TNF and VEGFA as the core BBR targets which affect DR. The GO analysis suggested that BBR could play a role in the treatment of DR through response to oxidative stress and regulation of apoptotic signaling pathway. KEGG pathway enrichment analysis identified the IL-17 signaling and Th17 differentiation pathways as potential target pathways for BBR suppression of immune inflammation. The core targets identified were RELA, MAPK1, IL-6, NFKBIA, and TNF. Molecular docking showed a strong binding force between BBR and RELA, MAPK1, and IL-6. The tissue sections from diabetic mice revealed alleviated retinal pathology following BBR treatment, and the number of CD4⁺ and IL-17⁺ T cells were significantly lower in the treatment group. Conclusion BBR can inhibit the DR inflammatory response by regulating the Th17/IL-17 signaling pathway. This is a newly identified immune mechanism of BBR, and provides a theoretical basis for further exploration of the pharmacological targets and mechanisms of BBR in the treatment of DR.

Effect of optical amplification on measurement of ganglion cell complex

ZHAO Hongxiao, ZHANG Han

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  105-109.  doi:10.6040/j.issn.1673-3770.0.2021.528

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Objective To observe the measurement of retinal ganglion cell complex(GCC)thickness in young myopia patients by optical amplification effect and its relationship with axial length(AL)and spherical equivalent(SE). Methods From September 2021 to November 2021, 102 young myopia patients(eyes)were selected, including 38 eyes in low myopia group(-0.5 D~-3.0 D), 39 eyes in moderate myopia group(-3.25 D~-6.0 D)and 25 eyes in high myopia group(>-6.0 D). The thickness parameters of GCC were measured by optical coherence tomography(OCT), and the optical amplification effect was corrected for the measurement results. The relationship between GCC thickness and AL was compared by one-way analysis of varianceand Pearson correlation analysis. Results There were significant differences in average GCC thickness, superior GCC thickness and inferior GCC thickness among the three groups, whether corrected or not(all P<0.05). Before and after GCC thickness correction, there was significant difference in middle and high myopia group(all P<0.001), but there was no significant difference in low myopia group(all P>0.05). Before correction, the average GCC thickness, superior GCC thickness and inferior GCC thickness were negatively correlated with AL and positively correlated with SE(all P<0.05). FLV was negatively correlated with AL(P<0.05), GLV was negatively correlated with SE(all P<0.001). After correction, the average GCC thickness, superior GCC thickness and inferior GCC thickness were positively correlated with AL and negatively correlated with SE(P<0.001). Conclusion The effect of optical amplification should be considered in the measurement of GCC thickness in young patients with moderate and high myopia.

Retrospective analysis of the causes of anterior capsular tear in early femtosecond laser-assisted cataract surgery

DONG Shuguang, GUO Fengfei, MENG Xuxia, YAN Shilong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  110-114.  doi:10.6040/j.issn.1673-3770.0.2021.568

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Objective A retrospective study to analyze the causes of anterior capsular tear in patients with femtosecond laser-assisted cataract surgery. Methods A total of 86 patients(105 eyes)who chose femtosecond laser-assisted cataract surgery(FLACS )were counted. All patients underwent circular capsulotomy of the anterior capsule and lens pre-chopping using femtosecond laser-assisted design, and then continued to complete phacoemulsification combined with intraocular lens implantation. All surgeries were performed by the same skilled surgeon, and patients with anterior capsular tear were recorded. Results In 105 eyes, 6 eyes(5.71%)had anterior capsular tear. Among them, 3 eyes(2.86%)had anterior capsule tear during femtosecond laser anterior capsule incision 2 eyes(1.90%)of patients with cataracts(all white of the lens)had tears during removal of the anterior capsule, and 1 eye(0.95%)of patient with grade Ⅳ nuclear cataracts had tears during phacoemulsification. Conclusion FLACS may cause anterior capsular tear during laser emission or phacoemulsification, especially for patients with white cataract, inflated cataract, and possibly other issues. By selecting suitable patients, and using a careful and standardized surgery operation, which can avoid the complications of anterior capsule tear to the greatest extent, is needed to take advantage of FLACS.

Clinical observation of horizontal incision in the treatment of congenital epicanthus with entropion and lower eyelid trichiasis

LI Zhizhe, LU Xiting, WANG Ying, GU Yonghui, LIU Jie

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  115-119.  doi:10.6040/j.issn.1673-3770.0.2022.015

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Objective To investigate the clinical effect of horizontal incision of the inner canthus on congenital epicanthus with entropion and lower eyelid trichiasis. Methods 36 cases(72 eyes)of congenital epicanthus with entropion and trichiasis of the lower eyelid were treated with a horizontal incision of the inner canthus to release the traction of the incised line of the inner canthus. The correction of lower eyelid trichiasis, the improvement of epicanthus, and the degree of scar formation were observed. Results After the operation, all 72 eyes of the 36 patients were corrected for trichiasis and epicanthus. The patients were followed up for 3 months, 6 months, and 12 months. The effective rate of trichiasis correction was 100%; the inner canthus space was narrowed, and the degree of aesthetics improved in all cases. Conclusion Incision of the inner canthus has a significant clinical effect on congenital epicanthus with lower eyelid trichiasis.

Research progress of adenotonsillectomy on speech and voice

MA Zhiqiang, SONG Huiyun,YU Hailing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  120-123.  doi:10.6040/j.issn.1673-3770.0.2021.559

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Tonsillar hypertrophy and adenoid hypertrophy are among the most common clinical disorders, usually presenting with glandular hyperplasia and hypertrophy in childhood, and inflammatory changes in adulthood. Routine treatments for tonsillar and adenoidal hypertrophy include tonsillectomy and adenoidectomy, wherein the tonsil and adenoid are resected to modify the shape of the vocal tract in the nasal, pharyngeal, and laryngeal cavities. This will lead to a change in airflow upon speaking, and subsequently, changes in speech and values of voice parameters. At present, with the increasing prevalence and detection rates of tonsillar and adenoidal hypertrophy, the clinical guidance of the assessment of the effects of tonsillectomy and adenoidectomy on speech and voice is also increasing, especially since these methods are the primary treatments. Therefore, the review of the mechanisms of tonsillectomy and adenoidectomy on speech and voice is important.

Diagnostic and therapeutic progress of blunt laryngeal trauma

PAN Zhongjing, LÜ Dan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  124-131.  doi:10.6040/j.issn.1673-3770.0.2021.441

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Blunt laryngeal trauma is an insidious, complex, and life-threatening injury that can result in serious complications affecting the quality of life. Non-specific symptoms appear in the early stage of blunt laryngeal trauma, and these are often combined with severe injuries in other parts of the body. Therefore, initial misdiagnosis or delayed diagnosis may easily occur. In the acute phase of injury, having a stable airway is the cornerstone for successful treatment. Delayed recognition and inappropriate interventions can lead to poor prognosis, making the recovery to normal breathing, swallowing, and vocal function difficult. Therefore, based on detailed medical history and physical examination combined with endoscopy and imaging results, neck surgery is performed if deemed necessary to conduct a comprehensive and accurate assessment of the injury. As a result, the surgery can guide the formulation of individualized treatment strategies. To improve the early recognition rate of blunt laryngeal trauma and provide ideas for the selection of its diagnosis and treatment plan and the management of complications, this study reviews the latest relevant literature and summarizes the diagnostic and therapeutic plans of the disease according to the difficulty in management.

Relationship between intestinal flora and thyroid diseases

WANG Anyang, LI Chaoyou, XUE Gang, WU Jingfang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  132-139.  doi:10.6040/j.issn.1673-3770.0.2021.482

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The gut microbiota is a large group of microbes found in the human gastrointestinal tract. Impaired gut microbiota homeostasis leads to intestinal epithelial barrier dysfunction that can lead to gut and systemic diseases. This study reveals the differences in composition of gut microbiota between patients with thyroid disease and healthy individuals, the effects of gut microbiota on thyroid hormone metabolism and thyroid function, as well as the possible relationship of gut microbiota with thyroid diseases(Hashimoto's thyroiditis, Graves' disease, and thyroid carcinoma). This study aims to explore the mechanism and treatment prospects of gut microbiota in thyroid diseases.

Application of optical coherence tomography angiography in macular telangiectasia type 2

LI Pengwei, SU Guangming, LIU Jiangchuan, MU Yalin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  140-144.  doi:10.6040/j.issn.1673-3770.0.2021.450

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Macular telangiectasia type 2(MacTel 2)is a bilateral, slowly-progressive neurodegenerative disease of the retina mainly characterized by vascular changes. Optical coherence tomography angiography(OCTA)is the ideal tool for detecting MacTel 2. In the early stage of MacTel 2, the telangiectasia shown by OCTA first appeared in the deep capillary plexus on the temporal side of the parafovea, which was closely related to the loss of the ellipsoid zone. Subsequently, the vascular density in the parafovea decreased, primarily involving the capillaries adjacent to the venules. The development of right-angle venules can promote the formation of retinal-choroidal anastomoses. The telangiectasia of some patients with advanced MacTel 2 can progress to neovascularization, and the use of vascular endothelial growth factor inhibitors has a significant effect on untreated neovascularization. This paper reviews the application of OCTA in MacTel 2.

Progress in the applications of XEN microstent in glaucoma surgery

ZHONG Yu, LIAO Zhimin, DUAN Xuanchu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  145-151.  doi:10.6040/j.issn.1673-3770.0.2021.468

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The major target of glaucoma treatment is lowing intraocular pressure, to prevent further optic nerve damage. The limit of traditional procedures, like the unstable postoperative intraocular pressure and postoperative complications, has contributed to the emergence of a new type of minimally anvasive glaucoma surgery, such as the XEN microstent implantation. The effectiveness and safety of this new technology have been confirmed in many clinical studies and have thus been gaining more attention. To enable ophthalmologists to better understand XEN microstent implantation in glaucoma surgery, this paper summarizes the applications and research progress of XEN microstent implantation in glaucoma surgery by analyzing and summarizing the related literatures on XEN microstent implantation in recent years.

Study on the clinical significance of posterior uveal melanoma biopsy

SUN Hao, YANG Hui, LI Jiao

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(1):  152-156.  doi:10.6040/j.issn.1673-3770.0.2021.570

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Posterior uveal melanoma(PUMs), the most common primary intraocular malignant tumor in adults, typically has an early onset that is insidious and asymptomatic. The diagnosis of patients with PUMs at home and abroad is primarily based on clinical features, which are easily missed or misdiagnosed. In recent years, oncologists have commonly used two types of biopsies to confirm the diagnosis of patients with PUMs: fine-needle aspiration biopsy(FNAB)and transvitreal retinochoroidal biopsy(TVRC). At present, there are few systematic studies on the application of FNAB and TVRC in the diagnosis of PUM. This paper reviews the clinical safety, sampling methods, and clinical significance of these two biopsy methods in the diagnosis of PUM.