Table of Content

20 January 2019 Volume 33 Issue 1

  

Editorial

One airway, one disease: clinical application of sublingual immunotherapy

Lei CHENG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  1-3.  doi:10.6040/j.issn.1673-3770.1.2018.048

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Progress and challenges in the management of asthma in China

Jiangtao LIN

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  4-8.  doi:10.6040/j.issn.1673-3770.1.2018.015

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Invited Review

Research progress of group Ⅱ innate lymphoid cells in the allergic rhinitis

Yinshi GUO,Hui LU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  9-12.  doi:10.6040/j.issn.1673-3770.1.2018.019

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Allergic rhinitis (AR) is an allergic respiratory inflammation. T helper type 2 (Th2) cell activation plays an important role in the mediation of the disease. AR involves the innate and adaptive immune systems. Type 2 innate lymphoid cells (ILC2s) are considered the innate counterparts of Th2 cells based on the cytokines they express. Accumulating evidence has demonstrated that innate immune cells function as homeostatic regulators in the body. ILC2s contribute to the pathology of allergic inflammatory diseases. Here, we review the characteristics of ILC2s and progress of research on the mechanism of AR.

Overall diagnosis and treatment strategy for allergic diseases related to hay fever

Kai GUAN,Lianglu WANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  13-19.  doi:10.6040/j.issn.1673-3770.1.2018.041

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Pollinosis refers to a series of clinical symptoms, such as allergic conjunctivitis, rhinitis, and asthma, that are mediated by specific immunoglobulin E (sIgE) after inhalation of allergic pollens by atopic individuals. The clinical symptoms of pollinosis depend on the season, region, and climate. Common pollens causing pollinosis come from trees, grass, and weeds. In northern China, the quality of life for patients with pollinosis is significantly worse than that for the patients with dust mite allergy. The weed pollen is more likely to induce asthma than the tree pollen. The diagnostic steps for pollinosis include anamnesis, allergen-specific diagnostic tests (skin test and serum sIgE test), and result assessment. Clinical management includes allergen avoidance, allergen-specific immunotherapy, and anti-inflammatory medicines (such as glucocorticoids, H1 antihistamines, and leukotriene receptor antagonists). Clinical data showed that the pollen extracts from the PUMCH Allergen Products Manufacturing and Research Center are particularly useful in the diagnosis of pollinosis. They have good efficacy and safety, and can prevent allergic rhinitis from developing into asthma and inhibit the emergence of reactions to new allergens effectively. Treatment efficacy can be maintained even after stopping active administration.

Recognizing the etiology of chronic cough in children of different ages

Chuangli HAO,Wenjing GU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  20-24.  doi:10.6040/j.issn.1673-3770.1.2018.021

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Chronic cough is a common disease in children. The etiology composition of chronic cough varies across children of different ages. Understanding the etiology of chronic cough in children at different ages has great significance for the diagnosis and effective treatment of chronic cough in children.

Problems associated with allergic asthma in children

Jie SHAO

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  25-27.  doi:10.6040/j.issn.1673-3770.1.2018.036

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The prevalence of childhood asthma varies from 8%-28% worldwide. Pediatric epidemiological studies in China have found that nearly one-third of the children with asthma have not received appropriate management. More attentions need to be paid to early interventions, treatments, and long-term outcomes of childhood asthma.

The prevalence, diagnosis and management of asthma in children in China

Chuanhe LIU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  28-32.  doi:10.6040/j.issn.1673-3770.1.2018.037

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In the past 20 years, the prevalence of childhood asthma has been increasing in China; its prevalence differs greatly between urban and rural populations. The proportion of asthma attack-related emergency room visits and hospitalization in children is still very high; the early diagnosis rate of childhood asthma is low and related treatment and management is not ideal. With complete understanding of the guidelines, correct applications in clinical practice, and appropriate laboratory examinations, pediatricians can improve early diagnosis of asthma and provide appropriate treatment plans and individualized preventive suggestions to children with asthma at an early stage; this can comprehensively improve asthma prevention and control and therefore, improve its prognosis.

Synchronous control and long-term efficacy of specific immunotherapy for allergic rhinitis and asthma

Qianhui QIU,Junxiao GAO

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  33-37.  doi:10.6040/j.issn.1673-3770.1.2018.017

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In recent years, the prevalence of allergic rhinitis(AR)and allergic asthma has increased significantly. Because of a deeper understanding of specific immunotherapy(SIT), it is currently believed that SIT may be the only treatment that changes the natural course of allergic diseases by regulating the immune mechanisms and can maintain long-term effects after treatment has been discontinued. This article reviews the simultaneous control and long-term efficacy of SIT for AR and asthma. A literature review and analysis of domestic and international studies indicates that SIT plays an important and positive role in the treatment of AR and asthma and can prevent AR from progressing to asthma. However, SIT is also associated with some problems that merit further discussion.

Endoscopic sinus surgery for chronic sinusitis with asthma

Hongmeng YU,Zhuofu LIU,Qi DAI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  38-41.  doi:10.6040/j.issn.1673-3770.1.2018.018

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Chronic rhinosinusitis (CRS) is a heterogeneous disease, and patients with asthma account for 10%-40% of the CRS cases and this number is increasing worldwide. In addition, the incidence of CRS is higher in patients with asthma than in the general population. At present, most of the studies suggest that endoscopic surgery combined with drug therapy can significantly improve the nasal symptoms of patients with CRS accompanied by asthma, and is conducive to long-term management of asthma. However, such patients are prone to recurrence after surgery and the risk for perioperative surgery is also high. This article focuses on the preoperative evaluation and perioperative management of patients with CRS accompanied by asthma, choice of surgical methods, and impact of endoscopic surgery on asthma.

Research Progress

Allergen inhalation challenge in the research of allergic rhinitis and asthma

Zheng ZHU,Wanjun WANG,Qiurong HU,Jing LI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  42-48.  doi:10.6040/j.issn.1673-3770.1.2018.016

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The prevalence of allergic disease is increasing in China with the progress of urbanization and the environmental and lifestyle changes. The pathogenesis of allergic rhinitis and asthma is currently believed to be mainly caused by the interaction of genetic and environmental factors, but the specific mechanisms are not fully understood yet. Chronic airway inflammation and airway hyperresponsiveness are typical pathophysiological features of allergic rhinitis and asthma. Natural exposure to allergens in the environment can induce exacerbation of the symptoms, cause increases in airway and systemic inflammation, and lead to increased airway hyperresponsiveness. Stimulation by inhalation of allergens in patients with allergic rhinitis and asthma can induce the onset of symptoms induced by natural allergen exposure, which can be used as a model for studying the pathogenesis of allergic rhinitis and asthma and to evaluate the efficacy of treatment drugs for both conditions. As they occur in the same airway and as a single disease, allergic rhinitis and asthma impact each other. The relationship between the upper and lower airways can be examined by stimulating one end and observing the reaction of the other end of the airways. House dust mites are one of the most common allergens and well related to the severity of allergic rhinitis and asthma in China, especially in the southern areas. In this review, we summarized the application of allergen nasal and bronchial provocation in the research of allergic rhinitis and asthma.

Advances in interaction mechanisms and treatment strategy between chronic rhinosinusitis with nasal polyp and asthma

Yu ZHANG,Xicheng SONG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  49-52.  doi:10.6040/j.issn.1673-3770.1.2018.033

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Chronic rhinosinusitis with nasal polyp (CRSwNP) and asthma are representative chronic inflammatory diseases, which often coexist in the upper and lower airways. It is difficult to perform an effective therapy for patients with CRSwNP accompanied by asthma because interaction mechanisms and therapeutic effects after medical treatment and endoscopic sinus surgery remain unclear. The European position paper on rhinosinusitis and nasal polyps 2012 (EPOS 2012) presents detailed guidelines on the therapy of CRSwNP with or without asthma, including intranasal corticosteroids, nasal irrigation with saline, and so on. In addition, comprehensive follow-up treatments need to be performed according to the feature and severity of symptoms of CRSwNP. Research shows that it is beneficial for improving the prognosis of patients with CRSwNP accompanied by asthma by combining sinus surgery with medical treatment, but further randomized clinical trials are needed to better understand the management of asthma accompanied by CRSwNP.

Research progress in the treatment of bronchial asthma with biological agents

Li SHA,Chuanhe LIU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  53-58.  doi:10.6040/j.issn.1673-3770.1.2018.040

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Bronchial asthma is a common chronic airway inflammatory disease of the respiratory system. Inhaled corticosteroids are the primary treatment strategy. Studies have shown that the clinical response to inhaled corticosteroids varies due to different types of airway inflammation. A variety of biological agents aimed at inflammatory mediators in airway inflammation have been developed. Randomized controlled trials of these agents have shown that patients with severe eosinophilic asthma benefit from therapy, but controversy remains regarding some aspects of their clinical effects. Their efficacy and safety in children, as well as their long-term effects on disease course and progression need further study and confirmation.

Academic Discussion

Paying attention to the 'lateral airway' allergic diseases in children

Qintai YANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  59-62.  doi:10.6040/j.issn.1673-3770.1.2018.042

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Allergic diseases are autoimmune diseases that involve multi-organ systems producing a variety of clinical manifestations; concurrently, there is an intrinsic and inseparable link between multiple systems and clinical manifestations, producing a variety of manifestations among different age-groups and populations. Focusing on allergic diseases that are associated with the respiratory airway in children is relatively complicated due to the dynamic changes observed with respect to their body structures and immune systems. Allergic rhinitis, allergic asthma, and otitis media with effusion are three examples of allergic respiratory diseases in children that affect the same airway at different anatomical regions, and the correlation between them is receiving greater attention. Whether the upper, lower, and lateral airways could ever truly be in concurrence with each other is worth an in-depth discussion, and thus, we put forward some minor thoughts and suggestions based on the available clinical research and literature.

Analysis of prevalence and related risk factors of bee venom in bee research population

CUI Le, GUAN Kai, LI Lisha, LI Junda, WANG Zixi, XU Yingyang, WANG Lianglu, YIN Jia

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  63-66.  doi:10.6040/j.issn.1673-3770.1.2018.034

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Objective Allergic reactions to bee venom are one of the common causes of severe allergic reactions. There are few studies on bee venom allergy in China; particularly, there is a lack of data on people at high risk of bee venom allergy. This study investigated the prevalence and clinical characteristics of bee venom allergies in the bee study population and analyzed the risk factors. Methods In September 2018, a cross-sectional survey was conducted among people who had been engaged in bee-related research at the Bee Research Institute of the Chinese Academy of Agricultural Sciences and the Department of Entomology of China Agricultural University. Results A total of 100 people were included in the study: median age 28 years(range: 19-56 years); females accounted for 69.0%. Among them, 34 cases(34.0%)reported having had allergic reactions to bee venom at work, 6 cases(6%)had large local reactions, and 28 cases(28%)had systemic reaction reactions. Among the 28 systemic reaction responders, there were 7, 7, 4, and 10 cases of systemic reactions in grades 1-4, respectively. The systemic reaction of grade 4 was the commonest(35.7%). Fifty percent of systemic reaction responders experienced large local reactions after initial bee sting. Logistic regression showed that the level of exposure, that is, the frequency of bee stings was a risk factor for bee venom allergy. Compared with the respondents who were not been stung in the past year, the OR(95% CI)of bee venom allergy of 1-3 and ≥4 bee stings in the past year were 6.362 ［95% confidence interval(CI), 2.014-20.092］ and 41.437(95% CI, 6.842-250.964). There was no statistically significant correlation between respondents' personal or family history of allergies(e.g. allergic rhinitis), family history of bee venom allergy and bee venom allergy(odds ratios=0.683(95% CI, 0.197-2.366), 0.600(95% CI, 0.131-2.749)and 2.582(95% CI, 0.201-33.099), respectively). Conclusion The situation of bee venom allergy in high-risk population cannot be ignored. For high-risk groups, it is necessary to pay close attention to protection and provide emergency medicine and equipment.

Characteristics of the distribution of inhaled allergens in patients with allergic rhinitis in Qingdao from 2008 to 2017

QIN Ya′nan, WANG Lin, JIANG Yan, YAN Shu, CHEN Min, YU Longgang, LI Na

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  67-72.  doi:10.6040/j.issn.1673-3770.1.2018.030

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Objective To study the characteristics of the distribution of common inhaled allergens in a populations of allergic rhinitis patients in Qingdao over the past ten years. Methods The skin prick test was performed on 4 737 patients with allergic rhinitis who visited the hospital in Qingdao from 2008 to 2017. Commonly inhaled allergens in Qingdao were selected for detection and the results were statistically analyzed. Results The five most common allergens that had a positive result on the skin prick test were dust mites, house dust mites, cockroaches, Artemisia grandis pollen, and sycamore pollen. Locust tree pollen caused a mild allergic reaction, while other allergens caused mainly moderate or moderately severe allergic reactions. The highest rate of dust mite allergy appeared from August to January. The highest rate of Artemisia sphaerocephala pollen and ragweed pollen allergies appeared in the summer. The highest rate of sycamore pollen allergy appeared from May to August. The highest rate of ash tree pollen allergy appeared in the spring and autumn. The highest positive rate of cockroach allergy appeared in September. The highest rate of cat and dog hair, and yellow-producing penicillium allergy appeared in summer. Among the allergic patients, those who were allergic to two or three allergens at the same time comprised the majority of the sample, and those who were allergic to a single allergen or four or more allergens comprised a smaller proportion of the sample. The highest rate of dust mite and yellow-producing penicillium allergy appeared in patients aged 7-17 years, while the highest rate for other allergies appeared in patients aged 18-40 years. There was no significant difference between the male and female populations in the rate of dust mite, house dust mite, wormwood pollen, or sycamore pollen allergy; the female population had a higher rate of allergy to ragwort pollen, locust tree pollen, cat hair, dog hair, and yellow-producing mildew than the male population, and the male populations had a higher rate of allergy to cockroaches than the female population. Conclusion The main inhaled allergens causing allergic rhinitis in the Qingdao area in the past ten years were dust mites, cockroaches, and pollen. Among the allergic patients, those who were allergic to two allergens at the same time comprised the majority of the group. The highest rate of dust mite allergy appeared in July and November. The highest rate of pollen allergy appeared in the spring and autumn. The highest rate of animal hair and mold allergy appeared in the summer. Most allergies were most common in the 18-40-year-old age group. There was no difference in the rates of dust mite, Artemisia pollen, or sycamore pollen allergy between sexes. Sex differences were present for other allergens.

Investigation and analysis of airborne ragweed pollen in Qingdao and Beijing areas from 2010 to 2015

WANG Zixi, QU Hui, WANG Ruiqi, HE Haijuan, GUAN Kai, LIU Jie, LU Daowen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  73-76.  doi:10.6040/j.issn.1673-3770.1.2018.035

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Objective As an invasive species, ragweed not only destroys the local vegetation, but also easily causes allergic rhinitis and asthma. It is one of the most important allergens causing pollinosis in summer and autumn in China. We investigated the concentration and distribution of ragweed pollen and analyzed its changing profile in the air of Qingdao and Beijing. Methods Two monitoring stations(west and east)were set up in Qingdao, and one in Beijing, and data were collected from 2010 to 2015. The pollen in the air was collected by the gravity sedimentation method and identified under microscopes. Pollen exposure analysis was performed daily, combined with open field investigation. Results Only Ambrosia artemisiifolia pollen were found in Qingdao. The pollen count was 175(west)and 257(east)in 2010; 508(west)and 589(east)in 2011; and 792(west)in 2015. The peak ragweed pollen concentration was in August and September, and reached its highest level in late August and early September. There was no breeding of ragweed in the wild near Beijing. Ragweed pollen count was 4 in 2010, 2 in 2011, and was not observed under a microscope from 2012-2015 in Beijing. Conclusion During the five-year-experimental period, pollen monitoring stations in the eastern and western parts of Qingdao showed that the concentration of ragweed pollen in the air increased every year, suggesting that strategies should be devised to check the spread of ragweed pollen, and to prevent and control pollinosis.

Correlation between PM_2.5 and upper airway resistance in patients with allergic rhinitis

JIN Xing, HU Dayu, ZHU Li, DENG Furong, LIU Junxiu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  77-80.  doi:10.6040/j.issn.1673-3770.1.2018.031

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Objective To investigate the relationship between upper airway resistance and the concentration of atmospheric particulate matter with diameter <2.5 micrometers(PM_2.5)in patients with allergic rhinitis(AR). Methods Sixty patients with clinically diagnosed AR were randomly selected for nasal acoustic reflex and nasal resistance measurement. The PM_2.5 concentration in their living areas was continuously monitored. Using SPSS 20.0 statistical software, multiple linear regression models were used. The patient's total nasal resistance, nasal volume, and nasal minimum cross-sectional area were correlated with the air pollution exposure levels. The level of significance was set at P<0.05. Results Nasal acoustic reflex and nasal resistance measurements showed that the total nasal resistance, nasal minimum cross-sectional area, and nasal volume of the subject varied dynamically with varying PM_2.5 concentration, and the difference was statistically significant. Conclusion The concentration of PM_2.5 affects the upper airway resistance of patients with AR. The greater the concentration of PM_2.5 and longer the exposure time, the greater the upper airway resistance of patients with AR.

The effects of air pollutants on the severity of allergic rhinitis symptoms caused by cypress pollen

LI Lisha, GUAN Kai, WANG Zixi, CUI Le

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  81-87.  doi:10.6040/j.issn.1673-3770.1.2018.026

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Objective The association between allergic disorder prevalence and monitored air pollutants has been supported by past research evidence. The aim of this study was to evaluate the effects of air pollutants on the severity of allergic rhinitis symptoms caused by cypress pollen. Methods Eighty-one patients with allergic rhinitis(AR)caused by cypress pollen were recruited. From 2016 to 2018, patients recorded daily average symptom scores during the cypress pollen season. Meanwhile, the meteorological data were acquired from the Meteorological Data Center of the China Meteorological Administration, and air pollutant data were acquired from the database of the China National Environmental Monitoring Center. The effects of air pollutant concentrations on the daily average symptom scores of patients with AR were then analyzed using the multiple linear regression model. Results A statistical correlation between the concentration of SO₂ and daily average AR symptom score was found in this study(regression coefficient=0.038, 95% CI［0.004, 0.072］, P=0.027)after adjusting for the effects of cypress pollen concentration and meteorological variables, while the associations between average symptom score and other air pollutants including PM_2.5, PM₁₀, CO, NO₂, and O₃ were insignificant. Conclusion The severity of AR caused by cypress pollen is correlated with air pollutant concentrations, and SO₂ might significantly increase the severity of AR symptoms.

Research on visit characteristics of children with acute laryngitis in Beijing between 2013 and 2017 and the correlation of the visit characteristics with meteorological factors and air pollutants

YANG Yaowei, LU Yingxia, GU Qinglong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  88-93.  doi:10.6040/j.issn.1673-3770.1.2018.023

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Objective This study aimed to assess the visit characteristics of children with acute laryngitis in Beijing and the correlation of the visit characteristics with meteorological parameters and air pollutants. Methods Information pertaining to children with acute laryngitis who were treated at the ear, nose, and throat(ENT)department of Capital Institute of Pediatrics between 2013 and 2017, including age, gender, diagnoses, medications, and so on was collected; the visit characteristics of children with acute laryngitis in Beijing during those five years were analyzed, and those characteristics and the meteorological parameters, such as average air temperature, average air pressure, average relative humidity, and average wind speed, as well as major environmental pollutants(PM_2.5, PM₁₀, SO₂, NO₂, CO, O₃)in Beijing during the study period. The SPSS 20.0 statistical package program was used to analyze the data. Results The ENT department of the Capital Institute of Pediatrics treated a total of 3 286 children with acute laryngitis between 2013 and 2017, and the male/female ratio was about 2∶1; children with acute laryngitis were commonly younger than 4 years of age(69.42%); of those children, those aged 1-2 years accounted for the largest proportion in terms of department visits, and the incidence tended to decrease gradually with age; after the age of 8 years, the incidence plateaued, and the gender differences were not evident. The number of department visits during those five years was 854, 662, 790, 574, and 406, respectively, showing a decreasing trend year by year, which was similar to the decreasing trends of PM_2.5 and PM₁₀; however, the seasonal characteristics, peak and valley seasons of department visits, and peak and valley months were all different in those years; there was a significant correlation between the seasonal visits and average PM_2.5 and CO(r value: 0.490, 0.547, respectively; P<0.05), but there was no significant correlation between the seasonal visits and meteorological factors(average air temperature, average air pressure, average relative humidity, and average wind speed), as well as the major environmental pollutants(PM₁₀, SO₂, NO₂, O₃); there was also no significant correlation between daily or monthly visits and daily or monthly average values of those parameters. Conclusion Evident age patterns and gender differences were noted among children with acute laryngitis in Beijing, and the incidence tended to decrease gradually with age; there was a significant correlation between the seasonal visits and average PM_2.5 and CO.

The prevalence and risk factors of bronchial asthma in patients with allergic rhinitis in Guangdong Province

HONG Haiyu, XU Guangfu, YANG Shuowei, SU Rongfei, HUANG Yili, CHI Mengshi,WANG Weihao,YANG Qintai

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  94-98.  doi:10.6040/j.issn.1673-3770.1.2018.038

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Objective A retrospective survey was performed on patients who were diagnosed with allergic rhinitis(AR)and its complication, bronchial asthma(BA). The characteristics and allergens in these patients with AR and BA were analyzed to determine the risk factors. Methods The medical records of 2 931 patients with AR(5-60 years old)who had undergone allergen skin puncture tests between June 2009 and May 2018, from two medical centers in Guangzhou and Zhuhai City(The Third and Fifth Affiliated Hospital of Sun Yat-sen University), were analyzed for patient characteristics, risk factors of BA, and allergen types using SPSS 20.0. Results Among the 2 931 patients, 207(7.06%)had AR with BA. The strongest risk factor for BA, as determined by a multiple logistic regression analysis, was AR for a duration of 5 years; this was followed by smoking, self-medication with antibiotics, a family history of AR and BA, and urban living. The most common sensitization was to house-dust mites(93.96%). Conclusion Our findings suggest that the risk factors for concomitant BA in patients with AR may be helpful in establishing preventive strategies.

Analysis of pulmonary function and its influencing factors in chronic rhinosinusitis without lower airway disease

WANG Yakun, ZHANG Yu, SONG Xicheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  99-102.  doi:10.6040/j.issn.1673-3770.0.2018.567

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Objective To explore pulmonary function and its related influences in chronic rhinosinusitis patients with nasal polyps(CRSwNP)without lower airway disease. Methods One hundred and sixty-one patients with chronic rhinosinusitis with nasal polyps(CRSwNP), 26 patients with chronic rhinosinusitis without nasal polyps(CRSsNP), and 34 healthy people serving as a control group were enrolled in this study. We compared pulmonary function among these three groups and analyzed the association between pulmonary function and clinical parameters in patients with CRSwNP. These clinical parameters included serum eosinophil count, serum-specific allergen IgE(sIgE), Lund-Mackay scores, exhaled nitric oxide levels, and VAS scores. Results Percentages of predicted forced expiratory volume in 1 second(FEV₁%pre)in the CRSwNP group were significantly lower than those in the control group(P<0.05), and sIgE was negatively correlated with vital capacity(VC), FEV₁%pre, and FEV₁/FVC(P<0.05). Conclusion The results suggest a potential obstructive pulmonary function change in patients with chronic rhinosinusitis. Serum-specific allergen IgE may be associated with changes in lung function in chronic rhinosinusitis.

Analysis of pulmonary function of patients who developed chronic rhinosinusitis with nasal polyps and asthma

WANG Jianwei, ZHANG Yu, SONG Xicheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  103-108.  doi:10.6040/j.issn.1673-3770.1.2018.032

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Objective To analyze the pulmonary function of patients who developed chronic rhinosinusitis with nasal polyps(CRSwNP). Methods The pulmonary function of 74 patients who underwent functional endoscopic sinus surgery(FESS)was measured and analyzed. The patients were divided into comparable groups under different criteria: male(49 patients)and female(25 patients)groups, smoking(32 patients)and non-smoking(42 patients)groups, serum-specific immunoglobulin E(IgE)-positive(27 patients)and serum-specific IgE-negative(47 patients)groups, elevated eosinophils in peripheral blood(27 patients)and non-elevated eosinophils in peripheral blood(47 patients)groups, and elevated eosinophils in nasal polyps(31 patients)and non-elevated eosinophils in nasal polyps(43 patients)groups. The pulmonary function of all the patients were completed under guidance of a professional allergist with qualifications; test data were collected using the German GANSHORN Pulmonary Function Instrument(PowerCube-Body). Analyzed indices of pulmonary function included the percentage of forced expiratory volume in the first second(FEV₁%pre), percentage of predicted value of the ratio of FEV₁ to forced vital capacity(FVC)(FEV₁/FVC% pre), percentage of maximum ventilatory volume estimated(MVV% pre),forced expiratory flow at 50% of FVC(FEF_50%), forced expiratory flow at 75% of FVC(FEF_75%), and maximal mid-expiratory flow(MMEF). After pulmonary function was evaluated, all 74 patients accepted individualized specific aerosol inhalation twice or thrice a day, combined with one inhalation of salmeterol xinafoate and fluticasone propionate powder twice a day. In addition, 10 mg of oral montelukast sodium and loratadine were administered once a day separately, along with a nasal spray of azelastine hydrochloride and budesonide twice a day. The medical therapy persisted for 1-14 days from admission to preoperation, and the patients were administered another aerosol inhalation 30 min before surgery and one inhalation of salmeterol xinafoate and fluticasone propionate powder before general anesthesia. The improvement in pulmonary function after medical treatment was also evaluated. Results All 74 patients underwent FESS unremarkably. On admission, FEF_50%, FEF_75%, and MMEF in the female group were lower than in the male group(t=3.213, 2.829, and 3.644, respectively; P=0.002 0, 0.006, and 0.000 5, respectively); FEV₁/FVC% pre was lower in the smoking group than in the non-smoking group(t=2.032, P=0.045 8), in the elevated eosinophils in peripheral blood group than in the non-elevated eosinophils in peripheral blood group(t=2.259, P=0.029 2), and in the elevated eosinophils in nasal polyps group than in the non-elevated eosinophils in nasal polyps group(t=2.634, P=0.010 3); and MVV% pre decreased significantly in the elevated eosinophils in nasal polyps group compared to in the non-elevated eosinophils in nasal polyps group(t=2.453, P=0.016 6). Pulmonary function indices including FEV₁%pre, FEV₁/FVC% pre, MVV% pre, FEF_50%, FEF_75%, and MMEF improved significantly after standardized medical treatment(P=0.000 0). Conclusion Female patients are more likely to develop small airway dysfunction compared to male patients among those who develop CRSwNP and asthma. Smoking and elevated eosinophils in peripheral blood and in nasal polyps may also influence pulmonary function. Standardized preoperative medical treatment is efficient in improving the pulmonary function of patients with CRSwNP and asthma and in decreasing the potential of acute attacks of asthma. Therefore, unremarkable surgeries are guaranteed.

Therapeutic ecacy of endoscopic elective vidian neurectomy for moderate-severe persistent allergic rhinitis with chronic sinusitis

QI Yan, LIU Junqi, PENG Shuya, LUO Kai, ZHANG Mingxia, WANG Zhenlin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  109-113.  doi:10.6040/j.issn.1673-3770.1.2018.028

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Objective To evaluate the therapeutic efficacy of endoscopic elective vidian neurectomy in the management of moderate-severe persistent allergic rhinitis with chronic sinusitis and to explore its possible mechanism. Methods One hundred thirty-two patients with moderate-severe persistent allergic rhinitis and chronic sinusitis who visited Xuanwu Hospital Capital Medical University from September 2015 to September 2016 were divided into two groups. Endoscopic elective vidian neurectomy was performed in 70 patients in the observation group, including amputation of the posterior nasal nerve and pharyngeal branch; 62 patients in the control group underwent conventional operation and conservative treatment. The visual analogue scale(VAS)score and Lund-Mackay score were assessed at 6 months, 1 year, and 2 years after operation. Results One hundred and six cases had complete follow-up data. The average VAS score decreased significantly from 7.6±2.2 to 2.3±1.2 at 6 months, to 2.6±1.7 at 1 year, and to 2.8±1.8 at 2 years after operation in the observation group(n= 56, P<0.05). The observation group had a complete control rate of 94.6%(53/56), which was significantly lower than the control group(n=50)at the same period after treatment. There was no severe complication such as xeroma and atrophic rhinitis in both groups. Furthermore, the difference in complications in the observation and control groups was not statistically significant(P>0.05). When correlation analysis of therapeutic efficacy 2 years after operation and the allergen test before operation was performed in the observation group, no significant correlation was observed(P>0.05). Conclusion Endoscopic elective vidian neurectomy is an effective and safe technique in the management of moderate-severe persistent allergic rhinitis with chronic sinusitis.

Clinical compliance and related factors to sublingual immunotherapy in patients with allergic rhinitis

CAO Cheng, XU Yu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  114-118.  doi:10.6040/j.issn.1673-3770.0.2018.299

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Objective To explore the clinical compliance to sublingual immunotherapy(SLIT)in patients with allergic rhinitis(AR). Methods From April 2014 to May 2016, 348 AR patients with dust mite allergy who received SLIT were followed up by telephone. Compliance to SLIT was statistically analyzed and factors influencing compliance were investigated. Results Among 348 patients, only 192 cases(55.17%)were successfully followed-up by telephone, while 156 cases(44.83%)did not return for additional examinations. The main reason for this loss was that patients’ phones were not accessible or they refused to answer the phone. The 192 successful follow-ups included 128 male patients and 64 female patients, with ages ranging from 3 to 69 years(17.08±13.71). The treatment time varied from one month to three years or more(because some patients could not describe accurately the specific medication time, the average medication time could not be calculated). Patients were divided by age into group A(age<14 years)and group B(age≥14 years). Concerning medication time, compliance was categorized into good compliance(time≥2 years)and poor compliance(time<2 years). Among the 192 successful follow-ups, the proportion of overall compliance was 25.52%(49/192), while the proportion of poor compliance was 74.48%(143/192).The age of male patients was 3-55(15.04±11.69)years, and that of female patients was 3-69(21.13±16.27)years. Compliance with SLIT was affected by gender(χ2=4.945 9, P=0.026). The proportion of male compliance was 30.47%(39/128), whereas the proportion of female compliance was 15.63%(10/64). In addition, compliance with SLIT was affected by age(χ2=4.257 4, P=0.039). Proportion of good compliance in groups A and B were 31.68%(32/101)and 18.68%(17/91), respectively. Among 143 patients with poor compliance, the effect of self-conscious immunotherapy was not obvious for 101 of them(70.63%). Reasons for terminating treatment included the following: symptomatic relief or control(14; 9.79%); personal reasons(12; 8.39%)as the treatment process affecting lifestyle, living in rural areas, and inconvenient traffic; mild adverse reactions to drugs during immunotherapy(13; 9.09%), family financial conditions(2; 1.40%), and other reasons(1, 0.70%), such as using Chinese Medicine instead. Conclusion Compliance to SLIT in patients with allergic rhinitis was not optimal, and was affected by age, gender, and subjective factors.

An analysis of 764 positive skin prick test results for Dermatophagoides farinae in patients with allergic rhinitis

HONG Dongdong, LIU Yuanxian, ZOU Lianqiang, WENG Juanling, DENG Wenxian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  119-123.  doi:10.6040/j.issn.1673-3770.0.2018.289

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Objective This study aimed to explore factors influencing a positive skin prick test for Dermatophagoides farinae(SPT-DF)in patients with allergic rhinitis(AR)and the correlation between positive SPT-DF results and AR symptoms. Methods SPT-DF was performed for suspected AR patients using SPT diagnostic reagents, and 764 SPT-DF-positive results were analyzed statistically. Results Of 764 SPT-DF-positive patients, 18(2.36%)were positive level “+”(level one); 23(3.10%)were positive level “++”(level two); 196(25.65%)were positive level “+++”(level three); and 527(68.98%)were positive level “++++”(level four). The differences in positive levels between SPT-DF-positive patients in six age groups(0-4 years, 5-14 years, 15-29 years, 30-44 years, 45-59 years, and 60-69 years)were statistically significant(χ2 = 20.138, P=0.001), and SPT-DF-positive levels decreased with advancing age-group ranges. There were no significant differences in positive levels between male and female SPT-DF-positive patients(Z=-1.503, P=0.133). In the age groups 15-29 years and 30-44 years, the positive level differences between male and female SPT-DF-positive patients were statistically significant(15-29 years, Z=-2.337, P=0.013; 30-44 years, Z=-3.129, P=0.001), with the positive levels of female patients being higher than those of male patients. Of 764 patients, 332(43.46%)had AR only. There were 432(56.54%)patients with other allergic diseases(allergic conjunctivitis, asthma, and allergic dermatitis), 367(48.03%)patients with two kinds of allergic diseases, 35(4.58%)patients with three kinds, and 30(3.93%)patients with four kinds. The number of patients with allergic diseases were as follows: allergic conjunctivitis, n=331; allergic dermatitis, n=56; and asthma, n=42. Among 764 SPT-DF-positive patients, differences in the positive levels between SPT-DF-positive patients with different numbers of allergic disease types were statistically significant(χ2=26.065, P=0.000), and the higher the number of allergic disease types, the higher the SPT-positive level. There were no significant differences in scores with respect to sneezing(F=0.207, P=0.891), runny nose(F=0.297, P=0.827), nasal congestion(F=0.174, P=0.913), nasal itching(F=0.256, P=0.857), itchy eyes(F=0.044, P=0.987), tearing(F=0.154, P=0.926), and the total symptom score(F=0.211, P=0.884)between different SPT-DF-positive levels. There was also no correlation found between SPT-DF-positive levels and scores with respect to sneezing(r_s=-0.036, P=0.387), runny nose(r_s=-0.034, P=0.392), nasal congestion(r_s=-0.026, P=0.433), nasal itching(r_s=0.056, P=0.141), itchy eyes(r_s=-0.039, P=0.379), tearing(r_s=-0.041, P=0.374), and total symptom score(r_s=0.032, P=0.397). Conclusion The SPT-DF-positive levels are affected by age and the number of allergic disease types in patients with AR, but are not affected by sex differences. The SPT-DF-positive levels have no correlation with AR symptom scores.

Effect of nasal irrigation combined with intranasal corticosteroids to treat allergic rhinitis and influence on exhaled nitric oxide and lung function

DU Jingwei, FENG Jun, MA Peng, LI Zhiyong, LI Hongguang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  124-127.  doi:10.6040/j.issn.1673-3770.0.2018.236

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Objective To investigate the effects of nasal irrigation combined with glucocorticoid on exhaled nitric oxide(FeNO), pulmonary function, and quality of life in patients with allergic rhinitis(AR). Methods A total of 120 AR patients, admitted to our hospital from March 2016 to March 2017, were selected and randomly divided into the observation group and control group(n=60 cases, each). The control group was treated with budesonide spray(60 μg, once on each side)once every morning and evening for 3 months. The observation group was treated with saline irrigation(100 mL, once on each side)once every morning and evening, and then with budesonide nasal spray for 3 months. The FeNO, FVC%, FEV₁%, PEF, VC%, and RQLQ scores were compared between the two groups. Results The levels of FeNO in the observation group and the control group were(750.2±89.4)×10^-10mol/L and(816.3±92.7)×10^-10mol/L, respectively, following treatment. There was a significant difference in the levels of FeNO between the two groups(t=-3.976, P<0.001). After treatment, the levels of FVC, FEV₁%, PEF, and VC% in the observation group were higher than those in the control group(t=3.207, 4.211, 2.780, 3.272 and P=0.002, <0.001, 0.006, 0.001, respectively). The RQLQ scores of the observation group and the control group were(29.0±6.4)and(34.4±7.0), respectively, with a statistically significant difference(t=-4.410, P<0.001). Conclusion Nasal irrigation combined with nasal glucocorticoid therapy can reduce FeNO, and improve the pulmonary function and quality of life of AR patients to a certain extent.

Clinical effect of budesonide nasal irrigation shortly after functional endoscopic endonasal surgery of chronic sinusitis

ZHANG Wei, LIU Yonggang, JIANG Lingyan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  128-130.  doi:10.6040/j.issn.1673-3770.0.2018.242

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Objective To investigate the therapeutic effectiveness and feasibility of budesonide nasal irrigation shortly after Functional Endoscopic sinus surgery(FESS)of chronic sinusitis by observing the recovery of the nasal mucosa. Methods Fifty-five participants with chronic rhino-sinusitis were divided into treated(budesonide and saline irrigation)and control(saline irrigation)groups according to irrigation contents twice daily. VAS(nose obstruction, nasal discharge, smelling, and facial pain)and Kennedy scores were collected before FESS, while LKES and SNOT-22 scores were collected and compared before and after nasal irrigation. Results VAS scores were 17.80±3.22 in the treated group and 18.66±3.43 in the control group(P<0.05). Kennedy scores were 3.45±1.09 in the treated group and 3.37±1.05 in the control group(P<0.05). Scores of LKES and SNOT-22 were compared between the treated and control groups(P<0.05). There were no adverse events during treatment and irrigation. Conclusions Nasal symptoms shortly after FESS could be improved with budesonide irrigation, especially by reducing nasal mucositis after surgery and promoting nasal mucosa recovery.

A randomized clinical observation of acupoint application combined with massage in the treatment of children with upper airway cough syndrome

CHEN Ying, XUE Mingxin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  131-134.  doi:10.6040/j.issn.1673-3770.0.2018.352

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Objective To explore the clinical effects of Tuina and massage combined with acupuncture on children with upper airway cough syndrome(UACS). Methods Seventy patients with pediatric UACS were randomly divided into a control group(35 patients)and a treatment group(35 patients). The control group was treated with osteopathic manipulation, and the treatment group was treated with the same manipulation as the control group as well as acupuncture. Results The total efficacy rates in the treatment group and the control group were 94.2% and 85.7%, respectively, though the difference was not statistically significant(P>0.05). The efficacy rates in the treatment group and control group were 54.2% and 31.4%, respectively, and this difference was statistically significant(P<0.05). Conclusion Tuina and massage combined with acupuncture application demonstrated a strong therapeutic effect on pediatric UACS; the effects of Tuina and massage combined with acupuncture application in pediatric UACS were better than Tuina and massage alone, and this approach is suitable for clinical popularization.

Preoperative ultrasonography in detecting cervical lymph node metastasis in differentiated thyroid cancer

GAO Xiaoqian, JIANG Zhen, GENG Chenchen, LIU Dayu, LI Li

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  135-139.  doi:10.6040/j.issn.1673-3770.0.2018.443

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Objective To investigate the clinical value of preoperative ultrasonography in detecting central compartment and lateral neck lymph node metastasis. Methods In total, 186 consecutive patients with pathologically proven differentiated thyroid cancer were involved in this retrospective study. All patients underwent operative US examination in the Department of Ultrasound and central-compartmental lymph node dissection in the Department of Otorhinolaryngology Head and Neck Surgery in Qilu Hospital of Shandong University(Qingdao), while 71 of them underwent lateral neck compartmental lymph node dissection between April 2017 and August 2018. According to the gold standard of biopsy, the sensitivity, specificity, positive predictive value(PPV), and negative predictive value(NPV)were calculated using SPSS 20.0 statistical software. All the patients were divided into two groups; groups A and B included patients with or without chronic lymphocytic thyroiditis(CLT). The sensitivity, specificity, PPV, and NPV of central neck compartmental lymph node metastasis detected using US were calculated. Results The sensitivity, specificity, PPV, and NPV of central compartmental lymph node metastasis detected using US were 68.9%, 56.3%, 75.0%, and 48.6%, respectively; those of lateral neck compartmental lymph node metastasis detected using US were 95.3%, 57.1%, 95.3%, and 57.1%, respectively. The sensitivity, specificity, PPV, and NPV in group A were 85.0%, 35.0%, 72.3%, and 53.8%, respectively; those in group B were 62.5%, 67.4%, 76.9%, and 50.8%, respectively. Conclusion Preoperative US for central and lateral neck lymph node metastasis is valuable for the management of cervical lymph node dissection. The diagnosis of lateral neck lymph node metastasis is much more accurate than that of central neck lymph node metastasis, while the diagnosis of central neck lymph node metastasis in patients with CLT is more accurate than that in patients without CLT.

Research progress on the relationship between obstructive sleep apnea syndrome and diseases of the respiratory and circulatory systems

LI Shaonan, YU Dan, WEN Lianji

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(1):  140-144.  doi:10.6040/j.issn.1673-3770.0.2018.528

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Obstructive sleep apnea syndrome(OSAS)is a common sleep-disordered breathing disorder. Owing to the pathophysiological changes associated with it, it can affect the whole body. In recent years, domestic and foreign research studies have focused on the relationship between OSAS and systemic diseases. A number of studies have confirmed that OSAS is an independent risk factor for various cardiovascular and respiratory diseases. Based on the current status of knowledge regarding OSAS acquired through domestic and foreign studies, this paper summarizes the clinical features, preferred treatment methods, and related basic research of OSAS-related respiratory and circulatory diseases. It provides a basis for the clinical diagnosis and comprehensive treatment of OSAS.