Table of Content

20 March 2019 Volume 33 Issue 2

  

Invited Review

Recurrence of nasopharyngeal carcinoma and application of endoscopic surgery

Yan JIANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  1-11.  doi:10.6040/j.issn.1673-3770.1.2019.011

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Radiotherapy is the conventional treatment for nasopharyngeal carcinoma. Although the 5-year survival rate has greatly improved, there are still several cases of recurrent or residual nasopharyngeal carcinoma. The treatment principles of recurrent or residual lesions include second-course radiotherapy, chemotherapy, and surgery. The complications following radical radiotherapy and second-course radiotherapy seriously affect the quality of life in patients. The current surgical methods include open surgery and endoscopic surgery. Open surgery can provide a sufficiently open field of operation, but is associated with some serious damage. Endoscopic nasopharyngeal carcinoma resection has been carried out lately, and only few medical institutions in China perform these operations. However, with the emergence of the concept of endoscopic skull base surgery and new medical instruments and equipment, endoscopic nasopharyngeal carcinoma surgery has become a good surgical choice. However, this requires strict surgical indications, skills of endoscopic skull-base surgery, and long-term follow-up.

Status of surgical treatment for recurrent nasopharyngeal carcinoma

Dongping CHEN,Zhihuan YANG,Yan ZHANG,Nan FANG,Bin QI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  12-16.  doi:10.6040/j.issn.1673-3771.1.2019.009

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Among the modalities for managing recurrent nasopharyngeal carcinoma, surgical treatment has attracted increased attention. With the continuous improvement in surgical techniques, especially the development of endoscopic nasopharyngoscopy, the standard treatment for recurrent nasopharyngeal carcinoma has gradually changed from re-radiotherapy to surgery. This paper reviews the important literature published in recent years; introduces various surgical methods for recurrent nasopharyngeal carcinoma treatment; and analyzes the advantages, disadvantages, curative effects; and side effects of these surgical methods.

Endoscopic surgery for the treatment of locally advanced nasopharyngeal carcinoma and serious complications after radiotherapy

Qianhui QIU,Zhuo CHEN

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  17-20.  doi:10.6040/j.issn.1673-3771.1.2019.012

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With the improvement in endoscopic techniques, endoscopy has gradually become an important approach for the comprehensive treatment of nasopharyngeal carcinoma. This article reviews the literature on the surgical treatment of locally advanced nasopharyngeal carcinoma and the endoscopic surgical treatment of radioactive necrosis, a severe complication of radiotherapy for nasopharyngeal carcinoma. Prospects for the development of future endoscopic surgery techniques for nasopharyngeal carcinoma have also been reviewed.

Protection of the internal carotid artery during surgery for nasopharyngeal carcinoma

Zhenlin WANG,Junqi LIU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  21-25.  doi:10.6040/j.issn.1673-3770.0.2019.071

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Internal carotid artery bleeding is a common complication during or after surgery for nasopharyngeal carcinoma and may result in hemiplegia or death. Internal carotid artery bleeding can also occur after radiotherapy. Prevention and management of this complication are of utmost importance for patient survival and quality of life. This article reviews the recent advances and reports our experience in the management of internal carotid artery bleeding. We also discuss the surgical options for extended resection of the tumor.

Progress in the comprehensive treatment for nasopharyngeal carcinoma

Haijun LU,Ji LIU,Xiao DING

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  26-30.  doi:10.6040/j.issn.1673-3770.1.2019.010

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Nasopharyngeal carcinoma is a distinct type of head and neck cancer that is common in South China, especially Guangdong and Guangxi. Because of the anatomical limitations of nasopharyngeal carcinoma and its sensitivity to radiotherapy, radiotherapy is the main treatment, although radiotherapy has certain limitations. Therefore, treatment for nasopharyngeal carcinoma includes radiotherapy combined with surgical treatment, chemotherapy, targeted therapy, and other comprehensive treatments.

Research Progress

Treatment of radiation-induced carcinoma in patients with nasopharyngeal carcinoma

Rui CHEN,Jieen LI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  31-34.  doi:10.6040/j.issn.1673-3770.0.2019.072

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Radiotherapy is currently the main treatment modality for nasopharyngeal carcinoma; however, post-radiotherapy, there is considerable risk of development of radiation-induced malignant tumors in the patients. In this paper, we have reviewed the diagnosis, pathogenesis, age and incubation period, pathological types, predilection sites, treatment, and prognosis of radiation-induced tumors.

Surgery Treatment for Recurrent Nasopharyngeal Carcinoma

Wenrui XU,Yan JIANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  35-38.  doi:10.6040/j.issn.1673-3770.0.2019.074

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Nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in China. Although three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, concurrent radiotherapy, and chemotherapy have significantly improved the local control rate and overall survival rate of NPC, about 10% of NPC recur locally and / or regionally after radical treatment. Recurrent nasopharyngeal carcinoma (NPC) is usually treated by re-operative radiotherapy and surgery. The choice of treatment method remains difficult. This article reviews the common surgical treatment methods and research progress of recurrent nasopharyngeal carcinoma.

Clinical Report

Types of endoscopic transnasal nasopharyngectomy for nasopharyngeal carcinoma

Quan LIU,Xicai SUN,Huapeng YU,Keqing ZHAO,Huankang ZHANG,Weidong ZHAO,Yurong GU,Houyong LI,Dehui WANG,Hongmeng YU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  39-45.  doi:10.6040/j.issn.1673-3770.1.2019.016

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To establish the types of endoscopic endonasal nasopharyngectomy for nasopharyngeal carcinoma (NPC) based on anatomic study and clinical applications.

Dissection of the skull base using an endoscopic endonasal approach was performed on a cadaver head. The procedures of endoscopic endonasal nasopharyngectomy for recurrent NPC (rNPC) were used and established.

The procedures of endoscopic endonasal nasopharyngectomy for rNPC were grouped into 4 types: type Ⅰ was used for rT₁ and rT₃ rNPC located in the midline of the nasopharynx and skull base: type Ⅱ was used for rT₂ rNPC with involvement of the cartilaginous Eustachian tube, medial petroclival region, and parapharyngeal space: type Ⅲ was used for rT₄ rNPC extending further laterally into the lateral petroclival region, infratemporal fossa, middle of the skull base, superior orbital fissure, cavernous sinus, and cranial nerves: and type Ⅳ was used for rNPC invading the internal carotid artery (ICA) and middle cranial fossa.

The 4 types of endoscopic endonasal nasopharyngectomy are effective for the surgical treatment of rNPC. Pre-operation evaluation and staged exposure of the ICA is reliable, which will be an effective guideline for surgical treatment of rNPC.

Efficacy of endoscopic surgery using two types of flaps to reconstruct the skull base after radiotherapy for nasopharyngeal carcinoma

Junxiao GAO,Qianhui QIU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  46-50.  doi:10.6040/j.issn.1673-3770.0.2019.049

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To explore the clinical application of free mucosal flap and vascularized mucosal flap in skull base surgery after radiotherapy for nasopharyngeal carcinoma.

A retrospective analysis of 42 cases of patients with nasopharyngeal carcinoma, who underwent radiotherapy in the Department of Otolaryngology, Zhujiang Hospital of Southern Medical University, was performed. All patients underwent mucosal flap surgery between July and November 2018. Seventeen patients underwent reconstruction surgery using a vascularized mucosal flap, and 25 underwent reconstruction surgery using a free mucosal flap. Nine patients underwent surgery twice. The area of the free mucosal flap was 4-6 cm², and the area of the vascularized mucosa flap was 6-20 cm².

Vascularized mucosal flaps were used in 17 patients: 12 mucosal flaps healed well (70.59%), 3 did not heal completely (17.65%), and 2 showed poor healing (11.76%). Three of these patients underwent a second surgery (17.65%). Free mucosal flaps were used in 25 patients: 13 mucosal flaps healed well (52.00%), 10 did not heal completely (40.00%), and 2 showed poor healing (8.00%). Six of these patients underwent a second surgery (24.00%). Vascularized mucosal flap was used in the second surgery in all 9 patients: in 8 of these patients, flap healing was good, whereas one patient showed poor healing. It was observed that the number of courses of radiotherapy had significant effects on the survival of mucosal flaps (P=0.007): mucosal flap healing was better in the first radiotherapy than in the second. Recurrence of nasopharyngeal carcinoma and osteoradionecrosis of the skull base after radiotherapy also had a significant effect on mucosal flap healing (P=0.017). The healing of mucosal flaps in patients with osteonecrosis was poor. Regardless of the administration of a second course of radiotherapy or occurrence of osteonecrosis, there was no significant difference in mucosal survival between the vascularized mucosal flap and free mucosal flap repair (P=0.153).

Mucosal flap repair is an important method for endoscopic surgery to repair skull base defects after radiotherapy for nasopharyngeal carcinoma. This procedure is not only economical and non-repulsive, but is also easy to perform. The number of radiotherapy treatments and occurrence of osteonecrosis have a significant influence on the survival of mucosal flaps. The repair method had no significant effect on the survival of the flap.

Clinical analysis of endoscopic surgery for nasopharyngeal carcinoma

Lijuan ZHAO,Yan JIANG,Longgang YU,Liang CAI,Min CHEN,Jisheng ZHANG,Zhiyuan LI,Jianbao JU,Na LI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  51-56.  doi:10.6040/j.issn.1673-3770.0.2019.073

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To explore the clinical efficacy in patients who underwent endoscopic nasopharyngectomy for primary advanced nasopharyngeal carcinoma (NPC).

Clinical data of 35 patients with NPC admitted to the Department of Otorhinolaryngology Head and Neck Surgery and Nasal Skull Base Surgery of the Affiliated Hospital of Qingdao University from January 2010 to June 2018 were retrospectively reviewed. Twenty-one patients were male, and 14 were female. The median age was 52 years (range, 17-75 years). There were five cases of nasal obstruction, 13 cases of snot with blood, 4 cases of hearing loss and stuffy ear, 5 cases of neck mass, 3 cases of pharyngeal discomfort, and 5 cases of headache and diplopia. The TNM stages were: 5 cases were at stageⅠ, 12 cases were at stage Ⅱ, 12 cases were at stage Ⅲ, and 6 cases were at stage Ⅳ. N_X 2 cases, N₀ 16 cases N₁ 9 cases, N₂ 7cases, N₃ 1 case. No patient was found to have distant metastasis. All patients underwent endoscopic resection of the lesions. Postoperatively, all patients were treated with radiotherapy or chemoradiotherapy. Using SPSS 22.0 software, Kaplan-Meier analysis and Log-rank test were done for the assessment of survival rate.

The pathological types of the 35 patients were as follows: 22 patients had undifferentiated type of non-keratinized carcinoma, 5 patients had non-keratinized differentiated carcinoma, and 8 patients had squamous-cell carcinoma. The follow-up ranged from 3 to 95 months, with relapse observed in 3 cases (10.0%), survival in 31 cases (82.5%), and death in 4 cases (17.5%). The overall 1 year survival rate (SR), 3 year SR, 5 year SR were 95.23%, 95.23%, and 87.91%, respectively.

Patients who undergo endoscopic nasopharyngectomy for NPC have better long-term prognosis.

Clinical Guidelines

Introduction to the SEOM clinical guidelines for nasopharyngeal cancer (2017)

Xiaohan SUN,Na LI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  57-59.  doi:10.6040/j.issn.1673-3770.1.2019.017

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Nasopharyngeal cancer is distinct from other cancers of the head and neck considering the biology, epidemiology, histology, diagnosis, and treatment. Radiation therapy is an essential component for treatment of nasopharyngeal cancer, and performing radiotherapy with chemotherapy improves the survival rates. Surgery is performed to salvage residual or relapsed disease. For metastatic disease, platinum/gemcitabine-based chemotherapy is required and patients may have more benefits. Follow-up of patients is essential, as sometimes, early detection of possible relapses can be managed with salvage treatment.

Comparison of two nasal irrigation methods during radiotherapy in patients with nasopharyngeal carcinoma

WANG Jun, XING Fenli, ZHU Ping, SUN Yaping, TANG Cuiju

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  60-63.  doi:10.6040/j.issn.1673-3770.0.2018.258

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Therapeutic effect of Zao-Jiao-Ci(the spine of Gleditsia sinensis Lam.)granule solution on radiation sinusitis after radiotherapy for nasopharyngeal carcinoma by sinus negative pressure replacement

GUO Sai, PENG Guiyuan, XIANG Feng, HUNAG Xiaoan, LIN Shanshan, QIAN Paizi, LI Linman, HUANG Guilan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  64-68.  doi:10.6040/j.issn.1673-3770.0.2018.454

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Objective To investigate the effect of saponin granule solution in the treatment of nasopharyngeal carcinoma after radiotherapy with radioactive sinusitis. Method Thirty patients with radioactive sinusitis after radiotherapy for nasopharyngeal carcinoma were randomly divided into the saponin group and the saline group. The saponin group received 20 mL of saponin granule solution for sinus negative pressure replacement treatment, 5 times a week; the saline group received 20 mL of normal saline for sinus negative pressure replacement, 5 times a week; the course of treatment was 3 week. Visual analogue scores(VAS)of nasal symptoms(including nasal obstruction, nasal secretion, anterior nasal secretion, headache/facial pain, loss of smell)and endoscopic scores(Kennedy scores)were performed of both groups before and after treatment. The efficacy and adverse reactions of the two groups were compared. Result There were no significant differences in the pre-treatment VAS and Kennedy scores between the two groups(P is 0.500 6, 0.725 7 respectively). However, after 3 weeks of treatment, the improvement of VAS of nasal secretion, nasal obstruction and loss of smellin the Zao-Jiao-Ci group, and the improvement of nasal endoscopic scores of nasopharyngeal secretion, middle nasal secretions and mucosal edema were significantly higher than those in the saline group, the differences were statistically significant(P is 0.003 3, 0.046 4, 0.018 8, <0.000 1, <0.000 1, <0.000 1). The total effective rate of the saponin group and the saline group were 100% and 26.67%, respectively. The difference between the two groups was statistically significant(χ2=22, P<0.000 1). There was no significant difference in the incidence of adverse reactions between the two groups(χ2=0.000 0, P=1.000). Conclusion The Zao-Jiao-Ci granule solution is effective in the treatment of nasopharyngeal carcinoma after radiotherapy with radiation sinusitis by sinus negative pressure replacement, which can significantly improve the clinical symptoms of patients and is safer.

Contact mini in patients with bilateral congenital microtia

SU Faren, MA Qifa, LIU Yuhong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  69-71.  doi:10.6040/j.issn.1673-3770.0.2018.006

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Objective To evaluate the clinical applications of Contact Mini in patients with bilateral congenital microtia. Methods Contact Mini and bone anchoring hearing aids(BAHA)worn by 36 patients with bilateral congenital microtia were compared in terms of pure tone hearing sound field audiometry findings, before and after wearing.The patients were followed up to observe daily communication and the response to sound after wearing Contact Mini. Results Hearing improved by an average of 38.8 dB and 34.5 dB after Contact Mini and BAHA usage, respectively. Although there was no statistically significant difference between the two groups(P>0.05), the daily communication was significantly improved. Conclusions Contact Mini device can effectively improve audiometry with a satisfactory effect in bilateral congenital microtia patients.

Analysis of treatment approaches for chronic suppurative otitis media with eustachian tube dysfunction

ZHANG Haoliang, YU Feng, WU Yunwen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  72-75.  doi:10.6040/j.issn.1673-3770.0.2018.094

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Objective To investigate the improved techniques for middle ear surgery in patients with chronic suppurative otitis media and eustachian tube dysfunction. Methods A total of 68 ears with chronic suppurative otitis media and eustachian tube dysfunction were analyzed. The observation group included 28 ears and underwent balloon eustachian tuboplasty and middle ear surgery at the same time. The control group included 40 ears and underwent middle ear surgery only. The Eustachian Tube Dysfunction Questionnaire-7(ETDQ-7)scores, auditory thresholds, and air-bone gap before and 3, 6, and 12 months after treatment were compared between the groups. Results The rate of improvement in auditory threshold in the observation group was 89%(25/28)and the frequency of dry ear was 93%(26/28). The rate of improvement in auditory threshold in the control group was 75%(30/40)and the frequency of dry ear was 95%(38/40). From 3 to 6 months after the operation, the observation group was satisfied with the treatment; however, symptoms of eustachian tube dysfunction recurred partially 6 to 12 months after the operation. Conclusion Results from this small sample indicate that middle ear surgery combined with balloon eustachian tuboplasty may be more effective in improving auditory thresholds than middle ear surgery alone. The frequency of dry ear was similar in both groups. Two simultaneous operations may yield good treatment effects in patients with chronic suppurative otitis media 3 to 6 months postoperatively, but symptoms are likely to recur partially 6 to 12 months after the operation.

Clinical significance and correlation between MIF and GSK-3β expression in laryngeal squamous cell carcinoma

ZOU Liangyu, LI Lianhe, YUE Wenhui, HAN Zhipeng, ZHANG Zihui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  76-80.  doi:10.6040/j.issn.1673-3770.0.2018.423

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Objective To investigate the clinical significance and correlation of macrophage migration inhibitory factor(MIF)and glycogen synthase kinase-3(GSK-3β)expression in laryngeal squamous cell carcinoma. Methods The expression of MIF and GSK-3β in cancerous tissues and corresponding non-cancerous tissues of 30 patients with laryngeal squamous cell carcinoma were examined by immunohistochemistry and compared with mucosal tissues from 10 patients without laryngeal squamous cell carcinoma. The relationship between MIF and GSK-3β expression in laryngeal tissue and the clinicopathological factors of patients was analyzed. The correlation between MIF and GSK-3β expression in laryngeal squamous cell carcinoma was also investigated. Results The expression rates of MIF in laryngeal carcinoma tissues, adjacent tissues and non-cancerous laryngeal mucosa were 73.33%, 40.00%, 20.00%, respectively. The expression rates of GSK-3β in the three tissue types mentioned above were 70.00%, 13.33%, and 20.00%, respectively. MIF and GSK-3β expression were correlated with tumor differentiation, TNM stage and lymph node metastasis, but not associated with age, gender, smoking history or drinking history (P>0.05). MIF and GSK-3β expression were also correlated with each other (r=0.592, P=0.003). Conclusion Increased MIF and GSK-3β expression can occur in laryngeal squamous cell carcinoma and in laryngeal squamous cell carcinoma disease progression. MIF and GSK-3β may be used as potential biomarkers for laryngeal cancer and as indicators of progression and prognosis during observation and monitoring of laryngeal cancer patients.

Curative effect analysis of endoscopic laryngeal surgery with plasma radiofrequency ablation versus open surgery to treat early glottic cancer

XU Xia, DENG Wenting, HUANG Chengzhi, CHEN Yongting, WANG Jian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  81-85.  doi:10.6040/j.issn.1673-3770.0.2018.177

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Objective To evaluate the clinical efficacy of endoscopic laryngeal surgery with plasma radiofrequency ablation vs. conventional open surgery to treat early glottic cancer. Methods Resection of laryngeal cancer was performed at our hospital between January 2013 and August 2016 in 55 patients with early glottic squamous cell cancer. Endoscopic laryngeal surgery with plasma radiofrequency ablation was performed in 35 patients(plasma group), and open surgery was performed in 20 patients(laryngofissure group). The situation of surgery, complications, recurrence rate, and postoperative change in voice were compared between the groups. Results The intraoperative blood loss(8.94±8.06 vs. 100.75±28.34 mL), operative time(15.60±7.20 vs. 94.00±9.95 min), length of hospitalization(6.86±0.77 vs. 11.45±1.05 days), postoperative pain scores(2.66±0.91 vs. 4.65±1.04), and the cough visual analogue scale scores(3.60±0.85 vs. 6.05±1.23)in the plasma group were better than those in the laryngofissure group(P<0.05). However, no intergroup difference was observed in the granulation hyperplasia and recurrence rates(P>0.05). Acoustic parameters, including fundamental frequency perturbation(jitter)(0.78±0.18 vs. 0.66±0.15%), amplitude perturbation(shimmer)(5.66±0.97 vs. 4.57±1.14%), and the harmonic noise ratio(17.41±2.58 vs. 15.39±1.63 dB)recorded a year postoperatively showed more significant improvement in the plasma than in the laryngofissure group. Notably, this intergroup difference was statistically significant(P<0.05). Conclusion Endoscopic laryngeal surgery with plasma radiofrequency ablation effectively treats early glottic cancer. This procedure scores over open surgery in terms of being a minimally invasive and highly effective approach associated with better voice preservation.

Treatment of coexisting obstructive sleep apnea and laryngopharyngeal reflux disease and analysis of its characteristic reflux symptom index and reflux finding score

HU An, XING Yanli, CHEN Xiaoping, XUE Xiaocheng, ZHANG Yi, XU Weihua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  86-89.  doi:10.6040/j.issn.1673-3770.0.2018.252

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Objective To analyze the reflux finding score(RFS)and reflux symptom index(RSI)in patients with laryngopharyngeal reflux disease(LPRD)and obstructive sleep apnea syndrome(OSAS)and to observe the clinical treatment effect. Methods Between January 2016 and December 2017, 100 patients with LPRD were selected. Patients with OSAS were included as the observation group(n=39), and the rest were observed as the control group(n=61). The RFS and RSI were assessed in the two groups. The RSI, RFS, apnea-hypopnea index(AHI), blood oxygen saturation(SaO₂), total reflux, and total reflux time were compared after 2 months of treatment. Results The total RFS and RSI scores in the observation group were significantly higher than those in the control group. The difference in the signs of RFS was statistically significant(P<0.05). Subglottic edema, disappearance of the laryngeal chamber, anaphylactic erythema/congestion, laryngeal mucosal edema, and the posterior combined hypertrophy or swelling score were significantly higher in the observation group than in the control group(P<0.05). In the RSI, the dyspnea, heartburn, chest pain, acid reflux, and gastric acid reflux scores were significantly higher in the observation group than in the control group(P<0.05). After treatment, the RSI scores in the observation group were higher than those in the control group(P<0.05), but the control group had significantly better dyspnea, heartburn, chest pain, and acid reflux scores than did the observation group(P<0.05). Before and after treatment, the AHI, SaO₂, and total reflux of the two groups were significantly different(P<0.05). The AHI and SaO₂ of the observation group showed a significant improvement after treatment than before treatment(P<0.05). The total reflux and total reflux time showed significant improvements in both the groups, but the improvement was better in the control group than in the observation group(P<0.05). Conclusion Coexisting OSAS may aggravate the symptoms associated with laryngopharyngeal reflux in patients with LPRD, which may be the cause of poor treatment outcome and symptom improvement in patients with LPRD.

Value of 128-slice CT 3D reconstruction in the Müller state in the evaluation of the upper airway obstruction plane in patients with OSAS

ZHANG Bingwen, CHEN Rongrong, WU Yuanqing, XU Jinjing, JIANG Liang, QI Jianwei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  90-94.  doi:10.6040/j.issn.1673-3770.0.2018.368

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Objective To explore the value of airway thin-layer scanning and three-dimensional reconstruction in 128-slice computed tomography(CT)in the assessment of upper airway obstruction in patients with obstructive sleep apnea syndrome(OSAS)in the Müller state. Methods Forty-two adult patients with moderate or severe OSAS in the state of quiet breathing and Müller maneuver(analog sleep breathing state)underwent 128-slice thin axial CT. CT software was used for the three-dimensional reconstruction of the upper airway, and the two states were examined and compared under the same planes of the cross-sectional area of retropalatal region. The warp length, length and thickness of the soft palate uvula, vertical length from the hard palate to the upper posterior part of the hyoid, and other parameters were evaluated. Results Compared with the quiet breathing state, except for the area under the Müller state, diameter differences before and after the area after the epiglottis were statistically significant(t=1.837, P=0.073). The rest of the plane blocked the left and right anteroposterior diameter based on the equal line measurement and cross-section. There were significant differences in the area(t=6.214, 6.969, 8.192, respectively; all P<0.001). The left and right areas of the tongue, front and rear diameters, and cross-sectional area t were 6.170, 2.510, and 8.579, respectively, and P was<0.001, 0.016, and<0.001, respectively. The left and right areas of the epiglottis area and transverse area t were 4.279 and 6.104, respectively, and all P values were <0.001. The differences in soft palate thickness and soft palate and uvula length were statistically significant(t=-4.473 and 5.724, respectively; all P<0.001). The position of the hyoid bone moved downward, and the difference was statistically significant(t=-6.302, P<0.001). Conclusion The three-dimensional reconstruction of the upper airway on 128-slice CT can better assess patients with OSAS in the airway obstruction plane, in favor of blocking the classification plane, and the value of predicting the outcome of estimated UPPP surgery can be estimated, providing references to patients with OSAS for individualized treatment.

Gene expression profile of lenses after vitrectomy and silicone oil tamponade co-treatment

LIU Dongmei, LI Yang, SONG Jike, GUO Dadong, MA Xianzhen, BI Hongsheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  95-98.  doi:10.6040/j.issn.1673-3770.0.2018.101

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Objective To explore the significantly differentially expressed genes(DEGs)in lenses via microarray expression profiling after vitrectomy and silicone oil tamponade co-treatment. Methods After vitrectomy and silicone oil tamponade usage, mRNA expression profiling was carried out 3 days, 1 month, and 3 months after surgery in experimental rabbits. A non-surgery control group was also established and analyzed. Furthermore, genes with significantly altered expression after surgery were detected via quantitative real-time PCR. Results The expression of 129 genes was significantly altered 3 days after surgery and these included 55 upregulated and 74 downregulated genes(altered ratio, ≥ 2 or ≤ 0.5). The DEGs were mainly involved in the oxidative stress and inflammation regulatory pathways. Moreover, 140 genes were differentially expressed 1 month after the surgery, including 72 significantly upregulated and 68 significantly downregulated genes. Three months after surgery, 134 genes showed significantly altered expression, including 75 upregulated and 59 downregulated genes. Cluster analysis revealed 29 post-surgery DEGs common to the 3 experimental groups, including 10 upregulated and 9 downregulated genes. The representative upregulated genes included NPPA, CD38, BPGM, PIN, and ELAM1, and the representative downregulated genes included VTN, GSTM2, BFSP2, LTB4DH, MMP2, and CAPNS1. The significantly DEGs were involved in functions such as oxidative stress, inflammation, transport, signaling transduction, apoptosis, and cell differentiation. Furthermore, real-time PCR analysis confirmed the altered expression of these genes, indicating the authenticity and reliability of our microarray expression profiling analysis. Conclusion mRNA expression profiling revealed a group of genes significantly altered in lenses after vitrectomy and silicone oil tamponade co-treatment. These altered genes were involved in oxidative stress and inflammation regulatory pathways, which may be responsible for cataract formation.

Phacoemulsification combined with intravitreal ranibizumab or triamcinolone acetonide injection for the treatment of cataract accompanied by diabetic macular edema

LIU Jianbo, ZHANG Huan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  99-104.  doi:10.6040/j.issn.1673-3770.0.2018.337

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Objective To investigate the efficacy and safety of phacoemulsification combined with intravitreal ranibizumab or triamcinolone acetonide injection for treating patients with cataract accompanied by diabetic macular edema(DME). Methods In this case-control study, 66 patients(78 eyes)with cataract complicated by DME were randomly divided into three groups. The control group was treated with phacoemulsification and intraocular lens implantation. The IVR group was treated with cataract surgery and intravitreal ranibizumab injection. The IVTA group was treated with cataract surgery and intravitreal triamcinolone acetonide injection. The differences in best corrected visual acuity(BCVA), macular center retinal thickness(CRT), and intraocular pressure were compared among the three groups preoperatively and 1 week, 1 month, 3 months, and 6 months postoperatively. Results There were no significant differences in sex, age, duration of DM, preoperative BCVA(LogMAR), CRT, and intraocular pressure among the three groups(P>0.05). The overall trend(time)of BCVA(LogMAR)and CRT changes with time in the three groups before and after operation was significant(P<0.05). The trend(time*group)of BCVA(LogMAR)and CRT changes over time among the three groups was significant. The comprehensive differences(group)in BCVA(LogMAR)and CRT among the three groups were also significant regardless of time(P<0.05). Comparison of BCVA(LogMAR)and CRT among the three groups revealed a significant difference between the IVR group and control group, and between the IVTA group and control group(P<0.05). In addition, there was no significant difference between the IVR and IVTA groups in BCVA(LogMAR)and CRT(P>0.05). The overall trend(time)of intraocular pressure changes with time in the three groups was significant(P<0.001). The trend(time*group)of intraocular pressure changes over time among the three groups was significant(P<0.001). In 1 week and 1 month after operation, the intraocular pressure of the IVTA group increased, and there was significant difference between the IVTA group and the control group, and between the IVTA group and the IVR group(P<0.05). The comprehensive difference(group)in intraocular pressure among the three groups was not significant regardless of time(P=0.249). Conclusion Phacoemulsification combined with intravitreal ranibizumab or triamcinolone acetonide injection can improve BCVA and reduce macular edema in patients with cataract accompanied by DME. In addition, ranibizumab does not cause an increase in intraocular pressure and is safer and more reliable than triamcinolone acetonide.

Clinical analysis of posterior intraocular lens dislocation

JIANG Xiuying, LI Yuanbin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  105-110.  doi:10.6040/j.issn.1673-3770.0.2018.430

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Objective To identify the predisposing factors and clinical characteristics of posterior intraocular lens dislocation, and to compare the surgical outcomes following treatment of dislocated intraocular lens. Methods This study is a retrospective evaluation of all cases with posterior intraocular lens dislocation that presented at the Yuhuangding Hospital from September 2007 until September 2017. All cases were divided into an early intraocular lens dislocation group(<3 months)and a late intraocular lens dislocation group(≧3 months)according to the time of occurrence. The medical records of 73 eyes of 70 patients were evaluated. The main outcome measures were primary disease and surgery, previous surgical history, ocular complications, axial, causes of dislocation, interval between cataract surgery and dislocation, type and degree of dislocation of intraocular lens, and surgical method for treatment of the dislocation. Results There were 11 eyes in the early intraocular lens dislocation group, including 9 eyes(81.8%)with posterior capsule rupture, 1 eye(9.1%)with history of trauma, 2 eyes(18.2%)with high myopia, and 4 eyes(36.4%)with prior vitrectomy. There were 62 eyes in the late intraocular lens dislocation group, including 12 eyes(19.4%)with history of trauma, 16 eyes(25.8%)with posterior capsule rupture, 27 eyes(43.5%)with zonular dehiscence, 20 eyes(32.3%)with high myopia, 7 eyes(11.3%)with uveitis, 4 eyes(6.5%)with retinitis pigmentosa, 11 eyes(17.7%)with prior vitrectomy, and 4 eyes(6.5%)with pseudoexfoliation syndrome. There were significant differences in the UCVA between the preoperative and postoperative stages. There was no significant difference in the UCVA between reposition and exchange. Conclusion Early dislocation of the intraocular lens is associated with surgical factors, such as posterior capsule rupture and improper placement of the intraocular lens. Late dislocation of the intraocular lens is associated with posterior capsule rupture and zonular dehiscence. High myopia, prior vitrectomy, and uveitis are risk factors for dislocation of the intraocular lens. It is necessary to choose the appropriate surgical method based on the complexity of dislocation of the intraocular lens.

Effect of beta elemene on the expression of IL-1 beta and ICAM-1 in the retina of diabetic rats

LI Baohua, LIU Ping, WANG Xin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  111-114.  doi:10.6040/j.issn.1673-3770.0.2017.442

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Objective To study the effect of beta elemene on IL-1 beta and intercellular adhesion molecule 1(ICAM-1)expression levels in rats with diabetic retinopathy, to validate the potential of beta elemene in the prevention and treatment of diabetic retinopathy. Methods Forty adult SD healthy rats were randomly divided into four groups: normal control group, diabetic group, 40 mg/kg beta elemene treatment group, and 80 mg/kg beta elemene treatment group. Diabetes was induced in rats by intraperitoneal injection of streptozotocin(STZ). The rats in the beta elemene treatment group were treated with beta elemene solution for 12 weeks. They were then executed, and their retinal tissue, aqueous humor, and serum were extracted. ELISA was used to determine the IL-1 beta and ICAM-1 protein expression in retina, aqueous humor, and serum of rats. Immunohistochemistry was used to detect the expression levels of IL-1 beta and ICAM-1 proteins in retinal tissues of rats. Western blotting was done to evaluate the expression levels of IL-1 beta and ICAM-1 proteins in the retinal tissue. Results ELISA assay revealed that, compared with the normal control group, the levels of IL-1 beta and ICAM-1 proteins in diabetic rat serum and retina were significantly higher(P<0.05); however, 40 mg/kg treatment group and 80 mg/kg treatment exhibited significantly lower IL-1 beta and ICAM-1 levels in rat serum and retina compared to the diabetic group (P<0.05), among which 80 mg/kg beta elemene treatment group exhibited lower serum and retinal IL-1 beta and ICAM-1 protein levels compared to 40 mg/kg beta elemene treatment group (P<0.05). There was no significant difference in IL-1 beta and ICAM-1 protein levels in aqueous humor among the groups (P>0.05). Immunohistochemistry results showed that compared with the normal control group, retinal IL-1 beta protein levels were higher in the diabetic group; however, 40 mg/kg treatment group and 80 mg/kg treatment group exhibited lower IL-1 beta levels compared with diabetic group; the retinal tissue isolated from normal group exhibited almost no expression of ICAM-1 protein, whereas the diabetic group exhibited high expression of ICAM-1 protein. The 40 mg/kg treatment group and the 80 mg/kg treatment group exhibited lower expression levels of ICAM-1 compared to diabetic group. Western blotting revealed that, compared with the normal control group, diabetes group exhibited significantly higher expression levels of retinal IL-1 beta and ICAM-1 proteins (P<0.05); 40 mg/kg treatment group and 80 mg/kg treatment group exhibited significantly lower retinal IL-1 beta and ICAM-1 protein levels compared to diabetic group (P<0.05), among which 80 mg/kg treatment group exhibited significantly lower retinal IL-1 beta and ICAM-1 protein levels compared to 40 mg/kg treatment group (P<0.05). Conclusion Beta elemene can inhibit the production of IL-1 beta and ICAM-1 inflammatory factors in serum and retinal tissue of diabetic rats, suggesting that beta elemene may be used in the prevention and treatment of diabetic retinopathy.

Role of GRP94 and EIF2α in trabecular bone of primary angle-closure glaucoma patients

TENG Xingbo, CAO Zhi, SUN Haixia, LIU Xianjin, YANGa Weizhou, ZHU Yan, ZHU Yuguang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  115-118.  doi:10.6040/j.issn.1673-3770.0.2018.378

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Objective The aim of this study was to investigate the role of endoplasmic reticulum stress in trabecular tissue of patients with chronic primary angle-closure glaucoma(PCACG)and to explore its role in the pathogenesis of PCACG. Methods Hematoxylin and eosin(H& E)staining was used to observe changes in the microscopic morphology of trabeculae. Expression of the endoplasmic reticulum stress-related factors, GRP94 and EIF2α, in trabecular tissues, was determined by immunohistochemistry. Results H&E staining showed altered morphology of trabecular tissues, such as the narrow trabeculae and narrow lumen and irregular pigmentation of Schlemm’s canal. Immunohistochemistry results showed that GRP94 and EIF2α were expressed in the trabecular tissue of the control group and their expression increased significantly in the experimental groups(P<0.05). Conclusion These results show that endoplasmic reticulum stress occurs in the trabecular tissue of PCACG patients. The EIF2α signaling pathway may participate in the oxidative damages of trabecular tissue and promote an increase in intraocular pressure.

Clinical analysis of botulinum toxin type A microinjection in the treatment of acute acquired concomitant esotropia

YUE Pengcheng, WANG Yuan, WAN Xiaomei, GONG Huaqing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  119-122.  doi:10.6040/j.issn.1673-3770.0.2018.547

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Objective To investigate the clinical efficacy of microinjection of botulinum toxin type A(BTX-A)into extraocular muscles through a microsurgical microincision of the bulbar conjunctiva in the treatment of acute acquired concomitant esotropia(AACE). Methods A retrospective analysis of continuous cases was performed. The data of AACE patients treated with BTX-A microinjection in Qingdao Eye Hospital between March 2017 and July 2018 were reviewed. Routine examination was conducted, and the eye position, eye movement, and diplopia before injection were recorded. BTX-A injection was administered under a surgical microscope through a small conjunctival incision of 1-2 mm at the adhesion of the internal rectus muscle to expose its distal end. Routine ophthalmic examination was performed, and eye position, eye movement, and diplopia were examined 1 week, 1 month, and 3 months after the injection. Results A total of 28 AACE patients(30 eyes)were treated with BTX-A microinjection in Qingdao Eye Hospital between March 2017 and July 2018. The average strabismus before treatment was 33.2±15.6^△(+15^△~+60^△). The mean strabismus at 1 week, 1 month, and 3 months of treatment decreased to 9.8±7.2^△ (P< 0.001), 7.8±3.4^△(P<0.001), 9.3±5.2^△(P<0.001), respectively. There were no statistically significant differences in strabismus between the patients who were re-examined 1 week, 1 month, and 3 months after the surgery (P>0.05). Postoperative review after 1 week, 6.7%(2/30)of the injection eye eyelid ptosis slightly, 6.7%(2/30)of the injected eye < 10 training vertical strabismus, 3m re-examination of the above symptoms have disappeared. Three months after the injection, the symptoms of diplopia disappeared in 78.6%(22/28)patients, decreased in 7.2%(2/28)patients, and showed no significant change in 14.2%(4/28)patients. Conclusion BTX-A microinjection for AACE is safe, has a low incidence of complications, is effective, and is an ideal choice for the injection of extraocular muscles without EMG guidance.

Role of miRNAs in inner ear development and apoptosis or regeneration of auditory hair cells

XIE Yi, HAN Fengchan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  126-129.  doi:10.6040/j.issn.1673-3770.0.2018.268

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MicroRNAs are a class of small noncoding RNAs that are involved in cell differentiation, proliferation, apoptosis, and metabolic processes via regulation of post-transcriptional mechanisms. In recent years, many studies have revealed the importance of miRNAs for the development of the inner ear in vertebrates, and preventing apoptosis and promoting regeneration of the auditory hair cells. Regulation of miRNAs may provide novel strategies to study the mechanism of hearing impairment and treat hearing disorders.

Prospect and progress of spontaneous cerebrospinal fluid otorrhea

WANG Yue, LIU Qian, WANG Haibo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  130-135.  doi:10.6040/j.issn.1673-3770.0.2018.431

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Spontaneous cerebrospinal fluid otorrhea(SCSFO)is a type of cerebrospinal fluid otorrhea that occurs without any of the obvious causes such as a history of temporal bone trauma or fracture, infection, or neoplasm. Two recognized but unverified theories have been proposed to explain its pathophysiology: congenital defect and arachnoid granulation. The leakage sites of SCSFO differ between young children and adults, and the common sites are the tegmen mastoid, tegmen tympani, and oval window. Though SCSFO is rare, it is an important cause of meningitis. For accurate diagnosis, we propose high-resolution computed tomography(HRCT)followed by a beta-2 transferrin and radionucleotide cisternogram. Surgical intervention is recommended.

Research progress on the regulation of HIF-1α expression in thyroid carcinoma

SONG Xiaoyu, SONG Xicheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  136-138.  doi:10.6040/j.issn.1673-3770.0.2018.317

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Intratumoral hypoxia is an important factor leading to poor tumor prognosis. Hypoxia inducible factor-1α(HIF-1α)is the major regulatory factor promoting tumor invasion and metastasis, and its expression in tumor cells is related to several factors. The regulatory mechanism of HIF-1α in thyroid carcinoma may be related to BRAFV600E regulation and regulation of CXCR4, VEGF, PTEN, and CD44V6 expression.

Application of optical coherence tomography angiography in retinal vein occlusion

LIANG Qianqian, YANG Tinghua, ZHAO Bojun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  139-142.  doi:10.6040/j.issn.1673-3770.0.2018.364

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Retinal vein occlusion(RVO)is a commonly encountered retinal vascular disease in the ophthalmology department. RVO is a retinal vascular disease. Observing the changes of the retinal blood vessels, especially the capillaries, is of great significance for the treatment of retinal vein occlusion and the observation and evaluation of its prognosis. Fluorescein angiography(FA)has long been the gold standard for the examination of retinal vascular diseases, but it is an invasive examination, allergies and may cause allergies and carries other risks. The recently emerging optical coherence tomography angiography(OCTA)is a rapid, non-invasive blood flow imaging technology. It can not only qualitatively analyze the shape of the eyes blood vessels, but more importantly, it can help to perform non-invasive quantitative measurement of the blood vessels and blood perfusion in the eye, as well as assessment of deep lesions. This article reviews the application, advantages, and limitations of OCTA in retinal vein occlusion. Retinal vein occlusion.

Progress in the treatment of congenital cataract

CHEN Ying, LI Yuanbin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  143-148.  doi:10.6040/j.issn.1673-3770.0.2018.254

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Congenital cataract is a common disease that can lead to blindness in children. Improvement in success rates have been observed owing to the development of microsurgical techniques. In children, the timing and methodology of surgery and selection of appropriate power of intraocular lens differs from that of adult cataract due to rapid growth of infantile eyes. In addition, when compared with adult cataract, congenital cataract is associated with higher rate of complications and requires long-term post-surgical training for correction of amblyopia. In view of the aforementioned characteristics, the present study reviewed the relevant literature, with the aim to provide insight into the treatment of congenital cataract.

New progress in refractive cataract surgery

TANG Wei, LI Yuanbin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  149-158.  doi:10.6040/j.issn.1673-3770.0.2018.325

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With the development of new cataract surgery techniques and intraocular lenses, we have entered the era of refractive cataract surgery. Refractive cataract surgery not only covers the delicate surgical procedure but also includes a constant update of surgical equipment, accurate preoperative examination, accurate intraocular lens measurement, preoperative and postoperative visual function analysis, and a personalized choice of refractive intraocular lens. The preoperative and postoperative evaluation, surgical operation and design, and the optimal conditions of intraocular lenses for refractive cataract surgery have been reviewed here.

SUN Ziwen¹, CUI Hongwei², SUN XilingEtiology, pathogenesis, and management of dry eye

SUN Ziwen, CUI Hongwei, SUN Xiling, CHEN Chen, ZHANG Lu, HU Zhulin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  159-166.  doi:10.6040/j.issn.1673-3770.0.2018.411

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Due to multiple influences of internal factors(tear film destruction, sex hormone disorders)and external factors(environment, surgery, and drugs), patients with dry eye disease have been encountered much more frequently and are presenting at a younger age. Dry eye disease has become one of the most common diseases of the ocular surface, with a multifactorial etiology. This paper reviews the newer reports on etiology, pathogenesis, and management of dry eye.

A case of untypical Hunt syndrome involving multiple groups of cranial nerves

YU Chungang, LI Jiandong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  167-168.  doi:10.6040/j.issn.1673-3770.0.2018.170

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A case of traumatic eyeball removal into the maxillary sinus

LIU Hongxia, WANG Shaopeng, LU Hui, GAO Lifen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  169-170.  doi:10.6040/j.issn.1673-3770.0.2017.475

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A case of transient monocular visual loss after vitrectomy for diabetic retinopathy

WANG Xinjuan, SHA Shike, MA Lusheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(2):  171-172.  doi:10.6040/j.issn.1673-3770.0.2018.201

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