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Table of Content

    20 May 2019 Volume 33 Issue 3
      
    Foreword
    The road ahead will be long and our climb will be steep
    Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  1-2.  doi:10.6040/j.issn.1673-3770.1.2019.050
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    Editorial
    WHO program on the prevention of deafness and China's response and role
    Xingkuan BU
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  3-8.  doi:10.6040/j.issn.1673-3770.1.2018.027
    Abstract ( 318 )   HTML ( 17 )   PDF (831KB) ( 155 )   Save
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    Hearing loss is the most widespread sensory organ disability in the world. It not only affects individuals and families but also becomes a heavy social burden. It is a major global public health issue. The WHO program on the prevention of deafness clearly sets out its objectives, tasks, priorities, and expected results. To complete the safeguards of the program, the World Health Assembly adopted a resolution (WHA 70.13) on the prevention of deafness and hearing loss, calling on member governments to make political commitments to accomplish nine tasks. China has worked closely with the WHO and actively responded to the call by not only doing a lot of work in the country but also playing a role globally.

    Invited Review
    Endotypes and precision medicine in chronic sinusitis treatment
    Huabin LI,Yuting LAI,Wenxiu JIANG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  9-13.  doi:10.6040/j.issn.1673-3770.1.2018.043
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    Chronic rhinosinusitis (CRS) is a common otolaryngologic disease, with a complex intrinsic pathological mechanism. Traditional medicine and surgery do not fully treat CRS. In recent years, precision medicine has been used to develop new biological agents to treat CRS based on its phenotype. This article reviews the current endotypes of CRS that have therapeutic significance, including type II inflammatory, eosinophilic, epithelial barrier function, and epithelium-derived cytokine endotypes, and those that are still in the theoretical stage of research, including the non-type II inflammatory phenotype and tissue remodeling.

    Physiological characteristics of voice and care of vocal health in the elderly
    Jiejie XU
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  14-18.  doi:10.6040/j.issn.1673-3770.1.2019.022
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    Degenerative age-related changes in the body organs can affect the structure and physiological function of the vocal cords and cause senescence of voice in the elderly. This paper summarizes the changes in laryngeal structure, glottis appearance, and physiological vocal characteristics of aged subjects, and states the steps that need to be taken to care for vocal health of patients at an advanced age. This will be helpful to distinguish between the physiological and pathological changes of the larynx in the elderly and carry out appropriate and reasonable voice protection measures, thereby improving the quality of life in the aged population.Degenerative age-related changes in the body organs can affect the structure and physiological function of the vocal cords and cause senescence of voice in the elderly. This paper summarizes the changes in laryngeal structure, glottis appearance, and physiological vocal characteristics of aged subjects, and states the steps that need to be taken to care for vocal health of patients at an advanced age. This will be helpful to distinguish between the physiological and pathological changes of the larynx in the elderly and carry out appropriate and reasonable voice protection measures, thereby improving the quality of life in the aged population.

    Comments and opinions on the nomenclature of snoring disease
    Min YIN,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  19-22.  doi:10.6040/j.issn.1673-3770.1.2019.002
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    The International Classification of Sleep Disorders (ICSD) renamed and redefined the term ′obstructive sleep apnea hypopnea syndrome′ (OSAHS) in 2005 and 2014; however, Chinese nomenclature still retains the term OSAHS. The term OSAHS is suggestive of the basic obstructive etiology of snoring, a necessary background of sleep, a typical feature of apnea and hypopnea, and a manifestation of a syndrome. The naming of OSAHS also reveals the clinical characteristics and diagnostic points of the condition, which seems reasonable. However, the word also reduces some misunderstanding because there are no real obstruction of upper airway, no real stop of breathing, and no clear boundary between apnea and hypopnea. As OSAHS has a clearly defined etiology and mechanism, characteristic symptoms and signs, diagnostic criteria, and effective treatments, it should be considered as an independent disease rather than a syndrome. The nomenclature of snoring disease in traditional Chinese medicine is much more refined and appropriate than OASHS.

    Differential diagnosis of vestibular migraines and several common types of peripheral vertigo
    Xiaolu LI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  23-26.  doi:10.6040/j.issn.1673-3770.1.2019.003
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    Vestibular migraines (VMs) are a type of migraine with vestibular symptoms. Cases of VMs reportedly account for 16% of outpatients with vertigo in otolaryngology departments. They are listed as one of the important causes of so-called refractory dizziness and have been one of the research hotspots in balance disorder in recent years. The pathogenesis of VMs is not yet clear, and their clinical manifestations are diverse. Some manifestations are not only similar to those of otogenic vertigo, but even coexist in the same patient. In addition, with the rapid development of clinical vestibular function examination and evaluation methods, it is possible to perform preliminary evaluations of the semicircular canals, otolith organs, and vestibular nerve function. In this paper, the pathogenesis of VMs and differential diagnosis of four types of clinically common otogenic vertigo, including Meniere′s disease, vestibular neuronitis, benign paroxysmal positional vertigo, and vestibular paroxysmia are discussed, so as to provide clues for the accurate treatment of balance disorder.

    Minimally invasive otoendoscopic surgery: a new path for ear surgery
    Dengyuan WANG, Zhibin CHEN, Guangqian XING
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  27-30.  doi:10.6040/j.issn.1673-3770.1.2019.020
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    This article reviews the history, advantages and disadvantages, and current applications of otoendoscopic ear surgery. The otoendoscopic approach has unique advantages over the microscopic approach; it allows the surgeon to visualize the surgical site more clearly from multiple angles and at various magnifications, enabling completion of procedures using the transcanal approach, thereby reducing the need for endoauricular or postauricular incisions and avoiding the associated morbidity. Otoendoscopes also reduce the rates of cholesteatoma recidivism in chronic ear surgery. Otoendoscopic ear surgery appears to be a promising new technique and a reliable alternative to traditional microscopic surgery.

    Research Progress
    A new mechanism of bilirubin-induced auditory nervous system injury
    Ling ZHANG,Haibo YE,Haibo SHI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  31-35.  doi:10.6040/j.issn.1673-3770.1.2018.044
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    Severe hyperbilirubinemia (jaundice) may lead to functional damage of a specific nervous system, presenting clinical characteristics such as nucleus selectivity and neonatal susceptibility. The auditory nervous system is extremely sensitive to bilirubin toxicity. The clinical manifestations comprise of acute functional impairment, which might be the first or only manifestation, or hidden and adult onset auditory neuropathy spectrum disorder. Scattered clinical and basic studies have shown that excitotoxicity is the main pathway of bilirubin-induced neurological dysfunction. However, the characteristics and mechanism of hearing impairment are still unknown. The generation and transmission of electrical signals in an auditory circuit depend on both the rhythmic firing of action potential of neurons and the synchronous transmission among nerve fibers. Moderate excitability is the basis of maintaining normal hearing, but “epilepsy-like” overexcitation may lead to an impairment of cell energy metabolism, increase in intracellular Ca2+, and eventual cell apoptosis or necrosis. Exploring the mechanism of bilirubin-induced auditory neurotoxicity is not only helpful in revealing the pathophysiological characteristics of auditory circuits, but also in shedding light on the pathogenesis and antagonistic measures of bilirubin encephalopathy.

    Current status of genetic research on allergic rhinitis
    Meiping LU,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  36-41.  doi:10.6040/j.issn.1673-3770.1.2019.021
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    Allergic rhinitis is a non-infectious inflammatory disease of the nasal mucosa caused by a combination of genetic and environmental factors. Although a fair understanding of its pathogenesis already exits and research on genetic factors associated with this condition has made significant progress, these studies are still limited to achieving statistically significant results; however, their clinical applications have a long way to go. This article mainly introduces the research strategy on genes related to allergic rhinitis, their interaction with the environment, the sharing overlap of allergic disease genes, epigenetic modifications, and the direction of gene research transformation.

    Progress of immune checkpoint inhibitors in the treatment of recurrent or metastatic head and neck squamous cell carcinoma
    Xi CHEN,Mingzhe QIAO
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  42-48.  doi:10.6040/j.issn.1673-3770.1.2019.001
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    Platinum-based chemotherapy combined with cetuximab is the standard treatment for recurrent or metastatic head and neck squamous cell cancer (R/M HNSCC), but facing easy recurrence with a short survival time. Immune checkpoint inhibitors (ICIs), that mainly meant PD-1/PDL-1 monoclonal antibodies, have become a new clinical therapy program for R/M HNSCC, and both pembrolizumab and nivolumab have been approved by the FDA for R/M HNSCC patients with previous platinum-based treatment failure. This review systematically summarizes the clinical trials of ICIs in R/M HNSCC and describes the toxic side effects and biomarkers of the drugs, in order to provide theoretical basis for clinical usage of ICIs in future.

    Original Article
    Temporal and spatial expression of the deafness-causing gene EYA4 during the embryonic development of zebrafish
    Fangzhou QIAN,Xiaobo HUANG,Qinjun WEI,Zhibin CHEN
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  49-55.  doi:10.6040/j.issn.1673-3770.1.2018.039
    Abstract ( 245 )   HTML ( 3 )   PDF (7560KB) ( 56 )   Save
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    Objective

    To study expression and localization of the deafness-causing gene EYA4 in different developmental stages of the zebrafish embryo and to lay a foundation for further investigation of the possible underlying mechanism of deafness using the zebrafish model.

    Methods

    Bioinformatics tools were used to analyze the homology of the zebrafish and human EYA4 gene. Temporal and spatial expression of the eya4 gene in the early stages of development of the zebrafish embryo (64-cell, oblong-sphere, 50%-epiboly, 15-somite, 24 hpf, 36 hpf, 48 hpf, 60 hpf, 72 hpf, and 1-week) was analyzed using whole-embryo in situ hybridization and semi-quantitative PCR.

    Results

    Results of bioinformatics analysis showed that the eya4 gene of zebrafish and the human EYA4 gene are highly homologous. Semi-quantitative PCR results showed that the eya4 gene of zebrafish was not expressed at the early stage of embryonic development (64-cell~50%-epiboly), and gradually began to be expressed at the 15-somite stage; its expression was highest at 24-48 hpf, after which expression levels slightly reduced and then stabilized. Results of whole-embryo in situ hybridization showed that the eya4 gene was not expressed at the following three stages of zebrafish development: the 64-cell stage, oblong-sphere stage, and 50 %-epiboly stage, which indicated that the eya4 gene shows non-maternal expression. At the 15-somite stage, low expression of the eya4 gene was detected. Expression levels of eya4 were highest during 24 to 48 hpf, and eya4 was expressed in parts of the nervous system in the head, the auditory hair cells of the inner ear, and the lateral line system. Expression levels of eya4 reduced and remained stable at 60 hpf to 1-week post fertilization.

    Conclusion

    The zebrafish eya4 gene and the human EYA4 gene are highly homologous. Studying the temporal and spatial expression patterns of the EYA4 gene during early development of zebrafish embryos will help determine its function in embryonic development and the mechanism of the deafness caused by the mutation of the EYA4 gene using the zebrafish model.

    Differential expression of synaptic vesicle glycoprotein 2A in central auditory system of rats
    Pengli LIU,Lu ZHANG,Xiaolu LI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  56-60.  doi:10.6040/j.issn.1673-3770.1.2019.004
    Abstract ( 184 )   HTML ( 1 )   PDF (1573KB) ( 73 )   Save
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    Objective

    To study the differential expression of synaptic vesicle glycoprotein 2A (SV2A) in various subregions of the central auditory system (CAS) of SD rats and to search for region-specific proteins.

    Methods

    Western blotting and immunohistochemistry were used to detect the expression of SV2A in the inferior colliculus (IC), cochlear nucleus (CN), superior olivary nucleus complex (SOC), and the remaining brain tissues including brain and cerebellum (Rest) of SD rats. One-way analysis of variance was used to compare the differences in protein expression between the groups.

    Results

    The results of western blotting showed that the expression of SV2A in CN was higher than that in Rest, IC, and SOC, and the differences were statistically significant (P = 0.006, P = 0.019, and P = 0.013, respectively). However, there were no statistically significant differences between IC and Rest (P = 0.802), SOC and Rest (P = 0.928), and IC and SOC (P = 0.99). The immunohistochemistry results also indicated that the expression of SV2A in CN was higher than that in Rest, IC, and SOC, and the differences were statistically significant (P = 0.003, P = 0.016, and P<0.001, respectively). However, there were no statistically significant differences between IC and Rest (P = 0.94), SOC and Rest (P = 0.863), and IC and SOC (P = 0.536). Therefore, SV2A can be considered as a region-specific protein of CN.

    Conclusion

    The high expression of SV2A in CN of rats suggests that SV2A may be involved in the processing of auditory information in the CN, which provides a new clue for further exploring the physiological function of CN and the etiology of central auditory processing disorder (CAPD) at the molecular level.

    An assessment of the clinical features of benign paroxysmal positional vertigo associated with Meniere' s disease
    Dengyuan WANG,Zhibin CHEN,Miaolin WANG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  61-65.  doi:10.6040/j.issn.1673-3770.1.2019.024
    Abstract ( 189 )   HTML ( 3 )   PDF (500KB) ( 59 )   Save
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    Objective

    To study the clinical characteristics and treatment outcomes of patients with benign paroxysmal positional vertigo (BPPV) associated with Meniere′s disease (MD).

    Method

    A total of 256 patients with BPPV were enrolled in the study, of which 32 patients with secondary BPPV were excluded. Out of the remaining 224 patients, 28 patients having BPPV associated with MD were included in the trial group and 196 patients with no adjunctive problem associated with BPPV (idiopathic) were included in the control group. All the patients were diagnosed using the Dix-Hallpike positional test and were treated with canalith repositioning procedure (CRP). The age, sex, site of involvement, type of BPPV, duration of symptoms, and treatment outcomes were compared.

    Results

    The clinical manifestations of BPPV were seen more commonly among the females in the trial group. (P<0.05). Involvement of the lateral canal of the ear was more common in patients in the trial group (P<0.001). There was no statistical difference in the average age and in right and left ear involvement between groups. BPPV was ipsilateral to the ear with MD in 75% of patients and MD was present before the diagnosis of BPPV in all patients. Comparative analyses of the cure rate of both groups after 1 day, 1 week, and 1 month were significant (P<0.01, P<0.05, P<0.05 respectively).

    Conclusion

    The clinical features and therapeutic outcomes of MD-associated BPPV differ from those of idiopathic BPPV. MD-associated BPPV was found to be more frequent in females and the lateral canal involvement was higher in most patients. Patients were already affected by MD before the development of BPPV. This disease may follow a different clinical course and respond less effectively to CRP treatment.

    Short-term effects of artificial titanium auditory ossicles in stage I mastoidectomy and tympanoplasty
    Wei LIN,Dongchao ZHU,Zhibin CHEN
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  66-70.  doi:10.6040/j.issn.1673-3770.1.2019.005
    Abstract ( 259 )   HTML ( 0 )   PDF (1412KB) ( 77 )   Save
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    Objective

    To explore the short-term effects of artificial titanium ossicles in stage I mastoidectomy and tympanoplasty.

    Methods

    From January 2013 to June 2017, 80 patients (81 ears) who underwent stage I mastoidectomy and tympanoplasty with artificial titanium ossicles were divided in two groups: the canal wall-up tympanoplasty and stage I ossicular implantation group (CWUT; 31 ears) and the canal wall-down tympanoplasty and stage I ossicular implantation group (CWDT; 50 ears). The short-term curative effects of artificial titanium ossicular implantation in these groups were observed and compared.

    Results

    The average postoperative air-bone gaps (ABG) in CWUT was 18.65±9.46 dB, and the success rate of hearing reconstruction was 83.87%. The average postoperative air-bone gaps (ABG) in CWDT was 19.90±9.42 dB, and the success rate of hearing reconstruction was 62.00%. There were significant differences in the mean values of air and air-bone gaps (ABG) between the groups before and after the operation (P < 0.05). The success rates of postoperative hearing reconstruction between the groups were statistically significant (P < 0.05).

    Conclusion

    The implantation of artificial titanium auditory ossicles in both CWUT and CWDT improve hearing.

    Association of vitamin D binding protein geneand CYP27B1 gene polymorphisms with mite-sensitized persistent allergic rhinitis among Han Chinese population
    Huiqin TIAN,Zhongfei WU,Ying LU,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  71-78.  doi:10.6040/j.issn.1673-3770.1.2019.006
    Abstract ( 203 )   HTML ( 4 )   PDF (597KB) ( 80 )   Save
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    Objective

    To evaluate whether polymorphisms in the vitamin D binding protein gene (GC) and CYP27B1 gene are associated with mite-sensitized persistent allergic rhinitis(AR) in this population.

    Methods

    An ongoing hospital-based case-control study consisting of 564 patients with mite-sensitized persistent AR and 583 healthy controls was conducted. Seven single nucleotide polymorphisms (SNPs) in GC and one SNP in CYP27B1 were selected for genotyping.

    Results

    The genotype and allele frequencies of rs4588,rs7041,rs3733359,rs16847024,rs843008,rs1565572,and rs11939173 in GC as well as rs10877012 in CYP27B1 were not significantly associated with susceptibility to mite-sensitized persistent AR. After stratification analyses, however, there are genotypes in different subgroups of rs16847024 in GC exhibited significantly decreased risk of mite-sensitized persistent AR, compared to wild CC genotype, and they are: CT (adjusted OR=0.62, 95% CI=0.41-0.94) and CT/TT (adjusted OR=0.62,95% CI =0.42-0.90)genotypes in the age subgroup of ≥17 years old, the CT/TT (adjusted OR=0.68,95% CI = 0.48-0.96) genotypes in the male subgroup, the CT (adjusted OR=0.70,95% CI =0.52-0.95) and CT/TT (adjusted OR=0.72,95% CI =0.54-0.97) genotypes in the subgroup of persistent AR without concomitant of asthma, and the CT (adjusted OR=0.70,95% CI =0.52-0.95) and CT/TT (adjusted OR=0.71,95% CI =0.53-0.94) genotypes in the subgroup of lower total IgE level. Analysis of the locus-locus interactions of GC and CYP27B1 revealed one model that involved two SNPs of only GC were statistically significant (P=0.001).

    Conclusion

    Our data suggest that ≥17 years old, male, no concomitant of asthma, and lower total IgE level may have an impact on the association of SNP rs16847024 in GC of the vitamin D pathway with the risk of mite-sensitized persistent AR in this Chinese population. Two variants of GC may be involved in genetic interactions in the pathogenesis of persistent AR.

    Association of Toll-like receptor pathway gene polymorphisms with allergic rhinitis
    Ruoxi CHEN,Qingzhao ZHANG,Meiping LU,Xinjie ZHU,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  79-87.  doi:10.6040/j.issn.1673-3770.1.2019.008
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    Objective

    The involvement of the Toll-like receptor (TLR) signaling pathway in allergic rhinitis (AR), asthma, and other allergic diseases is being intensively studied. The present study assessed the correlation between TLR pathway gene single nucleotide polymorphisms (SNPs) and incidence of AR, and investigated the influence of SNPs in the pathogenesis of AR.

    Methods

    Candidate TLR pathway SNPs were screened by a search of a bioinformatics database system using the TaqMan SNP genotyping system as part of a hospital-based case-control study of 452 AR patients and 491 healthy controls. Serum levels of eosinophil cationic protein, total IgE, and allergen-specific IgE were measured by the Immuno CAP blood test.

    Results

    Six SNPs were identified (TLR2 rs7656411, rs76112010, rs7682814 and CD14 rs2563298, rs2569190, rs2569191). Genotype frequencies of CD14 rs2563298 and rs2569191 were significantly different between the cases and controls (P<0.05). AR patients with asthma were significantly associated with the rs7656411, rs2563298, and rs2569191. Genotype frequencies of TLR2 rs7656411 were significantly different between controls and the male and history case subgroups. Significant differences were also found in genotypes of CD14 rs2563298 and rs2569191 compared with control and subgroups of cases. Gene interaction analysis revealed a three-locus interaction involving TLR2 rs7656411, CD14 rs2563298, and CD14 rs2569191 in AR cases.

    Conclusion

    Polymorphisms of TLR2 and CD14 in the TLR pathway may contribute to susceptibility of AR in this Chinese population.

    Artificial intelligence technology application in disclosing allergic rhinitis patientsneeds to otolaryngologists
    Changyu QIU,Jun ZHOU,De′en ZHUANG,Qing YANG,Meiping LU,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  88-94.  doi:10.6040/j.issn.1673-3770.1.2019.023
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    Objective

    To help otolaryngologists better understand the real needs of patients with allergic rhinitis (AR) to manage patients more rationally in clinical practice, we used artificial intelligence technology to analyze the online search information of AR in Chinese internet users in recent years.

    Methods

    AR ′hot research′ used the Baidu Index to analyze the daily average and peak trend of the Baidu platform ′allergic rhinitis′ search index. AR ′hot question′ used artificial intelligence technology to automatically extract and categorize the questions under the specified keyword ′allergic rhinitis′ from ′Badu Know′ and ′360 Question and Answer′. On this basis, a fusion algorithm based on Word2Vec model and semantic similarity matching is applied to merge similar questions. Then we analyzed the number of AR questions, the pageviews of AR questions, the distribution of appeals and symptom distribution data for AR questions.

    Results

    The search index daily average and peak values of ′allergic rhinitis′ in the Baidu platform were increasing annually. The three most frequently viewed answers to questions were the best treatment for AR, ruminant of AR, and means of coping with AR. The top three drugs mentioned in the questions were traditional Chinese medicine, antihistamines and nasal irrigation, while 64% of respondents knew nothing about AR drug treatment.

    Conclusion

    The application of artificial intelligence can help otolaryngologists better understand the real needs of patients and assist determining if the prevalence of AR is elevated. This study showed that Chinese AR patients were most concerned about AR treatment and expected that their symptoms could be improved through daily life management. However, their knowledge of AR regular treatment drugs was insufficient and they preferred traditional Chinese medicine and remedies. Besides, their awareness of the characteristics of AR and the concept of allergen or allergen avoidance were not enough. It was suggested that healthcare providers need to better educate patients and improve standardized treatment in clinical diagnosis and treatment.

    Analysis of malignant melanoma of the nasal cavity and paranasal sinuses in 23 cases
    Jiacheng ZHANG,Liqing ZHANG,Han ZHOU,Meiping LU,Wanyun XU,Yujie SHEN,Yaqin LIU,Min YIN,Weida DONG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  95-99.  doi:10.6040/j.issn.1673-3770.1.2019.015
    Abstract ( 225 )   HTML ( 0 )   PDF (4165KB) ( 88 )   Save
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    Objective

    To explore the clinical features, diagnosis, treatment outcomes, and prognosis of patients with malignant melanoma of the nasal cavity and paranasal sinuses.

    Methods

    A retrospective review was performed of 23 patients with malignant melanoma of the nasal cavity and paranasal sinuses treated between October 2007 and September 2018.

    Results

    The average age of the 23 patients was 61.7 years. The proportions of men and women were similar. The tumors mostly occurred in the lateral wall of the nasal cavity and often involved the maxillary, frontal, and ethmoid sinuses. After treatment, the patients were followed-up for 6 months to 10 years. The 1-, 2-, 3-, and 5-year survival rates were 78.26% (18/23), 42.10% (8/19), 20% (3/15), and 11.11% (1/9), respectively.

    Conclusion

    The symptoms of malignant melanoma of the nasal cavity and sinuses are concealed and complex, with high degrees of malignancy and metastasis and extremely poor prognosis. The treatment strategy includes extensive surgical resection and postoperative individualized chemotherapy, radiotherapy, targeted therapy, and immunotherapy. Early diagnosis and comprehensive treatment can significantly improve the survival rate of malignant melanoma.

    Value of preoperative hyperselective vascular embolization in juvenile nasopharyngeal angiofibroma treatment
    Qing ZHAO,Han ZHOU,Min YIN,Jian FENG,Jiacheng ZHANG,Yaqin LIU,Yujie SHEN,Ziping LIN,Weida DONG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  100-105.  doi:10.6040/j.issn.1673-3770.1.2019.013
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    Objective

    To summarize and analyze the clinical features, diagnostic methods, surgical approach, prognosis, and clinical value of preoperative hyperselective vascular embolization for juvenile nasopharyngeal angiofibroma (JNA).

    Methods

    Retrospective analysis of 31 patients with pathologically confirmed nasopharyngeal fibroangioma in the First Affiliated Hospital of Nanjing Medical University from January 2007 to July 2018 was performed. All patients underwent clinical staging based on preoperative imaging findings (according to Radkowski staging, 11 cases in stage Ia, seven in Ib, seven in IIa, three in IIb, two in IIc, and one in IIIa) after which surgical plans were developed. Sixteen patients underwent nasopharyngeal angiofibroma resection via a nasal endoscopy approach, nine via a nasal-hard palate approach, five via an oral approach, and one via a nasal side incision approach. Among all patients, 13 patients underwent selective vascular interventional embolization before surgery.

    Results

    Three patients were lost to follow-up. The remaining 28 patients were followed up for 6 months to 5 years and five patients developed recurrence of the disease. The operation time and intraoperative blood loss of patients with hyperselective arterial embolization before surgery were significantly lower than those without embolization (P<0.05). Preoperative embolization rate and intraoperative blood loss were significantly higher in patients with stage II?III JNA (P<0.05).

    Conclusion

    The clinical manifestations of JNA are variable. Preoperative detailed imaging methods such as computed tomography, magnetic resonance imaging, and digital angiography can help to perform accurate staging and develop a reasonable surgical plan. Preoperative Radkowski staging helps to guide the treatment of JNA. Preoperative hyperselective vascular embolization can reduce intraoperative blood loss, reduce the operation time, and reduce the recurrence rate significantly, which is worth advocating further.

    Preoperative platelet-lymphocyte ratio is an independent prognostic factor for laryngeal squamous cell carcinoma
    Huijun CHEN,Shenghua SONG,Han ZHOU,Weida DONG,Mingzhe QIAO,Xi CHEN,Jin XU,Ziping LIN,Guangqian XING
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  106-110.  doi:10.6040/j.issn.1673-3770.1.2019.018
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    Objective

    To evaluate the impact of preoperative platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and derived NLR (dNLR) on the prognosis in patients with laryngeal squamous cell carcinoma.

    Methods

    The clinical data of 473 patients with laryngeal squamous cell carcinoma who underwent primary surgery in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. According to preoperative PLR, NLR and dNLR, the receiver operating characteristic curve (ROC) for diagnosing tumor recurrence was drawn to determine PLR, NLR and dNLR thresholds, and then the patients were divided into the lower groups and the higher groups. Kaplan-Meier analysis and COX risk model were used to analyze the relationship between PLR, NLR, dNLR, and other clinicopathological parameters and recurrence of laryngeal squamous cell carcinoma.

    Results

    The area under the ROC curve (AUC) of PLR, NLR and dNLR for the diagnosis of tumor recurrence were 0.683, 0.720 and 0.696, respectively. Univariate analysis showed that PLR, NLR, dNLR, tumor classification, TNM stages, pathological differentiation, invasion of thyroid cartilage plate, lymph nodes metastasis, age and coagulation were associated with recurrence in patients with laryngeal squamous cell carcinoma; In COX regression model, a higher PLR, tumor classification and age were identified as independent risk factors for the recurrence of laryngeal squamous cell carcinoma (P<0.001; P=0.033; P=0.030).

    Conclusion

    Laryngeal squamous cell carcinoma patients with high preoperative dNLR are more likely to relapse. Preoperative PLR is a more valuable prognostic factor than NLR and dNLR for recurrence of laryngeal squamous cell carcinoma. It could be a clinically biomarker for the prognosis of laryngeal squamous cell carcinoma.

    Clinical analysis of 34 cases of cervical lipoma
    Yujie SHEN,Liqing ZHANG,Han ZHOU,Qing ZHAO,Jian FENG,Shenghua SONG,Weida DONG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  111-115.  doi:10.6040/j.issn.1673-3770.1.2019.019
    Abstract ( 254 )   HTML ( 137 )   PDF (5347KB) ( 93 )   Save
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    Objective

    To investigate the clinical features, imaging manifestations, and treatment of cervical lipoma.

    Methods

    The clinical data of 34 patients who were admitted to our hospital between November 2009 and July 2018 and pathologically diagnosed with cervical lipoma were analyzed.

    Results

    All patients underwent complete tumor resection without obvious complications, including 8 cases of tumor in the anterior cervical region, 17 cases of tumor in the sternocleidomastoid muscle region, and 9 cases of tumor in the lateral cervical region. The maximum diameter of the tumor ranged from 1 cm to 15 cm. No recurrence was found during an average follow-up of 3 months to 9 years.

    Conclusion

    The treatment of neck lipoma involves surgery, which should be based on the anatomy of the area in which the tumor is located. The disease has good prognosis, with few cases of recurrence or malignancy after complete excision.

    Vocal polyps treated with nasal endoscopy and angled-laryngeal forceps: report of 23 cases
    Lixian JU,Jingcheng LI,Keyu XIA,Weida DONG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  116-118.  doi:10.6040/j.issn.1673-3770.0.2018.426
    Abstract ( 236 )   HTML ( 0 )   PDF (1345KB) ( 74 )   Save
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    Objective

    To investigate the outcomes of endoscopic removal of vocal cord polyps with angled-laryngeal forceps.

    Methods

    Nasal endoscopy was performed after conventional intubation with a support laryngoscope, to identify lesions on an imaging system in 23 patients with difficulty in glottis exposure during vocal cord polyp surgery. Appropriate laryngeal forceps were chosen and bent to the required degree, 1-2 cm from the end. They were were then extended into the laryngoscope until reaching the vocal cord polyps. The polyps were then routinely excised, and the edge of the acoustic band was subsequently repaired. Postoperative management included routine intravenous infusion of antibiotics for 3 days and inhalation of budesonide aerosol twice daily for 3 days. The patients were advised 2 weeks of rest, deep breathing, and abstinence from smoking and alcohol.

    Results

    In all 23 patients, the vocal polyps were excised in the first attempt, with an average operative time of 10 min, and no serious complications, such as cervical spine injury, tongue injury, or tooth loss. All 23 patients were followed up for 3-12 months (average, 6 months) postoperatively. The postoperative course was uneventful and there was no obvious voice hoarseness. Re-examination using a laryngoscope showed smooth edges of the vocal cords, without adhesion and defects, and no polyp recurrence during the follow-up period.

    Conclusion

    Treatment of vocal polyps with difficult exposure of the glottis is possible with nasal endoscopy and angled-laryngeal forceps.

    Analysis of influencing factors and observation of therapeutic effects in patients with laryngopharyngeal reflux disease
    Yongyao LANG,Yun YANG,Qing LIU,Lindi XU,Ziping LIN
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  119-123.  doi:10.6040/j.issn.1673-3770.0.2018.472
    Abstract ( 198 )   HTML ( 0 )   PDF (503KB) ( 50 )   Save
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    Objective

    To understand the influencing factor and therapeutic effects of laryngopharyngeal reflux disease(LPRD).

    Methods

    A total of 112 patients with chronic laryngopharyngeal disease were enrolled in this study in the period from February 2018 to August 2018. The patients were diagnosed with LPRD using the reflux symptom index(RSI), the reflux finding score (RFS), and the visual analogue scale(VAS) score. The patients with LPRD were treaded with modifications in diet and living habits(primary treatment) and. with proton pump inhibitors (PPIs) and prokinetic agents(secondary treatment) for 4-6weeks. Simultaneously, the factors of age, sex, occupation, diet, cold, stress, mood and gastric history were analyzed by single-factor and binary logistic regression analysis. In addition, RSI and VAS score before and after treatment was analyzed.

    Results

    Among the 112 patients with chronic laryngopharyngeal disease, the follow-up rate was 90%. Among patients with LPRD, chronic laryngopharyngeal disease was diagnosed in 83% (83 cases).Single-factor analysis showed that diet(χ2=4.124, P<0.05)and history of stomach problems (χ2=14.912, P<0.01)were statistically significant, whereas sex(χ2=0.681, P>0.05), age(χ2=0.681, P>0.05), occupation(χ2=0.024, P>0.05), cold(χ2=0.649, P>0.05), stress(χ2=1.197, P>0.05), and mood(χ2=0.940, P>0.05) were not statistically significant. Binary logistic regression analysis showed that diet(x2=4.480, P<0.05) and history of stomach(χ2=7.792, P<0.01) were the influencing factors of LPRD. The clinical efficacy of treatment was significant in 50.61% (41 cases), effective in 37.07%(30 cases) and ineffective in 12.34%(10 cases). The differences of VAS(t=9.41, P<0.01) and RSI(t=10.59, P<0.01)score were statistically significant before and after primary treatment for mild LPRD. The differences of VAS(t=20.59, P<0.01) and RSI(t=22.03,P<0.01)score were statistically significant before and after primary combined with secondary treatment for mild LPRD. The differences of VAS(t=6.82,P<0.05) and RSI(t=4.8, P<0.05) score were statistically significant before and after primary combined with secondary treatment for severe LPRD.

    Conclusion

    LPRD was a common disease in the otorhinolaryngology clinic. Diet and history of stomach problems were the influencing factors of LPRD. It was treated effectively by adjusting diet and living habits combined with PPI and prokinetic agents.

    Review
    Detection and clinical application of nasal nitric oxide
    Zhiwen CHEN,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  124-128.  doi:10.6040/j.issn.1673-3770.1.2019.026
    Abstract ( 410 )   HTML ( 14 )   PDF (437KB) ( 92 )   Save
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    Nitric oxide (NO) is synthesized from arginine by the enzyme family NO synthases. NO is an endogenous modulator of airway function. NO from the nose can constitute a nasal defensive barrier, and keep the sinuses relatively sterile. The most commonly clinical detection of nasal nitricc oxide (nNO) is to directly collect NO with a nasal plug probe placed in the anterior nostril. nNO has been used for the screening diagnosis of cystic fibrosis and primary ciliary dyskinesia. However, nNO is related to many influences such as the plugged extent of the sinus. Dynamic monitoring nNO before and after treatment, and combination with frictional exhaled nitric oxide (FeNO)examination to early detect eosinophilic inflmmation in the upper and lower airways are more clinically valuable.

    Advances in endoscopic diagnosis of laryngeal cancer
    Jian FENG,Han ZHOU,Weida DONG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  129-133.  doi:10.6040/j.issn.1673-3770.1.2019.025
    Abstract ( 196 )   HTML ( 8 )   PDF (494KB) ( 106 )   Save
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    Laryngeal cancer is one of the most common malignancies of the respiratory system. Early diagnosis of this disease can help to avoid a wide range of surgical procedures, preserve the physiological function of the larynx, and significantly improve the prognosis. This article reviews the various advanced endoscopy techniques used for the early diagnosis of laryngeal cancer in recent years and analyzes the advantages and disadvantages of each technique. With these new endoscopic techniques being widely promoted and optimized, the practice of early diagnosis of laryngeal cancer is expected to increase gradually in the future.

    Nursing Field
    Comprehensive intervention on xerostomia after functional endoscopic sinus surgery
    Wenjin WAN,Yujie YAN,Na LI,Renyu GUO,Hui YUAN
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  134-137.  doi:10.6040/j.issn.1673-3770.1.2018.045
    Abstract ( 210 )   HTML ( 1 )   PDF (493KB) ( 67 )   Save
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    Objective

    To explore the effect of comprehensive intervention on xerostomia after functional endoscopic sinus surgery (FESS).

    Methods

    A total of 97 patients with FESS from May 1, 2018, to September 30, 2018, were randomly divided into two groups. The control group was treated with usual nursing, while the observation group was given comprehensive intervention. The improvement of the patients' xerostomia and their comfort and satisfaction rates were compared between two groups.

    Results

    The xerostomia grading of patients who underwent FESS at three hours, six hours, one day, and two days after the surgery was 2.06 ± 0.59, 1.20 ± 0.50, 0.98 ± 0.66, and 0.35 ± 0.48 respectively in the observation group, and 3.40 ± 0.54, 3.75 ± 0.48, 3.06 ± 0.32, and 2.38 ± 0.49 respectively in the control group. The degree of comfort was 5.47 points in the observation group, and 3.35 points in the control group. The satisfaction rates were significantly higher in the observation group (99.8%) than in the control group (87.5%). All the differences were statistically significant (P < 0.05).

    Conclusion

    The comprehensive intervention effectively improved xerostomia in patients who underwent FESS, increased their degree of comfort, and improved patients' satisfaction.

    Analysis of peer-support education in patients with continuous nursing after total laryngectomy
    Hui YAO,Wenjin WAN
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  138-142.  doi:10.6040/j.issn.1673-3770.1.2018.046
    Abstract ( 193 )   HTML ( 0 )   PDF (520KB) ( 66 )   Save
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    Objective

    To investigate the effect of peer-support education with New-voice Salon in patients after a total laryngectomy.

    Methods

    Eighty patients, who underwent a total laryngectomy for laryngeal cancer between October 2014 and September 2017, were randomly divided into two groups of 40 each: a control group and an observation group. The patients in the control group received routine care, while those in the observation group were provided both routine care and peer-support education.

    Results

    Before treatment, there was no significant difference in quality-of-life scores (including physical function, role function, emotional function, cognitive function, and social function) between the two groups (t = 0.954, 1.324, 0.401, 1.250, 0.265 and P = 0.343, 0.189, 0.690, 0.215, 0.992, respectively). After treatment, the quality-of-life scores of both groups had improved. However, the scores of the observation group were higher than those of the control group, and the difference between the two was determined to be statistically significant (t = 4.104, 6.736, 3.064, 4.430, 13.518, respectively; P of emotional function was 0.00381, the rest were lower than 0.001).

    Conclusion

    Peer-support education promotes the establishment of healthy behaviors in patients after a total laryngectomy and improves their personal capabilities, which improves patients' quality of life.

    Application of the integration of doctors′ and nurses′ nutrition management model after total laryngectomy
    Junfang GAO,Ping LIU
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  143-146.  doi:10.6040/j.issn.1673-3770.1.2018.047
    Abstract ( 225 )   HTML ( 4 )   PDF (482KB) ( 80 )   Save
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    Objective

    To explore the effects of the application of the integration of doctors′ and nurses′ nutrition management model after total laryngectomy, observe the recovery of patients, and improve nursing services.

    Methods

    From April 2017 to September 2018, 68 patients with laryngeal cancer undergoing total laryngectomy were randomly divided into nutrition management intervention and control groups. Each group included 34 patients. The nutrition management intervention group was attended by doctors and nurses. Nurses calculated the daily target nutrition according to the patients′ height, weight, and basal metabolic rate. According to the target nutrition, enteral nutrition preparation was administered daily through a nasogastric tube by an enteral nutrition pump, and nutrition management intervention was carried out throughout the course of quality control. The control group was offered routine nutritional intervention, and a syringe was used to administer normal fluids through a nasogastric tube. Changes in serum prealbumin, albumin, and body mass index (BMI) were observed one week after the surgery. Postoperative hospital stay, self-care ability, complications, and the incidence of adverse reactions were evaluated.

    Results

    The level of serum prealbumin, level of albumin, and BMI in the integration of doctors′ and nurses′ nutrition management intervention group were higher than those in the control group one week after the surgery, and the difference was statistically significant (P<0.05). Patients in the nutrition management intervention group had better self-care ability, shorter hospital stays, and a lower incidence of complications and adverse reactions compared with those in the control group, and the difference was statistically significant (P<0.05).

    Conclusion

    Application of the integration of doctors′ and nurses′ nutrition management intervention after total laryngectomy can significantly improve the nutritional status of patients, improve self-care ability, shorten hospital stay, and through careful nursing observation and treatment, can reduce complications and adverse reactions.

    Research Report
    Analysis of sensitization to inhalant allergens in patients with allergic rhinitis from Jiangsu and Anhui areas
    Junjun QIAN,Wencheng ZHOU,Zhongfei WU,Dongyun BU,Liqin WANG,Meiping LU,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  147-151.  doi:10.6040/j.issn.1673-3770.1.2019.036
    Abstract ( 201 )   HTML ( 0 )   PDF (462KB) ( 102 )   Save
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    Objective

    In this study, we aimed to understand the inhaled allergen spectrum of patients with allergic rhinitis (AR) in Jiangsu and Anhui provinces, and provide the basis for clinical diagnosis and the methods for intervention of AR.

    Methods

    A retrospective analysis of patients with rhinitis admitted to the First Affiliated Hospital of Nanjing Medical University from 2013 to 2017 was conducted. Based on age, the patients were divided into children groups (aged ≤12 years), juvenile group (aged 13~17 years), young group (aged 18~39 years), and quinquagenarian group (aged ≥40 years). All patients were from Jiangsu and Anhui provinces. Demographic and clinical features of the patients were investigated based on their age groups. Overall, 10 types of common inhaled allergens with specific IgE in serum were detected. The SPSS software (version 20) was used for the statistical analysis.

    Results

    Among 501 patients included in the study, 132 (26.35%) were found to be negative for serum-specific IgE test and 369 (73.65%) were positive for ≥1 allergen(s). Among the patients with AR, the first five allergens to show positivity were dermatophagoides pteronyssinus (75.88%), dermatophagoides farinae (73.98%), house dust (19.24%), alternaria (11.11%), and cat dander (6.78%). The positivity rate of alternaria in children and adolescents was 26.79% and 28.36%, respectively. Analysis of the allergen spectrum of the same patient showed that most of the sensitization was multiple allergens, and the triple allergens showed the highest positivity rate (60.16%). The main combination was dermatophagoides pteronyssinus + dermatophagoides farinae + house dust, accounting for 91.44% of the patients affected with triple allergens. The main allergens with serum specific IgE ≥grade 3 were dermatophagoides farinae (55.56%), dermatophagoides pteronyssinus (50.95%), and alternaria (6.78%).

    Conclusion

    Dermatophagoides pteronyssinus and dermatophagoides farinae were the main allergens affecting patients with AR in Jiangsu and Anhui areas. Alternaria is a common allergen affecting children and adolescents in this area and requires greater attention. Three indoor allergens, dermatophagoides pteronyssinus, dermatophagoides farinae, and house dust were closely related and can be used as a combination for the screening and diagnosis of AR.

    Case Report
    Intramuscular lipoma of the larynx:a case report
    Xinjie ZHU,Qingzhao ZHANG,Xi CHEN
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  152-153.  doi:10.6040/j.issn.1673-3770.1.2019.014
    Abstract ( 209 )   HTML ( 0 )   PDF (2101KB) ( 88 )   Save
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    Medical Education
    PBL teaching and the standardization training of residents in otolaryngology-head and neck surgery
    Min YIN,Yawen SHI,Xinjie ZHU,Zhibin CHEN,Xi CHEN,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  154-156.  doi:10.6040/j.issn.1673-3770.1.2019.035
    Abstract ( 162 )   HTML ( 1 )   PDF (393KB) ( 96 )   Save
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    Experience of clinical teaching in otorhinolaryngology for MBBS international students
    Xinjie ZHU,Ruoxi CHEN,Xiaolu LI,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  157-159.  doi:10.6040/j.issn.1673-3770.1.2019.033
    Abstract ( 191 )   HTML ( 1 )   PDF (354KB) ( 69 )   Save
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    Overseas Communication
    US Medical Education and Training
    Jing SHI
    Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(3):  160-163.  doi:10.6040/j.issn.1673-3770.1.2019.034
    Abstract ( 220 )   HTML ( 5 )   PDF (206KB) ( 63 )   Save
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    Physicians are privileged to hold one of the most prestigious careers worldwide. People are always reliant on physicians′ expertise; their skills, knowledge, dedication and compassion are all important factors that influence the decision-making process when dealing with health issues, or even with life and death. However, the education, training and licensure requirements for physicians differ significantly across the world. For example, most countries allow candidates to apply to medical schools right after high school graduation; whereas, in the United States, candidates can only apply to medical schools after four years of college. If you are a foreign medical graduate or one who is not currently in the medical field but have aspirations to practice medicine in US, the sophistication of the US medical education system may be confusing. To help people understand the journey of becoming a physician, this article will serve as a basic overview of the US medical education system. Although the journey is long, the reward is priceless.The US has more than 140 medical schools and thousands of graduate medical programs dedicated to educating future physicians. To become a physician in US, there are many steps to follow: candidates must apply to medical school after four years of college; take the USMLE (United States Medical Licensing Examination) step 1, step 2 and step 3 tests; go through a match process to find an ideal training program during senior year of medical school; and undergo GME (Graduate Medical Education) training, which varies depending on specialty, before finally receiving board certification. As one can see, the time commitment to becoming certified is extremely rigorous, and takes about 7-11 years after college. However, it doesn′t just start after college graduation. You must be preparing your medical school application since day 1 of college life, since the MCAT (Medical College Admission Test) involves science and medicine-specific knowledge. If your college major is more focused on the liberal arts, then you need to take some elective classes to meet the minimum science requirements. Even after successful admission to medical school, students need to start preparing for their USMLE tests and participate in medical research, if possible, which will help to increase their chances of matching into a better program for training. The match process is extremely stressful and unpredictable. Foreign graduates who are ECFMG (Educational Commission for Foreign Medical Graduate) certified can apply to match as well; however, there are usually fewer programs open to ECFMG applicants. Because government funding is GME's major source of funding, there is a cap to the number of residents and fellows each teaching hospital can have before they are required to pay out of pocket. If residents or fellows want to switch specialties, they need to reapply next year and receive training again in their new field. ACGME (Accreditation Council of Graduate Medical Education) established the standards for each program, and the skills, knowledge, professionalism, communication, and empathy are required before any physician can practice independently. In general, medical education in the US involves multiple years of formal training and standardized examinations before you can become an attending physician. However, medicine is an ever-changing field. Even after you become a board certified physician, you still have CME (Continue Medical Education) tests to complete every year. Learning is truly a lifelong aspect in the medical occupation.