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    20 May 2018 Volume 32 Issue 3
      
    The role of microbiome and infection in the pathogenesis of chronic rhinosinusitis
    CHENG Lei, QIU Changyu
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  1-5.  doi:10.6040/j.issn.1673-3770.1.2018.009
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    Pathogenesis, diagnosis, and treatment of chronic rhinosinusitis
    LI Huabin, LAI Yuting
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  4-9.  doi:10.6040/j.issn.1673-3770.1.2018.004
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    Chronic rhinosinusitis(CRS)is a multifactorial otolaryngologic disease, often requiring surgical intervention. The diagnosis of CRS is relatively clear based on the patients symptoms, and nasal endoscopy and sinus CT scan findings. However, the pathogenesis is complex with multiple treatment methods. Hence, the type of intrinsic pathologic mechanism and its target treatment method should be given greater consideration, in order to achieve the best therapeutic effects.
    Progress in classification of chronic sinusitis
    LOU Hongfei, WANG Chengshuo
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  10-13.  doi:10.6040/j.issn.1673-3770.1.2018.008
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    As a heterogeneous disease, chronic rhinosinusitis(CRS)is divided into different phenotypes and endotypes, presenting a disease spectrum with distinguished pathogenesis, clinical manifestations and prognosis. For such an intractable disease, it is essential to establish personalized treatment according to individual subtype within local patients.
    Endotype of chronic rhinosinusitis: from basic to clinical research
    ZHANG Guimin, LIN Peng
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  14-17.  doi:10.6040/j.issn.1673-3770.1.2017.054
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    Chronic rhinosinusitis(CRS)is a complex disease that involves multiple factors and is characterized by chronic persistent inflammation of the nasal and sinus mucosa. Owing to the high heterogeneity and complicated pathological mechanism, polyps of different endotypes may exhibit the same phenotype. The present research on the endotype of chronic rhinosinusitis focuses on the cellular and molecular biology aspects of the disease onset. We expect to identify specific molecular markers, which can be used as target molecules for accurate individualized treatment.
    Opinions on the treatment of chronic rhinosinusitis with allergic rhinitis
    CHEN Ming, YU Xuefei
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  18-22.  doi:10.6040/j.issn.1673-3770.1.2018.007
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    Chronic rhinosinusitis(CRS)and allergic rhinitis(AR)are both common chronic upper respiratory diseases and they have certain inherent links and similar inflammatory mechanisms. It is necessary to improve preoperative examination and treatment of allergies in patients with chronic sinusitis or nasal polyps including through food and environment allergen avoidance, immunotherapy, nasal irrigation, administration of nasal steroid hormones, antibiotics against sinus pathogens, and anti-allergy medications such as antihistamines and leukotriene receptor antagonists; and anti-gastroesophageal reflux surgery. Furthermore, vitamin D induces cell differentiation, participates in immune regulation, and regulates other endocrine systems, thus playing an important role in the inflammation involved in CRS and AR.
    Status of immunotherapy in allergic fungal rhinosinusitis
    QIN Gang, LIANG Zhuoping
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  23-26.  doi:10.6040/j.issn.1673-3770.1.2018.006
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    Allergic fungal rhinosinusitis(AFRS)is an allergic disease caused by a fungus that acts as an antigen at the nasal mucosa of atopic individuals, and produces a combination of type I and III allergic reactions. The incidence of AFRS is high, and it is easy to relapse after surgery and postoperative drug treatment. There are serious impacts on the quality of life in patients. Therefore, it is of great importance to seek a safe and effective comprehensive treatment plan. Immunotherapy performed as part of comprehensive therapy can significantly improve the clinical symptoms of AFRS and reduce the requirement for corticosteroids and other drugs. The clinical value of immunotherapy is confirmed further by the finding that patients with AFRS who receive this treatment do not need repeat surgery. However, the benefits of immunotherapy remain controversial owing to conflicting research findings, and therefore these benefits warrant further investigation in clinical practice.
    Syndrome differentiation of chronic sinusitis
    LI Ying
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  27-30.  doi:10.6040/j.issn.1673-3770.1.2017.056
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    The understanding of Traditional Chinese medicine(TCM)on pathogenesis of chronic sinusitis was discussed in this paper. From the viewpoint of “concept of holism and syndrome differentiation” of TCM, its features and advantages on treating sinusitis by using “different treatments for same disease” were highlighted, and the shortcomings and some remaining problems were also put forward.
    Frontal recess classification and analysis of the frontal sinus passageway in 100 Chinese cadaver heads
    WU Yanqiao, ZHENG Weiming, LI Jiusheng
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  31-36.  doi:10.6040/j.issn.1673-3770.1.2018.005
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    Objective To classify types of frontal recesses using Chinese cadaver heads, in order to simplify frontal recess classification and to allow easier and safer construction of the frontal sinus passageway for frontostomy. Methods A total of 100 Chinese cadaver heads underwent sliced sinus computed tomography scans. Data describing the frontal recess were summarized based on the International Frontal Sinus Anatomy Classification system. The frontal sinus passageway was analyzed and verified via cadaver dissection. Results The frontal sinus in Chinese cadaver heads exhibits very large variation in its composition. Cells were present in scans as follows: agger nasi cells in 95%; supra agger nasi cells in 26% of T1 scans, 6% of T2 scans; supra agger frontal cells in 19%; supra bulla cells in 53.5%; supra bulla frontal cells in 22%; and frontal septal cells in 23.5%. Agger nasi, supra agger, and supra agger frontal cells belong to the anterior frontal recess group; frontal septal cells belong to the medial frontal recess; supra bulla and supra bulla frontal cells belong to the posterior group. We classified the frontal sinus passageway into 10 types(in descending frequency): anterior medial(right side, 34 cases; left side, 35 cases); anterior(right side, 18 cases; left side, 17 cases); medial(right side, 14 cases; left side, 13 cases); anterior lateral(right side, 10 cases; left side, 10 cases); posterior(right side, 6 cases; left side, 7 cases); lateral(right side, 6 cases; left side, 5 cases); direct(right side, 3 cases; left side, 5 cases); posterior medial(right side, 3 cases; left side, 4 cases); slit(right side, 2 cases; left side, 0 cases); and posterior lateral(1 case for both sides). Conclusion Use of the International Frontal Sinus Anatomy Classification and the three-dimensional frontal sinus passageway methods may help rhinologists easily construct frontal sinus passageways and safely perform frontostomy.
    The expression and significance of interleukin-31, and interleukin-33 and its receptor ST2, in refractory rhinosinusitis
    ZHANG Liyue, LIU Jinlan, YAO Dongfang, LI Jieen
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  37-41.  doi:10.6040/j.issn.1673-3770.0.2017.430
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    Objective To study the expression of interleukinIL-31(IL-31), and interleukin-33(IL-33)and its receptor ST2, in the nasal mucosa of patients with refractory rhinosinusitis(RRS), and to investigate their role in the pathogenesis of RRS. Methods In this study, a refractory group, an initial treatment group, and a control group were established. The hematoxylin and eosin staining method was used to observe the morphology and detect the number of eosinophils(EOS)present in the mucosal tissues. The relative levels of IL-31, IL-33, and ST2 in the tissues were detected by immunohistological examination.Quantitative fluorescence real-time polymerase chain reaction was used to detect the mRNA levels of IL-31, IL-33, and ST2, and total serum immunoglobulin E(IgE)expression in the peripheral blood. Results (1)The number of EOS in the refractory group and initial treatment group were higher than that in the control group. Further, the number of EOS in the refractory group were higher than that in the initial group. (2) On immunohistological examination, the expression levels of IL-31 and IL-33 proteins in the refractory group and the initial treatment group were higher than those in the control group. Additionally, the expression levels of both IL-31 and IL-33were higher in the refractory group than in the initial treatment group. The expression of ST2 in the refractory group and the initial treatment group was higher than that in the control group, but there was no significant difference in the expression of ST2 between the refractory group and the initial treatment group. (3) At the level of mRNA expression, the levels of IL-31 and IL-33 in the refractory group and the initial treatment group were higher than those in the control group. Furthermore, the levels of IL-31 and IL-33 mRNA in the refractory group were higher than those in the initial treatment group. The ST2 mRNA levels in the refractory group and the initial treatment group were higher than that in the control group, but there was no significant difference between the refractory group and the initial treatmentgroup. (4) There was no significant difference between the three groups in the total IgE levels in the peripheral blood. Conclusion IL-31, and IL-33 along with its receptor ST2, may play an important role in the pathogenesis of chronic rhinosinusitis, especially in patients with RRS. Eosinophilic infiltration may also play an important role in the development of RRS.
    The expression and significance of p-ERK2/ ERK2 in nasal polyps
    LI Hongmei, WANG Lan, GAO Zhaohui, WANG Ying, XUE Jinmei
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  42-46.  doi:10.6040/j.issn.1673-3770.0.2017.522
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    Objective To detect the expression of p-ERK2/ ERK2 in nasal polyps(NPs)and to explore the clinical significance of p-ERK2/ ERK2 in the pathogenesis of NPs. Methods Indirect immunofluorescence and western blotting were used to detect the expression of p-ERK2/ ERK2 in NPs and normal nasal mucosa. Results In the NP group, p-ERK2 was primarily expressed in the proliferative epithelial cells, inflammatory cells, and glandular epithelial cells, and was localized predominantly in the nucleus; ERK2 was mainly expressed in the glandular epithelial cells and inflammatory cells, and was localized predominantly in the cytoplasm. In the normal nasal mucosa group, p-ERK2 was primarily expressed in the inflammatory cells and glandular epithelial cells, and was localized predominantly in the nucleus; ERK2 was mainly expressed in the inflammatory cells, and was localized predominantly in the cytoplasm. Considering fluorescence intensity as an index for expression, p-ERK2 expression showed a significant difference between the NP and normal nasal mucosa groups(P<0.05), while ERK2 expression did not(P>0.05). Using the gray values from Western blotting, p-ERK2 expression showed a significant difference between the two groups(P<0.05), while ERK2 expression did not(P>0.05). Conclusion p-ERK2 might play an important role in the pathogenesis of nasal polyps. However, ERK2 might not be involved in the initiation of nasal polyps; ERK2 was not only expressed in nasal polyps, but also in the normal nasal mucosa, suggesting that ERK2 might be involved in the maintenance of the normal physiological function of the nasal mucosa.
    BRF2 in the pathogenesis of chronic rhinosinusitis with nasal polyps
    GAN Bin, ZHANG Yongju, XU Anting
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  47-53.  doi:10.6040/j.issn.1673-3770.0.2018.068
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    Objective To study the expression and significance of BRF2 in chronic rhinosinusitis with nasal polyps. Methods 37 surgical specimens of chronic rhinosinusitis with nasal polyps(CRSwNP)and 18 surgical specimens of simple deviation of nasal septum were collected from 2016 to 2017 in the Department of Otorhinolaryngology Head and Neck Surgery, Second Hospital of Shandong University. Immunofluorescence staining was used to detect the expression and localization of BRF2 in chronic rhinosinusitis with nasal polyps. After cultured human nasal mucosa epithelial cells were stimulated with Llipopolysaccharides(LPS)in vitro, the expression and localization of BRF2 in cells were detected by immunofluorescence staining. Western blotting and quantitative real-time PCR were used to detect the expression of BRF2 and the endoplasmic reticulum stress-related protein GRP78 in cells. Results The expression of BRF2 in chronic rhinosinusitis with nasal polyps was up-regulated in whole cells and was particularly increased in the cytoplasm fraction. In vitro, LPS stimulation can induce the up-regulation of expression of BRF2 to be up-regulated in nasal mucosal epithelial cells and increase the distribution of BRF2 in the cytoplasm, and tThe expression of endoplasmic reticulum stress-related protein GRP78 was also increased. Conclusion BRF2 may mediate endoplasmic reticulum stress, which is involved in the pathogenesis of chronic rhinosinusitis with nasal polyps.
    Clinical significance of eosinophils and neutrophils in blood and allergic reaction in patients with chronic rhinosinusitis
    ZHANG Jie, GONG Qi
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  54-57.  doi:10.6040/j.issn.1673-3770.0.2017.422
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    Objective To analyze the percentage of eosinophils and neutrophils in the blood of patients with chronic rhinosinusitis(CRS)and clinical differences in allergic reactions. Methods We prospectively selected 150 patients with CRS treated in Baoshan District Dacheng Hospital in Shanghai and Dawn Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 2015 to May 2017. Clinical data and skin prick test results were collected, and the ratio of neutrophils and eosinophils in the blood, and their association with the onset of CRS, were analyzed. Results The pathological diagnosis showed that 45 cases were neutrophilic and 105 cases were eosinophilic. The percentage of eosinophilic granulocytes in the blood of patients with infiltrating eosinophils was significantly higher than that in the blood of patients with infiltrating neutrophils(P < 0.05). There were no significant differences in the distribution of CRS without nasal polyps, CRS with nasal polyps, and immunopathological features between the two groups of infiltrated patients(P>0.05). Conclusion The degree of infiltration of neutrophils and eosinophils in the pathological tissues of CRS patients was related to the ratio of eosinophils in the blood, and the degree of infiltration of local eosinophils and peripheral blood eosinophils appeared to be consistent.
    Effects of budesonide combined with saline nasal irrigation on chronic rhinosinusitis and nasal secretion of
    ZHENG Yani, LIU He, MA Liang, ZHANG Mingsheng, SUN Zhongwu
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  58-62.  doi:10.6040/j.issn.1673-3770.0.2017.455
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    Objective To investigate the effects of budesonide combined with saline nasal irrigation on chronic rhinosinusitis(CRS)and nasal secretion of interleukin(IL)-6, IL-8, and tumor necrosis factor-alpha(TNF-α). Methods One hundred and twenty-eight subjects were selected for the study from the patients with CRS treated in our hospital from February 2016 to May 2017. They were divided using a random number table generator into a control group that received saline nasal lavage alone(n=64)and an observation group that received saline nasal lavage to which budesonide suspension was added(n=64). The clinical efficacy and changes in IL-6, IL-8 and TNF-α levels in nasal secretions, the Lund-Kennedy score for the nasal cavity, and the computed tomography score for the paranasal sinuses were compared between the two groups before and after 4 weeks of treatment. Results The efficacy rate was significantly higher in the observation group than in the control group(93.75% [60/64] vs. 71.88% [46/64]; P<0.01). The nasal Lund-Kennedy and paranasal sinus computed tomography scores were significantly lower in both study groups after treatment than before treatment(P<0.01); however, the decreases in these scores were significantly greater in the observation group(P<0.01). The IL-6, IL-8, and TNF-α levels in nasal secretions were also significantly lower in both study groups after treatment than before treatment(P<0.01); however, the decreases in levels of these inflammatory markers were significantly greater in the observation group(P<0.01). No obvious adverse reactions occurred in either study group during treatment. Conclusion Budesonide combined with saline nasal irrigation can significantly relieve nasal inflammation, help to relieve symptoms such as nasal congestion and swelling, and have a curative effect in patients with CRS.
    Changes in nasal secretion of ECP, EGF and IL-6 in patients with chronic sinusitis before and after endoscopic sinus surgery and their clinical significance
    ZHANG Wei, ZENG Yuhan, YU Xiansong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  63-67.  doi:10.6040/j.issn.1673-3770.0.2017.547
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    Objective To investigate changes in eosinophil cationic protein(ECP), epidermal growth factor(EGF)and interleukin-6 in nasal secretions of patients with chronic rhinosinusitis(CRS)and nasal polyps before and after endoscopic sinus surgery, analyzing their significance for postoperative wound healing. Methods A total of 163 CRS patients with nasal polyps who underwent endoscopic sinus surgery were enrolled in this study. Nasal secretions was collected 1, 6, and 12 weeks after operation. The concentrations of ECP, EGF and IL-6 were detected by enzyme-linked immunosorbent assay. Results Compared with a control group, preoperative ECP, EGF, and IL-6 levels were significantly increased in the patients(P<0.001). The levels of ECP, EGF and IL-6 at 1 week postoperative were significantly lower than those in the control group(P<0.05). The levels of ECP, EGF and IL-6 at 6 weeks postoperative were significantly higher than those in the control group, and also higher than the preoperative and 1-week postoperative levels(P<0.05). The levels of ECP, EGF and IL-6 at 12 weeks postoperative were significantly lower than the preoperative levels and 6-week postoperative levels(P<0.05), significantly higher than the 1-week postoperative levels(P<0.05), and not significantly different from the preoperative levels(P>0.05). Linear regression analysis showed that preoperative ECP, EGF and IL-6 levels affected the healing of the surgical cavity 6 weeks and 12 weeks postoperatively(P<0.05). Conclusion The levels of ECP, EEG and IL-6 were significantly increased in patients with CRS nasal polyps before operation, and the dynamic changes during postoperative wound healing may have been related to the postoperative epithelial repair process.
    Influence of patient management on the clinical effect of sublingual dermatophagoides farinae drops in patients
    WU Xiangping
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  68-72.  doi:10.6040/j.issn.1673-3770.0.2018.044
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    Objective To analyze the influence of different patient management methods on the clinical effect and compliance to treatment with sublingual dermatophagoides farinae drops in patients with allergic rhinitis(AR). Methods One hundred and eighty patients with AR were randomly divided into a We-Media management Group(Group A, 90 patients)and a telephone management group(Group B, 90 patients). All patients were treated with sublingual immunotherapy(SLIT). In Group A, doctor-patient WeChat and/or QQ groups were formed. The doctor in charge acted as group leader, prepared monthly plans, sent to the patients SLIT-related information more than 3 times a week, and assessed patient reported outcome. In Group B, the patients were provided with on-the-spot demonstration and explanation and were followed up by telephone once every 3 month. We statistically analyzed dropout rates and the curative effect in the two groups at 1 year. Results The dropout rate in groups A and B was 13.3%(12/90)and 32.2%(29/90), respectively and the difference was statistically significant(χ2=9.128,P=0.003). The symptom scores before and after treatment were significantly different in both groups(P<0.05). There was no significant difference between Groups A and B before treatment(P>0.05), while the difference in the score of each symptom between the groups after treatment was significant(P<0.05). In Group A, the results were markedly effective in 15 patients(16.67%), effective in 49(54.44%), and ineffective in 26(28.89%), with a general effective rate of 71.11%(64/90). In Group B, the results were markedly effective in 13 patients(14.44%), effective in 26(28.89%), and ineffective in 51(56.67%), with a general effective rate of 43.33%(39/90). Conclusion The clinical effect and treatment compliance can be improved in patients with AR receiving SLIT by We-Media management.We-Media management is more advantageous especially in the long-term.
    Efficacy of the continuous suture technique in septoplasty
    WANG Lei, YUAN Ying, YU Xuemin, HAN Yue, WANG Ning, LI Xiao, LI Zejing, LI Long
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  73-75.  doi:10.6040/j.issn.1673-3770.0.2017.390
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    Objective To evaluate the efficacy of the continuous septum suturing technique in nasal septoplasty. Methods A total of 49 patients who underwent nasal septoplasty, were included in this study. The patients were randomly divided into two groups: a packing group and a suturing group. Postoperative signs and symptoms were compared between the two groups using visual analogue scales(VAS). Results Analysis of the VAS scores revealed that the patients in the packing group experienced significantly more postoperative nasal pain, headache, sleep disturbances, and epiphora(all P<0.05). There were no statistically significant differences between the two groups in nasal congestion, hemorrhage, septal hematoma, nasal septum perforation, and local infection(all P>0.05). Conclusion The continuous septum suturing technique can relieve postoperative pain and does not increase complications; thus it deserves further dissemination.
    Characteristics of respiratory epithelial adenomatoid hamartomas in the nasal olfactory cleft on computed tomography
    YU Qianqian, GUAN Ge, ZHANG Niankai, LI Na, WEN Junfeng, LIU Tingting, LIAN Yuanyuan
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  76-81.  doi:10.6040/j.issn.1673-3770.0.2017.355
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    Objective To study the characteristic computed tomography(CT)features of respiratory epithelial adenomatoid hamartomas in the olfactory clefts and to explore the differences found between hamartoma and chronic sinusitis with nasal polyps on a CT scan. Methods (1) The CT findings of 17 patients with histologically proven respiratory epithelial adenomatoid hamartoma in the bilateral olfactory clefts were retrospectively reviewed and CT features were analyzed. (2) The widths of the olfactory fissure area and the total nasal cavity on axial and coronal CT of 17 patients with hamartoma, 36 patients with nasal polyps, and 41 normal persons were measured and the ratio of the olfactory cleft to the nasal width was calculated. Results The analysis showed that patients with hamartoma presented with a soft tissue shadow in the olfactory fissure zone of equi-density with gray matter, and the width of olfactory cleft was increased. Median olfactory cleft widths in the axial and coronal CT images were: hamartoma, 11.5 and 11.8 mm; nasal polyps, 7.5 and 7.8 mm; and control group, 5.4 and 5.4 mm, respectively. The differences among the groups were statistically significant(all P<0.001). Total nasal width was not significantly different among the groups in either scan orientation. The median olfactory cleft width and total nasal width ratios were 45.5% and 43.5% for the hamartoma group, 30.0% and 30.0% for the nasal polyp group, and 22.0% and 21.0% for the control group, respectively, in the axial and coronal planes. The differences among the groups were statistically significant(all P<0.001). Conclusion Compared to normal and nasal polyposis CT-scans, REAH significantly enlarges the olfactory clefts width and olfactory cleft width / total nasal width. The enlargement of olfactory cleft is one of the characteristic signs of REAH,and CT can be used as a basis for the differential diagnosis of hamartoma and nasal polyps. Especially bilateral symmetry broadening is more valuable in diagnosis, and an olfactory cleft width more than 10 mm should be considered highly suggestive of hamartoma.
    Establishment of a three-dimensional pediatric larynx finite element model
    XU Hongming, GU Meizhen, CHEN Fang, JIANG Yugang, LI Xiaoyan
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  82-85.  doi:10.6040/j.issn.1673-3770.0.2017.329
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    Objective To establish a three-dimensional(3-D)pediatric larynx finite element model. Methods Materialises Interactive Mederical Image Control System was employed to process the DICOM images from a computed tomography(CT)scan of the larynx by means of distinguishing different components using gray-level thresholding for different tissues. All 3-D visualization models of the larynx were only generated by this software. ABAQUS software was used to handle the grid layout of the larynx finite element model. Results A 3-D model that finely represented the morphological characteristics of the pediatric larynx was generated using finite element technology. This model is comparable with the results of laryngoscopy. Conclusion The 3-D finite element model of the pediatric larynx provides a foundation for further study.
    Clinical analysis of intractable benign paroxysmal positional vertigo
    YAN Huiqin, WANG Hao
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  86-88.  doi:10.6040/j.issn.1673-3770.0.2017.384
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    Objective To investigate the clinical characteristics and treatment of intractable benign paroxysmal positional vertigo(BPPV). Methods A retrospective analysis was performed on 13 patients diagnosed as having intractable BPPV,and etiological factors, types, clinical features, and therapeutic effects were analyzed. Results Depending on the cause, concomitant illness was actively treated. Through correct manipulation and Brandt-Daroff treatment, 11 patients were cured, and none of the patients had any recurrence after 1 year of follow-up. The treatment was ineffective in 2 patients, one had a posterior semicircular canal, and one had horizontal semicircular canal BPPV and went to another hospital to undergo semicircular canal blockage surgery with good outcome. Conclusion Refractory BPPV may be associated with head trauma, sudden sensorineuraI hearing loss, and so on. First of all, we must actively treat the accompanying diseases according to the cause. Meanwhile, we should rehabilitate the patients with the correct method and combine Brandt-Daroff exercises. Most patients have good efficacy after treatment, and semicircular canal occlusion is effective for those with invalid refractory BPPV.
    Clinical characteristics of acute concomitant esotropia: long-term effects of curative treatment approaches
    HE Li, MA Luxin, ZHAO Bojun, CAO Suyan, WANG Yumei
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  89-90.  doi:10.6040/j.issn.1673-3770.0.2017.544
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    Objective The present study aimed to investigate the clinical features of acute concomitant esotropia, as well as the long-term effects of curative treatment approaches. Methods The study included 11 patients with acute concomitant esotropia who were treated by the same clinician between October 2014 and June 2017. We examined the effect of prism treatment or surgical intervention on diplopia, eye function, eye movement, and binocular visual function according to the clinical characteristics. Results Following the removal of the prism after at least 6 months of treatment, binocular vision had returned to normal. No postoperative diplopia was observed in surgical patients, who also exhibited improvements in ocular positivity, binocular vision, and eye movement. Conclusion Both prism and surgical treatment can be used to achieve satisfactory long-term outcomes in patients with acute concomitant esotropia. The appropriate treatment should be selected based on the patient’s clinical features, the size of the oblique visual field, and the degree of diplopia.
    Clinical observations following thermal pulsation system treatment for mild and moderate meibomian gland dysfunction
    LI Shang, ZHANG Wei, LU Hongshuang, ZANG Yunxiao, DONG Hongwei, GUO Chungang, PAN Zhiqiang, JIE Ying
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  91-95.  doi:10.6040/j.issn.1673-3770.0.2017.495
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    Objective To assess the clinical outcomes of using Lipiflow thermal pulsation system, on mild to moderate meibomian gland dysfunction(MGD), during treatment and at the 3 and 6 months follow up visit. Methods A retrospective analysis of clinical data of MGD patients who sought medical help and underwent LipiFlow treatment at Beijing Youan Hospital from March to November 2016, was conducted. The participants answered a SPEED questionnaire for before, and 3 and 6 months after treatment. In addition, other indicators assessed included, partial blinks(PB), lipid layer thickness(LLT), tear break-up time(TBUT), Schirmer I test(SIT), and meibomian glands yielding liquid secretion(MGYLS). Results SPEED scores at 3 and 6 months, after treatment, were(10.20±3.57)and(9.87±3.68)respectively, significantly lower than(12.13±2.42)before treatment. PB rate assessed at the same time points after treatment was 60% and 62.4%, significantly different than 72.24% before treatment. The other scores, in the order before treatment, 3 and 6 months after treatment, were as follows: LLT scores were(71.70±21.23),(72.03±20.52), and(74.60±20.07)nm; TBUT scores were(5.37±2.19),(6.33±2.34), and(6.40±2.50)s; SIT scores were(5.30±4.41),(5.93±4.51), and(7.43±7.26)mm; and MGYLS scores were(3.50±2.11),(4.23±1.99), and(3.83±1.97). No statistically significant differences were found for LLT, TBUT, SIT, and MGYLS scores. Conclusion Subjective symptoms were improved by thermal pulsation system treatment in mild and moderate MGDs, and PB rates were lowered. The efficacy lasted for up to 6 months.
    Effect of maternal allergy and environmental exposure on immune maturation
    LIANG Zhengyan, DENG Yuqin, TAO Zezhang
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  96-104.  doi:10.6040/j.issn.1673-3770.0.2017.363
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    In recent years, the effects of maternal allergy and environmental exposure on immune maturation have attracted a lot of attention. The period before and after birth is key to immune maturation, exchange of maternal allergic immune components in cord blood, but the exact mechanism is unclear. Meanwhile, environmental exposure may have positive or negative effects on fetal immune function. This article summarizes the exposure factors and their effects on immune maturation.
    Experience of Professor SUN Haibo in the treatment of chronic rhinosinusitis
    QU Zhongyuan, QU Rupeng, WANG Aiping, LENG Hui, SHI Lei, SUN Haibo
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  105-107.  doi:10.6040/j.issn.1673-3770.0.2018.055
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    Chronic rhinosinusitis is one of the most common diseases encountered in patients in the otorhinolaryngology department. This paper summarizes the clinical experiences of Professor SUN Haibo in the treatment of chronic rhinosinusitis. Professor SUN Haibo points out that the underlying basis of the pathogenesis of chronic rhinosinusitis is a disorder of the movement of qi and obstruction of the orifices. Further, he emphasizes the importance of the four local methods of diagnosis in clinical practice and treatment by elevating qi and clearing turbid; regulating liver and spleen; and ventilating lung qi.
    Excision of giant tumor in nasal floor involving palatine via oral-nasal combined approach under a nasal endoscope assisted: a report of 2 cases
    LIU Tingting, WANG Xuehai, CAI Xiaolan, TIAN Zejing, ZHANG Liqiang, LI Xuezhong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  108-110.  doi:10.6040/j.issn.1673-3770.0.2017.333
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    A report of 1 case of branchial fissure carcinoma and literature review
    LAN Yunying, YANG Yu, LI Hong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  112-114.  doi:10.6040/j.issn.1673-3770.0.2017.417
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    Partial excision of larynx by combined laryngeal and subglottic subtotal laryngectomy
    QIAN Ye, WEI Dongmin, LI Wenming, LEI Dapeng, PAN Xinliang
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  115-115.  doi:10.6040/j.issn.1673-3770.0.2018.062
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    Discussion on improving the effectiveness of theoretic study assessment of post-graduate students majoring in theoretical aspects of ophthalmology
    JIE Ying, ZANG Yunxiao
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2018, 32(3):  116-118.  doi:10.6040/j.issn.1673-3770.0.2017.501
    Abstract ( 1334 )   PDF (321KB) ( 223 )   Save
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    This paper proposes outlines the the limitations of the current methods for theused to study assess post-graduate courses covering the theoretical aspects of of ophthalmologicyal theory courses for graduate students with professional degree, and discusses the corresponding countermeasures and alternative evaluation criteria that couldo improve the effectiveness and pertinence of theoretical such course studys.