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    20 September 2018 Volume 32 Issue 5
      
    Application value of enhanced recovery after surgery in head and neck cancer surgery
    SONG Xicheng
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2018, 32(5):  1-4.  doi:10.6040/j.issn.1673-3770.1.2018.010
    Abstract ( 1290 )   PDF (605KB) ( 575 )   Save
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    Enhanced recovery after surgery(ERAS)involves a series of perioperative evidence-based interventions, which intends to attenuate surgical stress and accelerate postoperative functional recovery. ERAS protocols are made for individualized plans by multi-disciplinary collaboration, which has been widely used in many fields of surgery, but is still rarely used in head and neck surgery. ERAS plays an important role in improving survival rate and quality of life in head and neck cancer patients. In this article, we will discuss application value of ERAS in head and neck surgery in brief.
    Perioperative quality of life in patients with chronic rhinosinusitis with nasal polyps under enhanced recovery after surgery using QoR-15
    WU Xifu, KONG Weifeng, WANG Weihao, XU Huiqing, QI Min, YANG Qintai
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2018, 32(5):  5-8.  doi:10.6040/j.issn.1673-3770.0.2018.308
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    Objective To evaluate the perioperative quality of life in chronic rhinosinusitis with nasal polyps(CRSwNP)patients under enhanced recovery after surgery using the quality of recovery-15 scale(QoR-15). Methods Seventy-four patients with CRSwNP were randomly divided into an ERAS group and a control group. The ERAS group performed the ERAS protocols during the perioperative period, while the control group followed the traditional plan. Outcomes of QoR-15 were compared preoperatively and postoperatively, at 24 hours and 48 hours. Results Scores of Lund-Mackay between ERAS group and control group were(9.13±1.88)and(9.60±1.86), while Lund-Kennedy scores between ERAS group and control group were(2.69±0.78)and(2.57±0.72),(P>0.05). The operating time and bleeding volume between ERAS group and control group were(1.69±0.60)and(1.77±0.65)h, and(191.67±60.35)and(202.63±60.34)mL, respectively(P>0.05). The rate of Nausea/Emesis between ERAS group and control group was 11.11%(4/36)and 7.89%(3/38), respectively(P>0.05). Preoperative scores of QoR-15 were(139.19±4.21)and(140.07±5.96)in the ERAS group and control group(P>0.05). However, the postoperative scores were [(102.75±10.83)vs(83.14±5.43), P<0.05] [(115.31±10.14)vs(109.65±9.52), P>0.05] in ERAS group and control group, at 24 hours and 48 hours. Conclusion Thus, this study shows that the QoR-15 can be used for ERAS evaluation of perioperative quality of life in CRSwNP patients.
    Enhanced recovery after surgery for the treatment of chronic rhinosinusitis with nasal polyps
    SONG Xiaoyu, ZHANG Yu, LI Chenglin, SONG Xicheng
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2018, 32(5):  9-12.  doi:10.6040/j.issn.1673-3770.1.2018.012
    Abstract ( 1751 )   PDF (418KB) ( 489 )   Save
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    Objective To explore the perioperative application value of enhanced recovery after surgery(ERAS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP). Methods A total of 136 patients with CRSwNP were randomly divided into the ERAS group(n=70)and control group(n=66). Both groups underwent endoscopic nasal polypectomy and open sinus surgery. Patients in the ERAS group underwent preoperative education and perioperative airway assessment intervention and a series of optimization measures such as shortening fasting time, intraoperative controlled hypotension, and on-time analgesia, whereas those in the control group were treated with traditional perioperative treatment. The preoperative dysfunction of lung function, postoperative pain score, amount of nasal bleeding after 24 h, postoperative hospital stay, and total hospital stay between the two groups were compared. Results The preoperative tolerance rates of patients with preoperative pulmonary dysfunction in the ERAS and control groups were 93.3% and 75.0%, respectively(χ2=1.924, P=0.165). The VAS scores of nasal congestion, headache, eye pain, tearing, ear nausea, and sleep difficulties in the ERAS group were lower than those in the control group(P<0.001). The ERAS group had a blood loss of 5.7(3.0, 10.3)mL within 24 h postoperatively, whereas the control group had a blood loss of 7.2(5.0, 13.2)mL; there was no statistically significant difference in blood loss between the two groups (U=-0.913, P=0.361). The average hospitalization days in the ERAS and control groups were 4.6±0.8 and 7.5±1.1, respectively, with statistically significant difference(t=17.79, P<0.001). The postoperative hospitalization day of the ERAS and control groups were 2.1±0.5 and 3.8±0.3, respectively, with statistically significant difference(t=23.94, P<0.001). Conclusion The use of ERAS throughout the perioperative period in patients with CRSwNP can effectively reduce the psychological and physiological trauma stress response and shorten the hospitalization time.
    Preliminary application of enhanced recovery after surgery in the perioperative nursing in functional endoscopic sinus surgery
    QI Min, LI Hong, WANG Qian, TU Cuifang, YANG Qintai, XU Huiqing
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2018, 32(5):  13-18.  doi:10.6040/j.issn.1673-3770.0.2018.251
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    Objective To explore the role of enhanced recovery after surgery(ERAS)in perioperative nursing of functional endoscopic sinus surgery(FESS). Methods From October 1, 2017 to December 31, 2017, 48 patients who underwent general anesthesia functional endoscopic sinus surgery in our department were assigned to the ERAS group(n=17)and the conventional surgery group(n=31)according to the admission date. The hospitalization costs, the degree of postoperative pain, postoperative sleep, postoperative motivation, and postoperative feeding quality were compared between groups. Results There was no significant difference in hospitalization costs between the two groups(P=0.16). In the ERAS group, the pain was relieved on the day after surgery, and the willingness to move and the quality of eating were also significantly higher than those in the conventional surgery group(P<0.001). The pain level of the conventional surgery group should reach the similar level in the ERAS group on the 2nd day after surgery(P=0.14). The willingness to move and the quality of eating also need to reach the similar level in the ERAS group on the 1st postoperative day(P=0.23, P=0.15). Sleep quality did not show significant intergroup differences on the day after surgery(P=0.25), but the sleep time in the ERAS group was significantly longer than in the conventional surgery group(P=0.002). Conclusion ERAS is expected to help patients with FESS achieve greater postoperative comfort without a significant increase in hospitalization costs.
    Use of enhanced recovery after surgery in children with obstructive sleep apnea syndrome during the perioperative period
    LIU Dawei, ZHANG Yu, LI Chenglin, CHEN Xiumei, SONG Xicheng
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  19-22.  doi:10.6040/j.issn.1673-3770.1.2018.011
    Abstract ( 1459 )   PDF (401KB) ( 496 )   Save
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    Objective To explore the effects of enhanced recovery after surgery(ERAS)in children with obstructive sleep apnea syndrome(OSAS)during the perioperative period. Methods A total of 1 968 children who underwent adenoidal ablation and bilateral tonsillectomy under nasal endoscopy were randomly divided into the ERAS group(1 040 patients)and the traditional group(928 patients). The ERAS group was treated with the ERAS mode during the perioperative period, whereas the traditional group was treated with the traditional perioperative management. The postoperative hospital stay, incidence of complications, pain scores, mental status, and postoperative diet between the two groups were compared. Results The postoperative hospital stays were significantly shorter in the ERAS group than in the traditional group [(2.3±0.8)days vs(3.5±1.2)days]; t=-5.529, P=0.001). The complication rate was lower in the ERAS group than in the traditional group [0.19% vs 1.29%; χ2=8.413, P=0.004). The pain scores were 2.42±0.89, 3.40±0.82, and 3.12±0.62 at 2, 12, and 24 h after perioperative management in the traditional group, whereas the corresponding values in the ERAS group were 1.69±0.58, 2.32±0.69, and 2.13±0.42(all P<0.01). The mental status scores at 6, 12, and 24 h were 5.42±0.89, 3.40±0.82, and 3.12±0.75, respectively, in the traditional group and 3.36±0.57, 2.55±0.50, and 1.65±0.45, respectively, in the ERAS group(all P<0.01). The cold fluid diets at 6, 12, and 24 h after surgery were 2.0±1.2, 16.5±2.6, and 24.0±13.0 mL, respectively, in the traditional group and 5.0±1.8, 26.5±5.8, and 68±26 mL, respectively, in the ERAS group(all P<0.01). Conclusion ERAS is effective for children with OSAS undergoing nasal endoscopic adenoidectomy ablation and tonsil resection during the perioperative period.
    Enhanced recovery after surgery in sinus surgery
    WANG Li, ZHANG Yu, ZHANG Hua, LIU Xueyan, SONG Xicheng
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  23-26.  doi:10.6040/j.issn.1673-3770.1.2018.013
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    Simulation of the biomechanical effects of deaf appendage implantation in mastoid cortical bone
    MENG Wei, YU Zhenkun, ZHENG Yali, LI Guangfei, LIANG Longjun, WANG Xiaomin
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  27-30.  doi:10.6040/j.issn.1673-3770.0.2018.040
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    Objective To assess the ability of preoperative mastoid cortical bone implantation points and surrounding tissue to accept accurate positioning. Methods The study enrolled 20 sides of congenital external middle ear malformations that had undergone external auditory canal reconstructive surgery and had been evaluated with multislice computed tomography(MSCT). The control group included 20 normally developed mastoid processes that were also evaluated with temporal bone MSCT. Modeling software was used to create and mesh a three-dimensional tibial CT image for each study subject. The three-dimensional location of the premolars and tibial structure of each subject was analyzed. Results The analysis method used can perform rapid three-dimensional CT imaging of preoperative thin sacroiliac bone, precise positioning of preoperative implantation position, and evaluation of peripheral bone force conditions. After surgery for external and middle ear deformities, implantation using a ball drill at 750 rpm allowed a safe distance from the open osseous external auditory canal at a circumference of 2.07±0.05 mm. For patients without external middle ear malformations, the safe distance from the talus external auditory canal circumference was 1.83±0.07 mm, and cortical bone of the external auditory canal that has been formed will not be deformed by excessive instantaneous impact force of the drill during surgery. Conclusion This method is flexible and simple. For patients with external and middle ear deformities who have undergone auditory reconstructive surgery and wish to proceed with implantation surgery, this preoperative method can assess the mechanical effects of implantable titanium nails on mastoid cortical bone and the reconstructed external auditory canal wall.
    Characteristics of 42 patients with tinnitus and hyperacusis
    LIAO Libing, LIU Qiming, ZONG Ling, ZHAI Jinming, ZHANG Jianguo
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  31-36.  doi:10.6040/j.issn.1673-3770.0.2018.199
    Abstract ( 1972 )   PDF (432KB) ( 520 )   Save
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    Objective To explore the clinical, auditory and psychoacoustic characteristics of patients with tinnitus accompanied by auditory hypersensitivity and to explore its effects on patients. Methods Forty-two patients with tinnitus and hyperacusis who were admitted to the Department of Otorhinolaryngology, Second Affiliated Hospital of Guangzhou Medical University from March 2015 to March 2017, were detected the pure tone audiometry, tinnitus psychoacoustic characteristics, loudness discomfort level(LDL). Results There were 24 cases of tinnitus as the first chief complaint group(group A)and 18 cases of hyperacusis as the first main complaint group(group B). Tinnitus tone was given priority to with pure tone, frequency was given priority to with high frequency, and the loudness is mostly ≤5dB SL. Patients with hyperacusis is characterized by excessive attention or deliberate avoidance of normal environmental sounds, accompanied by irritability, palpitations, panic, fear, wearing earplugs, and dare not going out. LDL at frequencies between 0.125 and 8kHz were detected, and there was no significant difference in LDL between the two groups at the same frequency(P>0.05). Conclusion The severity of auditory hyperacusis cannot be judged by the loudness discomfort threshold; clinical tinnitus and auditory allergy are often accompanied, and attention should be paid to its influence on the work, life, sleep and mood of patients. The evaluation scale suitable for China's national conditions should be formulated and used.
    Characteristics of tinnitus and the related influencing factors in patients with Menieres disease
    HOU Xiaobing, REN Tongli, ZHANG Yibo
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  37-40.  doi:10.6040/j.issn.1673-3770.0.2017.205
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    Objective To discuss and analyze the characteristics of tinnitus and the related influencing factors in patients with Menieres disease. Methods A total of 69 patients with Menieres disease were enrolled in our hospital from August 2012 to August 2016, and the pure hearing threshold, tinnitus ipsilateral, course of disease, and sleep quality of the patients were determined. The tinnitus handicap inventory(THI)scale and the dizziness handicap inventory(DHI)scale were used. Results (1) Thirty-one cases showed a low frequency of tinnitus, 15 cases showed a median frequency of tinnitus, and 23 cases showed a high frequency of tinnitus. Tinnitus loudness <10 dB(SL), 10~14 dB(SL), and ≥15 dB(SL)was noted in 41, 18, and 10 cases, respectively; 60 cases showed persistent tinnitus while 9 showed non-persistent tinnitus. Forty-eight patients had no sleep disorders and 21 had sleep disorders. (2) Patients with persistent tinnitus(t=3.099, P=0.008), poor sleep quality(F=2.987, P=0.012), and high tinnitus loudness(F=3.356, P=0.013)had higher THI scores than those with intermittent tinnitus, better sleep quality, and low tinnitus loudness. The THI scores of patients with unilateral tinnitus were lower than those of patients with bilateral tinnitus. (3) Seizure frequency, duration, and average thresholds were positively correlated with the DHI score in multiple linear regression analysis. Conclusion The primary characteristic of tinnitus accompanied by Meniere's disease is low-frequency tinnitus. The severity of tinnitus shows some relationship with tinnitus loudness, duration, and sleep quality. Sex, age, ear, and bimodal test results have no effect on the DHI score, but the onset frequency, duration, and average hearing threshold are the main factors affecting the score. The higher the frequency of the patients, the more severe the dizziness will be.
    Clinical characteristics and prognostic factors for sudden idiopathic sensorineural hearing loss in children
    XU Ming, LUO Xinggu, TANG Hongbo, JIANG Qingshan
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  41-44.  doi:10.6040/j.issn.1673-3770.0.2018.019
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    Objective To analyze the clinical characteristics and prognostic factors for sudden idiopathic sensorineural hearing loss in children, and provide guidance for clinical practice and prognosis assessment. Methods We retrospectively analyzed clinical data from 67 pediatric sudden sensorineural hearing loss patients treated in our department from January 2010 to October 2017. The 67 patients were divided into two groups(recovery group and no-recovery group)on the basis of recovery of hearing. Univariate and multivariate analysis were used to examine factors associated with prognosis(sex, age, treatment onset, initial hearing threshold, presence of tinnitus and vertigo, history of viral infection, season, and audiogram configuration)for the recovery group and no-recovery group. Results 64.18% of pediatric patients showed onset of hearing loss in spring or winter. The average hearing threshold at initial presentation was 70.79±10.13 dB HL. As accompanying symptoms, 47 ears(70.15%)exhibited tinnitus, 41 ears(61.19%)exhibited vertigo, and the rate of viral infection was 19.40%. The audiogram configuration before hyperbaric oxygen therapy was ascending in 10.44%, descending in 2.99%, flat in 34.33%, and showed total deafness in 52.24% of cases. The average hearing threshold was 60.41±31.52 dB HL after treatment; the overall recovery rate was 53.73%; the complete recovery, marked recovery and recovery rates were 20.90%, 16.42% and 16.42%, respectively. According to the multivariate analysis, initial hearing threshold, total deafness and presence of viral infection had significant influences on prognosis(P<0.05). Conclusion Most pediatric patients experienced sudden sensorineural hearing loss in spring or winter, with a high rate of viral infections. The hearing loss was identified as severe, with high levels of tinnitus and vertigo, and most audiogram configurations either were flat or showed total deafness. Multivariate analysis revealed that lower initial hearing loss threshold, non-total deafness and history of viral infection were associated with a better prognosis.
    Characteristics of auditory brainstem response to high-frequency stimulus in young and middle-aged patients with sudden deafness and no history of vertigo or cardiocerebrovascular disease
    CHEN Wei, HU Zhongnan, TONG Zhaojun, LI Xiangyu, LIU Wenjun
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  45-49.  doi:10.6040/j.issn.1673-3770.0.2017.521
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    Objective To investigate the characteristics of auditory brainstem response(ABR)to high-frequency stimulus in young and middle-aged patients with sudden deafness and no history of vertigo or cardiocerebrovascular disease. Methods A total of 46 young and middle-aged patients with sudden deafness and 30 volunteers with normal hearing were enrolled from January 2016 to May 2017. All patients had no history of vertigo or cardiocerebrovascular disease, and all exhibited unilateral onset of sudden deafness. Pure tone audiometry, high-(51.1 times per second)and low-(11.1 times per second)frequency stimulation ABRs were tested for the affected side of patients, the normal side of patients, and both sides of volunteers; the results were categorized as the affected side, normal side, and control groups, respectively. The difference in I-V interpeak latency between high- and low-frequency stimulation ABRs(△IPL)and the rate of ears with abnormalities among the 3 groups were compared. Based on the △IPL of their affected side, patients were subdivided into affected side abnormal, normal, and no △IPL groups; the clinical curative effect was compared among the 3 groups. Based on the △IPL of their healthy side, patients were again subdivided into healthy side abnormal, normal, and no △IPL groups; the clinical curative effect was compared among the 3 groups. Results The test results of pure-tone audiometry were similar in the normal side and control groups(differences between these groups were not statistically significant(P>0.05)). The rate of ears that could not elicit ABRs to high-frequency stimuli and ears with abnormal △IPL in affected side and normal side groups was much greater than the corresponding rate in the control group; these differences were statistically significant(all P<0.05). Patients who could not elicit ABRs to high-frequency stimuli from the normal side exhibited a similar lack of ABRs from the affected side. Patients with abnormal △IPL from the normal side also showed abnormal △IPL from the affected side. The clinical curative effect in the affected side normal group was much better than in the abnormal group and the no △IPL group; these differences were statistically significant(all P<0.05). The clinical curative effect in the healthy side normal group was much better than in the abnormal and no △IPL groups; these differences were statistically significant(all P<0.05). Conclusion For young and middle-aged patients with sudden deafness and no history of vertigo or cardiocerebrovascular disease, it is common to observe abnormal △IPL between high- and low-frequency stimulation ABRs, as well as ears that could not elicit ABRs to high-frequency stimuli. If these characteristics are present on the affected side, they may be present on the healthy side; these characteristics in either side may be associated with a poor prognosis.
    Assessment of psychopathological characteristics in 30 patients with sudden sensorineural hearing loss
    ZHU Wenyan, JIN Xin, SHE Wandong, MA Yongchi
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  50-52.  doi:10.6040/j.issn.1673-3770.0.2018.112
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    Objective To investigate the psychopathological characteristics of patients with sudden sensorineural hearing loss(SSHL). Methods The Symptom Checklist-90(SCL-90)scores and plasma 5-hydroxytryptamine(5-HT)levels were determined in 30 patients with SSHL and 20 healthy adult controls. Results The total and average SCL-90 scores were 121.69±22.53 and 1.35±0.25, respectively, in the SSHL group, and 111.65±15.25 and 1.23±0.25 in the control group. There were no significant differences in total and average scores between the two groups(P>0.05). However, the SCL-90 scores for the four dimensions of somatization, depression, paranoia, and other(sleep, diet, etc.)were higher in the SSHL group than in the control group, and the difference was statistically significant(P< 0.05). The plasma 5-HT level in the SSHL group was significantly lower than in the normal control group(P<0.05)and the SCL-90 score was negatively correlated with the plasma 5-HT (r=-0.507, P=0.004). Conclusion Compared with healthy adults, patients with SSHL show a tendency toward mild psychopathology. Patients with SSHL have clear evidence of depression, paranoia, and sleep disorders, and significantly lower plasma 5-HT levels compared to healthy adults.
    Clinical analysis of 35 cases of lateral semicircular canal benign paroxysmal positional vertigo with transformable-direction eye shock
    ZHU Zijian, LIU Qiang
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  53-57.  doi:10.6040/j.issn.1673-3770.0.2018.036
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    Objective To investigate clinical features of transformable-direction eye shock and to evaluate the efficacy of manual reduction in its treatment in patients with lateral semicircular canal benign paroxysmal positional vertigo(LSC-BPPV). Methods A retrospective analysis was performed on thirty-five transformable-direction eye shock patients with LSC-BPPV(the transformable group)and thirty-eight invariant-direction eye shock patients with LSC-BPPV(the invariant group)from Jan. 2016 to Jul. 2017 in our hospital. The results were compared between these two groups. All patients were followed up for 6 months. Statistical analysis was performed using SPSS 19.0 software. Results The transformable group included 7 cases of spontaneous eye shock and 28 cases of intentional eye shock. Apogeotropic eye shock was changed to geotropic eye shock in 31 patients, and geotropic eye shock was changed to apogeotropic eye shock in 2 patients. Other 2 patients showed transformable-direction eye shock, which was repeated many times. The eye shock duration was more than 1 min in 6 patients,but it was less than 1 min in 29 patients. All patients were administered manual reduction treatment according to the eye shock direction and duration with the Barbecue maneuver, Gufoni maneuver, and forced prolonged position maneuver. The efficacy after the first manual reduction treatment was 62.86%(22/35)in the transformable group and 86.84%(33/38)in the invariant group, and the difference in the treatment efficacy was significant between these two groups(χ2=5.642, P=0.018). Total efficacy was 91.43%(32/35)in the transformable group and 97.37%(37/38)in the invariant group after manual reduction treatment for more than once, and no significant differences in total efficacy were observed between these two groups(χ2=1.241, P=0.265). The number of circulation of first success was 2.81±1.21 in the transformable group and 1.56±0.69 in the invariant group after manual reduction management, and a significant difference was found between these two groups(t=4.053, P=0.000). The recurrence rate was 17.14% in the transformable group and 23.68% in the invariant group at the 6-month follow-up visit, but no significant differences were observed between these two groups(χ2=0.478, P=0.490). Conclusion The key step for successful treatment is to determine which otolith and canal types are accurately affected. The efficacy after the first manual reduction treatment was lower in the transformable group than in the invariant group. More circulation of first success was needed in the manual reduction management. The total efficacy and recurrence rate did not show significant differences between these two groups. Therefore, manual reduction is an effective treatment for transformable-direction eye shock patients with LSC-BPPV.
    Clinical Analysis of Benign Paroxysmal Vertigo in preschool and school-age children
    LIU Bing, LI Bei, ZHANG Li, CHEN Min, ZHANG Jie
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  58-60.  doi:10.6040/j.issn.1673-3770.0.2018.075
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    Objective To explore the clinical characteristics of benign paroxysmal vertigo(BPV)in preschool and school-age children. Methods Findings from 48 children with BPV, who completed vertigo questionnaires and underwent audiological and vestibular function examinations, were analyzed. Results The patients were 3-12 years old(mean 7.0)and included 22 boys and 26 girls. Twenty-five children were of preschool-age, while 23 were of school-age. The rates of nausea and vomiting in preschool and school-age children were 35.7%(10/28)and 64.3%(18/28), balance dysfunction were 85.7%(12/14)and 14.3%(2/14), and headache were 18.2%(2/11)and 81.8%(9/11), respectively. The difference between the two groups for these three parameters was statistically significant. There was no statistically significant difference between pre-school and school-age children for pure tone audiometry, acoustic conduction, high stimulation rate ABR, and caloric test. Conclusion BPV in preschoolers and school-age children differs with regard to clinical presentation of symptoms such as nausea and vomiting, balance disorder, and headache.
    Insertion of microtubules in tympanic membrane for the treatment of middle ear atelectasis
    MENG Lixin, LI Jian, WEI Shanwen
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  61-65.  doi:10.6040/j.issn.1673-3770.0.2017.448
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    Objective To analyze the clinical efficacy of tympanic membrane microtubule placement in the treatment of middle ear edema. Methods Seventy-six patients with middle ear atelectasis were divided into two groups according to Dornhoffers staging criteria. Group A was comprised of 38 patients with middle ear atelectasis classified as grade Ⅰ or Ⅱ, and group B was comprised of patients with grades Ⅲ or Ⅳ. The results of pure tone audiometry and acoustic impedance measurements were compared for the two groups before surgery and 1 week, 1 month, and 6 months afterward, to assess the effects of treatment and observe the occurrence and recurrence of complications. Results There were statistically significant differences between the two groups in pure tone audiometry before tympanic microtubule implantation and at 1 week, 1 month, and 6 months afterward(P<0.05). There were also statistically significant differences in acoustic impedance before treatment and at 1 week, 1 month and 6 months afterward(P<0.05). In Group A, 36 cases(94.74%)showed fully effectiveness, compared to 30 cases(78.95%)in group B. The difference in efficacy was significant(P<0.01). In group A there were no cases of complications and no cases of recurrence, while in group B there were 2 cases(5.26%)with complications and 3 cases(7.89%)with recurrence. The incidence of complications and recurrence rate differed significantly in the two groups(P<0.05). Conclusion Tympanic microtubule implantation has good clinical effects in patients with grade Ⅰ or Ⅱ middle ear atelectasis, and can effectively reduce the incidence of complications and recurrence rate.
    Expression of IL-35 in allergic rhinitis and its effect on the immunoregulation of T cells
    LU Hangui, LIN Xinsheng, YAO Danmian, WEI Yongxin, LI Chuangwei
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  66-70.  doi:10.6040/j.issn.1673-3770.0.2018.105
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    Objective To investigate the expression of IL-35 in allergic rhinitis(AR)and to explore its effect on the immunoregulation of T cells. Methods A rat model of AR was established by using ovalbumin as the allergen. Rats were randomly divided into the control group, model group, dexamethasone group, and IL-35 intervention group. Anaphylaxis score of rats was analyzed and compared. RT-PCR was used to analyze the mRNA expressions of IL-35, IFN-γ, IL-4, and IL-17 in the nasal mucosa. The expression levels of IL-35, IFN-γ, IL-4, and IL-17 in peripheral blood were measured by enzyme linked immunosorbent assay. Flow cytometry was used to detect the percentage of Th1, Th2, and Th17 cells in peripheral blood. Results IL-35 intervention can significantly reduce the symptoms of AR rats. The expression levels of IL-35 and IFN-γ in the AR model group and in peripheral blood were significantly lower than in the control group, whereas the expression levels were higher in the IL-35 intervention group than in the AR group. IL-4 and IL-17 expression levels were significantly higher in the AR model group than in the control group, whereas the expression levels were lower in the IL-35 intervention group than in the AR model group. The percentage of Th1 cells in the AR model group was significantly lower than that in the control group, whereas the percentage of Th1 cells in the IL-35 intervention group was significantly higher than that in the AR model group. The percentage of Th2 and Th17 cells was significantly higher in the AR model group than that in the control group. The percentage of Th2 and Th17 cells in the IL-35 intervention group was significantly lower than that in the AR model group(P<0.05). Conclusion IL-35 expression was downregulated in AR rats. IL-35 intervention can reduce the inflammatory response by upregulation of IFN-γ and downregulation of IL-4 and IL-17. The mechanism may be related to the regulation of Th1, Th2, and Th17 balance.
    Factors associated with systemic adverse reactions after subcutaneous immunotherapy injections and treatment options
    WANG Tan, WU Ke, LI Lianqing, GONG Lili
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  71-74.  doi:10.6040/j.issn.1673-3770.0.2018.158
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    Objective To analyze the factors associated with and the treatment of systemic adverse reactions after subcutaneous immunotherapy(SCIT)injections. Methods We retrospectively analyzed the records of patients with systemic anaphylaxis who presented to the Allergic Diseases Outpatient Department between January 2013 and December 2017. Results A total of 4597 SCIT injections had been administered to 191 patients, and 23 cases/instances of systemic adverse reactions were reported in 21 patients. The incidence of systemic adverse reactions was 0.5%. An immediate reaction was observed in 17 and a delayed reaction was observed in 6 cases. Systemic adverse reactions occurred during the initial treatment in 6 and during maintenance treatment in 17 cases. Based on the World Allergy Organization immunotherapy guidelines, 7 cases were classified as grade 1, 15 as grade 2, 1 as grade 3, 0 as grade 4, and 0 as grade 5. After exclusion of the associated factors, continuing to inject the original dose showed no adverse reactions. Conclusion Systemic reactions usually occur during the dose maintenance period. Alcohol intake, infections, ingestion or inhalation of a large number of allergens, hot water baths, exercise, fatigue, emotional stress, fasting, early pregnancy, and a few specific immunoglobulin E-mediated diseases are known risk factors for systemic adverse reactions in patients who receive multiple injections and tend to develop tolerance to the dose. Detailed questioning regarding the patients recent life history prior to each injection and careful assessment of the injector are important to reduce systemic allergic reactions. Continuing to inject the original dose after excluding the contributory factors is safe.
    Computed tomography assessment of skull base height before endoscopic sinus surgery
    ZHANG Ruxiang, TIAN Hao, MA Youxiang
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  75-77.  doi:10.6040/j.issn.1673-3770.0.2018.322
    Abstract ( 1517 )   PDF (3145KB) ( 309 )   Save
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    Objective To explore the procedure of computed tomography(CT)and evaluate its clinical value in evaluating the height of the ethmoidal sinus skull base before endoscopic sinus surgery. Methods A total of 100 patients with coronal CT scans of the sinuses(200 sides)were selected in our hospital for measurement of the distance between the mid-point of the sieves and the mid-line of the orbital level of the anterior ethmoid artery. The sinuses were classified using the Keros classification, and the correlation between the Keros classification and the height of the ethmoid sinus base was determined using the Pearson correlation coefficient. Results The distance between the top of the ethmoidal artery from the anterior ethmoid artery to the midline of the orbital level was the height of the base of the ethmoid sinus. According to the height of the ethmoidal sinus skull base, 44%(88/200)were type Ⅰ(more than 7 mm, high skull base), 41%(82/200)were type Ⅱ(4-7 mm, middle skull base), and 15%(30/200)were type Ⅲ(less than 4 mm, low skull base). According to the Keros classification, type Ⅰ accounted for 37%(74/200), type Ⅱ for 52%(104/200), and type Ⅲ for 11%(22/200)of the sinuses; the Pearson correlation coefficient between Keros classification and ethmoidal sinus skull base height was 0.384(P<0.001), which indicated a weak correlation. Conclusion The height of the ethmoidal sinus skull base is significantly different. Pre-operative CT imaging evaluation can effectively identify low skull base variations to help avoid skull base injury, and thus reduce the complications of endoscopic surgery.
    Clinical efficacy of endoscopic plasma radiofrequency ablation in the treatment of adenoid hypertrophy and sinusitis in children and its effect on nasal mucociliary clearance
    WANG Chi, LIU Xing, KONG Lei, HONG Xinghe, NING Bo
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  78-81.  doi:10.6040/j.issn.1673-3770.0.2017.219
    Abstract ( 1645 )   PDF (457KB) ( 366 )   Save
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    Objective To investigate the clinical efficacy of endoscopic plasma radiofrequency ablation in the treatment of adenoid hypertrophy and sinusitis in children and its effect on nasal mucociliary clearance. Methods Ninety-six children with adenoid hypertrophy and sinusitis were randomly divided into two groups: the control group, in which the children were treated with conventional surgical resection, and the observation group, in which the children were treated with low-temperature plasma radiofrequency ablation. The operative time, intraoperative blood loss, and nasal endoscopic score were compared between the two groups. The nasal mucociliary transmission rate(MTR)was measured using the saccharin test before and after surgery. Results There was no difference between the two groups in clinical efficacy(P>0.05); differences in the operative time, intraoperative blood loss, and reduced amplitude of endoscopic score were statistically significant(P<0.05)between the two groups. In the control group, the MTR after treatment was significantly different from that before treatment(P<0.05); however, no significant difference was observed in the observation group(P>0.05). and there was a significant difference in the MTR after operation in the observation group(P<0.05). Conclusion Endoscopic plasma radiofrequency ablation is clinically effective for the treatment of glandular hypertrophy and sinusitis in children, and is associated with less intraoperative blood loss, shorter operative times, and no significant effect on nasal mucociliary clearance.
    Role of functional middle turbinectomy in functional endoscopic sinus surgery for chronic sinusitis
    SHEN Qinfeng, SHEN Xiaoyan, ZHU Rongqiang, JIANG Feifei, LANG Juntian
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  82-85.  doi:10.6040/j.issn.1673-3770.0.2018.176
    Abstract ( 1559 )   PDF (397KB) ( 246 )   Save
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    Objective To explore the efficacy of partial middle turbinectomy in endoscopic sinus surgery for chronic sinusitis with nasal polyps. Methods A total of 76 patients with chronic sinusitis and nasal polyps accepted functional nasal endoscopic surgery(FESS)from January 2014 to January 2017. Patients were divided into two groups randomly. One group of 38 patients underwent usual FESS surgery with the middle turbinate preserved, while the other group of 38 patients underwent FESS with middle turbinate removed. The cure rate, operation time, middle turbinectomy adhesion, symptom scoring and olfactory function were investigated and statistically analyzed. Results The operation time was(50.53±6.25)minutes in middle turbinate resection group, and(58.11±6.09)minutes in the other group(t=5.355, P<0.001). Six months after surgery, both groups had 100% effective outcome. The cure rate of the turbinate-preserved group was 78.95%(30/38)and of the resection group was 81.58%(31/38). After surgery, there was a significant difference for patents symptom scoring and middle turbinate adhesion between the two groups, which was much better in middle turbinate resection group. Conclusion Partial removing middle turbinate can shorten the time of nasal endoscopic surgery and middle turbinate adhesion, improving patients subjective feeling. It is suggested that for patients with moderate middle turbinate hypertrophy and polypoid changes, the lesioned middle turbinate need to be removed appropriately in functional endoscopic sinus surgery.
    Clinical study of endoscopic nasal vestibular cyst unroofing and low-temperature plasma for the treatment of nasal vestibular cysts while excluding the septal wall
    TIAN Zenghua
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  86-89.  doi:10.6040/j.issn.1673-3770.0.2018.020
    Abstract ( 1676 )   PDF (404KB) ( 375 )   Save
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    Objective To study the clinical efficacy of nasal endoscopic vestibule cyst removal with hypothermic plasma for treatment of nasal vestibular cysts while excluding the septal wall. Methods A total of 84 patients with nasal vestibular cysts were selected and randomly divided into group A and group B according to the random number table method, resulting in two groups with 42 patients each. The patients in group A were subjected to low-temperature-controlled plasma radio frequency ablation by nasal endoscopy. The patients in group B underwent traditional gingival sulcus cyst removal. We compared surgery duration, intraoperative bleeding, wound healing time, the VAS scores of pain at 12 h, 24 h, and 48 h after surgery; the total incidence of complications within one month after surgery; and the complications and recurrence during follow-up between the two groups. Results Surgery duration, intraoperative bleeding, and wound healing time in group A were 21.02±5.98 min, 13.55±4.01 mL, and 3.52±1.02 days, respectively. All values were significantly lower than in group B(surgery duration: 38.96±8.24 min; intraoperative bleeding: 51.88±9.30 mL; and wound healing time: 5.97±2.16 days; P<0.05). Additionally, the VAS scores of pain in group A at 12 h, 24 h, and 48 h after operation were significantly lower than those in group B(P<0.05). The recent complication rate in group A patients was 4.76%, which was significantly lower than the 19.05% complication rate in group B patients(P<0.05). The overall incidence of complications during follow-up was 2.38% and 7.14% in group A and B, respectively. The recurrence rates were 0 and 4.76% in group A and B, respectively. These differences were not significant. Conclusion Low-temperature-controlled plasma radio frequency ablation via nasal endoscopy combines multiple advantages of endoscopy and cryogenic plasma, i.e. simpler surgery, less postoperative pain, and fewer complications in comparison to cyst removal via the gingival sulcus.
    Application of combined dyclonine and lidocaine anesthesia for laryngeal examination using narrow-band imaging endoscopy
    DU Xiaoying, LI Na, KONG Demin, LIU Xiaohong, YANG Minjuan, REN Xiaoyong, HOU Jin
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  90-92.  doi:10.6040/j.issn.1673-3770.0.2018.100
    Abstract ( 1708 )   PDF (369KB) ( 246 )   Save
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    Objective To investigate the effect of combined dyclonine and lidocaine anesthesia in the examination of the larynx using narrow-band endoscopy. Methods Two hundred forty patients with laryngeal disease were examined using narrow-band imaging endoscopy. The subjects were randomly divided into three groups-dyclonine group, lidocaine group, and dyclonine with lidocaine group(80 subjects in each group), and the total effective rate was observed. The VAS scores were also recorded. Results The total effective rates were 70%(dyclonine group), 90%(lidocaine group), and 88.75%(dyclonine with lidocaine group), and the difference between the combined anesthesia group and lidocaine group was not statistically significant. The VAS score was lowest in the combined group(4.38±2.48), followed by the lidocaine group(4.78±2.83), and the dyclonine group(5.94±2.70). The difference was statistically significant. Conclusion The application of combined dyclonine and lidocaine is a safe and effective anesthetic technique for performing narrow-band imaging endoscopy in patients with laryngeal disease. Dyclonine alone does not induce adequate anesthesia for complete narrow-band endoscopy.
    Clinical outcomes of micro-drill recanalization and artificial nasolacrimal duct implantation with fifth-generation lacrimal endoscopy to treat nasolacrimal duct obstruction
    WANG Xingcun, ZHU Liqiang, ZUO Wenyuan, MENG Zhiqiang, LIU Yang, TI Tongxin
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  93-96.  doi:10.6040/j.issn.1673-3770.0.2017.256
    Abstract ( 1524 )   PDF (409KB) ( 320 )   Save
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    Objective To evaluate the effect of micro drill recanalization and artificial nasolacrimal duct implantation with fifth-generation lacrimal endoscopy for treating nasolacrimal duct obstruction. Methods Sixty-one patients with nasolacrimal duct obstruction were recruited between January 2014 and December 2015. They were treated with micro drill recanalization and implantation of an artificial nasolacrimal duct with fifth-generation lacrimal endoscopy. Results At the 6-month follow-up, the success rate was 91.8% with 48 patients cured, eight patients exhibiting improvement, and five patients exhibiting no improvement. Conclusion Micro drill recanalization and artificial nasolacrimal duct implantation with fifth-generation lacrimal endoscopy for the treatment of nasolacrimal duct obstruction was effective, safe, and minimally invasive. The results indicate that this treatment is suitable for clinical application.
    Targeted therapy for head and neck squamous cell carcinoma
    WU Jing, LIU Yehai
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  97-102.  doi:10.6040/j.issn.1673-3770.0.2018.058
    Abstract ( 1733 )   PDF (406KB) ( 552 )   Save
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    Head and neck cancer is one of the most common tumors in the world. More than 95% of all pathological types are squamous cell carcinomas. The combination of surgery and radiotherapy and chemotherapy is the widely accepted treatment for head and neck squamous cell carcinoma(HNSCC). However, the overall survival rate is low, mainly owing to tumor recurrence and/or metastasis. Meanwhile, in recurrent or metastatic HNSCC, surgery is often difficult. Moreover, the effect of radiotherapy and chemotherapy is also poor. The discovery of targeted therapy has provided a new approach for the treatment of HNSCCs, especially those that are recurrent or metastatic. To further understand the clinical therapeutic effect of targeted therapy, this article reviews the research progress of targeted therapy for HNSCC.
    Advances in the study of endoscopic thyroidectomy
    SUN Shasha, ZANG Chuanshan, QIU Jie, SUN Yan, SUN Guochen, CHU Qinggang
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  103-109.  doi:10.6040/j.issn.1673-3770.0.2017.499
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    With ongoing innovations and evolution of Surg instruments and equipment, and the continuous refinement of operating Tech, endoscopic Surg has been on the center stage of modern medicine for many years. In recent years, the clinical use of endoscopic-assisted or endoscopic thyroidectomy has gradually gained prominence. The majority of patients with thyroid disease are young and middle-aged women. Conventional transverse incision in the neck for open thyroidectomy has cosmetic implications, and so endoscopic thyroidectomy has great clinical value. However, there are still varied opinions on the approach, Surg methods, indications, and other aspects of endoscopic thyroidectomy. This article reviews the Surg methods, indications, contraindications and complications of endoscopic thyroidectomy, and the new advances in this field.
    Diagnosis and treatment of thyroid-associated ophthalmopathy
    ZHU Mingjuan, XING Kai, KANG Zefeng, LIU Jian
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  110-113.  doi:10.6040/j.issn.1673-3770.0.2018.034
    Abstract ( 1897 )   PDF (436KB) ( 703 )   Save
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    Thyroid-related ophthalmopathy is an organ-specific autoimmune disease associated with abnormal thyroid function. The extra-glandular ocular involvement affects the appearance of the patient; severe cases can present with diplopia, decreased vision, or even blindness. The pathogenesis is not yet fully understood, and the current clinical therapeutic approaches cannot cure or provide relief to all patients. Moreover, there are many clinical treatment methods. Histopathological examination of the ocular soft tissue and extra-ocular muscles shows some immune inflammatory response, but the exact pathogenesis of this disease is not clear. This article reviews the latest research on the clinical diagnosis and treatment of thyroid-related ophthalmopathy.
    Clinical diagnosis and treatment of 32 cases of vocal cord leukoplakia
    WANG Chunyu, ZHANG Fen, WANG Beibei, LI Yuyue, WANG Xiaoyu, LI Zhiyun, ZHANG Qingquan
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  114-116.  doi:10.6040/j.issn.1673-3770.0.2018.338
    Abstract ( 1356 )   PDF (307KB) ( 291 )   Save
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    Laryngocelesecondary to Laryngectomy:a case report and literature review
    YE Shufeng, ZHANG Xu, SU Kai, LI Hejie, TENG Bo
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  117-118.  doi:10.6040/j.issn.1673-3770.0.2018.152
    Abstract ( 1434 )   PDF (2149KB) ( 370 )   Save
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    A case report of Grisel syndrome following adenoidectomy in Crouzon children
    ZHOU Dingkun, CAI Yu,TIAN Yanhua, TENG Bo, FENG Qingjie
    J Otolaryngol Ophthalmol Shandong Univ. 2018, 32(5):  119-120.  doi:10.6040/j.issn.1673-3770.0.2018.153
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