Table of Content

20 November 2025 Volume 39 Issue 6

  

Lateral Skull Base Surgery Cross-Disciplinary Integration

Features and treatment of lateral skull base dural arteriovenous fistulae

CHAO Bo, SU Youle, GUO Ruoyu, FU Jiayue, LYU Xianli

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  1-7.  doi:10.6040/j.issn.1673-3770.0.2024.415

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As a rare type of intracranial vascular malformation, lateral skull base dural arteriovenous fistula(DAVF)has a unique anatomical location and complex hemodynamic characteristics, which makes its clinical manifestations diverse and its treatment difficult. In this study, we retrospectively analyzed the literature reports and clinical cases of lateral skull base DAVF at home and abroad in recent years, and systematically summarized the characteristics of this disease in terms of imaging manifestations, hemodynamic changes, clinical symptoms, and other aspects. On this basis, the indications, operation techniques and efficacy assessment of endovascular intervention were discussed, aiming to provide a scientific basis for clinical decision-making. It also provides ideas and directions for future basic research and clinical treatment innovation of lateral skull base DAVF.

Subtotal resection of facial nerve schwannoma with preservation of facial nerve function

GAO Juanjuan, XU Jia, CHEN Wenjing, LIANG Sichao, GUO Zhenping, CHEN Junyan, GUO Xiang, YI haijin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  8-16.  doi:10.6040/j.issn.1673-3770.0.2024.434

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Objective The present study aims to investigate the indications of subtotal resection of facial nerve schwannoma with facial nerve-preserving surgery for patients with mild facial nerve paralysis(HB Ⅰ-Ⅱ)and obvious accompanied symptoms. Methods A retrospective analysis of the clinical data of three cases of facial nerve schwannoma that underwent subtotal resection with facial nerve-preserving surgery was conducted. The analysis encompassed the clinical manifestations, auxiliary examinations, operative approaches, and postoperative prognoses. Results Of the three patients, one exhibited facial nerve function of HB Ⅱ prior to surgery, while the other two demonstrated normal facial nerve function preoperatively. Preoperative imaging findings demonstrated that the mass had grown along the course of the facial nerve. Among the patients, one individual exhibited no symptoms of facial palsy prior to surgery, yet EMG results indicated facial nerve impairment. Subtotal resection of the facial nerve schwannoma was performed under intraoperative facial nerve electrophysiological monitoring. Post-operative observations revealed that the function of the facial nerve had been well preserved. Furthermore, no significant changes to facial nerve function were observed in the immediate post-surgical period. Furthermore, no substantial alterations in facial nerve function were detected during the extended follow-up period of up to three years. Conclusion For patients with facial nerve schwannoma, if the patient's facial nerve function is graded HB Ⅱ or better at the time of surgery, and the patient has strong desire to preserve facial nerve function, then subtotal resection of the facial nerve schwannoma can be contemplated, with this being performed under electrophysiological monitoring during surgery.

Clinical diagnosis and treatment features of 18 cases of necrotizing otitis externa

LI Zan, LU Qi, SHEN Weidong, HOU Zhaohui, WU Nan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  17-22.  doi:10.6040/j.issn.1673-3770.0.2024.444

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Objective To explore the diagnosis and treatment features of necrotizing otitis externa. Methods We retrospectively analyzed the clinical data of 18 patients(20 ears)with necrotizing otitis externa including clinical features, diagnosis, treatment and prognosis. Results Among the 18 patients, 10 were male and 8 were female, with unilateral onset in 16 cases and bilateral onset in 2 cases. Typical clinical features were ear pain, otorrhea and hearing loss. Four cases developed facial paralysis of varying degrees. Imaging examinations indicated bone destruction of the external auditory canal in 15 cases, and extensive involvement of the skull base was observed in 4 severe cases. The clinical staging was based on clinical manifestations and imaging features. This group of cases included 14 cased of Kraus stage Ⅰ, 2 cases of Kraus stage Ⅱ and 2 cases of Kraus stage Ⅲ. 12 patients were treated by medication and 6 patients underwent surgical management. The anti-infective therapy was continued for 2 months after the patients discharge from the hospital and followed up for more than 1 year. One case recurred after 10 months, another one recurred in the contralateral ear after 6 months and a patient passed away 5 months later, while the rest of patients recovered successfully. Conclusion Necrotizing otitis externa should be actively treated with comorbidities. The main treatment is anti-infection. For those who have been treated with unsatisfactory results, serious conditions or severe complications, timely surgical intervention is recommended. A good prognosis can mostly be achieved, while those with skull base or intracranial involvement have a poor prognosis.

Original Article

Diagnosis and treatment of chronic suppurative otitis media combined with fungal infection of the external auditory canal

LI Kang, LI Xuanyi, LIU Wen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  23-30.  doi:10.6040/j.issn.1673-3770.0.2024.077

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Objective Conduct a comparative analysis of the precision between pathogen culture and smear microscopy for the diagnosis of chronic suppurative otitis media combined with fungal infections of the external auditory canal. This study also aims to evaluate the therapeutic efficacy of triamcinolone acetonide and econazole nitrate cream, evaluate the safety of its application in patients with perforation of the tympanic membrane, and the results of tympanic membrane repair and surgery after control of fungal infections. Methods A total of 44 patients diagnosed with chronic suppurative otitis media with tympanic membrane perforation combined with fungal infection of the external auditory canal were included in this study. Pathogenic bacteria culture and smear microscopy were performed to compare the positivity rate of the two diagnostic methods, and pure tone audiometry was also performed to evaluate hearing levels. After treatment with triamcinolone acetonide and econazole nitrate cream, smear microscopy and pure tone audiometry were repeated to assess the effect of treatment. The control group was divided into a fungal group and a control group according to whether they were infected or not with fungi. The control group consisted of 35 patients with chronic suppurative otitis media who underwent endoscopic repair of the tympanic membrane. For the 35 cases of patients with chronic suppurative otitis media who underwent otoscopic repair of the tympanic membrane, the fungal group performed 32 cases of otoscopic repair of the tympanic membrane after negative microscopic examination, comparing the healing rate of the tympanic membrane, healing time, dry ear time, and hearing between the two groups. Results The positive rate of fungal infection detected by pathogenic bacteria culture was 73.7%, of which common fungal species included Aspergillus and filamentous fungi, combined with bacterial infection(26.3%). The positive rate of smear microscopy was 77.5% and the difference between the positive rates of the two methods of examination was not statistically significant(P=0.695). After treatment with the application of triamcinolone acetonide and econazole nitrate cream, the patients' fungi were completely controlled by otoscopic examination and smear microscopy, the smear microscopy was negative and the difference in the results of pure tone audiometry before and after treatment was not statistically significant(P<0.001). The repair of the tympanic membrane was performed after the fungal infection was controlled and there were no statistically significant differences in the healing rate of the tympanic membrane(P>0.999), the healing time(P=0.593)and the dry ear time(P=0.945)between the two groups compared to the simple perforation group. Conclusion Smear microscopy and pathogenic bacteria culture have a high positive rate. Triamcinolone acetonide and econazole nitrate cream are effective in treating patients with tympanic membrane perforation combined with fungal infection of the external auditory canal without significant ototoxicity. The success rate of tympanic membrane repair surgery in patients did not change significantly after control of fungal infection.

Preliminary study on neurotransmitter levels in the anterior cingulate cortex and their relationship with hearing levels in patients with age-related hearing loss

TAO Duoduo, SHI Bin, ZHAO Yunshu, LI Yonggang, LIU Jisheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  31-39.  doi:10.6040/j.issn.1673-3770.0.2024.242

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Objective This study aims to explore whether ARHL is related to the ACC from the perspective of neurotransmitter levels, thereby providing experimental evidence for understanding the mechanisms of ARHL. Methods The study included 8 ARHL patients, 8 age-matched, gender-matched normal hearing(NH)elderly individuals were recruited as the control group. Pure-tone audiometry was used to assess the hearing levels of all subjects at 0.25, 0.5, 1, 2, 4, and 8 kHz. Magnetic resonance spectroscopy(MRS)was employed to measure γ-aminobutyric acid(GABA)and glutamine-glutamate(Glx)levels in the ACC of both groups. Data were statistically analyzed using SPSS v27.0. Results Compared to the NH group, the ARHL group showed significantly lower GABA levels(P=0.021)and significantly higher Glx levels(P<0.001). GABA levels were significantly negatively correlated with 8 kHz pure-tone thresholds(P=0.014), and Glx levels were significantly positively correlated with pure-tone thresholds at 0.5, 1, 2, 4, and 8 kHz(all P<0.05). Conclusion Neurotransmitter dysregulation in the ACC of ARHL patients is associated with the degree and frequency of hearing loss, which may provide a theoretical basis for future research on the mechanisms underlying ARHL.

Exploring the clinical implications of normal VOR gain with refixation saccades in lateral canal

MA Xiaobao, SHEN Jiali, YANG Jun, CHEN Jianyong, ZHU Songhuan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  40-45.  doi:10.6040/j.issn.1673-3770.0.2024.441

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Objective By comparing the results of video Head Impulse Test(vHIT)and caloric test(CT), to study the clinical significance of refixation saccade(RS)waves in the horizontal semicircular canals and provide reference for clinical diagnosis. Methods Three groups of data were randomly selected from the database: normal vHIT, without RS without VOR gain reduction(83 cases); RS vHIT, with RS without VOR gain reduction(81 cases); abnormal vHIT, with RS with VOR gain reduction(54 cases). The abnormality rates of the three groups of the CT were compared respectively. In addition, two groups of data were randomly selected from the database, group A was normal CT(91 cases), group B was abnormal CT, a total of 125 cases; and the incidence of RS without VOR gain reduction in vHIT was compared respectively. Results The CT abnormality rates of normal vHIT, RS vHIT and abnormal vHIT were 28.92%, 50.62% and 94.44%, respectively, and the differences between the two comparisons of the three groups were statistically significant(P=0.015,P<0.001 and P<0.001). The incidence rates of vHIT RS without VOR gain reduction in group A and group B were 34.07% and 32.80% respectively, and the difference was not statistically significant(P=0.845). Conclusion The appearance of RS during the horizontal semicircular canals vHIT test, without VOR gain reduction, can serve as an important indication for supplementing the CT or other vestibular function assessments. This approach allows for a comprehensive and detailed evaluation of the patient's vestibular function.

Correlation between aromatase and estrogen receptor expression in the primary auditory cortex of mice at different developmental stages and hearing ability

TANG Xi, HUANG Maoling, ZHANG Jiqiang, ZHONG Cheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  46-53.  doi:10.6040/j.issn.1673-3770.0.2024.517

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Objective To investigate the expression and potential regulatory roles of aromatase(AROM)and three estrogen receptors(ERs)—estrogen receptor alpha(ERα), estrogen receptor beta(ERβ), and G protein-coupled receptor 30(GPR30)—in the primary auditory cortex(A1)during auditory development. Methods Male C57BL/6J mice at different postnatal stages—postnatal day 7(P7), P14, P21, P30, and P60-were selected. Auditory thresholds were measured by auditory brainstem response(ABR), and qRT-PCR, Western bloting, and immunohistochemistry were performed to examine the expression changes of AROM and ERs in the A1. Spearman correlation analysis was conducted between expression levels and hearing thresholds. Results ABR thresholds decreased significantly from P14 onward(P<0.05), reaching maturity at P30. qPCR revealed that the expression of AROM, GPR30, and ERβ increased with age(P<0.05)while ERα peaked at P30(P<0.05). Protein levels(Western bloting and immunohistochemistry)confirmed a significant developmental increase in AROM and ERs expression(P<0.05). Spearman correlation analysis showed strong correlations between the developmental changes in hearing thresholds and the expression of AROM(∣r_s∣=0.75)and ERβ(∣r_s∣=0.72), a weak correlation with GPR30(∣r_s∣=0.64), and no significant correlation with ERα. Conclusion Postnatal auditory development in mice progressively matures, accompanied by increasing expression levels of AROM, GPR30, and ERβ in the A1. The AROM-GPR30/ERβ axis is suggested to potentially facilitate the establishment and maturation of auditory function in mice.

Bibliometric analysis of biologic agents for the treatment of chronic rhinosinusitis based on the Web of Science database

LI Yangsong, YUAN Fayang, YANG Yan, ZHANG Tian, YU Guodong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  54-64.  doi:10.6040/j.issn.1673-3770.0.2024.021

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Objective Through bibliometric analysis, this paper discussed the research status, hotspots, and development trends of biological agents in the treatment of chronic rhinosinusitis to provide a reference for research in this field. Methods Relevant literatures on the treatment of chronic rhinosinusitis with biological agents from 2004 to 2023 were retrieved from the Web of Science core collection database were retrieved. Using CiteSpace and VOSviewer software, the included literature was analyzed by country/region, institution, author, keyword, journal, and literature co-citation. Results A total of 761 articles were included, and the total number of articles was increasing. The countries, institutions and authors with the highest number of publications were the United States, Ghent University and Bachert C. The top journals in this field are International Forum of Allergy & Rhinology and Journal of Allergy And Clinical Immunology-InPractice; the research hotspots mainly focus on the application of biological agents in chronic rhinosinusitis with nasal polyps and asthma, as well as the pathophysiology of chronic rhinosinusitis; the research frontiers mainly focus on dupilumab and mepolizumab. Conclusion The curative effect of biological agents in the treatment of chronic rhinosinusitis is clear, which has gradually attracted the attention of scholars and has a good prospect of application.

Endoscopic correction of caudal septal cartilage deviation:clinical outcome analysis

LI Shuai, HUANG Chunyan, CHANG Mingzhang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  65-70.  doi:10.6040/j.issn.1673-3770.0.2024.069

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Objective Explore the surgical method and efficacy of endoscopic correction of caudal septal cartilage deviation. Methods A retrospective analysis of 26 patients with septal cartilage deviation admitted were performed. Patients underwent endoscopic retension-fastening of the caudal septal cartilage for correction. Nasal endoscopy, Nasal congestion VAS score and SNOT-20 score were performed before surgery, one month after surgery and one year after surgery. Results None of the 26 patients had serious complications. One month and one year after surgery, 22 patients had a centered septum and 4 patients had a nearly centered septum. Nasal congestion VAS score and SNOT-20 score showed a significant decrease 1 year after surgery compared to before surgery(P<0.01). Conclusion Endoscopic retension-fastening of the caudal septal cartilage is an effective surgical method for the treatment of cartilage caudal deviation, which can improve the quality of life of patients.

Effect of interleukin-13 receptor-α2 on nasal mucosal remodeling in rats with allergic rhinitis by TGF-β1/Smad signaling pathway

QIN Nana, LI Yufen, SUN Yuhao, WEI Jian, LI Qin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  71-77.  doi:10.6040/j.issn.1673-3770.0.2024.152

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Objective To investigate the effect of interleukin-13 receptor α2(sIL-13Rα2)on nasal mucosal remodeling in rats with allergic rhinitis(AR)and its possible mechanism. Methods Rats were divided into AR model group, sIL-13Rα2 treatment group and control group by random number table method, 10 rats in each group. After constructing the Wistar rat AR model with ovalbumin and aluminum hydroxide in the AR model group and sIL-13Rα2-treated group of rats, 50 μL of phosphate buffer and 50 μL of sIL-13Rα2(100 μg)were dripped into the nasal cavity on each side of each rat from the 4 th to the 12th week, respectively, twice a week.Nasal mucosa tissues of rats were taken 24 h after the end of the last drop, and were stained with hematoxylin-eosin staining to observe the pathological changes. Reverse Transcription-Polymerase Chain Reaction was used to detect the levels of TGF-β1, Smad2, Smad3 and Smad7 mRNA in the nasal mucosa tissues of rats in each group, and Western blot was used to detect the expression of TGF-β1, Smad2, Smad3 and Smad7 proteins. Results The nasal mucosa of rats in AR model group was swelled, basement membrane thickened, epithelial cells arranged disorderly, interstitial edema, and infiltration of a large number of inflammatory cells, whereas the above inflammatory changes were significantly reduced in sIL-13Rα2 group rats. The intensity of TGF-β1, Smad2 and Smad3 mRNA expression in the nasal mucosa of sIL-13Rα2 group rats was significantly lower than that of AR model group rats(P<0.001, P<0.001, P<0.001).The intensity of Smad7mRNA expression in the nasal mucosa tissue of sIL-13Rα2 group was significantly higher than that of AR model group(P<0.001). The protein expression of TGF-β1, Smad2, and Smad3 in the nasal mucosal tissues of rats in the sIL-13Rα2 treatment group was significantly lower than that in the AR model group(P<0.05, P<0.001, P<0.001). The protein expression of Smad7 in the nasal mucosal tissues of rats in the sIL-13Rα2 treatment group was significantly higher than that in the AR model group(P<0.01). Conclusion Instillation of IL-13Rα2 into nasal cavity can significantly reduce the remodeling of nasal mucosa in AR rats by inhibiting the overexpression of TGF-β1, Smad2 and Smad3 and up-regulating the expression of Smad7 in nasal mucosa.

Construction and validation of risk prediction model for nasal septal deviation complicated with chronic sinusitis

DU Kangli, ZHENG Zhenyu, XU Zhanjiang, ZHANG Yu, CHEN Lu, LU Mengyao

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  78-86.  doi:10.6040/j.issn.1673-3770.0.2024.536

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Objective Nasal septal deviation(NSD)and chronic rhinosinusitis(CRS)are two common otolaryngology conditions. While existing research has primarily focused on analyzing their correlation, there is a lack of predictive tools to guide clinical decision-making. This study analyzed patients' clinical and imaging data to develop a highly accurate and interpretable predictive tool, and provide novel, evidence-based support for personalized interventions, Using traditional logistic regression, we constructed a risk prediction model and performed internal validation. Methods A total of 310 patients diagnosed with NSD between October 1,2022, and June 1,2024, were enrolled in the study, and their clinical data was collected. After preprocessing the data, 285 patients were included in the analysis and randomly assigned to a training set(199 cases, or 70%)and a validation set(86 cases, or 30%)in a 7∶3 ratio. Independent risk factors were identified through logistic regression analysis, and based on these results, a nomogram risk prediction model was constructed. The model's performance was then evaluated using a receiver operating characteristic(ROC)curve, a calibration plot(with bootstrapping), and a decision curve analysis(DCA). Results In the training set, the area under the ROC curve(AUC)was 0.760(95% confidence interval ［CI］): 0.686-0.834). In the validation set, the AUC was 0.800(95% CI: 0.689-0.911). The mean absolute error(MAE)for the calibration plots was 0.017 in the training set and 0.015 in the validation set. Decision curve analysis(DCA)showed that the model has potential clinical utility. Conclusion Age, history of allergic rhinitis, degree of septal deviation, and location of deviation were identified as independent risk factors for concurrent CRS in NSD patients. The nomogram prediction model developed, which is based on these factors, can be used to identify high-risk patients with NSD complicated by CRS in clinical practice.

Application of narrow band imaging endoscopy combined with voice acoustic analysis in the differential diagnosis of vocal cord leukoplakia

LIU Ziqi, HUANG Jiali, WANG Liqin, CHEN Xi, ZHANG Liqing, ZHOU Han

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  87-96.  doi:10.6040/j.issn.1673-3770.0.2024.003

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Objective To explore the application value of narrow band imaging(NBI)endoscopy combined with computerised voice acoustic analysis in the differential diagnosis of benign and malignant vocal cord leukoplakia. Methods Related clinical data of 49 patients with vocal cord leukoplakia were collected, including age, smoking, alcohol consumption, values of reflux symptom index(RSI)and reflux findings score(RFS), side, range, and anterior commissure involvement of the vocal cord. 49 patients were divided into benign and malignant groups separately according to the endoscopic and histopathological diagnosis of NBI,and then their vocal acoustic indexes were statistically analysed. Logistic regression and receiver operating characteristic curve(ROC)analysis were used to further assess the value of narrow band imaging endoscopy combined with voice acoustic analysis in the differential diagnosis between benign and malignant vocal cord leukoplakia. Results One-way ANOVA showed that jitter, shimmer and MPT in voice acoustic analysis were both statistically significant(P<0.05)in the comparison between benign and malignant groups under NBI endoscopy and histopathological diagnosis separately, and DSI was statistically significant(P<0.05)under histopathological diagnosis. Binary logistic regression analysis revealed that jitter and shimmer were independent risk factors affecting benign and malignant vocal cord leukoplakia whereby the receiver operating characteristic curve was constructed. The area under ROC curve(AUC)of NBI, jitter and shimmer was 0.836, 0.739 and 0.743, respectively, all of which had moderate diagnostic value for malignant vocal cord leukoplakia(0.7<AUC≤0.9). The diagnostic thresholds for jitter and Shimmer were 0.605 and 15.835, respectively. The area under the curve of NBI combined with jitter and shimmer was 0.942(AUC>0.9;95%=0.72-0.96). Conclusion Computerised voice acoustic analysis jitter and shimmer are sensitive indicators to predict the nature of vocal cord leukoplakia. Combining voice acoustic analysis with NBI endoscopy can improve the diagnostic efficiency of benign and malignant vocal cord leukoplakia and reduce the missed diagnosis of malignant vocal cord leukoplakia.

Autophagy-related long noncoding RNA is a prognostic indicator for head and neck squamous cell carcinoma

PAN Linlin, WAN Jiaming, LI Yue, HE Long

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  97-107.  doi:10.6040/j.issn.1673-3770.0.2024.149

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Objective To investigate the potential relationship between autophagy-associated long non-coding RNA(LncRNA)and prognosis in patients with head and neck squamous cell carcinoma(HNSCC)and to explore autophagy-related prognostic LncRNA in HNSCC and their functions. Methods Data on autophagy-related genes and HNSCC patients were downloaded from the Human Autophagy Database(HADb)and The Cancer Genome Atlas(TCGA). Autophagy-related prognostic LncRNAs for HNSCC were screened using Pearson correlation analysis and Cox regression analysis. Functional enrichment analysis was conducted and a risk model was constructed. The patients were divided into high- and low-risk groups based on the median risk score, and the survival times of the two groups were compared. The predictive ability of the risk model for the prognosis of HNSCC was evaluated using Receiver Operating Characteristic(ROC)curves, and its clinical value was explored. Finally, validation was performed. Results A total of 910 autophagy-related LncRNA for HNSCC were initially selected, and 7 autophagy-related prognostic LncRNA were identified as independent prognostic factors for HNSCC, namely AL357033.4, AL160006.1, AC069360.1, AL132712.1, AC245041.2, LINC00707, and AC082651.3, and a risk model was established. The survival time of the high-risk group was significantly lower than that of the low-risk group, with the HR of the risk model being 1.470(P<0.001). The AUC of the risk model in the ROC curve was 0.736, which was superior to other clinical characteristics. The risk score was significantly associated with the AJCC, pT, and pN stage(P<0.001, P<0.043, P<0.002, respectively). The results of GSEA indicated that the significant difference in survival time between the high-risk and low-risk groups may be due to different immune states induced by the risk model. Conclusion The risk model predicts the prognosis of HNSCC, indicating a potential key role for this feature in the occurrence and development of HNSCC.

Long-term rotation stability and visual quality of Toric intraocular lens implantation with steep-axis clear corneal incision

HAO Wenna, MENG Wei, SHAO Zhen, LIU Dongmei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  108-112.  doi:10.6040/j.issn.1673-3770.0.2024.040

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Objective To investigate the long-term rotation stability and visual quality of Toric intraocular lens implantation with steep-axis clear corneal incision. Methods A retrospective analysis was conducted on 111 cases(111 eyes)of cataract surgery performed at the affiliated Ophthalmology Hospital of Shandong University of Traditional Chinese Medicine, spanning from January 1, 2018, to March 21, 2022. All patients underwent transparent corneal incision in the steep axis position, along with phacoemulsification of cataracts and implantation of Toric IOL. The visual quality of the patients was evaluated through preoperative visual acuity, recent follow-up visual acuity, postoperative comprehensive refraction, and OPD-Scan III examinations. The study aimed to compare the axial changes of Toric IOL in the conforming, non-conforming, and oblique axis directions of steep-axis transparent corneal incision implantation groups at 12-24 months, 24-36 months, and 36-48 months postoperatively. Data analysis was performed using one-way analysis of variance and paired sample t-test methods. Results In 11 eyes, the mean uncorrected visual acuity(UCVA)after surgery(0.13±0.21)LogMAR was significantly higher than before(0.90±0.71)LogMAR(P<0.001). The mean best corrected visual acuity(BCVA)after surgery(0.06±0.14)LogMAR was significantly higher than before(0.70±0.70 LogMAR)(P<0.001). The Strehl ratio(SR value)of the Point spread function(PSF)after surgery(0.06±0.04)was higher than before(0.01±0.01)(P<0.001). In the modulation transfer function(MTF)curve, the Area ratio(AR)of 4mm increased after surgery(0.31±0.11)compared with that before surgery(0.15±0.06)(P<0.001). The average rotation Angle of Toric IOL was(2.78±2.50)°. The rotation angles of Toric IOL implanted with steep axis clear corneal incision in the with the rule, against the rule and oblique direction after surgery and at different time points after surgery were analyzed. The WTR astigmatism was(2.90±2.43)°, the ATR astigmatism was(2.69±2.66)°, and the oblique astigmatism was(2.83±2.23)°. There was no significant difference among the three groups(P=0.932). The postoperative rotation angles were(2.72±2.11)° at 12-24 months,(2.81±2.54)° at 24-36 months, and(2.81±2.78)° at 36-48 months. There was no significant difference among the three groups(P=0.985). Conclusion Acrysof IQ Toric implantation has a good rotation stability in the capsule. The rotation angle of Acrysof IQ Toric implantation is not related to implantation through steep-axial clear corneal incision in the direction of with the rule, against the rule or oblique axis, and has no relationship with different follow-up periods. Acrysof IQ Toric implantation can effectively correct corneal astigmatism and provide good visual quality.

Correlation between serum levels of Sestrin2 and NADPH oxidase-2 and fundus lesions in patients with diabetes retinopathy

GAO Lin, HE Jinmei, YANG Mingyi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  113-117.  doi:10.6040/j.issn.1673-3770.0.2024.068

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Objective To explore the correlation between serum levels of stress-inducing protein 2(Sestrin2)and NADPH oxidase 2(NOX2)and fundus lesions in patients with diabetic retinopathy(DR). Methods 139 patients with diabetes who visited our ophthalmic clinic. According to the clinical diagnosis of the patient's ophthalmology, the patients were grouped into the DR group and the non-DR group, and then according to the stage of the disease of the DR patients, the DR group was divided into the hyperplastic DR group and the non-hyperplastic DR group. Clinical data and serum Sestrin2 and NOX2 expression levels were analyzed. Pearson's correlation between the severity of fundus lesions and serum Sestrin2 and NOX2 expression levels was analyzed by Pearson; Multivariate logistic regression model was applied to analyze the factors influencing DR. Results The serum Sestrin2 content in the DR group ［(1.97±0.38)ng/mL］ was obviously lower than in the non-DR group ［(3.74±0.84)ng/mL), while the NOX2 content ［(11.38±1.59)ng/mL］ was much higher than that in the non-DR group ［(6.75±1.69)ng/mL］(P<0.05). The expression level of serum Sestrin2 in the non-proliferative DR group was obviously higher than in the proliferative DR group and decreased with the aggravation of the disease(P<0.05). The level of NOX2 expression in the non-proliferative DR group was obviously lower than in the proliferative DR group and increased with the aggravation of the disease(P<0.05). Logistic regression analysis showed that high levels of Sestrin2 were a protective factor for DR, while high serum FPG and high NOX2 were risk factors for DR(P<0.05). Conclusion The expression level of Sestrin2 is low, the expression level of NOX2 is increased, and its changes are closely related to fundus lesions in patients with DR.

Analysis of factors affecting detection in quantitative visual assessment of infants

CHEN Tingyi, GONG Hui, CHEN Liang, LIANG Ping, WANG Xian, LIU Yaling, HU Yarou,ZHANG Guoming

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  118-125.  doi:10.6040/j.issn.1673-3770.0.2024.229

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Objective To analyze the factors affecting the detection of quantitative visual assessment in infants, extract clinical experience, and improve detection rates. Methods This prospective observational study included 240 infants(0-36 months)who visited the pediatric fundus clinic at Shenzhen Eye Hospital between November 2022 and February 2024. Two examiners with different levels of experience conducted quantitative visual assessments, recording the basic characteristics, initial visual target selection, cooperation level, and preparation status of each child. A logistic regression model was used to identify factors influencing the detection of quantitative visual assessment. Based on these factors, a receiver operating characteristic(ROC)curve was used to develop a nomogram prediction model, with calibration evaluated using the Hosmer-Lemeshow(H-L)test and calibration curves. Results This study included 240 infants. Univariate logistic regression analysis identified effective initial visual targets(OR=119.182, 95%CI:45.904-309.435), high level of cooperation(OR=14.806, 95%CI:7.014-31.256)and thorough preparation(OR=182.668, 95%CI:25.166-1 325.898)as positive influencing factors for higher detection rates. In contrast, the presence of eye disease(OR=0.178, 95%CI:0.093-0.338)and premature birth(OR=0.329, 95%CI:0.184-0.586)were negative influencing factors, associated with lower detection rates. These differences were statistically significant. Multivariate regression analysis, including statistically significant factors, indicated that effective initial visual targets(OR=23.340, 95%CI:2.973-183.243), cooperation level(OR=20.380, 95%CI:2.859-145.278)and thorough preparation(OR=1 380.262, 95%CI:130.876-61 702.162)were key factors influencing the detection of quantitative visual assessment in infants. The analysis of the ROC curve revealed that the area under the curve(AUC)of the prediction model was 0.995(95%CI:0.991-1.000), with a sensitivity of 95.00%, specificity of 100% and precision of 96.60%. Conclusion The detection rate of quantitative visual assessment in infants is influenced by multiple factors. To improve detection rates in clinical practice, it is essential to ensure thorough preparation, select effective initial visual targets, and enhance the level of cooperation of infants.

Granular cell tumor of the hypopharynx:two cases report and literature review

LI Demin, DONG Nian, MA Xu, ZHANG Jin, DING Detao, WU Yungang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  126-132.  doi:10.6040/j.issn.1673-3770.0.2024.267

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Objective Discuss the clinical features of granular cell tumor(GCT)of the hypopharynx, aiming to raise awareness among otolaryngologists to enhance sensitivity towards this tumor and reduce the occurrence of misdiagnosis and missed diagnoses. Methods Improve relevant examinations and perform hypopharyngeal mass excision under support laryngoscopy. Results Two postoperative pathological cases were diagnosed as hypopharyngeal granular cell tumors. One case has been followed up for 3 years with no recurrence, and the other has been followed up for 1 year with no recurrence. Conclusion Hypopharyngeal GCT is more common in women than in men, with benign cases being more frequent. The clinical symptoms are non-specific, and pathology is the gold standard for diagnosis, requiring differentiation from other hypopharyngeal masses. Surgical resection is the primary curative method, with recurrence being rare post-surgery. Close follow-up is essential after surgery.

Larynx fibrosarcoma: a case report and literature review

LIU Yuzhu, CHEN Yao, YUAN Tiejun, LI Chunsen, LI Bo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  133-137.  doi:10.6040/j.issn.1673-3770.0.2024.146

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Objective To review the clinical manifestations, pathological features, treatment and prognosis of laryngeal fibrosarcoma. Methods The clinical data of a case of laryngeal fibrosarcoma were reviewed and the relevant literature was reviewed. Results Laryngeal fibrosarcoma should be distinguished from vocal cord(or ventricular)polyps and its diagnosis is mainly based on pathological examination. Treatment consists mainly of surgery + radiotherapy. Conclusion The standard of care for laryngeal fibrosarcoma is still unclear, and the boundaries of safe surgical resection margins need to be further explored. Radiotherapy helps to improve the prognosis of patients. For early T1 or T2 laryngeal fibrosarcoma, it is not advisable to blindly extend the resection area under the premise of ensuring a negative resection margin and preserving some laryngeal function. Routine dissection of cervical lymph nodes is not recommended. In patients with suspected cervical lymph node metastasis on imaging, the ipsilateral II-IV lymph nodes may be dissected and sent for intraoperative freezing, and the contralateral cervical lymph nodes may be reserved as appropriate.

Misdiagnosis of lingual tuberculosis: a case report and literature veview

SUN Shuo, YUAN Tiejun, CHEN Yao, QI Lingling, HAN Rongrong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  138-143.  doi:10.6040/j.issn.1673-3770.0.2024.020

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Objective To discuss the clinical manifestations, diagnosis, treatment, and reasons for missed diagnosis of the extremely rare lingual tuberculosis to provide a clinical reference for otolaryngologists. Methods The clinical data of 1 case of with lingual tuberculosis were reviewed. We analyzed the clinical characteristics and the reasons why it was easily missed. Results The clinical manifestations of Lingual Tuberculosis are atypical, systemic symptoms are rare, the rate of misdiagnosis and underdiagnosis is extremely high, and the confirmation of the diagnosis still needs to rely on pathological examination. Regarding treament, systemic anti-tuberculosis agents are the mainstay of therapy. Conclusion Tuberculosis of the tongue is a rare and difficult disease to diagnose and is easily misdiagnosed as cancer of tongue base. Histopathology combined with tuberculosis-related ancillary tests could help improve the diagnostic yield and must be taken into account in our early differential diagnosis.

Minimal quantity vitrectomy for laser-pointer induced full-thickness macular hole in a child: a case report and literature review

SONG Yanling, SI Yuanyuan, CUI Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  144-147.  doi:10.6040/j.issn.1673-3770.0.2024.007

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Objective To report the clinical features and limited vitrectomy treatment of a child with full-thickness macular hole caused by a laser pointer. We also discuss the possible process of macular hole formation and the experience of surgical treatment. Methods The diagnosis and treatment of this case were reviewed, and the case data and relevant literature were analysed and discussed. Results A round hole with a diameter of 1/4 of the optic disc was observed in the macula of the affected eye. The base of the hole was gray-white and there was a yellowish fan-shaped lesion on the nasal side of the hole. After inducing posterior vitreous detachment, a small amount of vitreous body around the posterior pole was resected. The internal limiting membrane was peeled back in a radius of approximately 1.5 PD centred on the macula. and the surgery was completed with air-fluid exchange. 12 days after surgery, OCT showed a successful closure of the macular hole. Conclusion Minimal quantity vitrectomy is effective for the repair of laser-induced full-thickness macular hole in children with lesions limited to the macular region.

SMILE correction of refractive regression after PRK surgery: a case report and literature review

CHEN Tao, JIANG Yang, LI Ying

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  148-153.  doi:10.6040/j.issn.1673-3770.0.2024.218

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Objective To explore the feasibility of SMILE as a corrective procedure for refractive regression after surface refractive surgery, based on a case of refractive regression 23 years post-PRK. Methods A retrospective case study of a patient who underwent binocular PRK for myopia correction 23 years ago and experienced refractive regression postoperatively. The patient met the criteria outlined in the SMILE expert consensus, and underwent secondary SMILE corrective surgery. Relevant literature was reviewed and summarized. Results Intraoperative scanning proceeded smoothly, and the corneal stromal lenticules were successfully separated and extracted. During postoperative follow-up, uncorrected distance visual acuity of both eyes exceeded the preoperative best-corrected distance visual acuity. Conclusion This case sims to serve as a reference for SMILE as secondary corrective surgery following surface refractive surgery in clinical practice.

Review

Advances in the study of nonpharmacologic treatment of bilateral vestibulopathy

HAN Xinyu, CHEN Ganggang, LI Ying, ZHOU Liyuan, YANG Jie, WU Jiaxin, LI Yujun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  154-159.  doi:10.6040/j.issn.1673-3770.0.2023.452

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Bilateral vestibulopathy(BVP)is a chronic disorder of the vestibular system characterized by unsteadiness when walking or standing, which is further exacerbated by dark or uneven surfaces, and oscillopsia. Vestibular rehabilitation is the mainstay of treatment for BVP, but the effectiveness of treatment varies from person to person. Some new treatment modalities, such as sensory substitution therapy, noisy vestibular electrical stimulation, and artificial vestibular implantation provide more selectivity in the treatment of BVP. The aim of this review is to discuss the non-pharmacological treatment of BVP, and to provide a reference for the clinical diagnosis and treatment of this disease.

Application of intranasal corticosteroids in pediatrics

XIONG Qin, ZHANG Yan, WU Rina, LI Feng, TANG Lixing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  160-167.  doi:10.6040/j.issn.1673-3770.0.2024.061

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Intranasal corticosteroids(INCS)are various nasal sprays containing glucocorticoids and are currently the first-line treatment for allergic rhinitis and mild-to-moderate chronic sinusitis. They have significant local anti-inflammatory effects, reduce oedema and can restore normal nasal mucosa, effectively relieving symptoms such as nasal congestion, runny nose and sneezing in patients. Due to the safety and tolerability advantages of local medication, INCS has also been used in recent years for conditions such as paediatric obstructive sleep apnoea, adenoid hypertrophy and secretory otitis media. The use of INCS in recent years is summarised and several issues of clinical concern are discussed.

Anti-cancer mechanism and research progress of kaempferol

WANG Xiaojie, ZHANG Mingjun, SONG Zheying, CUI Limei, SONG Xicheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2025, 39(6):  168-178.  doi:10.6040/j.issn.1673-3770.0.2023.511

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One of the major targets of medical research is cancer cells, which possess characteristics such as evasion of apoptosis, infinite replication potential, continuous angiogenesis, evasion of immune destruction, and tissue invasion and metastasis. Kaempferol, a flavonoid compound, has shown significant anti-cancer activity with multiple mechanisms of cancer inhibition. We conducted a comprehensive literature review to identify the primary anti-cancer mechanisms of kaempferol. These mechanisms include inhibition of tumour angiogenesis, anti-inflammatory effects, antioxidant properties, cell cycle regulation, inhibition of tumour cell metastasis and induction of tumour cell apoptosis. In addition, progress has been made in researching the combined use of kaempferol with other drugs. However, the clinical use of kaempferol is severely hampered by its poor water solubility and low bioavailability. The lack of solubility has been addressed by the continuous development of nano-drug delivery systems, which provide a solution to this limitation. The integration of nanomaterials to load kaempferol has gained traction in various research institutions, highlighting the pivotal role of nanomaterials in enhancing the stability, delivery efficiency and anticancer efficacy of kaempferol. This development highlights the importance of nanotechnology in improving the application of kaempferol in cancer treatment. We anticipate that this synthesis will stimulate further investigation into the anti-cancer mechanisms and applications of kaempferol.