Table of Content

20 March 2018 Volume 32 Issue 2

  

Problems we face in children with obstructive sleep apnea hypopnea syndrome

LI Yanzhong, ZHANG Tai

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  1-5.  doi:10.6040/j.issn.1673-3770.1.2018.003

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Obstructive sleep apnea hypopnea syndrome(OSAHS)in children is a common disease in the department of otolaryngology, and its incidence is high, and it is a serious harm to the growth and development of children. The incidence of OSAHS in children is related to many factors. The most common cause is tonsillar hypertrophy and adenoid hypertrophy. Adenotonsillectomy is the preferred treatment for OSAHS in children. But there are still some problems that need to be addressed. This paper reviews the preoperative evaluation and diagnosis of OSAHS in children, the improvement of quality of life after operation and postoperative continuous intervention.

Evaluation of sleep structure disorder in children with obstructive sleep apnea hypopnea syndrome

LIU Dabo

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  6-8.  doi:10.6040/j.issn.1673-3770.0.2017.534

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In recent years, many studies have been conducted on obstructive sleep apnea hypopnea syndrome in children, but most of the research has been focused on respiratory parameters such as the apnea hypopnea index and the lowest oxygen saturation. Few studies have focused on changes in sleep structure disorder, and the conclusions of the studies are inconsistent.

Post-surgery management in children with obstructive sleep apnea syndrome

XU Zhifei, NI Xin

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  9-13.  doi:10.6040/j.issn.1673-3770.0.2018.069

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Obstructive sleep apnea syndrome(OSAS)is a common pediatric sleep-respiratory disorder. OSAS can cause impairments in childrens physical and neurocognitive development, cardiovascular systems, endocrine systems, and metabolic status. Adenoidal or tonsillar hypertrophy are the most common causes of pediatric OSAS. Adenotonsillectomy(T&A)is therefore the first-line treatment for children with OSAS. Although most children show significant improvement after T&A, the incidence of residual disease is between 21.6% and 49%, depending on the definition of residual disease and the presence or absence of risk factors for OSAS. Follow-up and management of residual OSAS is beneficial to avoid disease-related complications. This paper summarizes the potential risk factors for residual OSAS and useful follow-up strategies after adenotonsillectomy in children, and aims to improve the diagnosis and management of pediatric sleep-disordered breathing.

The relationship between allergic reaction and children obstructive sleep apnea hypopnea syndrome

WANG Yan, SHI Xiaoli

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  14-18.  doi:10.6040/j.issn.1673-3770.1.2018.002

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Children obstructive sleep apnea hypopnea syndrome, which have the high incidence, endangering children growth seriously, is a kind of ENT common diseases. The high incidence of OSAHS in children is related to many factors, the most common of that is tonsil hypertrophy and adenoid hypertrophy. Tonsils and adenoids are lymphatic tissues, locating at the entrance to the digestive tract and respiratory tract, and exposing to various ingestion and allergens for a long time. More and more studies have shown that allergic reactions play an important role in the pathogenesis of OSAHS in children, however, different opinions have also been put forward. This article summarizes the latest research results, and the relationship between allergic reactions and OSAHS in children, and then provides the basis for the medical treatment of children OSAHS.

Long-term follow-up study on non-invasive ventilation in children with moderate to severe

YANG Wei, ZHENG Li, XU Zhifei

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  19-24.  doi:10.6040/j.issn.1673-3770.0.2018.041

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Objective To investigate the long-term efficacy of non-invasive ventilation in children with moderate to severe obstructive sleep apnea-hypopnea syndrome(OSAS), especially those with residual postoperative OSAS after tonsillectomy and/or adenoidectomy. Methods We conducted a follow-up study between October 2012 and October 2017 in children who were diagnosed with moderate to severe OSAS through polysomnography(PSG)and were treated with non-invasive positive pressure ventilation(NPPV). Most of them had underlying diseases or postoperative residual OSAS after tonsillectomy and/or adenoidectomy. Polysomnography was performed during non-invasive ventilatory support; pressure titration was performed manually in the sleep center, while the mode was chosen based on disease conditions in individual patients. Polysomnography data were recorded and compared between before and after treatment with NPPV. Patients who received NPPV support after discharge were examined at follow-up visits 3 and 6 months later, and every 6 months after that. Clinical symptoms and PSG parameters were monitored during therapy, and factors associated with compliance were evaluated. Results Thirty patients received non-invasive ventilation treatment through October 2017; 26 of them were boys. The average age was 7.2±3.7 years. Ventilation was stopped in 11(36.7%)children after discharge, while 19(63.3%)children received non-invasive ventilation at home. The apnea-hypopnea index(P<0.001), the lowest SpO₂(P<0.001), and the percentage of sleep time with the SpO₂<0.90(P<0.001)were improved in all children receiving NPPV treatment at the time of hospitalization. Most OSAS patients experienced relief from snoring and apnea and improvement in respiratory distress and daytime symptoms. However, there was no improvement in irritability and distraction after 6 months of treatment. Parental awareness of the importance of this disease(P=0.001), craniofacial malformation(P=0.008), and frequent sleep apnea or dyspnea before treatment(P=0.029)were associated with compliance with NPPV treatment. Conclusion Non-invasive ventilation therapy can be performed successfully in special pediatric populations. Long-term NPPV treatment can improve clinical symptoms considerably in children with moderate to severe OSAS, especially those with underlying diseases or residual OSAS after tonsillectomy and/or adenoidectomy. Education for parents about sleep-disordered breathing and reducing adverse reactions might improve compliance with NPPV treatment in children.

Risk factors associated with obstructive sleep apnea-hypopnea syndrome in children: a retrospective case-control study

SHEN Ling, LIN Zongtong, LIN Xing, YANG Zhongjie

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  25-29.  doi:10.6040/j.issn.1673-3770.0.2018.086

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Objective The aim of this study was to investigate the potential risk factors for pediatric obstructive sleep apnea-hypopnea syndrome(OSAHS)and their possible synergistic effects. Methods Three hundred and twenty-one children with OSAHS diagnosed by polysomnography and a control group comprising 321 children matched for age and sex but without obstruction of the upper respiratory tract were enrolled between January 2016 and January 2017. The data from cases and controls were analyzed retrospectively. Results Multivariate logistic regression analysis showed that adenoid hypertrophy, tonsil hypertrophy, and chronic sinusitis were independent risk factors for pediatric OSAHS(P<0.05). The incidence of pediatric OSAHS was 3.229 78 times higher when chronic sinusitis was present than when it was not(P<0.001). When compared with grade Ⅰ tonsils, the ORs for grade Ⅱ, grade Ⅲ, and grade Ⅳ tonsils were 1.596 58(P=0.032 2), 2.306 52(P=0.000 8), and 4.430 85(P<0.001), respectively. When compared with grade Ⅰ adenoids, the ORs for grade Ⅱ, grade Ⅲ, and grade Ⅳ adenoids were 1.804 33(P=0.005 1), 2.883 38(P<0.001), and 3.220 91(P=0.000 2), respectively. Stratification analysis showed that the degree of adenoid hypertrophy was greater in patients with chronic sinusitis and was associated with a gradual increase in risk of OSAHS(P=0.004 1). Conclusion The causes of obstructive sleep apnea syndrome in children are multifactorial. Adenoid hypertrophy, tonsil hypertrophy, and chronic sinusitis may be potential risk factors for pediatric OSAHS. Chronic sinusitis could act synergistically with hypertrophic adenoids to increase the risk of OSAHS.

The application of wearable devices in the diagnosis of children obstructive sleep apnea

ZHONG Jianwen, LIU Dabo, LUO Xiangqian, HUANG Zhenyun, QIU Shuyao, CHENG Chao, YANG Liqiang, YI Xinhua, ZENG Jinhong

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  30-33.  doi:10.6040/j.issn.1673-3770.0.2017.535

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Objective This study aimed to evaluate the feasibility of using wearable devices for the diagnosis of obstructive sleep apnea(OSA)in children. Methods This study included 48 children diagnosed with obstructive sleep apnea; all underwent both, use of wearable devices and full polysomnography(PSG). Data from 46 cases were valid and were analyzed. Results There was no significant difference between wearable devices and PSG in the oxyhemoglobin desaturation index,(median 3.55 ［2.12, 10.04］ vs 3.23 ［1.12, 8.89］, P>0.05), mean oxygen saturation(95.93±1.67 vs 95.52±1.27, P>0.05), or lowest arterial oxygen saturation(83.80±7.47 vs 85.63±6.41, P>0.05). In addition, the sensitivity, specificity, accuracy, and KAPPA of wearable devices for the diagnosis of OSA were 88.89%, 60%, 82.61%, and 0.49, respectively. Wearable devices were associated with less surgical time and lower cost than PSG. Conclusion Wearable equipment are characterized by high accuracy, easy operation, and are cost-effective; furthermore, they can be used for screening and evaluation of OSA pre- and post-operatively.

Analysis of coblation complications in children with obstructive sleep apnea-hypopnea syndrome

QIU Shuyao, LIU Dabo, ZHONG Jianwen, YANG Liqiang

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  34-37.  doi:10.6040/j.issn.1673-3770.0.2017.533

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Objective To explore the causes of complications after low-temperature coblation surgery in children with obstructive sleep apnea-hypopnea syndrome(OSAHS), and to summarize the treatment and outcome of these complications. Methods The subjects were 3 106 patients with OSAHS who underwent low-temperature coblation adenoidectomy with or without tonsillectomy under general anesthesia in our department, between October 2007 and June 2017. We counted the number of patients with postoperative complications including postoperative bleeding, fever, perforation of palatopharyngeal arch, and nasal reflux, and analyzed the causes of complications. Results The postoperative bleeding rate was 2.44%(76/3 106). Twelve patients underwent reoperation for hemostasis under general anesthesia, 2 patients were sent to the pediatric intensive care unit, 1 required transfusion because of excessive blood loss, and another experienced choking during anesthesia. Forty-four patients showed fever in the week after the operation, with body temperatures higher than 38.5 ℃, but the temperatures were reduced to normal after symptomatic treatment. Pharyngopalatine arch perforation occurred in 5 cases, of which 3 were self-healing. One patient experienced nasal cavity reflux when eating because of a palatine fistula after the operation; this patient was healed after conservative treatment. Conclusion The complication rate for low-temperature coblation surgery is low in children with OSAHS, but if not handled properly, complications can cause serious, and even life-threatening, consequences. Therefore, we should try to prevent complications, to deal with them in a timely manner, and to minimize the damage they cause.

Evaluation of the clinical curative effect of nose surgery in combination with nasal corticosteroids in

GAO Jinliang, NIAN Wanqing, LI Shuo

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  38-42.  doi:10.6040/j.issn.1673-3770.0.2017.404

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Objective To discuss the clinical efficacy and safety of nasal glucocorticoid-assisted endoscopic adenoidectomy in the treatment of adenoidal hypertrophic snoring in children. Methods Ninety-eight cases of children with adenoidal hypertrophic snoring were randomly divided into control and observation groups, with 49 cases in each group. While patients in the control group were treated with endoscopic adenoidectomy, Cefaclor Granules by oral administration, dexamethasone by inhalation, and other conventional treatments, patients in the observation group were treated with a nasal glucocorticoid. The treatment efficiency, incidence of adverse events, A/N of nasopharynx lateral radiograph, apnea-hypopnea index, sleep quality, and levels of immune and inflammatory factors before and after treatment were compared between the two groups. Results The total effective rate of treating adenoidal hypertrophic snoring was noted to be 89.80%(44/49)and 73.47%(36/49)for the observation and control group respectively. This rate in the observation group was significantly higher than that in the control group(χ2=4.356, P=0.037). There was 1 case of nasal bleeding and 1 case of nasal vestibule dryness sensation reported in the observation group, with a 4.08% incidence rate of adverse reactions in this group. On the contrary, no nasal bleeding and nasal vestibule dryness was reported in the control group and there was no significant difference in the incidence rate of adverse reactions between the two groups(P>0.05). Before treatment, there were no significant differences in A/N of nasopharynx lateral radiograph, apnea-hypopnea index, and sleep quality between the two groups(P>0.05). After treatment, the A/N of nasopharynx lateral radiograph, apnea-hypopnea index, and sleep quality of the two groups were all improved, and there was a significant difference between the two groups(P<0.05). Before treatment, there were no significant differences in IgE, LTE4, TNF-α, IL-6, and IL-8 levels between the two groups(P>0.05). After treatment, the levels of IgE, LTE4, TNF-α, IL-6, and IL-8 in the two groups decreased, and there was a significant difference between the two groups(P<0.05). Conclusion This study reported that nasal glucocorticoid-assisted endoscopic adenoidectomy inhibited the inflammatory factors and reduced snoring, nasal congestion, and other clinical symptoms, with little risk and improved sleep quality, in children with adenoid hypertrophy snoring and can be worth popularizing.

Hypoxia inducible factor-1 alpha and vascular endothelial growth factor expression in the soft palate of

LI Hao, LI Yanzhong, WANG Yan

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  43-47.  doi:10.6040/j.issn.1673-3770.0.2017.246

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Objective To investigate hypoxia inducible factor-1 alpha(HIF-1α)and vascular endothelial growth factor(VEGF)expression in the soft palate in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS), and to explore the role of these factors in the pathogenesis of OSAHS. Methods Immunohistochemistry was used to detect HIF-1α and VEGF expression in the soft palate of 30 patients with OSAHS(experiment group)and six who had undergone tonsillectomy(control group). Results Hematoxylin-eosin staining of the soft palate revealed epithelial hyperplasia, thickening of the lamina propria, disordered muscle fibers in various stages of degeneration, and angiogenesis in the experimental group. Immunohistochemical staining revealed overexpression of HIF-1α in the nuclei and cytoplasm of cells in the squamous, epithelial, basal, and spinous layers, and strongly positive expression of VEGF in the cytoplasm of cells in the squamous, epithelial, basement, and stratum spinosum layers of the soft palate mucosa in patients with moderate to severe OSAHS. VEGF showed focal positive expression in glandular epithelial cells and vascular endothelial cells. HIF-1α and VEGF expression was positively correlated with the apnea-hypopnea index(P<0.05)and negatively correlated with the lowest nocturnal oxygen saturation(P<0.01). Conclusion Pathologic changes in the soft palate of patients with OSAHS were strongly correlated with the degree of hypoxia. HIF-1α and VEGF may play an important role in the development of OSAHS.

Effects of nasal continuous positive airway pressure on glucose and lipid metabolism, hs-CRP, and

ZHANG Huifang,YANG Hongzhen

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  48-51.  doi:10.6040/j.issn.1673-3770.0.2017.421

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Objective To investigate the effects of nasal continuous positive airway pressure(NCPAP)on the levels of glucose and lipid metabolism, hs-CRP and S100A12 in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Forty OSAHS patients were selected for prospective study, and randomly divided into a control group(receiving routine conservative treatment)and an experimental group(receiving NCPAP treatment)by the coin-tossing method, with each group containing 20 patients. The treatment continued for 3 months. Before and after treatment, the levels of blood glucose, blood lipid, hs-CRP and S100A12 were analyzed. Results In both groups, the levels of total cholesterol(TC), triglyceride(TG)and LDL cholesterol were significantly decreased after treatment, while the levels of HDL cholesterol were significantly increased(all P<0.05). (1) The levels of TC, TG and LDL-C in the experimental group were significantly lower than those in the control group, while the levels of HDL-C in the experimental group were significantly higher than those in the control group(P<0.05). (2) Fasting blood glucose(FBG)and 2 h postprandial blood glucose(PBG)levels were significantly decreased after treatment(P<0.05). The levels of FBG and 2 h PBG were significantly lower in the observation group than in the control group(P<0.05). (3) hs-CRP and S100A12 levels were significantly decreased after treatment(P<0.05). The levels of hs-CRP and S100A12 in the experimental group were significantly lower than in the control group(P<0.05). Conclusion Nasal continuous positive airway pressure can significantly regulate blood glucose and lipid metabolism and reduce hs-CRP and S100A12 levels in patients with OSAHS, thereby reducing the cardiovascular complications of OSAHS patients and improving their prognosis.

Effect of nasal dilation on quality of sleep in adult patients with chronic rhinosinusitis and

GONG Qi, ZHANG Jie, ZHAO Pingping

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  52-55.  doi:10.6040/j.issn.1673-3770.0.2017.423

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Objective To investigate the effect of nasal cavity expansion on the sleep quality of adult patients with chronic rhinosinusitis and sleep apnea-hypopnea syndrome. Methods Eighty patients with chronic rhinosinusitis and sleep apnea-hypopnea syndrome were enrolled in this study. Nasal resistance tests, nasopharyngeal and laryngological examination, and polysomnography, as well as Epworth sleepiness scale(ESS)and Nasal Sinus Outcome Measures-20 Scale(SNOT-20)assessments, were performed on all patients before treatment. At the 3-month postoperative follow-up, all patients were again assessed using the aforementioned indicators. Results After 3 months, SNOT-20 scale score decreased in all patients (P<0.05), compared with the preoperative score; ESS and total nasal resistance also significantly decreased(P<0.05 for both). Conclusion SNOT-20 Scale and polysomnography measurements accurately evaluate the efficacy of the nasal cavity expansion joint monitoring technique; application of the nasal expansion technique can significantly improve sleep quality in adult patients with chronic rhinosinusitis and sleep apnea-hypopnea syndrome.

The evaluation on mild cognitive impairment in patients with moderate-severe obstructive sleep apnea and

WANG Hongmei, LI Lianhe

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  56-61.  doi:10.6040/j.issn.1673-3770.0.2017.427

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Objective To investigate the mild cognitive impairment measured by necropsy ecological scales and the P300 of ERP in the patients with moderate-severe obstructive sleep apnea and hypopnea syndrome(OSAHS). Methods A total of 30 patients(patients group)who were monitored by Polysomnography(PSG)and 20 volunteers(controls groups)were enrolled, the 30 patients were carried out to determine whether the participants have mild Cognitive Impairment(MCI)by Montréal cognitive assessment scale(MoCA).Parallel Epworth sleepiness scale(ESS)and P300.All of them were monitored for apnea/hyponea index(AHI)、lowest oxygen saturation(LSaO₂)、mean oxygen saturation(MSaO₂)during sleep and the total sleep time of SaO₂<90%(CT90), the oxygen saturation index(ODI)、the respiratory micro arousal(RMI)and sleep structure. And compare the parameter one by one. Compare the various indicators and correlation the MoCA score, P300 parameters and the PSG parameters. Results Compared with the control group, the moderate-severe OSAHS patients, there was no significant statistically different in age and educational level. The BMI and ESS increased,the score of MoCA in OSAHS group strikingly lower than that of the control group, the MoCA analysis showed that memory/delayed recall score was significantly decreased, the AHI increased.the score of LSaO₂ and MSaO₂ decreased, CT90% increased, ODI and RMI increased significantly, the S1 and S2 prolonged, the S3、S4 and REM shortened, the Cz,C3,C4,Pz P300 latency was significantly prolonged in P300. Correlation analysis showed that the MoCA memory/delayed not associated with ESS, AHI, MSaO₂, CT90%, Cz, C3, C4, and was positively related to LSaO₂, and was negatively the RMI, ODI, CT90%, the latent period of Pz, the amplitude of Fz, Pz P300 latency and Fz P300 amplitude had significant influence on the MoCA. Conclusion Moderate-severe OSAHS patients existing MCI, the memory function of patients with OSAHS was significantly associated with the RMI which caused by the sleep structure disorder, P300 detection can be used as electric physiological indicator of cognitive dysfunction in OSAHS patients, combined the MoCA score can promptly evaluate the cognitive dysfunction in OSAHS patients, and promptly make a diagnosis and give treatment according to the evaluation result.

Clinical analysis of language rehabilitation in 295 cases of cochlear implantation

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  62-65.  doi:10.6040/j.issn.1673-3770.0.2017.425

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Objective To identify factors contributing to effective rehabilitation after cochlear implantation. Methods We evaluated the outcome of rehabilitation in 295 patients who underwent cochlear implantation by analysis of auditory performance(CAP), speech intelligibility rating(SIR), and articulation on audiovisual speech recordings. Results The hearing threshold was 25-40 dB in all patients except for 2, who had a combination of microcochlear and inner ear malformations and a hearing threshold of 45 dB. In univariate analysis, wearing a hearing aid, age at the time of cochlear implantation, time since implantation, degree of inner ear malformation, amount of residual hearing, and presence of leukodystrophy were correlated with CAP and SIR, whereas the surgical implantation method used and presence of otitis media or Waardenburg syndrome were not. In multivariate analysis using a stepwise logistic regression model, the most significant contributors to CAP and SIR were time since implantation and presence of leukodystrophy. Conclusion The outcomes of cochlear implantation are generally satisfactory and the degree of auditory rehabilitation is influenced by many factors.

Comparison and significance of different automated auditory brainstem response testing times in infants

ZHOU Jialei, SUN Shibing, LI Jingyu, CHEN Fang, LI Xiaoyan

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  66-69.  doi:10.6040/j.issn.1673-3770.0.2017.494

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Objective To explore the effect of different testing times on the automated auditory brainstem response(AABR)results in infants. Methods Ninety-seven infants were assigned to the following groups: group A(60 ears in 30 infants, normal hearing), group B(60 ears in 33 infants, mild hearing loss), and group C(60 ears in 34 infants, moderate to profound hearing loss). AABR testing times of 60 s and 600 s were employed in all three groups. The consistency of AABR results in groups A, B, and C were evaluated by the kappa consistency test. The t-test and one-way analysis of variance(ANOVA)were used to compare the time required among the three groups. Results The results showed a concordance of κ=1.000,0.854,and 0.896, respectively. The times required for actual screening in group A were 17.82 ±7.99 s and 26.73 ±75.48 s, with no significant difference(P=0.328). The times required for actual screening in groups B and C were 60 s with a testing time of 35.62±20.04 s and 54.15±11.92 s, were 600 s with a testing time of 239.05±277.69 s and 481.63±228.51 s; the time required for each ear was significantly shorter than the testing time(P<0.001). With the same time settings, there was a significant difference among the three groups(P<0.001), and the time required for testing increased with the increase in hearing loss. Conclusions Setting the AABR testing time at 60s had no effect on the results, indicating that the testing time can be reduced while maintaining the same screening efficiency and quality.

Spring pollinosis in Qingdao west district

LIU Jie, QU Hui, LU Daowen, XIN Huaxiu, GUO Yanli

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  70-72.  doi:10.6040/j.issn.1673-3770.0.2017.274

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Objective To investigate the classification of airborne pollens that cause pollinosis, the amounts of airborne pollens in spring in Qingdao west district were measured and their relationship with pollinosis was examined. Methods Airborne pollens were collected using the gravity precipitation method by Yes sampler from March to June in 2015. In addition, 126 patients were diagnosed with spring pollinosis on the basis of results of intradermal skin tests and specific intranasal provocation tests with pollen allergens. Results A total of 7486 pollen grains were collected from March to June in 2015. Most of the pollens collected were of Pinus, followed by Broussonetia, Betula, Broussonetia, and Populus. The skin test results showed that the highest positivity rate was that for the pollen of Platanus(38.10%), followed by Poplar(35.72%), Pinus(32.53%), and Betula(30.16%). These woody pollens were major allergenic pollens in spring in the west district of Qingdao city. Among the 126 cases of spring pollinosis, 43(34.13%)were complicated with asthma, 89(70.63%)cases were associated with allergic conjunctivitis and 1(0.79%)had a severe allergic reaction(anaphylaxis). Conclusion The main sensitized pollens in spring in the western part of Qingdao are those of Platycladus, Populus, Pinus, and Betula, which are the main causes of spring pollinosis.

Analysis of paranasal sinus fibrous dysplasia in 36 cases

LIU Xiaojing, WANG Yuan, ZHANG Liqing, FENG Jian, ZHAO Qing, SONG Shenghua, ZHOU Han, DONG Weida

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  73-78.  doi:10.6040/j.issn.1673-3770.0.2017.434

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Objective To explore the clinical features, surgical approaches, and treatment outcomes of patients with paranasal sinus fibrous dysplasia. Methods A retrospective review of 36 patients with paranasal sinus fibrous dysplasia treated between October 2009 and October 2016 was performed. All patients underwent surgery based on the results of preoperative imaging. Nasal endoscopic resection was performed in 18 cases, a Caldwell-Luc procedure in 4, lateral rhinotomy in 7, combined nasal endoscopic resection and Caldwell-Luc procedure in 4, coronal incision craniotomy in 3, coronal incision craniotomy combined with Caldwell-Luc procedure in 2, and optic canal decompression in 3. Results Of 36 cases followed for 6-60 months, 2 developed a recurrence and the remaining 34 recovered without difficulty. Cerebrospinal fluid rhinorrhea occurred in 2 cases, and 1 case had an intracranial hematoma. Of the 36 cases, 28 underwent radical bone resection and 8 underwent conservative excision to improve function and appearance. Conclusion Paranasal sinus fibrous dysplasia presents with complex clinical manifestations. Surgical resection of affected bone is the main treatment, while retaining function and appearance as much as possible, based on preoperative imaging and patient preferences. The prognosis is good, with low rates of recurrence or malignant transformation

Surgical strategies for nasal inverted papilloma and corresponding recurrence rates

WANG Yuan, ZHOU Han, LIU Xiaojing, ZHANG Liqing, ZHAO Qing, FENG Jian, DONG Weida

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  79-83.  doi:10.6040/j.issn.1673-3770.0.2017.441

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Objective To investigate the surgical strategies for nasal inverted papilloma(NIP)and the corresponding recurrence rates. Methods The clinical data of 181 patients admitted to our hospital from October 2010 to October 2016 with NIP were retrospectively analyzed. All patients underwent nasal endoscopy, computed tomography(CT), or MRI examination before surgery to determine the extent of the disease. Clinical evaluations were made according to the Krouse staging system, and patients were scheduled for surgery. Of those, 124 patients underwent endoscopic sinus surgery, 27 underwent nasal resection, and 30 underwent endoscopic surgery combined with Caldwell-Luc surgery. All were followed up for 1 to 6 years. Results The total postoperative recurrence rate for the 181 NIP patients was 17.7%(32/181). The recurrence rates by surgery type were as follows: endoscopic sinus surgery, 15.3%(19/124); nasal resection, 25.9%(7/27); and endoscopic sinus surgery combined with Caldwell-Luc surgery, 17.7%(32/181). There were no significant differences between the three groups(P>0.05). The recurrence rates for patients with different Krouse staging scores were statistically analyzed. The recurrence rates for grade Ⅰ, grade Ⅱ, grade Ⅲ, and grade Ⅳ lesions were 11.8%(2/17), 11.6%(8/69), 17.2%(11/64), and 35.5%(11/31), respectively. The recurrence rate increased with tumor grade at the time of surgery. There were significant differences in recurrence rates among all stages(P<0.05). Conclusion Endoscopic sinus surgery has become the main treatment for NIP, and the recurrence rate observed was similar to that for endoscopic sinus surgery combined with Caldwell-Luc surgery. The rate of postoperative recurrence increased with the stage of NIP at the time of surgery. Choice of surgical procedure, complete removal of the tumor, and strict follow-up are key to successful treatment.

A polysaccharide from hedyotis diffusa induces apoptosis and inhibits migration in Hep-2 cells

ZHAO Xiaoyan, WU Caiqin, REN Xiaoyong, WANG Zhenghui

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  84-87.  doi:10.6040/j.issn.1673-3770.0.2017.323

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Objective The aim of this study was to explore the anti-tumor potential of a polysaccharide isolated from Hedyotis diffusa(HDP)in Hep-2 human larynx squamous carcinoma cells. Methods Cell cycle and apoptosis were analyzed by detecting changes in protein expression by flow cytometry. Apoptosis was further characterized by detecting relevant proteins by western blotting. Results HDP suppressed the proliferation of Hep-2 cells in a time- and dose-dependent manner. Cell cycle analysis revealed that exposure to HDP(400 μg/mL)caused G₀/G₁ cell cycle arrest in Hep-2 cells. Moreover, flow cytometry revealed that Hep-2 cells treated with HDP for 24 h underwent apoptosis to a significantly greater extent than untreated control cells. HDP treatment promoted the expression of caspase-3, caspase-8, and caspase-9, and reduced the expression of Bcl-2. HDP also inhibited cell migration and suppressed the expression of MMP-2 and uPA. Conclusion HDP possesses suppressive effects against aggressive phenotypes of human larynx squamous carcinoma cells and may have therapeutic potential for this particular malignancy.

Risk factors for rupture of the capsule membrane during phacoemulsification cataract surgery

LI Houxiu, LIU Zhonghua, CHEN Zhi

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  88-90.  doi:10.6040/j.issn.1673-3770.0.2017.267

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Objective To identify the risk factors for rupture of the posterior capsule during phacoemulsification cataract surgery. Methods The clinical data for patients who underwent phacoemulsification cataract surgery at our hospital between January 1, 2014 and December 31, 2016 were retrospectively reviewed. The data for 42 eyes(38 patients)in which posterior capsule rupture occurred intraoperatively were compared to those for 215 randomly selected eyes(190 patients)in which posterior capsule rupture did not occur(ratio 1∶5). Univariate and multivariate logistic regression models were used to identify risk factors for posterior capsule rupture during phacoemulsification cataract surgery. Results Univariate analysis revealed that patient sex, preoperative visual acuity <20/200, surgery for retinal detachment, vitreous surgery, vitreous hemorrhage, and nuclear stage were associated with rupture of the posterior capsule during phacoemulsification cataract surgery. In multivariate analysis, preoperative visual acuity <20/200, vitreous hemorrhage, and degree of nuclear sclerosis remained as independent risk factors for posterior capsule rupture in phacoemulsification cataract surgery. Conclusion Posterior capsular rupture is more likely to occur during phacoemulsification cataract surgery in patients with a preoperative visual acuity <20/200, vitreous hemorrhage, and a higher degree of nuclear sclerosis.

Clinical applicability and therapeutic effect analysis of the modified park method double-eyelid operation

XIE Yanyan, ZHANG Jixun, JIANG Duyin

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  91-94.  doi:10.6040/j.issn.1673-3770.0.2017.319

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Objective In this study, we aimed to evaluate the therapeutic effect of the modified Park method double-eyelid operation. Methods Five hundred and sixty-four modified Park method double-eyelid operations were performed from April 2013 to December 2016; 551 of the patients were female and 13 were male. The average age of the patients was 31 years(range, 16 to 46 years). Bilateral modified Park method double-eyelid operations were performed on all the patients, and 162 patients underwent epicanthoplasty as well. In each patient, the margin of the upper eyelids coincided with the pupil, and the levator muscle force was higher than 8 mm. Results Postoperatively, the incision healed at the first stage in 98.9% of the patients and there was only minor tumescence when the stitches were removed at 7 days after the operation. The follow-up duration in all patients ranged from 2 to 25 months. As a result, 94.5% of the patients achieved natural and smooth double eyelids with symmetrical configuration and minor scar. Their incisions healed quickly with tight skin tissue underneath. Conclusion The modified Park method double-eyelid operation results in a short convalescence period, natural double eyelid, higher levator muscle force, lifted upper eyelid, and a favorable effect.

Traumatic wound dehiscence after penetrating keratoplasty: eight cases and a literature view

WANG Juan, ZHAO Min, XU Mei, ZHANG Qi, ZHOU Shanbi

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  95-98.  doi:10.6040/j.issn.1673-3770.0.2017.279

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Objective To analyze the patient characteristics, risk factors, complications, and visual outcomes of traumatic wound dehiscence after penetrating keratoplasty and to highlight the importance of prevention of trauma after penetrating keratoplasty. Methods We retrospectively reviewed the medical records at our institution from 2014 to 2015 and identified 8 eyes(8 patients)who had undergone penetrating keratoplasty followed by traumatic wound dehiscence. A review of the PubMed database identified reports on 49 further eyes(49 patients), giving a total of 57 eyes(57 patients). Results The 57 affected eyes were in patients of mean age 39.86±17.63 years. The mean duration between the data of penetrating keratoplasty and the trauma was 23.05±15.99 months. The associated anterior segment injuries included prolapse of the lens/intraocular lens in 26 eyes, prolapse of the iris in 22 eyes, and hyphema in 19 eyes. The associated posterior segment injuries included prolapse of the vitreous in 18 eyes, vitreous hemorrhage in 17 eyes, retinal detachment in 8 eyes, and suprachoroidal hemorrhage in 3 eyes. After traumatic wound dehiscence, 1 patient had endophthalmitis and 1 patient developed proliferative vitreoretinopathy. Best-corrected visual acuity was 0.1 or better in 21 eyes, better than hand motion to less than 0.1 in 13 eyes, hand motion or light perception in 15 eyes, and no light perception in 8 eyes after retreatment. Injury of the limbs and different objects was the most common cause of wound dehiscence. Conclusion Patients who undergo penetrating keratoplasty have a life-long risk of wound dehiscence, regardless of age, indication for penetrating keratoplasty, and time since penetrating keratoplasty. Wound dehiscence is more likely to occur after trauma, particularly in the first year after penetrating keratoplasty. Most patients have a poor visual outcome. Absence of serious eye complications and posterior segment injury is associated with a better visual outcome.

Analysis of immunoglobulin G4-related ophthalmic disease associated with secondary glaucoma

XIE Hongbin, YANG Meina, CHEN Qingshan, LIU Xuyang, FAN Ning

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  99-102.  doi:10.6040/j.issn.1673-3770.0.2017.354

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Objective Immunoglobulin(Ig)G4-related disease has recently been recognized as a relatively rare systemic lesion with abnormal lymphocytes. IgG4-related disease can involve one or multiple organs, and is called IgG4-related ophthalmic disease(IgG4-ROD)when ocular tissue is involved. To analysis of IgG4-ROD associated with secondary glaucoma and to discuss its treatment method. Methods We analyzed clinical manifestations, biopsy, imaging examinations, the response to hormone therapy, and long-term observation. Results The serum IgG4 level is considered the most important serologic characteristic of the disease and has high diagnostic value but lacks specificity. Most patients respond to long-term glucocorticoid therapy, typically with symptomatic improvement, reductions in the size of masses or organ enlargement, improvement in organ function, and often a decrease in serum IgG4 levels. Conclusion Secondary glaucoma is one of the complications associated with IgG4-ROD, but there is still no consensus regarding the choice of surgical procedure, and the long-term postoperative outcome is unknown. It is important to recognize and address the complications of IgG4-ROD and the side effects associated with use of corticosteroids.

Advances in diagnosis and treatment of polypoid choroidal vasculopathy

WANG Xian, LI Ying, ZHAO Bojun

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  103-106.  doi:10.6040/j.issn.1673-3770.0.2017.543

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Polypoid choroidal vasculopathy(PCV)is characterized by visible orange lesions on fundoscopy. Indocyan-nine green angiograph depicts one or more hyperfluorescent polypoid lesions, with or without abnormal branching vasculature, and also serous and hemorrhagic retinal pigment epithelial detachment. Because of its unique clinical features and higher incidence, increasing attention is being paid to PCV. With advances in science and medical technology, new screening devices, therapies, and drugs are being adopted, all of which has led to a new phase in the understanding, diagnosis, and treatment of PCV. This article reviews the progress of PCV in terms of its diagnosis and treatment.

One case of sudden deafness treated by Professor Fu Wenbins Moxibustion plus acupuncture

HE Jiangshan, ZHOU Junhe, FU Wenbin

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  107-109.  doi:10.6040/j.issn.1673-3770.0.2017.397

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Low-grade myofibroblastic sarcoma of the nasal sinuses: a case report

XU Qian, GU Qingjia, FAN Jiangang, LI Jingxian

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  110-112.  doi:10.6040/j.issn.1673-3770.0.2017.478

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Severe thrombocytopenia after endoscopic sinus surgery: one case report

HU Daocai, ZHONG Junwen, YANG Xudong

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(2):  113-114.  doi:10.6040/j.issn.1673-3770.0.2017.419

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