Journal of Otolaryngology and Ophthalmology of Shandong University

Relationship of anxiety and depression with illness stage in patients with sudden hearing loss and its influencing factors

HUANG Fang, ZHENG Zhijuan, XIE Lei

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 1-6. doi:10.6040/j.issn.1673-3770.0.2017.449

Abstract ( 1551 )

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Objective To investigate the relationship of anxiety and depression with illness stage in patients with sudden hearing loss, and to analyze the factors influencing anxiety and depression. Methods Forty-five patients with sudden hearing loss in the acute stage(acute group), 71 subjects with sudden hearing loss in the chronic stage(chronic group), and 30 healthy subjects(control group)were enrolled from January 2016 to January 2017. The degrees of anxiety and depression in each group were evaluated using the Hamilton Anxiety(HAMA)and Hamilton Depression(HAMD)scales. General information and data of illness and treatment were recorded, and the factors influencing anxiety and depression were analyzed using the classification and regression tree. Results The HAMA and HAMD scale scores and the incidence rates of anxiety and depression in the acute group were much higher than those in the chronic and control groups(compared with the chronic group, Z=-9.100, P<0.001; Z=-9.091, P<0.001; χ2=31.209, P<0.001; χ2=35.845, P<0.001. compared with the control group, Z=-7.336, P<0.001; Z=-7.324, P<0.001; χ2=21.674, P<0.001; χ2=23.148, P<0.001). These indexes were similar between the chronic and control groups, although the differences were not statistically significant(Z=-1.018, P=0.308; Z=-0.042, P=0.967; P=0.671; P=0.722). In the patients with anxiety or depression, the proportion of those with acute illness was higher(χ2=31.209, P<0.001, χ2= 35.845, P<0.001), and the proportions of those with mild deafness and no or mild tinnitus were lower(χ2=12.650, P<0.001; χ2=18.629, P<0.001). In the patients with depression, the proportion of males was lower(χ2=4.424, P=0.035). These differences were statistically significant. The disease stage and degree of deafness were the main factors influencing anxiety and depression in all the patients. In the chronic group, the patients with poor prognosis had a higher prevalence of anxiety or depression; the differences were statistically significant(Z=-2.445,P=0.014; Z=-2.815,P=0.005). Conclusion In this study, the patients with acute sudden hearing loss had high prevalence rates of anxiety and depression. Disease stage and degree of deafness were the main factors influencing anxiety and depression. The patients with chronic illnesses who received treatment with better efficacy had lower risks of anxiety and depression.

Relationship between the psychoacoustic characteristics of tinnitus and high frequency hearing threshold

HUANG Juan, PANG Yufeng, GONG Jingrong, DONG Yuehui

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 7-10. doi:10.6040/j.issn.1673-3770.0.2017.453

Abstract ( 1650 )

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Objective To investigate the relationship between the pitch of tinnitus and high frequency hearing threshold(HFHT). Method A total of 156 patients with tinnitus and normal hearing thresholds between 125 and 8 000 Hz were included. Psychoacoustic characteristics of tinnitus and HFHT were recorded. The HFHTs of subjects with normal hearing thresholds but without tinnitus were measured as a control group. The patients were then divided into four groups according to age(25-35 years old, 36-45 years old, 46-55 years old, and ≥55 years old). The patients were divided into nine groups based on their tinnitus pitch: low-frequency group(125 Hz, 250 Hz, and 500 Hz), middle-frequency group(1.5 kHz and 3 kHz), and high-frequency group(4 kHz, 6 kHz, 8 kHz, and ≥9 kHz). The data available from the nine groups and the control group were analyzed. Results No correlation was found between the groups with and without tinnitus. Age, presence of tinnitus, and interaction had significant influence on HFHT. There was no difference between the low-frequency and control groups. In the middle-frequency group, there was significant hearing loss related to frequency, including at 9 kHz in the 1.5 kHz group and at 11.2 kHz in the 3 kHz group. In the high-frequency group, there was significant hearing loss related to frequency, including at 10 kHz in the 4 kHz group, at 10 kHz and 11.2 kHz in the 6 kHz group, at 10 kHz in the 8 kHz group, and at 10 kHz and 12.5 kHz in ≥9 kHz group. The hearing levels at 11.2 kHz in the 8 kHz and ≥9 kHz groups were statistically significantly lower than those in the control group(P<0.01). Conclusion HFHT correlated with age and presence of tinnitus. The decrease of hearing thresholds at 10 kHz and 11.2 kHz in the middle-frequency and high-frequency groups may be a sensitive indicator for alterations in the basal cochlea, which could lead to clinical therapy for high-frequency tinnitus.

Clinical efficacy of postauricular mastoid subperiosteal injection with betamethasone and lidocaine hydrochloride

HUANG Yingming, WAN Baoluo, JIN Yuwei

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 11-13. doi:10.6040/j.issn.1673-3770.0.2017.508

Abstract ( 3167 )

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Objective To investigate the effect of postauricular mastoid subperiosteal injection with betamethasone and lidocaine hydrochloride for idiopathic sudden deafness. Methods A 100 cases of idiopathic sudden deafness with concomitant tinnitus reported at the Henan Province Peoples Hospital between May 2015 and May 2016 were retrospectively studied. These cases were divided into the injection group(50 cases)and non-injection group(50 cases). The pure tone audiometry thresholds across 0.25-4 kHz and tinnitus levels of patients were evaluated before and after treatment. Results Based on audiometry measurements, in the injection group, 10 cases(20%)were cured, 20(40%)showed good effect, 13(26%)showed moderate effect, and 7(14%)showed no effect, whereas in the non-injection group, 5 cases(10%)were cured, 10(20%)showed good effect, 18(36%)showed moderate effect, and 17(34%)showed no effect. Tinnitus evaluation indicated that, in the injection group, 10 cases(20%)were cured, 15(30%)showed good effect, and 25(50%)showed no effect, whereas in the non-injection group, 6 cases(12%)were cured, 13(26%)showed good effect, and 31(62%)showed no effect. Conclusion The study found that postauricular mastoid subperiosteal injection with betamethasone and lidocaine hydrochloride was beneficial for patients with idiopathic sudden deafness.

Analysis of tympanic sinus CT classification and surgical procedure in management of otitis media

CHEN Tao, LIU Shanping, LU Yongtian

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 14-16. doi:10.6040/j.issn.1673-3770.0.2017.538

Abstract ( 1578 )

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Objective Retrospective analysis of tympanic sinus computed tomography(CT)classification(the relationship between the tympanic sinus and the facial nerve)in 90 ears with otitis media to explore the indications of endoscopic and microscopic surgery for the treatment of posterior tympanic disease. Methods Preoperative CT examinations of 90 ears with otitis media were retrospectively reviewed and classified. CT classifications were summarized, and the numbers and proportions of each type were analyzed. Results CT examinations of 90 ears with otitis media were classified as follows: type A, 43 ears(47.78%); type B, 45 ears(50%); and type C, two ears(2.22%). Conclusion Tympanic sinuses of types A and B are predominant; thus, endoscopic middle ear surgery is suitable for most cases of otitis media. However, microscopic surgery remains the best approach for tympanic sinuses of type C.

Transcription factor NKX2-1 regulates eosinophilic inflammation in chronic rhinosinusitis with nasal polyps

HUANG Yuan, BA Luo, LI Bo, YU Wenxing, YANG Fangli, DU Jintao

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 17-23. doi:10.6040/j.issn.1673-3770.0.2018.183

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Objective To define the endotypes of chronic rhinosinusitis with nasal polyps(CRSwNP)on the basis of the expression of different key cytokines, and to investigate the mechanism via which the new transcription factor, NKX2-1, orchestrates eosinophilic inflammation in nasal polyps(NPs). Methods Polyp tissue was obtained from patients with nasal polyps and turbinate tissue was obtained from the controls after functional nasal endoscopic surgery. The expression levels of key cytokines(IL-5, IFN-γ, and IL-17A,)as well as NKX2-1 and CCL17 in NPs of different endotypes and control tissues were determined using enzyme-linked immunosorbent assay,immunohistochemistry, and western blot analysis. Results We observed that 24% patients with CRSwNP were IL-5 positive and showed infiltration of eosinophilic cells and increased IL-4 and IgE levels; 40% NPs were negative for key cytokines(KCNNPs)but showed increased levels of IL-8 and IL-1β and no eosinophilic inflammation. The expression of NKX2-1 in IL-5 + NPs was significantly lower than in normal controls. Moreover, the expression of CCL17 was significantly higher in IL-5 + NPs, which was associated with reduced NKX2-1 expression and eosinophil accumulation. Conclusion The downregulation of NKX2-1 in IL-5+ NPs may be associated with tissue eosinophilic inflammation. This indicates that NKX2-1 might be a special factor in NP pathophysiology.

Psychological status of patients with deviated nasal septum or chronic sinusitis with nasal polyps

CHEN Wangxing, ZHAO Xue, LIU Yan, LIU Yue, JIN Chunshun

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 24-27. doi:10.6040/j.issn.1673-3770.0.2018.081

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Objective To investigate the psychological status of patients with nasal diseases such as deviated nasal septum(DNS)and chronic rhino-sinusitis with nasal polyps(CRSwNP), and to analyze the changes after surgical intervention. Methods We applied the Zung-self-rating anxiety scale(SAS)and Zung-self-rating depression scale(SDS)as psychological assessment tools. A qualitative study was conducted to analyze the anxiety and depression of 41 patients with DNS, 44 patients with CRSwNP, 31 patients with vocal cord polyp(Control Group)and 39 healthy people. Results The preoperative SAS and SDS scores in different groups were Healthy(36.74±10.39; 38.51±11.30), Control Group(38.52±10.99; 42.26±10.42), CRSwNP(42.00±13.54; 43.84±15.44), DNS(45.02±10.80; 48.32±11.21). The SAS and SDS scores of the DNS group were significantly different from the Control and Healthy groups(P<0.01). The scores could be reduced by surgical treatment(P<0.05). However, almost 1/3rd of patients with nasal diseases reported the same levels of anxiety and depression postoperatively. Conclusion We conclude that the prevalence of anxiety and depression in nasal disease patients is higher than that in the normal population. More attention should be paid to the emotional reactions of inpatients with nasal diseases; psychological interventions against negative emotions should be provided to patients when treating them for somatic diseases.

Effect of short-term glucocorticoid inhalation on nasal symptoms and adrenocortical function in patients with eosinophilic chronic sinusitis accompanied by nasal polyps

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 28-31. doi:10.6040/j.issn.1673-3770.0.2017.170

Abstract ( 1450 )

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Objective The aim of this study was to investigate the effect of short-term glucocorticoid inhalation on nasal symptoms and adrenocortical function in patients with both eosinophilic chronic sinusitis and nasal polyps. Methods A total of 40 patients with eosinophilic chronic sinusitis with nasal polyps were enrolled from June 2013 to June 2016 in the hospital, and they were randomly divided into two groups: one control group(20 patients)with glucocorticoid treatment by nasal spray and one observation group(20 patients)with glucocorticoid treatment by inhalation. The short-term clinical efficiency, visual analogue scale(VAS)scores of nasal symptoms, Lund-Kennedy endoscopic score, eosinophil(EOS)count, and serum cortisol concentration were compared between these two groups before and after treatment. The follow-up recurrence rate in both groups was also investigated. Results The clinical excellence and overall efficiency were significantly higher in the observation group than in the control group(P<0.05). The VAS scores of nasal symptoms and Lund-Kennedy endoscopic score were significantly lower in the observation group than in the control group after treatment, and the observation group also showed significantly decreased aforementioned scores after treatment compared with before treatment(P<0.05). The follow-up recurrence rates in 3 months and 6 months were significantly lower in the observation group than in the control group(P<0.05). EOS count was significantly lower in the observation group than in the control group after treatment, and the observation group also showed significantly reduced EOS count after treatment compared with before treatment(P<0.05). No significant differences in serum cortisol concentration were observed between these two groups both before and after treatment(P>0.05). Conclusion Compared with glucocorticoid treatment by nasal spray, glucocorticoid treatment by inhalation can significantly relieve nasal symptoms, inhibit the aggregation of eosinophils, and reduce the long-term recurrence risk, but the inhalation treatment has no significant effects on the adrenocortical function in patients with both eosinophilic chronic sinusitis and nasal polyps.

Nasal related somatoform disorders

SUN Shujuan, SHI Lei, FAN Zhaomin, SHI Guanggang

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 32-36. doi:10.6040/j.issn.1673-3770.0.2017.498

Abstract ( 1337 )

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Objective To study the diagnosis and treatment of nasal related somatoform disorders. Methods In the two patients in our hospital with nasal related somatoform disorders, the main complaints were recurrent nasal obstruction, purulent nasal discharge, pain, sleep disorders, etc. However, their physical examination, and CT scans and other auxiliary examinations did not match their clinical symptoms. The patients always reported a history of repeated nasal surgeries. According to the diagnostic criteria, two patients were initially diagnosed with nasal related somatoform disorders. After further discussion with the patients and their families, we planned individualized treatment programs with comprehensive medical treatment, psychological therapy, and implied surgery, according to the patients disease process. Results Substantial improvements were noted in the two patients after surgery. The patients mental scale scores were significantly improved postoperatively. On WeChat and telephone follow-up, the patients reported that they have begun to work and have an improved quality of life. Conclusion Psychotherapy and implied surgery have a good therapeutic effect on patients with somatoform disorders.

Computed tomography and magnetic resonance imaging features of maxillary hemorrhagic necrotizing polyps

ZHA Yang, LÜ Wei, QI Fang, WANG Xiaowei, GAO Zhiqiang

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 37-42. doi:10.6040/j.issn.1673-3770.0.2018.135

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Objective To improve the accuracy of preoperative diagnosis by determining the computed tomography(CT)and magnetic resonance imaging(MRI)features of maxillary hemorrhagic necrotizing polyps. Methods We retrospectively reviewed 14 cases of maxillary hemorrhagic necrotizing polyps diagnosed and operated in the last 3 years. We studied the CT and MR images of these patients and determined the imaging features of the disease and the key points for differential diagnosis. Results The main features observed on CT imaging included an expansive lesion that led to bone destruction and a soft tissue mass extending to the middle meatus. The main portion of the lesion had intermediate signal intensity on T₁-weighted imaging(T₁WI)and high signal intensity on T₂WI, surrounded or divided by bands or strips of low signal intensity on T₂WI. The “embryo sign” on enhanced T₁WI is a unique feature of the disease. Some cases have similar CT imaging features to those of fungal sinusitis, inverted papilloma, and maxillary carcinoma. However, these diseases have different features on MRI, which can provide more information for differential diagnosis. Conclusion Compared with CT alone, combined CT and MRI can provide more information on maxillary hemorrhagic necrotizing polyps to enable surgeons to make a more accurate diagnosis before surgery. It is useful in the planning of endoscopic surgery and communicating with patients.

Establishment of a standardized model of traumatic optic neuropathy in cats

LI Junyi, LI Xiumei, WAN Jingming, BI Jingyu, LIU Juan, XU Hualin, JIANG Yan, LI Na

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 43-47. doi:10.6040/j.issn.1673-3770.0.2017.433

Abstract ( 1521 )

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Objective To establish a standardized model of traumatic optic neuropathy in cats by using a standard clip and to simultaneously observe the changes in flash visual-evoked potential. Methods Ten adult healthy cats were enrolled in the study. The right eye was identified as the experimental eye; and the left eye, as the control eye. The optic nerves of the right eyes were clamped for 30 seconds to establish traumatic optic nerve injury models. The flash visual-evoked potential in was recorded in all experimental and control eyes at 1 hour, 3 days, 1 week, 2 weeks, and 4 weeks after injury. The peak latency and amplitude of the main wave P100 were recorded, and a statistical analysis was performed. Results The flash visual evoked potential peak latency and amplitudes of the main wave P100 were no significant differences before operation, but there were significant differences after traumatic optic neuropathy between the two groups(P< 0.05). The flash visual evoked potential peak latency and amplitudes of the main wave P100 were no significant differences before operation(F=1.48, P=0.19; F=1.63, P=0.15). In the experimental group, there were statistically significant differences between the 1 hour after injury and 3 days, 1 week, 2 weeks, and 4 weeks after the injury(F=7.38, P=0.008 7; F=4.38, P=0.027). There were statistically significant differences between 3 days after the injury and 1 week,2 weeks and 4 weeks after the injury(F=6.49, P =0.019; F=3.97, P=0.036). There were statistically significant differences between 1 week after the injury and 2 weeks and 4 weeks after the injury(F=6.02, P=0.011; F=3.37, P=0.041).The peak latency of P100 was gradually extended, and the amplitude gradually decreased in the 2 weeks after the injury. After 2 weeks, it tended to be stable. There was no statistically significant difference between the two groups after 2 weeks and 4 weeks after the injury(F=2.24, P=0.11; F=2.01, P=0.12). Conclusion The standardized cat model of traumatic optic neuropathy was successfully established by using the same clamp. The flash visual-evoked potential examination is the objective evaluation tool. The flash visual-evoked potential peak latency of the main wave P100 was significantly prolonged with a decreased amplitude, in the standardized cat model of traumatic optic neuropathy.

Correlation analysis between Ryan index and reflux symptom index and reflux finding score, in the diagnosis of

WANG Gang, WU Wei, WANG Lei, LIU Hongdan, XU Xiaohang, XU Bingxin, DING Ruiying, ZHOU Ying, HAN Haolun, GONG Jing,LI Baowei, SUN Zhezhe

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 48-52. doi:10.6040/j.issn.1673-3770.0.2017.507

Abstract ( 3527 )

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Objective To explore the correlation between Ryan index and reflux symptom index(RSI)and reflux finding score(RFS), in the diagnosis of laryngopharyngeal reflux diseases. Methods In a retrospective study, the clinical data of 230 patients presenting at the hospital with suffering from laryngopharyngeal discomfort for more than a month, in our hospital from February 2016 to November 2016, were analyzed. All patients were received underwent electronic laryngoscopy, assessment of RSI and RFS, and pharyngeal pH monitoring. Results There were 35 patients(15.2%)whose with positive Ryan index were scorepositive(15.2%). The positive rate of RSI, RFS, RSI or RFS, and RSI and RFS were positive in 46.5%,28.7%,60.9%,and 13.9% of the patients, respectively. The RFS score in the Ryan index positive group was higher than that in the Ryan index negative group, while the RSI score in the Ryan index positive group was not statistically different from that in the Ryan index negative group. The Ryan index positive rates in the RFS, RSI or RFS, and RSI and RFS positive groups were higher than that in the RFS, RSI or RFS, and RSI and RFS negative groups. The kappa values between the Ryan index group and RSI, RFS, RSI or RFS, and RSI and RFS groups were -0.06,0.394,0.116, and 0.172, respectively. When pH monitoring was regarded as the gold standard, the sensitivity of RSI, RFS, RSI or RFS, and RSI and RFS were 37.1%, 74.3%, 82.9%, and 28.6%, respectively; the specificity was were 51.8%, 79.5%, 43.1%, and 88.2%, respectively; the positive predictive values was were 12.1%, 39.4%, 20.7%, and 30.3%, respectively; and the negative predictive values was were 82.1%,94.5%,93.3%,and 87.3%, respectively. The correlation coefficients between RSI and upright and supine Ryan scores were -0.056 and -0.083, respectively; the correlation coefficients between RFS and upright and supine Ryan scores were 0.425 and 0.166, respectively. Conclusion Pharyngeal pH monitoring is an objective and non-invasive method which can reflect laryngopharyngeal reflux directly. There is a positive correlation between the RFS and the Ryan index, however, the consistency of correlation between RFS/RSI and Ryan index were is poor. Further studies research areis needed to get moredevelop an accurate scale and pH diagnostic index for the diagnosis of laryngopharyngeal reflux disease.

Up-regulation of miR-200b may inhibit epithelial mesenchymal transition process to prevent the proliferation, migration, and invasion of human laryngeal cancer Hep-2 cells

LI Guobin, ZHANG Zhancheng, WANG Xinyan

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 53-57. doi:10.6040/j.issn.1673-3770.0.2017.301

Abstract ( 1317 )

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Objective We investigated the effects of up-regulation of miR-200b on the proliferation, migration, and invasion of human laryngeal cancer Hep-2 cells. Methods Human laryngeal carcinoma Hep-2 cells were cultured and randomly divided into the miR-200b mimic group, miR-control sequence group, and blank control group. The expression of miR-200b was detected by real-time fluorescence quantitative PCR. The MTT assay was used to detect cell proliferation. The Transwell method was used to detect cell migration and invasion. The expression of E-cadherin, N-cadherin, and β-catenin proteins was detected by western blotting. Results Compared to the blank control group and miR-control sequence group, the relative expression level of miR-200b in the miR-200b mimic group was significantly increased(F=70.766, P<0.001). Compared to the blank control group ［(0.22±0.05),(0.45±0.07),(0.59±0.06),(0.72±0.08), and(0.85±0.07)］ and miR-control sequence group ［(0.24±0.06),(0.46±0.08),(0.61±0.07),(0.70±0.05), and(0.84±0.06)］, the absorbance A values at 24, 48, 72, and 96 h in the miR-200b mimic group ［(0.21±0.04),(0.29±0.06),(0.40±0.04),(0.53±0.07), and(0.58±0.05)］ were decreased and the differences were statistically significant(F=0.134, 6.449, 37.299, 5.352, and 29.921, P=0.876, 0.010, 0.000, 0.018, and 0.000, P<0.05). Compared to the blank control group ［(140.2±2.3),(127.9±6.0)］ and miR-control sequence group ［(141.0±1.2),(130.4±7.4)］, the number of migrating cells and number of invasive cells in the miR-200b mimic group ［(98.5±2.4),(90.9±2.8)］ were decreased and the differences were statistically significant(F=845.523, 88.859, P both <0.001). Compared to the blank control group ［(0.35±0.07),(0.54±0.10),(0.76±0.12)］ and miR-control sequence group ［(0.24±0.03),(0.60±0.14),(0.65±0.24)］, the relative expression level of E-cadherin protein in miR-200b mimic group cells(0.54±0.14)was increased, whereas the relative expression levels of N-cadherin and β-catenin proteins ［(0.31±0.10),(0.35±0.06)］ were decreased; these differences were statistically significant(F=17.287, 10.083, 10.434, P<0.001, 0.002, 0.001). Conclusion Up-regulation of miR-200b gene expression in laryngeal squamous cell carcinoma may reduce cell proliferation and inhibit cell migration and invasion. The mechanism may be related to inhibition of the epithelial mesenchymal transition process.

Clinical analysis of low-grade myofibroblastic sarcoma of the head and neck

BAI Yong, YIN Yingchun, HAN Xuefeng, YIN Zhaofu, LI Xuezhong

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 58-61. doi:10.6040/j.issn.1673-3770.0.2017.068

Abstract ( 1765 )

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Objective To investigate the clinical characteristics, imaging features, diagnosis, and treatment of low-grade myofibroblastic sarcoma(LGMS)of the head and neck. Methods A retrospective study of 2 patients with LGMS of the head and neck was performed, and previous cases of LGMS affecting the head and neck reported in the literature were reviewed. The clinic-pathological characteristics, imaging features, diagnosis and treatment were recorded. Results The symptoms of LGMS depend on the location of the tumor. Hoarseness is the first symptom of LGMS affecting vocal cord, along with an increase in dyspnea. LGMS of the neck manifests as a painless mass. It has been observed that LGMS of neck manifests as a painless mass with smooth surgace, capsule, and wide base, while its interface is unclear. Computed tomography demonstrated moderate or inhomogeneous density of tumor necrosis. Moreover, the tumor is characterized by calcification, or even bone destruction, and slight uniform ring enhancement. T₁W2 weighted MRI showed the tumor with low signal or limited numbers, while in T₂W1 weighted phase, homogeneous or inhomogeneous high signal was observed. The tumor consisted of spindle cells and small polygonal cells arranged in bundles, loose, and braided arrangement. The neoplasm showed diffuse infiltrative growth, and could invade the mucosa squamous epithelium. Tumor cells had unclear, fusiform shape, and the nucleus was slender, enlarged, irregular, and hyperchromatic. On immunohistochemistry analysis, the tumor cells were positive for vimentin, SMA, desmin, and actin, but negative for S-100. Treatment methods mainly focus on extensive surgical resection, and in the 2 cases that were followed up for 12-23 months, no recurrence and metastasis were observed. Conclusion LGMS of the head and neck is a very rare tumor, which lacks easily recognizable clinical and imaging manifestations. Pathological diagnosis must be combined with immunohistochemical examination, while extensive resection is the most effective method of treatment. Specifically, a thoroughgoing resection and negative margin are the keys to success of surgery. LGMS of the head and neck is not sensitive to chemotherapy and radiotherapy. Disease prognosis is good, while recurrence depends on complete resection.

Treatment of pharyngeal and laryngeal hemangiomas with pingyangmycin

XU Wen, TANG Wei, YU Shaoqing, LI Shaohui, GE Rongming

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 62-64. doi:10.6040/j.issn.1673-3770.0.2017.285

Abstract ( 1779 )

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Objective To investigate the therapeutic effect of local injection of pingyangmycin using suspension laryngoscopy for treatment of pharyngeal and laryngeal hemangiomas. Methods Sixteen patients with pharyngeal and laryngeal hemangiomas received multiple injections of pingyangmycin at various locations in the hemangiomas under the guidance of a suspension laryngoscope. Results A total of 16 patients received local injections of pingyangmycin. Among them, the cancer was completely cured in 14(87.50%)patients, while the remaining 2(12.50%). With respect to complications, 2 patients developed low-grade fever and 1 had a mild gastrointestinal reaction. Three of the patients received a single injection of pingyangmycin, 9 received it twice, 3 received it thrice, and 1 received it 4 times. None of them had a relapse over the 6-month follow-up period. Conclusion Pingyangmycin is effective for the treatment of pharyngeal and laryngeal hemangiomas, though there is some risk of adverse events.

Use of negative pressure drainage for prevention of salivary fistula after parotidectomy: an analysis of 112 cases

LIU Yiping, LIN Yuanchao

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 65-67. doi:10.6040/j.issn.1673-3770.0.2017.258

Abstract ( 1742 )

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Objective To analyze the clinical factors related to post-parotidectomy salivary fistula, and to prevent and treat the complications of parotid gland surgery. Methods From January 2010 to June 2016, 112 patients with parotid diseases were treated using surgical procedures; a negative pressure drainage tube was placed in the wound on the first 3 postoperative days, and compression bandage was used for a short while after extubation for 3 days. The patients were followed up for development of salivary fistula, and symptomatic treatment was administered where necessary. Results Of the 112 patients, 104 healed without infection; 7 developed a mild salivary fistula,, and 1 experienced postoperative cavity hemorrhage and salivary fistula which resolved with therapy. Conclusion Negative pressure drainage can effectively prevent the occurrence of parotid fistula and shorten the period of application of compression bandage, and the postoperative therapeutic effect of traditional compression bandage on the salivary fistula can be confirmed.

Relationship between acute intraocular hypertension and lateral geniculate neuron autophagy and apoptosis in rats

SU Jie, AI Xin, MA Chunmei, YANG Fuyu, HUANG Shuai

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 68-71. doi:10.6040/j.issn.1673-3770.0.2017.550

Abstract ( 1354 )

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Objective To investigate the relationship between acute intraocular hypertension and lateral geniculate neurons autophagy and apoptosis in rats. Methods Ninety Sprague-Dawley rats were randomly divided into control, experimental, and 3-methyladenine(3-MA)groups. Each group was divided into 5 subgroups. The control group only received anterior chamber penetration. An acute intraocular hypertension rat model was established using the anterior chamber perfusion technique. The rats in the 3-MA group were injected with 3-MA. At 6 h, 12 h, 24 h, 3 d, and 5 d after the injection, LC3-Ⅱ and Beclin-1 expression in the lateral geniculate nucleus were detected using immunohistochemistry. The apoptotic level in the nerve cells was measured using the dUTP-digoxigenin nick end labeling(TUNEL)assay. Results LC3-Ⅱ and Beclin-1 was expressed in the experimental and 3-MA groups at 6 h, and the levels peaked at 24 h and then gradually returned to baseline levels. However, the expression levels of LC3-Ⅱ and Beclin-1 in the 3-MA group were lower than those in the experimental group at each time point(P<0.05). On the basis of the TUNEL assay results, we found that the apoptosis rate peaked at 3 d in the experimental and 3-MA groups. The apoptosis rate remained high at 5 d. The apoptosis rate was lower in the experimental group than in the 3-MA group at each time point after 24 h(P<0.05). Conclusion Acute intraocular hypertension in rats can lead to lateral geniculate neuron autophagy and apoptosis. Autophagy in lateral geniculate neurons may be a protective factor for neurons.

Impact of dry eye on corneal endothelial cell density and morphology

YANG Xue, LI Ying

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 72-76. doi:10.6040/j.issn.1673-3770.0.2018.151

Abstract ( 1984 )

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Objective To evaluate the impact of dry eye on corneal endothelial cell density and morphology and explore the influencing factors involved. Method 156 patients were recruited from the ophthalmology department of our hospital between June 2017 and January 2018 and were divided into two groups, a dry eye group and a control group, on the basis of their history and examination results. Examinations included uncorrected visual acuity, slit lamp examination, non-contact intraocular pressure, tear break-up time, Schirmer I test(without anesthesia), corneal fluoresce staining, and non-contact specular microscope for evaluating the corneal endothelia. Meanwhile, the patients’onset time of dry eye symptoms and ocular surface disease index(OSDI)were also collected. Results Compared with the control group, the endothelial cell density(ECD)was statistically lower, and the average cell area(ACA)was statistically larger. Age, duration of dry eye symptoms, and OSDI were negatively correlated with ECD, and were positively correlated with ACA. Age and OSDI were positively correlated with a coefficient of variation. Moreover, the hexagonality of corneal endothelial cells in females was statistically lower than in males. Conclusion Corneal endothelial cells in the dry eye patients had reduced density and damaged morphology.

Early visual acuity recovery and related factors in myopic patients after small incision lenticule extraction

SONG Sen, LI Ying, DING Xin, JIN Yumei

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 77-79. doi:10.6040/j.issn.1673-3770.0.2017.298

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Objective To investigate the visual acuity improvement and related factors in myopic patients after small incision lenticule extraction(SMILE), in order to provide clinical data for standardization of SMILE surgery. Methods This retrospective clinical study included a total of 64 myopic patients(128 eyes)between January 2016 and August 2016. All patients underwent standard SMILE surgery performed by a single experienced surgeon. Visual acuity was assessed 1 day and 1 week after surgery. Correlations among postoperative uncorrected visual acuity(UCVA)and preoperative factors such as age, gender, preoperative equivalent sphere(SE), keratometry, central corneal thickness(CCT), as well as postoperative factors such as residual stromal bed thickness(RST)and ablation depth/corneal thickness ratio(AD/CT)were statistically analyzed. Results On postoperative day 1, 30.4% of eyes achieved a UCVA of 0.8 or better and 10.2% eyes achieved a UCVA of 1.0 or better. Additionally, 5.5% of the eyes achieved preoperative best corrected visual acuity(BCVA). At 1 week postoperatively, 90.6% of the eyes achieved a UCVA of 0.8 or better and 64.1% of the eyes achieved a UCVA of 1.0 or better. Additionally, 33.6% of the eyes achieved preoperative BCVA. No significant correlations were observed among the preoperative and postoperative visual acuity and age, gender, keratometry, CCT, SE, RST, and AD/CT. Conclusion Recovery of early visual acuity may be correlated with corneal wound healing and inflammatory responses, and changes in the corneal microstructure may be another factor responsible for slower visual recovery following SMILE.

Application of periorbital blood supply for repairing tissue defects in the orbital region

LI Guifen, YI Lina

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 80-83. doi:10.6040/j.issn.1673-3770.0.2017.233

Abstract ( 1567 )

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Objective The aim of this study was to investigate the application of periorbital blood supply for repairing tissue defects in the regiones orbitalis. Methods A total of 100 patients with tissue defects in the regiones orbitalis were enrolled from December 2013 to December 2016 in the hospital. According to the treatment protocol, the patients were divided into group A and group B, with 50 patients in each group. Group A was treated with periorbital flap and rotation prosthesis, such as ear before reflux axial flap, forehead island flap, and reflux after ear type axial flap, and nasolabial sulcus flap. Group B was administered subcutaneous flap treatment. Results Treatment efficiency was significantly higher in group B than in group A, but the healing time and complication rate were significantly lower in group B than in group A(P<0.05). The postoperative blood flow velocity(BFV)and blood flow rate(BPR)were significantly higher than the preoperative values. In both group A and group B, and the postoperative BFV and BPR were significantly higher in group B than in group A(P<0.05). Conclusion The periorbital flap has advantageous characteristics, such as rich blood supply, good plasticity, and similarity of materials and colors to those of surrounding regions. Therefore, the periorbital flap is suitable for repairing tissue defects in in the regiones orbitalis, and combined treatment with hypodermic and periorbital flap shows a better therapeutic effect with improved safety.

Application of autologous orbital periosteum combined with amniotic membrane in reconstruction of eyelid defects

L(¨overU)Huiyan, ZHANG Xiuchuan, ZHOU Cunying, LI Bo, LI Weibing

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 84-86. doi:10.6040/j.issn.1673-3770.0.2017.523

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Objective To observe the clinical effect of autologous orbital periosteum combined with amniotic membrance transplantation in the reconstruction of external canthal eyelid defects. Methods Twelve eyes with defects of full-thickness external canthal eyelid due to eyelid tumor were included. All subjects underwent reconstruction of the full-thickness external canthal eyelid defects using autologous orbital periosteum combined with amniotic membrane and periorbital rotation glide flaps. All patients were followed for 6 to 60 months. Results All reconstructed eyelids showed natural appearance with good function and without deformities such as eyelid margin notch, irregular contractures of the upper margin, ectropion, or entropion. The implanted periosteum was not displaced, absorbed, or infected in any patient. All flaps were well healed, and there was no relapse of the eyelid tumor. Conclusion Autologous orbital periosteum is an ideal substitute for meibomian tissue. Amniotic membrane transplantation can effectively prevent or reduce the adhesion of eyelid and eyeball as well as vault stenosis. Autologous orbital periosteum combined with amniotic membrane to reconstruct severe external canthal eyelid defects has high clinical value, and is easily obtained, simple to use, with fewer complications and excellent curative effect.

Effects of using corneal bandage lens on the cornea after strabismus surgery

YAN Bin, ZHOU Huaisheng, PI Liuqing, DUAN Hucheng, YAN Shigang

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 87-90. doi:10.6040/j.issn.1673-3770.0.2018.033

Abstract ( 1630 )

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Objective To investigate the use of corneal bandage lens(CBL)on postoperative complications after strabismus surgery. Methods Randomized This randomized pilot study involved 60(60 eyes)patients requiring strabismus surgery, who were randomly divided into two groups: CBL(30 patients, 30 eyes)and control(30 patients, 30 eyes). The CBL group was treated with CBL after strabismus surgery, whereas the control group was treated with strabismus surgery alone. The pain, ocular surface irritation symptom, corneal dellen(CD), and conjunctival granuloma(CG)scores at postoperative days 1, 2, 7, and 14 were observed and analyzed. Tear break-up time(BUT)and corneal fluorescein staining score(CFSS)at postoperative days 7 and 14 were also observed and analyzed. Results Pain and ocular surface irritation symptom scores at postoperative days 1 and 2 were significantly lower in the CBL group than in the control group, with no statistically significant difference at postoperative days 7 and 14. CFSS was evidently reduced at postoperative day 7 and BUT was significantly increased at postoperative days 7 and 14 compared with those of the control group, but CFSS had no statistically significant difference at postoperative day 14. Postoperative complications included two cases of CD at postoperative day 7 and one case of CG at postoperative day 14 in the control group, while these postoperative complications were not observed in the CBL group. Conclusion The use of CBL after strabismus surgery significantly relieved postoperative pain and irritation ocular surface, decreased CD and CG postoperative complications, relieved the symptoms and signs of dry eyes, and finally improved patients’comfort and satisfaction.

Wideband tympanometry test in infants

ZHOU Jialei, SUN Shibing, LI Xiaoyan

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 91-94. doi:10.6040/j.issn.1673-3770.0.2018.150

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The special anatomical and functional characteristics of the middle and outer ear of infants limit the usability of traditional single-frequency tympanometry testing in assessing middle ear function. The wideband tympanometry test can evaluate the reception and transmission of sound energy in a wide frequency range(0.2-8 kHz). Compared with the conventional single-frequency tympanometry, it does not require external pressure to the ear-canal and has the advantages of short test time and dynamic assessment of peripheral auditory development characteristics and middle ear function in infants. The wideband tympanometry test can improve the accuracy of hearing screening and middle ear function assessment in infants.

Relationship between YKL-40 and chronic rhinosinusitis

QIAO Shufen, YANG Feilun, WANG Zhenni, LI Xuezhong

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 95-99. doi:10.6040/j.issn.1673-3770.0.2017.214

Abstract ( 1358 )

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YKL-40 is a member of the mammalian chitinase proteins family, also known as chitinase 3-like 1 or cartilage glycoprotein 39. In recent years, several studies have demonstrated that YKL-40 is highly expressed in many inflammatory diseases such as asthma, arthritis, and tissue remodeling disease. Chronic rhinosinusitis(CRS)is a persistent inflammation that manifests as nasal congestion, viscous secretions, nasal mucosal hyperemia, and posterior nasal drip, with secondary manifestations of facial pressure and headache. The pathogenesis of CRS is complicated. Inflammatory reactions and tissue remodeling are known to play important roles in the pathological processes of CRS. CRS is controversial in many aspects, such as classification, diagnosis, and treatment. At present, classification mainly depends on clinical diagnosis using, for example, nasal endoscopic examination and computed tomography. No biomarkers that reflect the pathophysiology and characteristics of CRS have been found. This study investigated the correlation of YKL-40 expression with tissue remodeling and the inflammatory reactions in CRS, and the possibility of using YKL-40 as a serum marker.

Perioperative blood glucose management in patients with obstructive sleep apnea hypopnea syndrome and hyperglycemia

LÜ Xuqin, WAN Wenjin

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 100-104. doi:10.6040/j.issn.1673-3770.0.2018.038

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Objective To explore the effect of perioperative blood glucose management on controlling complications in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)and hyperglycemia in the perioperative period. Methods 30 patients with OSAHS and hyperglycemia who were treated in our hospital were selected as the study subjects. All patients underwent comprehensive preoperative psychological care; management of blood glucose levels, activity, and diet. The patients were observed for postoperative complications, blood glucose levels, pain control, other blood glucose management factors, and surgical complications. Results Perioperative blood glucose was well controlled in 30 patients. Two patients exhibited postoperative complications, including 1 patient with secondary hemorrhage and 1 patient with hypoglycemia, and were fully recovered with timely and effective treatment. No patients had diabetic ketoacidosis. Conclusion Perioperative blood glucose management can effectively improve the curative rate and control the postoperative complication rate in patients with OSAHS and hyperglycemia.

Allergen test results in 2 000 patients with allergic rhinitis in Wuxi District

PU Hongbo, DU Xiaodong

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 105-107. doi:10.6040/j.issn.1673-3770.0.2018.120

Abstract ( 1326 )

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Giant cell reparative granuloma of temporal bone: a report of one case

LIU Feifei, WANG Xiwen

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 108-109. doi:10.6040/j.issn.1673-3770.0.2017.511

Abstract ( 1498 )

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Individualized treatment of pharyngeal and laryngeal cavernous hemangioma:a report of two cases.

DAI Yacuo, LI Jing, WAN Baoluo, ZANG Yanzi, HUANG Yingming

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 110-112. doi:10.6040/j.issn.1673-3770.0.2017.463

Abstract ( 1331 )

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Submandibular bronchogenic cyst: one case report

LIANG Bo, HUANG Pu, LI Xuemei, LI Yan

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 113-114. doi:10.6040/j.issn.1673-3770.0.2017.470

Abstract ( 1170 )

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Lateral neck dissection

WEI Dongmin, LI Wenming, QIAN Ye, LIU Dayu, LEI Dapeng, PAN Xinliang

J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(4): 115-115. doi:10.6040/j.issn.1673-3770.0.2018.255

Abstract ( 1488 )

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