Table of Content

20 September 2023 Volume 37 Issue 5

  

Original Article

Repairing skin defects 18 cases of the external auditory canal with retroauricular pedicled flaps

SHAO Yongliang, ZHOU Kunpeng, LI Guangsheng, ZHANG Xuemei, YANG Zeyin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  1-5.  doi:10.6040/j.issn.1673-3770.0.2022.250

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Objective This study aimed to repair skin defects and enlarge the cavity of the external auditory canal with retroauricular pedicled flaps. Methods Sixteen patients with external auditory canal cholesteatoma and two patients with external auditory canal atresia were selected for this study. All surgical procedures were performed under general anesthesia through the retroauricular approach. Stenosis of the external auditory canal and annular granulation growth or atresia of the isthmus of the external auditory canal were observed during the operations. The bone canal of the external auditory canal was enlarged. Subsequently, the pedicled skin flap was removed at the retroauricular incision and transferred forward into the auditory canal to cover the skin defect of the posterior wall of the auditory canal and expand the cavity of the external auditory canal. Results The skin grafts of the auditory canal of all patients survived after the operation. The shape of the auditory canal of all patients recovered well 6 months after the operation, without stenosis or atresia. Conclusion The retroauricular pedicled skin flap is easy to obtain without new incisions. After skin grafting of the auditory canal, necrosis is unlikely to occur because of the blood supply to the skin grafts, which reduces the reoccurrence of auditory canal stenosis or atresia.

Bioinformatic analysis of the transcriptome of basal stem cells of individuals with chronic rhinosinusitis with nasal polyps

WANG Mingming, LUO Yang, HE Shaojuan, ZHANG Xianxing, LI Xuezhong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  6-15.  doi:10.6040/j.issn.1673-3770.0.2022.246

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Objective The differentially expressed genes(DEGs)involved in the proliferation and differentiation of basal stem cells(BSCs)of individuals with chronic rhinosinusitis with nasal polyps(CRSwNP)were analyzed using bioinformatics to identify the mechanisms underlying the epithelial barrier damage in CRSwNP and to gain insights for potential treatment strategies. Methods The transcriptome chip microarray dataset of the proliferation and differentiation of BSCs of nasal polyps was downloaded from the gene expression omnibus(GEO)database. R software was then used for weighted gene co-expression network analysis(WGCNA)to build networks and screen disease-associated genes on the basis of their differential expression between the CRSwNP group and the normal control group, and the online tool DAVID was used to perform gene ontology(GO)analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment of the DEGs. A protein interaction network of the DEGs was constructed using the STRING database and analyzed by applying the MCODE plugin in Cytoscape software. Finally, a transcription factor network of core genes was constructed using the NetworkAnalyst tool and by integrating the transcription factor database. Results This study found that a total of 175 disease-associated genes showing differential expression between the BSC of the CRSwNP and normal control groups(P<0.05, ∣logFC∣>1). GO and KEGG pathway analysis revealed that these DEGs were mainly enriched in the negative regulation of endopeptidase activity, serine-type endopeptidase inhibitor activity, and the Wnt signaling pathway. Analysis of the constructed protein interaction network was performed to identify core genes such as IVL and SPRR2A. These genes were all upregulated during the differentiation of BSCs, and they were found to interact with each other. Furthermore, this analysis revealed that the transcription factor GATA2 plays a critical role in the differentiation of BSCs. Conclusion IVL, SPRR2A, and GATA2 may be involved in the mechanism through which the epithelial barrier is damaged in CRSwNP. Inhibition of endopeptidase activity may be the key mechanism involved in the epithelial barrier damage. This study provides new insights into the biological mechanism underlying the epithelial barrier damage in CRSwNP and our findings could help develop a treatment strategy for CRSwNP.

Clinical observation of the effect of infiltrating Biprofen Gelatin Sponge after functional endoscopic sinus surgery

WANG Lixue, ZENG Yi, WANG Lixin, PENG Xianbing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  16-25.  doi:10.6040/j.issn.1673-3770.0.2022.351

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Objective To investigate the efficacy and safety of gelatin sponge packing with infiltrating Biprofen spray in patients with CRSwNP after nasal endoscopic surgery. Methods 112 patients with CRSwNP undergoing nasal endoscopic surgery were randomly divided into three groups: those receiving intraoperative packing of momethasone furoate gelatin sponge and postoperative irrigation with physiological sea water(group A), intraoperative packing of momethasone furoate gelatin sponge and postoperative irrigation with Biprofen spray(group B), and intraoperative packing of gelatin sponge of infiltrating Biprofen spray and postoperative irrigation of the postoperative cavity of Biprofen spray(group C). SNOT-22 score, Lund-Kennedy endoscopic score and vascular endothelial growth factor(VEGF)expression in vesicles were determined before the operation and at 2, 4, 8 and 12 weeks postoperatively. The differences in subjective and objective scores before and after the operation were compared among the three groups to evaluate their safety. Results a total of 93 patients completed the required 3-month follow-up. The subjective score after operation was significantly lower than before, but there was no significant difference among the follow up nodes of the three groups postoperatively. Objective endoscopic evaluation showed a statistically significant difference in 2, 4, 8 and 12 weeks after operation, and a trend of A>B=C was observed. The differences in objective immunohistochemical score was statistically significant at 12 weeks of follow-up and showed a A>B=C trend. Conclusion The intraoperative packing effect of infiltrating momethasone furoate gelatin sponge is the same as that of infiltrating Biprofen gelatin sponge, which can effectively improve the subjective symptoms of chronic sinusitis with nasal polyps after nasal endoscopic surgery, accelerate mucosal recovery and epithelialization, and VEGF expression in mucosal tissue is significantly decreased. Thus, the clinical application of infiltrating Biprofen gelatin sponge is safe.

Low-grade non-intestinal-type adenocarcinoma in the nasal cavity: a case report and literature review

SUN Jie, XIAO Xuping, LI Yunqiu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  26-30.  doi:10.6040/j.issn.1673-3770.0.2022.375

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Objective To summarize and analyze the clinical features, diagnostic methods, and treatment of low-grade non-intestinal-type adenocarcinoma(non-ITAC)within the nasal cavity. Methods The clinical data of a patient with low-grade non-intestinal-type adenocarcinoma within the nasal cavity was retrospectively analyzed with further review of relevant literature to summarize its clinical manifestations, diagnosis, treatment and prognosis. Results The patients underwent follow-up for 9 months, and had no symptoms such as nasal obstruction, purulent and/or bloody nasal discharge. Granulation tissue could be seen at and below the ostium of the sphenoid sinus. Based on the clinical data of this patient, we reviewed previous reports in the Chinese and English databases on low-grade non-ITAC within the nasal cavity, totaling 18 cases. The data showed CK7 was positive(94.4%), CK20 was negative(61.1%), CDX-2 was negative(61.1%), Ki-67 proliferation index was 1%~15%, treatment using only surgery(77.8%), postoperative adjuvant radiotherapy(16.6%), and surgery after radiotherapy(5.6%).The patients were closely followed-up for 9 months to 6 years, with an average follow-up time of 35.8 months. Ten of them had no recurrence. Conclusion The clinical and imaging features of non-ITAC of the nasal cavity and paranasal sinuses are important for diagnosis, and the pathological immunology is helpful for grading, treatment and prognosis.

Analysis of the epidemic characteristics of allergic rhinitis and related allergic diseases in China using Baidu index data

WANG Jian, DU Weijia, XUE Tao, CHEN Fuquan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  31-41.  doi:10.6040/j.issn.1673-3770.0.2022.401

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Objective To analyze the epidemic characteristics of allergic rhinitis(AR)in various areas of China by means of the Baidu Index website data, and to analyze the possible temporal and spatial correlations between AR and related allergic diseases. Methods On the Baidu Index website, AR was used as the key search word to extract data of Chinese from January 2011 to June 2022. The temporal and spatial data characteristics of AR and related allergic diseases were analyzed, and the correlations between AR and related allergic diseases were explored. Results The extracted volume of AR in China shows obvious seasonal variations. The first peak appears from April to June, and the second, higher peak, appears from August to October. The allergy season of AR in the northern provinces is short and mostly concentrated in the Spring and Autumn. The southern provinces have a long allergy season, which usually lasts from Spring to Autumn. Geographically, the northern region exhibits double sharp peaks, the western region has single peaks, the Yangtze River basin is associated with double peaks, and the southeast region manifests with wide peaks. On the whole, the extracted volume of AR was positively correlated with the volume for related allergic diseases("allergic conjunctivitis", "allergic cough", "allergic asthma" and "allergic urticaria")(R values were 0.400, 0.354, 0.396, 0.346, respectively, all P<0.001); The extracted volume of "allergic conjunctivitis" was positively correlated with that of "allergic asthma"(R=0.685, P<0.01). The volume of allergic conjunctivitis and allergic cough(R=-0.327, P<0.01), and the volume of allergic asthma and allergic urticaria(R=-0.200, P<0.05)were negatively correlated. The correlations between the extracted volume of AR and related allergic diseases in Beijing, Shanghai and Guangzhou were not the same as those in the whole country. Conclusion The search volume of AR and related allergic diseases showed different trends in different regions of China, which is consistent with the domestic epidemiological characteristics of AR. It is recommended online and offline popular science and preventive education for allergic diseases should be carried out in accordance with the characteristics of each region.

A clinical efficacy analysis of vidian neurectomy in the treatment of type 2 chronic rhinosinusitis with allergic rhinitis

WANG Xiaoai, ZHANG Qianqian, CHENG Xiangyu, LI Zhipeng, ZHANG Weitian, YE Haibo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  42-49.  doi:10.6040/j.issn.1673-3770.0.2022.471

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Objective To investigate the clinical efficacy and vidian neurectomy(VN)in the treatment of type 2 chronic rhinosinusitis with allergic rhinitis(CRSwAR). Methods This was a retrospective study of 47 patients with moderate to severe type 2 CRSwAR who presented to our department for endoscopic sinus surgery(ESS)combined with VN surgery, from September 2019 to September 2021. The severity and extent of the patient's disease preoperatively and 1 year postoperatively were assessed using the sinonasal outcome test-22(SNOT-22)questionnaire, allergy-related serology(peripheral blood eosinophils, serum total immunoglobulin E, serum allergens, etc.), electronic nasopharyngoscopy(Lund-Kennedy scale), and the sinus CT(Lund-Mackay scale). Results From the analysis, the preoperative and 1-year postoperative SNOT-22 score was ［38.00(23.00,54.25)］ and ［10.00(5.00,18.50)］, respectively. The postoperative score was significantly lower than the preoperative score, and the difference before and after treatment was statistically significant(P<0.001). The clinical symptoms of nasal obstruction, sneezing, clear runny nose, rhinorrhea and reduction of smell all improved after treatment as indicated by the significantly lower scores after treatment than before treatment(P<0.001). The preoperative Lund-Kennedy and Lund-Mackay scores were ［9.00(6.75,12.00)］ and ［15.50(10.75,22.00)］ respectively, while 1 year postoperatively, these scores were significantly different at ［3.00(2.00,4.00)］ and ［3.50(1.00,6.50)］ respectively(P<0.001). One month after surgery, 18 patients(38.30%)had dry eyes and 2 patients(4.26%)had numbness in the palate. At 1 year follow-up, except for 2 patients who still had dry eyes, the symptoms of dry eyes and numbness in the palate basically disappeared and no serious complications such as cranial or orbital problems occurred. The total effective rate of treatment at 1 year after surgery was 89.36% for patients with type 2 CRSwAR. The changes in peripheral blood eosinophils, total serum immunoglobulin E and serum allergens before and after treatment were not statistically significant(P=0.130,P=0.184,P=0.763). Conclusion ESS combined with VN is a safe and effective treatment for moderate to severe type 2 CRSwAR, significantly improving symptoms of nasal obstruction, rhinorrhea, sneezing and reduction of smell without serious complications.

Diagnostic utility of folate receptor-positive circulating tumor cells in patients with laryngeal squamous cell carcinoma

ZHANG Zhuping, YE Qi, GUO Bei, LIN Ling

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  50-53.  doi:10.6040/j.issn.1673-3770.0.2022.433

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Objective To determine serum levels of folate receptor-positive circulating tumor cells(FR⁺-CTCs)in patients with laryngeal squamous cell carcinoma(LSCC)and investigate its utility in the diagnosis of LSCC. Methods Forty-two patients with LSCC and 22 with benign laryngeal lesions admitted to the authors’ hospital were enrolled in this study. The significance of peripheral blood levels of FR⁺-CTCs, combined with clinical characteristics, in the diagnosis of LSCC was analyzed. Results FR⁺-CTC levels in patients with LSCC were higher than those in the benign group(t=7.269, P<0.001). Additionally, FR⁺-CTC level was associated with clinical stage, T stage, and differentiation grade(P<0.05), but not with sex, age, location, smoking, or lymph node metastasis(P>0.05). The area under the receiver operating characteristic curve was 0.857; sensitivity was 76.2% and specificity was 95.5% for the detection of LSCC with 9.0 FU/3 mL as the cut-off value. Conclusion Peripheral blood levels of FR⁺-CTCs in patients with LSCC were increased and was associated with clinical stage and differentiation grade. The determination of FR⁺-CTC levels is anticipated to be applied in the clinical diagnosis of LSCC.

Construction of an immune-associated gene prognostic model and screening of targeted molecular drugs for laryngeal squamous cell carcinoma based on the TCGA database

ZHANG Yonghong, ZHANG Hui, WANG Caihua, YANG Xinxin, WU Yungang, ZHAO Yufeng, PANG Taizhong, LI Xiaoyu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  54-62.  doi:10.6040/j.issn.1673-3770.0.2021.471

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Objective To construct a prognostic model of laryngeal squamous cell carcinoma(LSCC)and screen for targeted molecular drugs for LSCC based on a comprehensive bioinformatics analysis. Methods The gene expression matrix and patient clinical information for 123 LSCC and normal control samples were downloaded from the TCGA database and a comprehensive bioinformatics analysis was performed. The analyses included weighted gene co-expression network analysis(WGCNA); identification of prognostic immune genes(PI-genes); construction of an LSCC prognostic model; differential gene, survival, risk, and independent prognostic analyses; ROC curve drawing, and screening for potential LSCC target drugs. Results A weighted gene co-expression network of 1 352 immune-associated mRNAs(I-mRNAs)and clinical traits was constructed, and two modules(brown and red)that were the most correlated with the survival status of patients with LSCC were identified. Then, 26 PI-genes were identified and a prognostic model for LSCC was constructed based on 8 candidate PI-genes(CPI-genes)(KC877982.1, AC017100.1, AATBC, LINC02031, ULBP1, SEMA6C, NRTN, and CALCB). Subsequent analyses indicated that our prognostic model could predict the survival and risk prognosis of patients in the high- and low-risk groups and verified the independent predictive ability and accuracy of the prognostic model. Finally, five potential targets of LSCC(rilmenidine, hycanthone, anisomycin, megestrol, and AR-A014418)were identified. Conclusion Eight CPI-genes based on the prognostic model of LSCC were constructed, and five potential targeted molecular drugs were screened. This is expected to provide a new direction for prognosis prediction and precise treatment of LSCC.

Intracranial pneumatosis caused by peritonsillar abscess incisional drainage: a case report and literature review

XU Cong, LU Guowei, LÜ Yongbin, LIU Dawei, SONG Xicheng, SUN Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  63-67.  doi:10.6040/j.issn.1673-3770.0.2022.458

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Objective To provide clinical references to otolaryngologists by investigating the clinical manifestations, underlying mechanisms, diagnosis, treatment, and prognosis of intracranial pneumatosis secondary to peritonsillar abscess incision. Methods We reviewed the relevant literature and retrospectively analyzed the clinical data of a patient with intracranial pneumatosis who underwent incisional drainage for a peritonsillar abscess in our hospital. Results The patient was almost asymptomatic in the early stage. As the disease progressed and gas accumulation increased, the patient presented with headaches and vomiting. According to the literature, intracranial pneumatosis can be life-threatening. Intracranial pneumatosis can be caused by various factors. However, it rarely arises spontaneously, without a history of cranial injury. Based on imaging findings, we suspect that in our patient, the intracranial pneumatosis was caused by external gases that entered the parapharyngeal space during surgical incision. As gases accumulate, a pressure difference is generated, and a “ball-valve” effect is induced. The gas is forced upward along the lumen surrounding the internal jugular vein and enters the skull through the jugular foramen. Conclusion Symptomatic intracranial pneumatosis due to a peritonsillar abscess incisional drainage is rare. It may be readily overlooked as the early symptoms are nonspecific. To optimize patient prognosis, otolaryngologists should be aware of the possibility of such complications and consider imaging examinations for early diagnosis and treatment.

Kujiu decoction for refractory pharyngeal ulceration: a case report and literature review

YAO Yuning, ZHANG Longsheng, SUN Jing, CAO Kegang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  68-73.  doi:10.6040/j.issn.1673-3770.0.2022.469

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Objective To report a case of refractory pharyngeal ulceration treated with Kujiu decoction according to the ancient Chinese literature, Shanghanlun, and study the specific syndrome and formulation of Kujiu decoction. Methods This study reviewed and summarized the diagnosis and treatment process of a case of refractory pharyngeal ulceration that was treated with Kujiu decoction. Findings from a review of the literature on the prescription, formulation, and indications of Kujiu decoction were summarized. Results Kujiu decoction was effective for pharyngalgia, pharyngeal ulcerations, and aphonia caused by “Shaoyin disease” and “Yin deficiency and fire exuberance syndromes”. Vinegar can be used as Kujiu. In Kujiu decoction, Kujiu, pinellia, and albumen were used together to achieve the effects of nourishing yin, clearing heat, and resolving phlegm, which in turn, treated pharyngalgia and pharyngeal ulceration. Zhang Zhongjing's method of adding albumen after the temperature of the decoction became lukewarm may enhance the effects. Clinically, Kujiu decoction can be used to treat acute and chronic pharyngitis, aphonia, laryngogenic cough, globus hysteriocus, and oral ulcerations after radiotherapy. Conclusion Kujiu decoction has definite clinical efficacy in the treatment of pharyngeal ulcerations and other pharyngeal diseases. Further studies on the optimal decoction formulation are warranted. Furthermore, in the future, studies that investigate its clinical applications and mechanisms of action are also necessary.

Treatment of hoarseness based on physiological function of the liver

ZHOU Xiaoqing, YAN Yajie, LI Yingchun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  74-79.  doi:10.6040/j.issn.1673-3770.0.2022.330

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Objective To investigate the idea of treating hoarseness by targeting the liver. Methods To analyze the correlation between the physiological and pathological of the liver and throat, and summarize through 2 typical medical records. Results The clinical treatment of hoarseness via the liver is mainly based on the evidence of the effects on liver fire flaming, Qi stagnation and blood stasis, liver fire attacking the lung, liver-Qi stagnation with spleen-Qi deficiency, liver-stomach disharmony, and liver-kidney Yin deficiency on symptoms. Conclusion Hoarseness is a common and frequent symptom of Otorhinolaryngology-associated diseases; it has been treated by targeting the lung, spleen, and kidney for many generations. In clinical practice, hoarseness onset and symptoms are closely related to liver function.

Laryngeal abscess with destruction of thyroid cartilage caused by enterococcus faecalis:a case report and literature review

ZHANG Jing, ZHU Guochen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  80-84.  doi:10.6040/j.issn.1673-3770.0.2022.463

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Objective We summarized a case of laryngeal abscess with destruction of the thyroid cartilage caused by enterococcus faecails to improve the understanding of the disease and achieve early diagnosis and appropriate treatment. Methods The clinical data of a patient who had laryngeal abscess with destruction of the thyroid cartilage caused by enterococcus faecails was retrospectively analyzed. Additionally, a summarized systematic review of related literature was included. Results Twenty-one patients with laryngeal abscess were enrolled in the study, including the present case and cases from sixteen relevant literature published in Chinese and English between 1980 and 2022. The mean age at the time of presentation was 51 years(range 19-72 years), and males were more than females(14:7). The main symptoms were hoarseness(12/21), dyspnea /wheezing(8/21), and dysphagia(5/21). The predisposing factors included upper respiratory tract infection(4/21), immunosuppression of various etiologies(3/21), diabetes(2/21), laryngeal surgery(2/21), tuberculosis(1/21), head and neck trauma(1/21), accidental foreign body aspiration(1/21), and radiation injury(1/21). It was complicated by laryngeal carcinoma in five patients. The pus was extracted for bacterial culture to determine the causative pathogen; this yielded pseudomonas aeruginosa(3/21), methicillin-resistant staphylococcus aureus(1/21), nocardia farreri(1/21), mycobacterium tuberculosis(1/21), enterococcus faecalis(1/21), klebsiella pneumoniae, pseudomonas aeruginosa, or enterobacter cloacae mixed infection(1/21). The laryngeal cartilage affected was mainly the thyroid cartilage(4/21); the arytenoid cartilage(2/21)and cricoid cartilage(1/21)were also affected. Treatment methods included abscess drainage(13/21), tracheotomy(10/21), partial laryngectomy(7/21, 2 patients with laryngeal cancer), total(extended)laryngectomy(3/21, all patients with laryngeal cancer), and CO₂ laser surgery(2/21). Conclusion The main risk factor for laryngeal abscess is upper respiratory tract infection. Laryngeal abscess can be complicated by laryngeal cancer. The most common symptom of laryngeal abscess is hoarseness, which may lead to airway obstruction or even different degrees of vocal cord fixation. Therefore, preparedness to perform tracheotomy is necessary at all times. When laryngeal abscess occurs concurrently with laryngeal cartilage destruction, detailed knowledge of the associated symptoms and signs and confirmation with endoscopic and imaging examination are required. The best therapeutic approach can be determined based on the patient's condition, and it is necessary to differentiate the diagnosis from the laryngeal tumor. Surgery should be performed in a timely to completely remove the lesions, clarify the diagnosis, and optimize the final functional outcomes.

Expression of TGFBI in head and neck squamous cell carcinoma and its clinical significance

ZHOU Yijing, ZOU Jianyin, YI Hongliang, WU Hongmin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  85-95.  doi:10.6040/j.issn.1673-3770.0.2022.459

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Objective To explore the expression of transforming growth factor β induced gene(TGFBI)in head and neck squamous cell carcinoma(HNSCC)and its clinical significance. Methods Single-cell RNA-Seq sequencing data from the NCBI database were used to analyze TGFBI expression in immune cells and Bulk RNA-Seq was used to explore the infiltration of the tumor microenvironment in HNSCC. The gene expression and prognostic value of TGFBI in HNSCC were analyzed using TCGA database and validated using clinical specimens. TCGA database were used to assess the response of HNSCC patients to targeted therapy and immunotherapy after grouping according to TGFBI expression and to analyse the effect of gene mutations on TGFBI expression. Results High TGFBI was expressed in M2 macrophages. High TGFBI was associated with poor prognosis in patients with HNSCC. Patients with low TGFBI expression may respond to immunotherapy, while patients with high TGFBI expression may respond to targeted therapy. Mutations in TP53 were significantly associated with high TGFBI expression. Conclusion There is some evidence that TGFBI can be used as a biomarker for predicting survival and treatment response in patients with HNSCC.

Thyroid cartilage damage and airway invasion caused by tracheogenic cyst: a rare case report

LI Shaohua, PENG Hongbin, LU Biaoqing, XU Qingwen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  96-98.  doi:10.6040/j.issn.1673-3770.0.2022.236

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Objective To reduce misdiagnosis and erroneous treatment of tracheal cysts by investigating their clinical manifestations, diagnostic criteria, treatment, and prognosis. Methods The clinical data of a patient with a tracheal cyst was retrospectively analyzed and relevant literature was reviewed. Results The clinical manifestations of tracheal cysts lack specificity, and routine indirect laryngoscopy has been known to cause mistaken or delayed diagnoses. Electronic laryngoscopy and imaging examinations can improve diagnosis rates. Tracheal cysts can be treated effectively with decompression surgery, and pathological biopsies can be helpful for diagnosis and prognosis assessment. Conclusion Tracheal cyst of characteristic clinical and imaging manifestation. Medical history, systemic examinations, and pathological biopsies are very important for diagnosis and treatment of tracheal cysts.

Key candidate genes associated with the molecular mechanisms of adenoid cystic carcinoma identified by bioinformatics

HAO Hong, CHEN Gang, WANG Lin’e

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  99-106.  doi:10.6040/j.issn.1673-3770.0.2022.278

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Objective This paper used a bioinformatics approach to identify key genes associated with adenoid cystic carcinoma(ACC)to explore the etiology and pathogenesis. Methods The microarray datasets GSE36820 and GSE88804 were obtained from the Gene Expression Omnibus database(GEO). Common differentially expressed genes(DEGs)between ACC and normal tissues were identified. Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses were performed using the Database for Annotation, Visualization, and Integrated Discovery(DAVID). A protein-protein interaction(PPI)network incorporating the discovered DEGs was constructed using String online software and Cytoscape software. Key genes were obtained by cytoHubba of Cytoscape. The mRNA level expression of key genes was validated using the GSE59702 dataset. Results GO analysis revealed that the DEGs were enriched in biological processes including multicellular organismal homeostasis, antimicrobial humoral response, and retina homeostasis. KEGG pathway analysis indicated that the DEGs were enriched in salivary secretion, PPAR signaling, and tyrosine metabolism. GSEA enrichment analysis found genes that were enriched in cell cycle mitosis, TP53-mediated transcriptional regulation, Rho family guanosine triphosphatase mediated signaling, tumor pathways, and mitosis. The mRNA expression levels of DTL, CENPU, BUB1B, ANLN, CENPF and TOP2A were significantly increased in tumor tissues. Conclusion The key candidate genes identified in the present study may be involved in ACC growth and pathogenesis, and offer new research directions in the quest for therapeutic targets and diagnostic markers.

Fundus changes in high myopia cataract with posterior scleral staphyloma

YUSUFU·Maierhaba, ABULA·Kelimujiang, DING Lin, QIN Yanli, CHEN Xueyi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  107-114.  doi:10.6040/j.issn.1673-3770.0.2022.354

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Objective To investigate the fundus changes in high myopia cataract with posterior scleral staphyloma. Methods This was a retrospective case-control study, the data of 103 eyes of 68 patients with cataract between August and December 2021 were analyzed. All cases were divided into two groups based on axial length: the high myopia group, with an axial length ≥ 26.5 mm, and the control group, with an axial length of 22.0-24.0 mm. The high myopia group was divided into two subgroups: those with staphyloma and those without staphyloma. Cirrus HD-OCT 5000 was used to measure the retinal thickness(RT), choroidal thickness(CT), retinal nerve fiber layer(RNFL)and optical coherence tomography angiography(OCTA)at the fovea and at 1 000 μm and 3 000 μm from the fovea. Moreover, the optical coherence tomography(OCT)and optical coherence tomography angiography of the macular and optical nerve were measured. All patients were graded according to the ATN classification of high myopia fundus lesions. Results The control group had the best postoperative vision acuity, followed by the high myopia group without staphyloma, while the high myopia group with staphyloma had the worst. The ATN grade of patients with staphyloma was significantly higher than that of patients without staphyloma(P=0.007,0.015,0.001). The high myopia group had thinner RT, CT, and retinal nerve fiber layer(RNFL)compared with those in the control group(P=0.004,0.004,0.001,0.001,0.018,0.001). Moreover, the area of the foveal avascular zone(FAZ)in high myopia group was smaller(P=0.001,0.001)and the optical nerve OCTA blood flow signal was lower(P=0.025,0.001,0.001,0.001,0.026,0.001,0.001,0.001). However, there was no significant difference in OCTA between patients with and without staphyloma(P=0.871,0.964,0.888,0.911,0.765,0.999,0.999,0.806). Conclusion The fundus lesions of high myopia patients with posterior scleral staphyloma are more serious, and this may affect visual recovery after cataract surgery. This may also be related to the RT, CT, RNFL, macular and optic nerve blood flow, and FAZ dysplasia difference.

Study on the change of OCTA and its correlation with visual acuity in patients with CSC before and after TCM syndrome differentiation and treatment

ZHANG Xiaohan, WEI Li, YANG Kaili, CHEN Haiyan, LI Yansong, WANG Ping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  115-122.  doi:10.6040/j.issn.1673-3770.0.2022.361

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Retinal artery occlusion during treatment of primary vitreoretinal lymphoma:a case report and literature review

ZHAO Hui, HUANG Chao, CUI Wenxuan, SI Mingwei, YANG Mengyao, WANG Hong, ZHOU Fang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  123-127.  doi:10.6040/j.issn.1673-3770.0.2022.444

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Objective This study reports the clinical features and treatment of a case of retinal artery occlusion during vitreoretinal lymphoma treatment. We also analyze and describe the relevant reasons for retinal artery occlusion formation. Methods The diagnosis and treatment of the case were reviewed. The case data and related literature were analyzed and discussed. Results After admission, according to the medical history, symptoms, and signs, cytokines in intraocular fluids and gene rearrangement were detected and a diagnosis of "vitreoretinal lymphoma" was established. Methotrexate intravitreal injection and regular follow-up were performed. However, retinal artery occlusion occurred before another planned intravitreal injection. Conclusion Vitreoretinal lymphoma diagnosis is challenging because its clinical symptoms could mimic other eye diseases. In the treatment course, attention should be paid to the eye and systemic system to improve patients' quality of life and survival time.

The protective effect of hydroxysafflor yellow A on light-induced retinal injury in rats

FU Yixuan, WANG Tao, CAO Jing, LI Guangda, ZHENG Lingfang, XU Wanjing, ZHAO Shuang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  128-134.  doi:10.6040/j.issn.1673-3770.0.2022.455

Abstract ( 254 )   PDF (6528KB) ( 62 )   Save

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Objective To investigate the protective effect of hydroxysafflor yellow A(HSYA)on light-induced retinal injury in rats. Methods Thirty Sprague-Dawley rats were randomly divided into the blank control group, model control group, and HSYA group(10 rats per group). The rats in the latter two groups were treated with 0.9% NaCl solution and 5.0 mg/mL HSYA, respectively, once a day for 14 days. At the end of the experiment, the pathological sections of the right eye were removed and examined. The morphology of the retina was observed after HE staining, the expression of active caspase-3 protein was detected by immunohistochemistry, and the apoptotic index was calculated using TUNEL staining. Results HE staining showed that the retinal tissue morphology and cell structure of the blank control group were normal. In the model control group, the retinal tissue morphology was disordered, the cells of the RGC, INL, and ONL layers were unevenly dispersed, a large number of cells were disintegrated, the boundary between the inner and outer segments of the photoreceptor cells was not clear, and the retinal pigment epithelium(RPE)layer was disordered. The morphology of the retina in the HSYA group was generally normal, and no obvious damage was observed. The integrated optical density of caspase-3 protein detected by immunohistochemistry was significantly higher in the model control group than in the blank control group(P<0.001), while the integrated optical density of caspase-3 protein in the HSYA group was significantly lower than in the model control group(P<0.001). TUNEL staining showed that the apoptotic index of the model control group was significantly higher than that of the blank control group(P<0.001), while the apoptotic index of the HSYA group was significantly lower than that of the model control group(P=0.021), and the differences were statistically significant. Conclusion HSYA improved abnormal changes in the retinal tissue structure caused by light damage in rats, reduce the expression of caspase-3 protein, and inhibit the apoptosis of retinal cells after light damage. Based on these findings, HSYA has a certain protective effect against retinal light damage.

Review

Advances in anti-PD-L1/PD-1 therapy and non-coding RNA regulation in nasopharyngeal carcinoma

TU Qiaoling, LI Yufeng, PENG Jun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  135-141.  doi:10.6040/j.issn.1673-3770.0.2022.214

Abstract ( 328 )   PDF (439KB) ( 136 )   Save

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Nasopharyngeal carcinoma(NPC)is a malignant head and neck tumor type derived from nasopharyngeal epithelium. Successful treatment of patients with advanced or recurrent NPC remains difficult. Recent studies have shown that immunotherapy is effective for these patients. Programmed death ligand 1(PD-L1)is highly expressed in NPC. PD-L1 binding to programmed death receptor 1(PD-1)on the surface of T cells can inhibit T cell activation, leading to immune escape by NPC. Non-coding RNA plays important roles in regulating the occurrence and development of NPC. Searching for upstream ncRNAs that can regulate the PD-L1/PD-1 axis can provide new ideas for immunotherapy of NPC. This article reviews the role of the PD-L1/PD-1 axis in NPC immunotherapy and summarizes progress of research related to ncRNA regulation.

Research progress in the relationship between autonomic nervous system dysfunction and nasal diseases

ZHANG Miao, YANG Yingchao, FU Zhihui, SU Kaiming

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  142-148.  doi:10.6040/j.issn.1673-3770.0.2022.215

Abstract ( 359 )   PDF (2749KB) ( 100 )   Save

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The autonomic nervous system is composed of two parts: the sympathetic and the parasympathetic nervous systems. It plays an important role in maintaining the normal physiological activities of the body and the homeostasis of the internal environment. An imbalance in the autonomic nervous system can trigger a range of symptoms called autonomic nervous system dysfunction(ANSD). As nasal autonomic nerves are widely distributed,ANSD is not uncommon in nasal diseases. It has been verified that patients with rhinitis, sinusitis, deviated nasal septum and other diseases can develop ANSO. Some psychological symptoms such as anxiety and depression after nasal surgery and functional rhinoplasty may also be related to ANSD. This article reviews autonomic nerve dysfunction and nasal diseases, and aims to provide a better understanding of ANSD in nasal diseases.

Review of factors influencing the prognosis of endoscopic dacryocystorhinostomy

LIU Nan, PANG Mingjie

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  149-155.  doi:10.6040/j.issn.1673-3770.0.2022.223

Abstract ( 185 )   PDF (1264KB) ( 152 )   Save

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Following the development and application of nasal endoscopic technology in nasal-eye related diseases, endoscopic dacryocystorhinostomy has become the main surgical method for treatment of chronic dacryocystitis due to it high surgical safety and success rate. Basically, the procedure creates a new tear drainage channel between the lacrimal sac and the nasal cavity. Synechiae, stenosis, and cicatricial closure of the ostium are the most common causes of failure for this procedure. Normal epithelialization of the anastomosis can be affected by the preoperative nasal cavity and paranasal sinus lesions of the patient, and different surgical methods and postoperative management can also affect the outcomes of surgical treatment to a certain extent. In this study, we review the factors related to the prognosis of endoscopic dacryocystorhinostomy, aiming to provide a reference to improve the prognosis and clinical management of this procedure.

Research progress on the role of TH2 cytokines in Type2 chronic rhinosinusitis with nasal polyps

ZHU Yu, ZHU Xinhua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  156-161.  doi:10.6040/j.issn.1673-3770.0.2022.258

Abstract ( 384 )   PDF (1375KB) ( 144 )   Save

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Chronic rhinosinusitis(CRS)are classified as type 2 and non-type 2 intrainflammatory types according to the pathogenesis, where type 2 inflammation corresponds to chronic rhinosinusitis with nasal polyps(CRSwNP)dominated by eosinophil infiltration. Patients with typical type 2 CRSwNP are typically resistant to current treatments and exhibit high recurrence rates. Although some success has been achieved regarding treatment, targeting a single TH2 cytokine cannot completely eliminate type 2 CRSwNP in most patients. Therefore, targeting the TH2 cytokine and its downstream signal transduction pathway may present a novel approach for endotherapy. In this study, we review the intracellular signaling pathways activated by various type 2 cytokines(IL-4, IL-5, IL-9, IL-13, IL-25, and IL-33)after binding to their specific receptors in type 2 CRSwNP, in order to provide new targets for type 2 CRSwNP therapeutics.

Progress in treatment of olfactory dysfunction following SARS-Cov-2

JIN Jing, LENG Hui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  162-174.  doi:10.6040/j.issn.1673-3770.0.2022.306

Abstract ( 356 )   PDF (5982KB) ( 122 )   Save

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Olfactory dysfunction(OD)is among the main symptoms of coronavirus disease 2019(COVID-19). Currently, the pathogenesis of OD associated with COVID-19 remains unclear, and specific treatment is unavailable. In this paper, we present a review of recent literature that describes OD, in addition to current treatment strategies for COVID-19 and COVID-19-induced OD. We have summarized the therapeutic approaches and compared the treatment methods of safety consultation, olfactory training, drug treatment, acupuncture, traditional Chinese medicine,Japanese traditional Chinese medicine and others. Furthermore, we discuss the challenges in clinical application and future development to serve as guidelines for the clinical management of COVID-19-induced OD.

Research progress in the clinical treatment and drug regimen for patients with pregnancy rhinitis

ZHANG Kunyi, XIAO Xuping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  175-183.  doi:10.6040/j.issn.1673-3770.0.2022.349

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Although various treatment options are available for rhinitis, research on the treatment and medication regimen for patients suffering from pregnancy rhinitis is relatively scant. In pregnant patients, the pharmacokinetics and pharmacodynamics of drugs differ significantly from those in non-pregnant patients. Some drugs may cross the placental barrier and cause adverse effects on the embryo, fetus, and even in the newborn. Therefore, the choice of medical regimen for patients with pregnancy rhinitis needs careful consideration. Corticosteroids, decongestants, antihistamines, chromones, and anticholinergics are commonly used for treating rhinitis, and it is important to study their efficacy and safety in patients with pregnancy rhinitis. In this article, we present research update on pregnancy rhinitis, with a focus on evaluating the current clinical treatment and medication regimen for patients with this condition.

Therapeutic progress of glottic insufficiency caused by unilateral vocal fold paralysis

ZEGN Qinghan, LÜ Dan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  184-191.  doi:10.6040/j.issn.1673-3770.0.2022.297

Abstract ( 376 )   PDF (496KB) ( 225 )   Save

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Vocal folds are important structures of voice formation. Their dysfunction affects the voice, breathing, and swallowing function. Glottis insufficiency is common in the clinic, and its most common etiology is unilateral vocal fold paralysis, which can lead to hoarseness, dyspnea, and complications such as dysphagia and aspiration, which seriously affect the quality of life and are potentially life-threatening. Therefore, it is very important to find the cause of glottic insufficiency and choose the appropriate treatment. At present, there are various treatment methods for glottic insufficiency caused by unilateral vocal fold paralysis; however, their therapeutic effect has not reached the optimal state. Therefore, herein, we review the treatment progress of glottic insufficiency caused by unilateral vocal fold paralysis.

Application of metagenomic next-generation sequencing in cervical necrotizing fasciitis

QIN Nian, XIAO Yu, ZHANG Kunyi, LI Jingkun, XIAO Xuping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  192-197.  doi:10.6040/j.issn.1673-3770.0.2022.319

Abstract ( 477 )   PDF (849KB) ( 160 )   Save

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Metagenomic next generation sequencing is a novel microbiological diagnostic technique that does not rely on isolation and cultivation of pathogens. In theory, it can promptly detect all pathogen information in samples and has been used to diagnose many infectious diseases. Cervical necrotizing fasciitis is a fatal infectious disease with a high mortality rate. Cervical necrotizing fasciitis is one of the critical diseases in otorhinolaryngology head and neck surgery. Rapid detection of the infection causing pathogens is essential in improving the rescue success rate and prognosis. This article analyzes the application progress of the metagenomic next generation sequencing in necrotizing cervical fasciitis, to provide a new diagnostic basis for the early detection of the infection.

The mechanism of copper-induced tumor cell death and its research progress in cancer therapy

HUANG Yanli, LI Junzheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  198-205.  doi:10.6040/j.issn.1673-3770.0.2022.279

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Copper is an essential trace element in the human body that plays a key role in several basic biological functions. The safe and specific transport of copper is regulated by copper chaperones and copper transporters. Copper plays an important role in tumor growth, epithelial-mesenchymal transition, tumor microenvironment and pre-metastatic niche formation. Disruption of copper homeostasis alters tumor cell growth and leads to cell death. Copper can induce tumor cell death in several ways, such as reactive oxygen species accumulation, proteasome inhibition, and antiangiogenesis. A new form of copper-induced regulated cell death, called “cuprotosis,” differs from previously known cell death mechanisms and has become a research hotspot in the field of tumor therapy. In this paper, recent research on the mechanism of copper-induced tumor cell death is introduced, and recent research of copper-induced tumor cell death in the treatment of breast, colorectal, lung, and prostate cancers is reviewed.

The influence of dietary on allergic disease

YU Zhujun, NING Yunhong, TAN Zhimin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  206-214.  doi:10.6040/j.issn.1673-3770.0.2022.294

Abstract ( 267 )   PDF (1720KB) ( 113 )   Save

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Allergic disease is a common condition that affects all age groups and dietary factors have a significant impact on allergic disease. The incidence of allergic disease is increasing, which makes the management of this disease a concern for the global community. This study aimed to analyze the influence of dietary factors on allergic disease. We examined four populations of interest: pregnant persons; infants; pre-school children and school age children; adolescents and adults. The study findings suggest that the influence of dietary factors on the incidence of allergic disease is complex and is affected by genetic and regional factors. Therefore, we recommend selecting an appropriate diet based on age, geographical, and genetic factors.

Relationship between allergic diseases and diabetes mellitus and underlying mechanisms

LU Gan, DENG Yuqin, TAO Zezhang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(5):  215-222.  doi:10.6040/j.issn.1673-3770.0.2022.411

Abstract ( 275 )   PDF (510KB) ( 134 )   Save

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Allergic diseases and diabetes mellitus(DM)are systemic chronic diseases associated with inflammation. Both conditions involve multiple organs and complex pathogenesis. However, current evidence on the relationship between allergic diseases and DM is contradictory, and there have been few reports on associated mechanisms. Most studies have reported that DM was positively associated with asthma in allergic diseases, but negatively associated with allergic rhinitis and atopic dermatitis. The different associations may be due to ethnicity and race differences. The mechanisms associated with allergic diseases and DM are not yet fully understood and may be related to pro-inflammatory pathways and blood glucose metabolism. This article reviews epidemiological and mechanistic studies related to allergic diseases and DM to enhance clinical knowledge of their co-morbidities.