Table of Content

20 July 2025 Volume 39 Issue 4

  

Multidisciplinary management of carotid burst syndrome associated with nasopharyngeal carcinoma-Exoert Consensus

Expert consensus on clinical management recommendations for carotid blowout syndrome secondary to NPC treatment

QIU Qianhui, XIAO Xuping, YANG Qintai, YE Jing, DENG Zeyi, WANG Desheng, TAN Guolin, JIANG weihong,

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  1-18.  doi:10.6040/j.issn.1673-3770.0.2023.500

Abstract ( 434 )   PDF (18342KB) ( 58 )   Save

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Carotid Blowout Syndrome(CBS)refers to rupture of the carotid artery and/or its branches. CBS is a life-threatening complication of head and neck cancer after radiotherapy. Because radiotherapy is the first-line treatment for nasopharyngeal carcinoma, radiation-induced necrosis and tumor recurrence increase patient risk of experiencing CBS. The high mortality and morbidity of CBS after nasopharyngeal carcinoma radiotherapy poses a great challenge for clinicians. To enhance understanding and develop standards for application of CBS management, we organized an expert consensus on a comprehensive management strategy for nasopharyngeal carcinoma-related CBS, based on domestic and international guidelines and relevant literature. Emergency processing, a comprehensive management strategy, and a clinical nursing and prevention program are presented in detail in this consensus, which aims to provide a theoretical basis and clinical recommendations for more effective treatment of nasopharyngeal carcinoma-related CBS based on pathogenesis mechanism, predisposing factors, and characteristics of imaging during examination.

Clinical Research

Analysis of factors associated with stroke and cranial nerve palsy after unilateral internal carotid artery embolization in patients with nasopharyngeal carcinoma after radiotherapy

WANG Siquan, ZHU Hongshen, ZHANG Xiaobin, ZHAO Zhouyang, MA Yue, YANG Yimei, HUANG Lijin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  19-25.  doi:10.6040/j.issn.1673-3770.0.2024.421

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Objective To analyze the factors related to stroke and cranial nerve paralysis following unilateral internal carotid artery(ICA)embolization in patients with nasopharyngeal carcinoma after radiotherapy, in order to reduce the probability of postoperative complications and improve the quality of life for these patients. Methods A retrospective analysis was conducted on the clinical data of 109 patients who underwent unilateral ICA embolization in the Department of Neurosurgery at the Third Affiliated Hospital of Southern Medical University between March 1, 2018, and October 31, 2022. These patients were followed up for one month. Patients with postoperative symptoms of stroke or cranial nerve paralysis were defined as the symptomatic group(17 cases), while the rest were classified as the asymptomatic group(92 cases). Logistic regression analysis was performed on factors such as gender, age, body mass index(BMI), blood pressure, preoperative hemoglobin levels, the status of the ipsilateral ICA, whether the contralateral ICA was stenosed, whether the ophthalmic artery compensated for the middle cerebral artery, the occlusion segment, and the side of occlusion. Results There were no statistically significant differences between the symptomatic and asymptomatic groups in terms of gender, age, BMI, whether the contralateral ICA was stenosed, the side of occlusion, or the balloon occlusion test(BOT)(all P>0.05). However, there were statistically significant differences in the occlusion segment(P=0.001), the status of the occluded ICA(stenosis, normal, or presence of a pseudoaneurysm)(P=0.010), and preoperative hemoglobin levels(P=0.024)with respect to the occurrence of postoperative stroke/cranial nerve paralysis. Elevated hemoglobin levels(OR=0.971)were identified as a protective factor, while occlusion extending to the cavernous sinus segment(OR=2.292)was identified as a risk factor. Conclusion For patients with nasopharyngeal carcinoma requiring ICA occlusion, preoperative hemoglobin levels should be maintained at ≥90 g/L. Occlusion at segments below the cavernous sinus can reduce postoperative symptoms of cranial nerve paralysis, particularly oculomotor and abducens nerve paralysis.

Expression of EphB2 in nasopharyngeal carcinoma tissues and its correlation with clinicopathological characteristics

HUANG Qiao, REN Yi, HOU Tao, LIAO Xingwei, ZHU Zi’ang, ZHAN Xiaolin, LIU Ying, YIN Shihua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  26-30.  doi:10.6040/j.issn.1673-3770.0.2024.367

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Objective To investigate the expression and clinical significance of erythropoietin-producing human hepatocellular B2(EphB2)in tissues of patients with nasopharyngeal carcinoma(NPC). Methods 194 NPC patients were enrolled as the study group, and 80 patients with chronic nasopharyngeal mucosal inflammation were included as the control group. Immunohistochemistry(IHC)and Western blot were used to detect the EphB2 levels in tissues. Kaplan-Meier survival analysis was performed to evaluate the relationship between the expression of EphB2 and the prognosis of patients with NPC, and Cox regression analysis was used to identify independent risk factors for poor prognosis. Results Immunohistochemistry and protein blotting experiments showed that EphB2 protein level was highly expressed in NPC tissues compared with chronic inflammatory tissues of nasopharyngeal mucosa(t=157, P<0.001). The expression level of EphB2 in NPC tissues was correlated with clinical stage(χ2=24.573, P<0.001), depth of tumor invasion(χ2=6.280, P=0.012), presence of cervical lymph node metastasis(χ2=5.576, P=0.018), distant metastasis(χ2=7.588, P=0.006), EBV infection(χ2=6.754, P=0.009), and the presence of recurrence(χ2=9.182, P=0.002). Kaplan-Meier curves revealed that NPC patients with high EphB2 expression had a poor prognosis(χ2=7.010, P=0.008). Cox regression analysis further revealed that EphB2 was an independent risk factor affecting the prognosis of NPC. Conclusion EphB2 is an independent risk factor affecting the prognosis of NPC, which may be involved in the process of NPC occurrence and development, and it is expected to be a biological marker and potential therapeutic target for the early diagnosis and prognosis evaluation of NPC.

Efficacy analysis of concurrent chemoradiotherapy with high and low cumulative cisplatin doses in the treatment of nasopharyngeal carcinoma

SUN Chunxiao, WANG Wenqing, YUE Tian, LIU Jisheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  31-41.  doi:10.6040/j.issn.1673-3770.0.2025.123

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Objective The objective of this study is to conduct a quantitative comparison of the survival efficacy and adverse reactions between the cumulative cisplatin dose(CCD)≤200 mg/m² cohort and the CCD>200 mg/m² cohort through meta-analysis, providing an evidence-based rationale for individualised treatment. Methods A systematic search was conducted across PubMed, Embase, Web of Science, Cochrane Library and Chinese Biomedical Literature Database up to February 2025. The observational indexes included 5-year overall survival(5-OS), 5-year progression free survival(5-PFS), 5-year distant metastasis free survival(5-DMFS)and adverse events(AEs). RevMan 5.4 software was utilized to perform the meta-analysis. The heterogeneity among the included studies was assessed using I² values. Furthermore, funnel plots were used to evaluate potential publication bias. Results Nine cohort studies were included. Data covering 7,418 patients diagnosed with nasopharyngeal cancer were collected, includeding 5,899 cases in the CCD≤200 mg/m² cohort and 1,519 cases in the CCD >200 mg/m² cohort. In comparison with the cohort of CCD >200 mg/m², the CCD≤200 mg/m² cohort did not exhibit a statistically significant reduction in 5-OS(RR=0.98,95%CI:0.96-1.00), 5-PFS(RR=0.96,95%CI:0.91-1.01)and 5-DMFS(RR=0.97,95%CI:0.93-1.01). Further subgroup analyses of 5-OS and 5-DMFS yielded consistent results. In relation to AEs, the CCD≤200 mg/m² cohort demonstrated a conspicuously diminished occurrence of acute toxic reactions compared to the CCD >200 mg/m² cohort. This was observed in grade 1-4 leukopenia(RR=0.91,95%CI:0.86-0.97),grade 1-4 ALT elevation(RR=0.69,95%CI:0.58-0.82)and any grade of creatinine elevation(grade 1-4: RR=0.73,95%CI:0.60-0.88; grade 3-4: RR=0.20,95%CI:0.04-0.89). With regard to late toxicities, both grade 1-4 hearing impairment(RR=0.81,95%CI:0.70-0.94)and any grade of dermal fibrosis(grade 1-4:RR=0.77,95%CI:0.64-0.92; grade 3-4: RR=0.43,95%CI:0.21-0.89)exhibited a substantial reduction within the CCD≤200 mg/m² cohort. However, no statistically significant differences were found between the two cohorts in other AEs, including grade 3-4 leukopenia, grade 3-4 ALT increase, grade 3-4 hearing impairment and any grade of anemia, thrombocytopenia, neutrophilic leukopenia, AST increase, dry mouth, clenching of teeth or cranial neuropathy. Conclusion This study indicates that in the treatment of nasopharyngeal carcinoma with concurrent chemoradiotherapy(CCRT), CCD≤200 mg/m² may achieve therapeutic efficacy comparable to that of CCD>200 mg/m², and may potentially reduce the risk of AEs.

Construction of a decision tree algorithm to predict the risk of radiation oral mucositis in nasopharyngeal carcinoma patients after radiotherapy

XU Fei, ZHU Guangxi, WANG Kexin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  42-48.  doi:10.6040/j.issn.1673-3770.0.2023.447

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Objective To construct a decision tree model for predicting the risk of radiation oral mucositis(ROM)in nasopharyngeal cancer patients after radiotherapy. Methods One hundred nasopharyngeal cancer patients admitted to the hospital from January 2022 to June 2023 were prospectively selected as study subjects, and the patients were categorized into <3 ROM(n=81)and ≥3 ROM(n=19)according to whether or not ≥3 ROM occurred. Risk factors for the occurrence of grade ≥3 ROM after radiotherapy in nasopharyngeal cancer patients were analyzed using univariate and multivariate logistic regression, and an associated decision tree prediction model was established. Results The incidence of ROM after radiotherapy in 100 nasopharyngeal cancer patients was 96.0%. Univariate and multifactorial logistic regression analyses showed that smoking, concurrent chemotherapy, albumin level <35 g/L, and oral pH <7.0 were independent risk factors for the occurrence of grade ≥3 ROM after radiotherapy in nasopharyngeal carcinoma patients, whereas the use of oral mucosal protectants was a protective factor(P<0.05). The results of the accuracy validation of the decision tree model constructed using it showed that the area under the working characteristic curve(ROC)(AUC)of its subjects was 0.924(95%CI: 0.901~0.946). Conclusion There are more influencing factors for the occurrence of grade ≥3 ROM after radiotherapy in nasopharyngeal cancer patients, and the decision tree model constructed based on the influencing factors has good predictive ability for the risk of grade ≥3 ROM after radiotherapy in nasopharyngeal cancer patients.

Treatment of internal carotid artery rupture caused by tumor recurrence and skull base osteonecrosis after radiotherapy for nasopharyngeal carcinoma

WANG Zaixing, TANG Zhiyuan, LI Dingbo, SHI Zhaohui, ZENG Xianhai, ZHANG Qiuhang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  49-58.  doi:10.6040/j.issn.1673-3770.0.2024.228

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Objective To investigate the internal carotid artery protection techniques and perioperative management strategies of endoscopic surgery for local recurrent nasopharyngeal carcinoma or skull base osteonecrosis after radiotherapy for nasopharyngeal carcinoma. Methods The clinical data of patients with local recurrent nasopharyngeal carcinoma and skull base osteonecrosis of nasopharyngeal carcinoma who received endoscopic surgery at Department of Otolaryngology, Shenzhen Longgang Otolaryngology hospital from January 2019 to December 2023 were retrospectively analyzed. The gender and age of the patients near or involving the internal carotid artery were analyzed and summarized, the lesion site and its relationship with the internal carotid artery, the resection of the lesion, the protection methods of important blood vessels during the operation, the postoperative internal carotid artery bleeding and its management, and the postoperative recovery were analyzed and summarized. Results A total of 47 patients were included, with a male to female ratio of 25∶22 and an average age of 50.98±10.93 years. There were 29 cases of recurrence and 9 cases of internal carotid artery invasion. In the osteonecrosis group, the lesion invaded the internal carotid artery in 6 cases. During the postoperative follow-up, 5 patients in the recurrence group had tumour recurrence at the site adjacent to surgery, and the average recurrence time was 15 months. The incidence of postoperative internal carotid artery rupture bleeding was 6.9% and the mortality rate was 10.34%. In the osteonecrosis group, 1 patient was found to have recurrent osteonecrosis at 7 months after surgery and was treated again. The incidence of postoperative internal carotid artery rupture bleeding was 5.6% and the mortality was 11.11%. Bleeding occurred in the high internal carotid artery in both groups, and the lesions were found to have invaded the internal carotid artery before surgery. Conclusion For patients with local recurrence of nasopharyngeal carcinoma or with skull base osteonecrosis near or involving the internal carotid artery after radiotherapy, the extent of the tumour and surrounding major blood vessels should be fully evaluated before surgery, and the appropriate surgical protocols and management methods should be formulated. Surgical safety can be improved by mastering the surgical skills to protect the internal carotid artery and by paying attention to the protection of major blood vessels.

Retrospective analysis of nutritional indexes and their impact on wound healing in patients with radiation-induced skull base osteoradionecrosis after treatment with nasopharyngeal carcinoma

SUN Fang, XIE Chubo, QIU Qianhui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  59-68.  doi:10.6040/j.issn.1673-3770.0.2024.244

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Objective The aim of this study was to investigate the influence of relevant nutritional indicators on the success of trauma repair in patients with nasopharyngeal carcinoma with osteoradionecrosis of the skull base, and to provide clinical guidance. Methods We retrospectively analyzed 100 clinically documented complete cases who underwent endoscopic removal of necrotic tissue from the skull base and tissue trauma repair for skull base osteoradionecrosis. The effects of nutritional indicators on surgical wound repair were analyzed using univariate and multivariate Logistic regression. Also chi-square tests were used to analyze the relationship between repair success and postoperative internal carotid artery hemorrhage, and continuity-corrected chi-square tests were used to deal with the theoretical frequency 1≤T < 5 cases. Results Univariate analysis showed that the success rate of surgical repair in normal-weight ［body mass index(BMI)=(18.5-23.9)kg/m²］ patients was 6.43 times higher(OR=6.43, P<0.001)than that in low-body-weight(BMI<18.5 kg/m²)patients, whereas the success rate in obese patients(BMI≥24 kg/m²)was weight patient by 27 times(OR=27.00, P=0.003). In addition, total protein(OR=1.10, P=0.035), albumin(OR=1.29, P=0.001), total cholesterol(OR=1.69, P=0.019), and hemoglobin(OR=1.04, P=0.005)were significantly associated with successful surgical repair. Although peripheral blood lymphocyte count was associated with successful surgical repair(OR=2.32, P=0.068), the difference did not reach statistical significance. Surgical repair success was significantly lower in patients with a Controlling Nutrition Status(CONUT)score of ≥2(OR=0.20, P=0.042). After multivariate analysis further corrected for confounders, surgical repair success rates remained significantly higher in normal-weight and obese weight than in low-weight patients(OR=9.99 and 77.14, respectively; both P<0.001). However, the independent effects of other nutritional indicators were diminished in the multivariate analysis. In addition, the rate of internal carotid artery bleeding after three months was significantly lower in the successful repair group than in the failed repair group(4.62% vs. 28.57%, P=0.002). Conclusion The findings of this study suggest that BMI is a important factor that influencing the success of surgical wound repair, with normal weigh and obese patients having significantly higher surgical repair success rates than low weight patients. In addition, nutritional indices such as total protein, albumin, total cholesterol, and hemoglobin were also significantly associated with surgical repair success, whereas higher CONUT scores were associated with lower success rate. However the independent effect of BMI remained significant in the multivariate analysis, while the independent effects of the remaining nutritional metrics were attenuated. The rate of internal carotid artery bleeding after three months was significantly lower in the successful repair group than in the failed repair group, suggesting that successful surgical repair may reduce the risk of postoperative complications.

Imaging-based observation and analysis of the pharyngeal internal carotid artery trajectory

JIANG Zhilin, ZHU Ruikai, QIU Qianhui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  69-76.  doi:10.6040/j.issn.1673-3770.0.2024.376

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Objective The objective of this study was to delineate the course of the pharyngeal segment of the internal carotid artery(ICA)through imaging analysis, with the aim of providing guidance to prevent ICA injury during endonasal endoscopic surgeries. Methods A retrospective analysis of MRI and CTA imaging data from patients' ICAs was conducted, with arterial morphologies being classified based on inflection points. The distances and angles between the ICA and key anatomical landmarks(midline, intracranial entry plane, pharyngeal wall)were measured in multiple dimensions to identify any patterns that could inform surgical approaches. Results In the course of the evaluation of 124 ICA sides, it was found that nine of these exhibited complex trajectories with multiple inflection points. The conventional ICA course exhibited a medial trend, with a mean coronal distance from the midline of(21.85±3.26)mm, an intracranial entry angle of(76.32±15.53)°, and a mean sagittal entry angle of(71.84±11.55)°. It is noteworthy that a critical intracranial entry angle of 60° was identified in the coronal view of CTA scans, suggesting a threshold for surgical risk. Conclusion Variations in the ICA have the potential to result in surgical channel stenosis and alterations in anatomical landmark relationships, which are of critical importance for the purpose of planning. Comprehensive imaging assessments are essential for identifying pharyngeal ICA anomalies, and preoperative interventions should be considered when indicated to mitigate surgical risks.

Computed tomography angiography-based assessment of internal carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma and its associated factors

ZHU Ruikai, WU Jiarong, SUN Fang, XIE Chubo, QIU Qianhui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  77-84.  doi:10.6040/j.issn.1673-3770.0.2025.156

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Objective To investigate the incidence and risk factors of internal carotid artery(ICA)stenosis after radiotherapy for nasopharyngeal carcinoma(NPC)based on computed tomography angiography(CTA)evaluation, and to provide a basis for early screening and intervention. Methods Clinical data of 151 NPC patients who underwent radiotherapy and were admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Provincial People's Hospital, between February 2018 and November 2022, were retrospectively analyzed. All patients underwent head and neck CTA to assess ICA stenosis. Patients were categorized into a normal group(no stenosis, n=77)and an abnormal group(including mild, moderate, severe stenosis, or complete occlusion, n=74)based on post-radiotherapy ICA status. Clinical characteristics were compared between these groups, and Logistic regression analysis was used to identify potential influencing factors, such as gender, age, hypertension, diabetes mellitus, hyperlipidemia, smoking history, post-radiotherapy interval, radiotherapy course, and TNM staging. Results Among the 151 NPC patients after radiotherapy, ICA stenosis severity was evaluated using the North American Symptomatic Carotid Endarterectomy Trial(NASCET)method. The distribution was as follows: no stenosis accounted for 50.99%, mild stenosis for 12.58%, moderate stenosis for 27.15%, severe stenosis for 5.31%, and complete occlusion for 3.97%. Univariate analysis revealed statistically significant differences between the normal and abnormal groups in terms of gender, age distribution, presence or absence of hypertension, smoking history, post-radiotherapy interval, radiotherapy course, and TNM stage(P<0.05). Logistic regression analysis indicated that age(51-70 years)(OR=7.917, 95%CI: 5.913-9.921), female gender(OR=3.394, 95%CI: 1.980-4.808), hypertension(OR=2.872, 95%CI: 1.640-4.104), smoking history(OR=2.219, 95%CI: 1.103-3.335), post-radiotherapy interval(>10 years)(OR=4.125, 95%CI: 2.081-6.169), re-irradiation(OR=5.912, 95%CI: 4.474-7.350), and local/regional recurrence(OR=3.056, 95%CI: 1.790-4.332)were all identified as independent risk factors significantly associated with ICA stenosis in NPC patients after radiotherapy(P< 0.05). Conclusion Regular screening for ICA stenosis is recommended for NPC survivors, especially those aged >50 years, female, with hypertension, a history of smoking, a post-radiotherapy interval >10 years, undergoing re-irradiation, or experiencing local/regional recurrence, to enable early intervention and improve prognosis and quality of life.

Research Progress

Changing the diagnosis and treatment of nasopharyngeal cancer: biomarkers and nasal endoscopic surgery synergise to advance early treatment development

QIN Debo, XUE Jiancheng, YANG Wenyue, HU Bing, CHEN Tao, YU Yanping, MENG Qingguo, SUN Huanji, MIAO Beiping, LU Yongtian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  85-92.  doi:10.6040/j.issn.1673-3770.0.2024.542

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The diagnosis and treatment of nasopharyngeal carcinoma has entered a new era characterized by “precision screening, minimally invasive intervention, and preservation of function”. In the screening arena, breakthroughs in Epstein-Barr virus biomarker detection technologies-including CRISPR-associated protein 12a amplification-free assays, P85 antibody testing, and T-cell receptor sequencing-have achieved sensitivity and specificity of 97.9% and 99.3%, respectively, enabling disease prediction 6-12 months before clinical diagnosis. The synergistic application of multi-microRNA panels with narrow-band imaging(NBI)and I-scan virtual chromoendoscopy has shifted screening paradigms from single-marker approaches to multimodal integration.In therapeutics, endoscopic nasopharyngectomy(ENPG)demonstrates superior precision(negative margin rate ≥90%)and functional preservation, achieving a 5-year survival rate of 92.1% in early stage patients while significantly improving quality of life compared to conventional radiotherapy. However, challenges remain, including tumor heterogeneity, limited accessibility of advanced technologies in primary care settings, and restrictive eligibility criteria for ENPG. Future efforts should focus on:(1)multi-omics AI-driven risk stratification models;(2)synergy between surgery and immunotherapy(e.g., neoadjuvant PD-1 inhibitors);(3)portable diagnostic tools;(4)multicenter trials to validate long-term outcomes. Through interdisciplinary collaboration, the management of NPC is moving from empirical to precision medicine with the goal of achieving “early detection rates >80% and functional preservation rates >90%” and ultimately overcoming the global burden of this regionally prevalent malignancy.

Immune mechanism and clinical application of the intranasal vaccine in nasopharyngeal-associated lymphoid tissues

FU Lijun, WANG Haiyang, WANG Yuqi, ZOU Yuhao, ZOU Jian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  93-99.  doi:10.6040/j.issn.1673-3770.0.2024.499

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Intranasal vaccines are used to prevent respiratory infectious diseases by inducing local mucosal and systemic immune responses through action on nasopharyngeal-associated lymphoid tissue and have demonstrated potential for the treatment of brain and autoimmune diseases. Intranasal vaccines combined with new adjuvants and delivery systems can significantly enhance antigen immunogenicity and have shown initial results in the prevention of diseases such as influenza and new coronaviruses. On the contrary, tonsil-like organs, as an emerging three-dimensional experimental model, can accurately mimic the immune microenvironment and provide new tools for vaccine evaluation and design optimization. This article reviews the progress of intranasal vaccine research in clinical applications and analyzes the role of novel adjuvants, delivery systems, and tonsil-like organs in their optimization, with the aim of providing theoretical support for the development and application of intranasal vaccines in the future.

Syndrome differentiation treatment and understanding of traditional Chinese medicine in carotid blowout syndrome

GU Zhanxin, ZHAO Zhouyang, ZHANG Xiaobin, YANG Yimei, HUANG Lijin, HUANG Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  100-107.  doi:10.6040/j.issn.1673-3770.0.2024.224

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Carotid blowout syndrome is one of the acute and critical complications secondary to the comprehensive treatment of nasopharyngeal carcinoma. In the field of traditional medicine of the motherland, due to different clinical manifestations, it can be classified as “hang sang yan”, “bi nv” or “bi hong”. The treatment of carotid blowout syndrome is a comprehensive treatment model. It can be treated with a multi-disciplinary approach. Traditional Chinese medicine intervention plays an important role in the clinical symptoms and prognosis of CBS patients. It can be improving the clinical symptoms and the quality of life of patients. In this paper, we cover the carotid blowout syndrome recognizing and syndrome differentiation treatment. We examine the name,“hang sang yan”,and its connotations,as well as discuss the etiology,pathological mechanism,and Integrated traditional Chinese and western medicine nursing and recuperation. In order to provide a reference for the treatment of carotid blowout syndrome.

The role and significance of the skull base fascial tissue barrier in endoscopic resection of locally early recurrent nasopharyngeal carcinoma

WU Jiarong, QIU Qianhui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  108-113.  doi:10.6040/j.issn.1673-3770.0.2024.382

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Historically, the standard management of recurrent nasopharyngeal carcinoma(rNPC)involved two cycles of radiotherapy. However, the efficacy of the second cycle was suboptimal, resulting in a 5-year survival rate that fell below expectations and severe side effects, including radionecrosis, multiple cranial nerve deficits, and nasopharyngeal hemorrhage. These complications significantly impaired patients' quality of life and, in some cases, led to fatal outcomes.Recently, advancements in surgical techniques have emerged, offering a novel approach to managing rT1-rT3 recurrent nasopharyngeal carcinoma. For early-stage rNPC patients with rT1-rT3 tumors located in the midline area, the ability of endoscopic surgery to achieve complete tumor resection and R0 status is critical for their prognosis. The skull base fascial tissue, an integral connective tissue on the surface of the skull base, plays a crucial role. It adheres to the superficial aspect of the skull base muscles and the deep aspect of the mucous membranes. Its dense structure and strategic location provide a natural barrier against malignant tumors.Consequently, examining the clinical significance of the skull base fascial tissue in determining the extent of nasopharyngeal surgical resection can enhance clinical diagnostics and therapeutic strategies. This paper reviews the structural characteristics of the skull base fascia and its role and significance in resisting tumor invasion during early rNPC nasopharyngeal resection, highlighting its potential to improve clinical guidance in the management of this disease.

Original Article

Evaluation of the efficacy and safety of site-specific acupuncture for the treatment of sudden hearing loss: a systematic review and network Meta-analysis

ZHENG Zehao, WEI Jiali, LIU Jiatao, ZHOU Yuqi, SUN Wenting, LI Yuxuan, BAI Peng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  114-127.  doi:10.6040/j.issn.1673-3770.0.2024.354

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Objective To systematically evaluate and compare the efficacy and safety of site-specific acupuncture in the treatment of sudden hearing loss. Methods Randomized controlled trials on the efficacy and safety of acupuncture for sudden hearing loss were retrieved from PubMed, the Cochrane Library, Web of Science, SinoMed, CNKi, Wanfang, and VIP databases. Literature was screened and checked independently by two investigators using NoteExpress software to determine the inclusion of literature, data were extracted using Excel, risk of bias was assessed using the Cochrane Collaboration's Risk of Bias(RoB)2.0 tool, and Meta-analysis was performed using R software. Results A total of 20 studies involving 1,453 patients were included, evaluating 13 different interventions. The RoB 2.0 assessment revealed that one study had a low risk of bias, while the remaining studies exhibited a moderate risk of bias. The results of the Meta-analysis indicated that acupuncture was effective in sudden hearing loss, with cervical acupuncture combined with auricular acupuncture showing the greatest efficacy. Additionally, the combination of acupuncture and western medicine demonstrated superior effectiveness. In the ranking of the surface under the cumulative ranking curve(SUCRA)value for the primary outcome(the number of patients with hearing enhancement of more than 15 dB after treatment), cervical acupuncture + auricular acupuncture + western medicine(92.3)ranked highest, followed by cephalic and facial acupuncture(80.84), cervical acupuncture + western medicine(70.64), and so on. The ranking of the secondary outcome pure tone hearing threshold was highest for cephalic and facial acupuncture(88.42), followed by cephalic and facial acupuncture + auricular acupuncture + western medicine(74.15). Regarding safety, five studies reported relevant outcomes, with one study observing a case of subcutaneous hematoma and bruising in both groups, though this did not impact the progress of the trial. Conclusion Site-specific acupuncture is effective in treating sudden hearing loss, especially cervical acupuncture combined with auricular acupuncture, and shows a favorable safety profile. However given the limited number of included studies, further high-quality randomized controlled trials are needed to validate these findings.

Genetic analysis of MARVELD2 gene variants in two deafness cases

LI Jie, SU Weina, LIN Qian, ZHANG Qishu, HOU Cheng, YANG Zhenjiao, XIANG Lili

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  128-134.  doi:10.6040/j.issn.1673-3770.0.2025.101

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Objective Next generation sequencing technology was used to investigate the potential genetic causes of deafness in two probands and their families. Methods A retrospective analysis was conducted on two probands and their family members. This analysis included collecting medical histories, performing physical examinations, conducting audiological evaluations, and performing genetic testing and analysis for deafness. Results Both probands exhibited bilateral profound sensorineural hearing loss and had no other systemic abnormalities or syndromic features. Genetic testing revealed pathogenic variants in the MARVELD2 gene in both probands,either homozygous or compound heterozygous. The proband in family A carried a homozygous c.1331+1G>A variant that she inherited from her parents. The proband in family B carried compound heterozygous variants c.1331+1G>A/c.782G>A(p.Gly261Glu)and transmitted the heterozygous c.1331+1G>A variant to her daughter. Conclusion This study strengthens the evidence that loss-of-function variants in the MARVELD2 gene can cause profound sensorineural hearing loss. Testing for the MARVELD2 gene is significant for screening, diagnosing, and providing prenatal genetic counseling for deafness.

Through the orbit with sinus huge foreign bodies embedded in the base of the skull: a case report and literature review

GUO Rongchang, LIU Qinghang, WANG Hongzeng, SUN Shujun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  135-141.  doi:10.6040/j.issn.1673-3770.0.2023.486

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Objective To explore the clinical diagnosis and treatment plan for traumatic foreign bodies in the nasal cavity and paranasal sinuses, in order to avoid clinical misdiagnosis or missed diagnosis, and to provide a clinical reference for the treatment of traumatic foreign bodies in the nasal cavity and paranasal sinuses. Methods A retrospective analysis was performed on the clinical data of a patient with giant nasal eye penetration and skull base entrapment foreign body injury, and relevant literature on foreign bodies in the nasal cavity and paranasal sinuses was reviewed. Results Based on the patient's history and CT examination, the foreign body in the paranasal sinus and the orbital penetration injury were confirmed. The foreign body was successfully removed by nasal endoscopy combined with external eye approach during surgery, and the patient recovered well after surgery. Conclusion Foreign bodies in the nasal cavity and paranasal sinuses are common emergencies in the otolaryngology department. Some foreign bodies in the nasal cavity and paranasal sinuses caused by trauma often bring difficulties in clinical diagnosis and treatment. Detailed history taking, imaging examination and nasal endoscopic examination can provide the basis for diagnosis to avoid misdiagnosis or missed diagnosis. Surgeons must choose surgical techniques flexibly according to specific circumstances, among which endoscopic nasal surgery has gradually become the preferred treatment method.

The effect of environmental and meteorological factors on the outbreak of acute epiglottitis and tonsillitis in downtown Yangzhou

LIU Di, WANG Zhenzhen, GUAN Bing, ZHU Bing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  142-150.  doi:10.6040/j.issn.1673-3770.0.2024.435

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Objective To study the relationship between environmental and meteorological factors and the incidence of acute epiglottitis and tonsillitis in downtown Yangzhou, and to provide a basis for clinical prevention. Methods A retrospective study was conducted on patients with acute epiglottitis and tonsillitis admitted to the Northern Jiangsu People's Hospital from January 1, 2014 to December 31, 2022. Air pollutant concentration data from the National Urban Air Quality Real-Time Publishing Platform and meteorological data from the United States National Centers for Environmental Information(NCEI)were collected. Group differences were compared using the Kruskal-Wallis H test with Bonferroni correction for pairwise comparisons. The Spearman correlation coefficient was used to analyze the correlation between environmental-meteorological factors and the incidence of acute epiglottitis and tonsillitis, followed by linear regression to identify the environmental risk factors for acute epiglottitis and tonsillitis. Results A total of 1,256 patients with acute epiglottitis were enrolled from 2014 to 2022, with cases occurring predominantly in spring and a higher prevalence in males ［(53.15±5.90)years］. A significant positive correlation was observed between the onset of acute epiglottitis and PM₁₀, SO₂, CO, O₃, and wind speed(P<0.05). Linear regression analysis showed that season, CO and O₃ significantly influenced the onset of acute epiglottitis(P<0.05). Seasonal analysis showed: Spring: positive correlation with SO₂ and temperature difference. Summer: Positive correlation with SO₂, CO and NO₂. Fall: Positive correlation with SO₂ and CO, but negative correlation with temperature difference. Winter: positive correlation with PM_2.5, PM₁₀, SO₂ and CO. A total of 65,272 patients with acute tonsillitis were included, mainly in summer with male predominance(mean age: 22.46±3.72 years). Positive correlations were found with PM_2.5, PM₁₀, SO₂, NO₂, CO, wind speed and precipitation, whereas a negative correlation was observed with temperature difference(P<0.05 ). Through linear regression analysis, the effects of temperature difference, NO₂ and wind speed on the onset of acute tonsillitis are statistically significant(P<0.05 ). Conclusion In downtown Yangzhou, acute epiglottitis occurs predominantly in the spring and disproportionately affects the middle-aged and elderly population, while acute tonsillitis occurs in the summer, especially among the young. Both diseases have a male predominance. Environmental and meteorological factors are significantly associated with the onset of acute epiglottitis and tonsillitis. It suggests that we need to prevent the impact of environmental and meteorological factors on acute epiglottitis and tonsillitis in our daily lives.

Bioinformatic analysis of miRNA-mRNA network involved in thyroid function impairment by high-fat diet

DOU Tao, DOU Naixin, WANG Ru, YANG Qian, GUAN Qingbo, WANG Lei, YU Chunxiao

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  151-160.  doi:10.6040/j.issn.1673-3770.0.2024.161

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Objective To analyze the miRNA-mRNA regulatory network involved in high-fat diet-induced damage to thyroid function using bioinformatics methods, and to provide new targets for early intervention in lipid toxicity-induced thyroid dysfunction. Methods Rats were fed a high-fat diet for 8 weeks to establish a model of thyroid function damage, with a normal diet group as control. Agilent chips were used to detect thyroid miRNA and mRNA expression, and the “limma” package in RStudio was used to screen for differentially expressed miRNA and mRNA. The miRwalk was used to predict potential downstream target genes regulated by differentially expressed miRNA. The predicted target genes and differentially expressed mRNA were intersected using weishengxin websites to establish a differential miRNA-mRNA network. Gene ontology(GO)annotation and kyoto encyclopedia of genes and genomes(KEGG)pathway analysis of the intersected mRNA were performed using the Metascape website. protein-protein interaction(PPI)analysis was conducted using the String online platform, and the PPI network hub was visualized using Cytoscape,hub genes were selected using the CytoNCA plugin in Cytoscape. A potential miRNA-mRNA network affecting thyroid function due to high-fat diet was established based on the selected hub genes. Results 27 upregulated and 6 downregulated miRNAs, 775 upregulated and 543 downregulated mRNAs were screened, with 301 overlapping mRNAs between downregulated miRNA targets and upregulated mRNAs, and 278 overlapping mRNAs between upregulated miRNA targets and downregulated mRNAs, resulting in 491 and 777 miRNA-mRNA pairs, respectively. GO and KEGG analysis revealed that differential mRNAs were enriched in pathways related to thyroid hormone synthesis and cell proliferation. Further screening identified 10 hub genes including Src, Pebp1, Il1b, Plcg1, Igf1, etc. A key miRNA-mRNA regulatory network was established based on these hub genes, including regulatory pairs such as miR-3473/Src、miR-339-3p/Igf1、miR-674-5p/Igf1、miR-339-3p/Ntrk2、miR-99b-3p/Ntrk2. Conclusion The miRNA and mRNA, such as miR-3473、Igf1 and Ntrk2 may be involved in high-fat diet-induced damage to thyroid function.

Comparison of safety and efficacy between transaxillary endoscopic thyroidectomy and conventional open thyroidectomy for Stage T1 thyroid carcinoma

ZHANG Zhonghua, WANG Hui, WANG Junxin, ZHANG Meiling, ZHANG Jian, ZHANG Endong, PAN Xinliang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  161-167.  doi:10.6040/j.issn.1673-3770.0.2025.100

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Objective The objective of this study is to compare the safety and efficacy of transaxillary non-inflatable endoscopic thyroidectomy versus conventional open thyroidectomy in the treatment of stage T1 thyroid carcinoma. Methods A retrospective analysis was performed on 50 patients who underwent transaxillary non-inflatable endoscopic thyroidectomy(experimental group)and 50 patients who received conventional open thyroidectomy(control group). Patients were selected from cases of stage T1 thyroid carcinoma between July 16, 2022 and July 16, 2024. Using propensity score matching(1∶1 ratio)based on gender, age, body mass index, tumor size, and tumor location. Comparison of operative outcomes between the two groups included: operative time, intraoperative blood loss, number of lymph nodes harvested, positive lymph nodes detection rate, postoperative hospitalization time, hospitalization costs, postoperative neck pain(assessed by VRS-5), complication rates, and neck cosmetic satisfaction. Results The operation time, hospitalization costs and satisfaction with the neck appearance of the experimental group were significantly higher than those of the control group, and the differences were statistically significant(both P<0.05). The experimental group showed significantly lower postoperative neck pain intensity compared to the control group, with a statistically significant difference(Z=-4.22, P<0.001). No statistically significant differences were observed in intraoperative blood loss, number of lymph nodes harvested, positive lymph nodes detection rate, postoperative hospitalization time, or complication rates(both P>0.05). During follow-up(6-24 months), no tumor recurrence occurred in either group. Conclusion Transaxillary non-inflatable endoscopic thyroidectomy has been shown to provide an effective radical treatment for stage T1 thyroid carcinoma. In comparison with the conventional open thyroidectomy, this approach has been shown to yield superior cosmetic outcomes, significantly reduce postoperative neck pain, and may enhance patients' quality of life.

Analysis of the reasons and prognostic outcomes for tracheostomy in pediatric patients following posterior fossa tumor resection

WANG Hua, ZHANG Fengzhen, LONG Ting, ZHAO Jing, LI Hongbin, WANG Shengcai, WANG Guixiang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  168-173.  doi:10.6040/j.issn.1673-3770.0.2025.028

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Objective This study aims to explore the clinical characteristics and outcomes of children who underwent tracheostomy after posterior cranial fossa tumor resection. Methods A retrospective analysis was conducted on 26 pediatric cases that underwent tracheostomy due to posterior fossa tumors. The following data were collected and analyzed: basic patient information, postoperative intubation duration, postoperative respiratory and swallowing conditions, tracheotomy indications, tracheotomy complications, and tracheotomy duration. Patients were observed for at least one year, with follow-ups conducted in outpatient settings or via telephone. Results This study included a total of 26 patients, consisting of 19 males and 7 females. The patients’ ages of the patients ranged from 1 to 13 years old, with an average age of(4.60±3.08)years. The tumor locations were as follows: the fourth ventricle/vermis of the cerebellum in 15 cases, the medulla oblongata and brainstem in 7 cases, the pons in 2 cases, the jugular foramen area in 1 case, and the cerebellar hemisphere in 1 case. Postoperative pathology results were as follows: astrocytoma in 6 cases, ependymoma in 8 cases, meningioma 1 case, craniopharyngioma 1 case, lipoma 1 case, and medulloblastoma in 9 cases. The tracheotomy operation was performed in 25 children for the purpose of persistent mechanical ventilation. The average duration of anesthetic intubation was 14 days. One child was extubated post-surgically but subsequently underwent tracheotomy one month after the operation due to breathing difficulties. Of the 26 patients, two were lost to follow-up, two died, thirteen underwent decannulation, and nine did not. The mean duration of tracheotomy tube usage was 7.8 months. Thirteen children received nasal feeding due to swallowing problems. There were two cases of left vocal cord paralysis, two cases of right vocal cord paralysis, and four cases of bilateral vocal cord paralysis. No patient experienced complications within a period of two weeks following their tracheotomy surgery. Following-decannulation, there were no complications related to tracheal stenosis or tracheomalacia. Conclusion The safety and efficacy of tracheotomy in children diagnosed with posterior cranial nerve dysfunction following surgical intervention for posterior cranial fossa tumors has been well-documented. Children who undergo tracheotomy after posterior cranial fossa tumor surgery require regular evaluation for respiratory and swallowing recovery. The timing of decannulation should be determined based on the individual situation of the child.

The study on the accuracy of TORIC IOL axis examination and its influencing factors using OPD Overview mode

ZHOU Weiwei, LIU Zhen, ZHANG Yi, LIU Hanjing, ZHU Yan, ZHU Yuguang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  174-180.  doi:10.6040/j.issn.1673-3770.0.2024.106

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Objective To study the accuracy of Toric IOL axial position examination with the OPD Scan Ⅲ Overview mode after the implantation of Toric IOL, and analyze the factors affecting the measurement accuracy of Toric IOL axial position. Method Petrospective cohort study. From November 2021 to November 2022, a total of 100 patients(100 eyes)who underwent phacoemulsification combined with TECNIS Toric IOL(AMO)implantation in our hospital were selected. The patients were followed up with residual corneal astigmatism examination 1 day, 1 week and 1 month after the operation. The axial position of Toric IOL was measured with the OPD overview mode, the mydriatic OPD overview mode, the OPD Toric mode and the slit-lamp method. Based on the measurement results in the OPD Toric mode, the differences and consistency of the measurement results of the 4 methods were analyzed. To analyze the accuracy of TORIC IOL axis examination according to IOL axial position deviation(APD), the OPD data of patients with a large IOL APD(APD>5°)and those with an accurate IOL APD(APD≤3°)were selected for comparisons such as the photopic pupil diameter(Photopic), the mesopic pupil diameter(Mesopic), the photopic Kappa angle(PDist), the mesopic Kappa angle(MDist), the distance from the mesopic pupil center to the photopic pupil center(MPDist)and so on. Results The residual astigmatism of the patients was significantly lower than that before the surgeries at 1 day, 1 week and 1 month after the operation(P<0.05). The results showed that the absolute values of the axial deviation of Toric IOL measured with OPD Overview mode, OPD Toric mode and slit lamp method were 2.37±2.21°, 0° and 0.74±0.64°, respectively, with high accuracy and consistency. The absolute value of the axial deviation in the mydriatic OPD overview mode was 4.34±3.98°, which was significantly different from that in the other three modes. The differences of the IOL axial position measurement were statistically significant with the OPD Overview mode, the mydriatic OPD Overview mode, the OPD Toric mode and the slit-lamp mode(Z=104.97, P<0.001). There were no statistically significant differences between OPD Overview mode and OPD Toric mode, OPD Overview mode and slit lamp method, and OPD Toric method and slit lamp method(P>0.05). There was a positive correlation between the APD and PDist(Photopic Kappa angle)(r=0.135, P=0.034).There was no significant correlation between APD and the Photopic pupil diameter(Photopic), Mesopic pupil diameter(Mesopic), MDist and MPDist(P>0.05). Conclusion The OPD Overview mode was an objective and accurate IOL axial position measurement method with certain application value in ophthalmology. PDist is one of the factors affecting the APD measurement with the OPD Overview mode.

Risk factors for epiretinal membrane formation following pars plana vitrectomy for rhegmatogenous retinal detachment

WANG Huanxia, WANG Shuya, WANG Ying, SUN Xuan, HUANG Jie, WANG Xingrong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  181-185.  doi:10.6040/j.issn.1673-3770.0.2024.370

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Objective To analyze the influencing factors of epiretinal membrane formation after pars plana vitrectomy for primary rhegmatogenous retinal detachment(RRD). Methods A total of 109 patients(109 eyes)who underwent vitrectomy for rhegmatogenous retinal detachment(RRD)were included. Based on the postoperative occurrence of secondary epiretinal membrane(ERM), they were divided into two groups: the secondary ERM group(12 patients, 12 eyes)and the non-secondary ERM group(97 patients, 97 eyes). After 6 months of postoperative follow-up, the age, lens status, retinal hiatus, retinal detachment involved in macular area, PVR grade, vitreous hematoma, intraoperative fillings and laser number were compared between the two groups, and the influencing factors on the formation of macular anterior membrane were analyzed by binary Logistic regression. Results The incidence of epiretinal membrane after pars plana vitrectomy for RRD was 11.01%. There were statistically significant differences in the lens status and PVR grade between the two groups(χ2=11.608, P=0.001; χ2=14.492, P=0.001). The results of binary Logistic regression analysis showed that lens status and PVR C grade were influencing factors for postoperative epiretinal membrane(OR=0.074, 95%CI: 0.008~0.670, P=0.021; OR=0.018, 95%CI: 0.001~0.503, P=0.018). Conclusion Aphakic eye, intraocular lens eye, and PVR C grade were risk factors for postoperative epiretinal membrane.

Review

Research status and progress in diagnosis and treatment of laryngeal inflammatory myofibroblastic tumor

SHI Jinlian, LI Jianxing, HUANG Yousheng, LIN Mingxuan, LIU Lingyun, LU Yongtian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  186-192.  doi:10.6040/j.issn.1673-3770.0.2024.297

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Inflammatory myofibroblastic tumor(IMT)is a rare mesenchymal neoplasm that occurs predominantly in the lung, with laryngeal involvement being relatively rare. Clinical manifestations of laryngeal IMT typically include hoarseness and breathing difficulties, which, due to their non-specific nature, often lead to misdiagnoses as other laryngeal conditions. Pathologically, laryngeal IMT is predominantly composed of inflammatory cells such as giant cells, plasma cells, and lymphocytes, together with spindle-shaped tumor cells that exhibit phenotypes of smooth muscle cells or myofibroblasts. These cells are interspersed with varying degrees of cell density and vascular distribution. The definitive diagnosis of laryngeal IMT is based on a combination of imaging studies, pathological evaluation, and immunohistochemical testing.Surgical excision remains the treatment of choice for laryngeal IMT. For cases where surgery is not feasible or there is recurrence or metastasis, targeted therapies, such as ALK inhibitors, have shown potential benefits. Tumor size, staging, and extent of surgical resection are important prognostic factors. This article reviews recent research advancements in the pathogenesis, clinical characteristics, diagnostic methods, and treatment strategies for laryngeal IMT, with the aim of improving the precision of diagnosis and effectiveness of treatments for this condition.

Tonsillar microbiota of children, immune regulation and diseases

YUE Bingyan, ZOU Jian, LEI Lei, WEN Qiao, QIAN Yingxue

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(4):  193-200.  doi:10.6040/j.issn.1673-3770.0.2025.230

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The dynamic balance and diversity of the tonsillar microbiota constitute a core component of the upper respiratory immune defense system in children. Therefore, in-depth analysis of the composition and functions of the tonsillar microbiota is imperative for maintaining optimal pediatric health. Traditional culture techniques can detect a limited range of pathogenic bacteria, but are inherently restricted by the spectrum of culturable microorganisms. In contrast, 16S rRNA gene sequencing has the potential to overcome these limitations, offering a novel and comprehensive perspective for profiling the microbiota.This article systematically reviews the current advances in detection technologies, characteristics of core microbial communities, genetic and environmental influencing factors, causal relationships between microbiota dysbiosis and disease, and clinical intervention strategies based on microbiota modulation in pediatric tonsils. This review aims to provide a theoretical basis for the precision diagnosis, treatment, and health management of pediatric tonsillar diseases, and to guide future research into the interaction mechanisms between the tonsillar microbiota and host immunity.