Table of Content

20 May 2026 Volume 40 Issue 3

  

Original Article

Glucocorticoids alleviate endolymphatic hydrops induced by arginine vasopressin by downregulating aquaporin-2

LI Mengxin, XU Hui, ZHANG Xiaoling, XUE Qing, JI Shuangyu, LI Yingying, CUI Limei,

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  1-6.  doi:10.6040/j.issn.1673-3770.0.2025.141

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Objective To investigate the therapeutic effect of glucocorticoids on arginine vasopressin(AVP)-induced endolymphatic hydrops(ELH)in rats and its association with the regulation of aquaporin-2(AQP2)expression. Methods Wistar rats were randomly divided into four groups: control(normal saline), model(desmopressin acetate), dexamethasone(DXM)intervention, and DXM + mifepristone(RU486)intervention groups. Cochlear tissues were collected for hematoxylin-eosin staining to assess the degree of ELH, quantified by the ratio(R value)of the scala media area to the sum of scala media and scala vestibuli areas. Immunohistochemistry was performed to analyze the distribution and expression of AQP2 protein in the cochlea, and qRT-PCR was used to detect AQP2 mRNA expression levels. Results Compared with the control group, the model group showed significant ELH(P<0.01)and markedly increased AQP2 mRNA and protein expression(P<0.05). The DXM group exhibited reduced ELH(P<0.05)and decreased AQP2 expression(P<0.05)compared with the model group. In the DXM+RU486 group, both ELH severity and AQP2 expression were significantly higher than those in the DXM group(P<0.001). Immunohistochemistry revealed widespread AQP2 expression in the stria vascularis(SV), spiral ligament(SL), organ of Corti(OC), Reissner's membrane, and spiral ganglion neurons, with predominant localization to the cell membrane. Changes in AQP2 expression in the SV and SL were consistent with the degree of hydrops. In the OC, although AQP2 expression decreased in the DXM group, the difference was not statistically significant. Conclusion Glucocorticoids may alleviate AVP-induced ELH by downregulating AQP2 expression in the cochlea, particularly in the SV and SL. This effect can be partially reversed by the glucocorticoid receptor antagonist mifepristone.

Packaging of AAV-ie-Tnfaip8l2 and its effect on improving auditory function in Tnfaip8l2^-/- mice

WANG Min, LIU Hao, JIANG Luhan, TAN Liyue, LI Wen, FU Xiaolong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  7-15.  doi:10.6040/j.issn.1673-3770.0.2025.177

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Objective Adeno-associated virus(AAV)serves as a critical vector for gene therapy. This study aimed to package AAV-ie-Tnfaip8l2 virus, systematically evaluate whether AAV could be used as a vector to achieve in situ overexpression of Tnfaip8l2 protein in the cochlea, and explore its transduction efficiency in the inner ear tissues of gene knockout mouse models and therapeutic effects on auditory function. Methods The recombinant expression vector AAV-ie-Tnfaip8l2 was constructed using molecular cloning techniques. AAV-ie capsid plasmids and helper plasmids were co-transfected into 293T cells to complete the assembly and replication of viral particles. High-purity, high-titer recombinant AAV preparations were obtained via ultracentrifugation and chromatography purification. Using microinjection technology, AAV-ie-Tnfaip8l2 was injected into the round window of newborn Tnfaip8l2^-/- mice through the round window membrane. When the Tnfaip8l2^-/-mice reached 35 days of age(the typical period when hearing loss becomes apparent), the therapeutic effects were evaluated using methods such as audiological tests, scanning electron microscopy, and immunofluorescence. Results High-titer AAV-ie-Tnfaip8l2 virus could be successfully packaged for cochlear round window injection, enabling efficient in situ overexpression of the Tnfaip8l2 in the cochlea of Tnfaip812^-/- mice. Audiological function tests showed that compared with the control groups, the click, tone burst(4 k, 8 k, 12 k, 16 k, 24 k, 32 k), and DPOAE thresholds in the AAV-ie-Tnfaip8l2 replenishment group mice were significantly reduced(P<0.05, n=3). Scanning electron microscopy revealed that the disordered arrangement of stereociliary bundles in outer hair cells was significantly improved. Conclusion This study confirmed that AAV-ie-Tnfaip8l2 can achieve efficient in situ expression of the Tnfaip8l2 in the mouse cochlea via round window injection, partially rescuing the hearing function of Tnfaip8l2^-/- mice. These findings provide new experimental evidence for therapeutic strategies for age-related hearing loss.

Analysis of the surgical efficacy of adhesive otitis media under continuous irrigating mode for endoscopic ear surgery

ZHANG Guomin, WANG Maohua, GAO Song, WU Wenbin, YU Youjun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  16-19.  doi:10.6040/j.issn.1673-3770.0.2025.329

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Objective To evaluate the clinical application value and surgical efficacy of Continuous Irrigating Mode for Endoscopic Ear Surgery(CIM-EES)in the treatment of adhesive otitis media. Methods Clinical data were retrospectively collected from 36 patients diagnosed with adhesive otitis media who underwent tympanoplasty(including artificial ossicular reconstruction)under general anesthesiain the Department of Otorhinolaryngology, Dongnan Hospital of Xiamen University from February 1,2023 to June 1,2024. Among these patients, 19 were treated using CIM-EES, while the remaining 17 underwent surgery under conventional otoendoscopic techniques. The operative duration, intraoperative middle ear structural visibility index(MESVI), postoperative complications, and hearing improvement were compared between the two groups. Results The MESVI score in the CIM-EES group(8.11±1.59)was significantly higher than that in the conventional group(4.47±1.23)(t=7.59,P<0.001). The average operation time in the CIM-EES group(1.52±0.42)hours was significantly shorter than that in the conventional group(1.97±0.38)hours(t=-3.31,P=0.002). No significant difference was observed in preoperative and postoperative air conduction thresholds between the CIM-EES group(preoperative: 48.92±18.23 dB; postoperative: 41.76±17.98 dB)and the conventional group(preoperative: 47.75±18.62 dB; postoperative: 37.97±15.29 dB)(t=5.26,P<0.01;t=4.12,P<0.01). No major postoperative complications were observed in either group; however, the preservation rate of the tympanic nerve was higher in the CIM-EES group compared to the conventional group. Conclusion CIM-EES could shorten operative time, demonstrating statistical advantages in improved intraoperative visualization and better preservation of anatomical structures in the surgical management of adhesive otitis media. It is a safe, efficient, and promising technique suitable for broader clinical application.

Meta analysis of clinical efficacy of cochlear implant in elderly patients with postlingual deafness

LI Shiyun, XIE Yan, PAN Jiayu, CHEN Meixin, LONG Dan, ZHANG Chunlin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  20-30.  doi:10.6040/j.issn.1673-3770.0.2023.524

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Objective Evaluate the impact of cochlear implant on hearing rehabilitation and quality of life in elderly patients with postlingual deafness. Methods Search was conducted in the PubMed, SinoMed, CNKI, WanFang data and VIP databases from 2000 to 2023. Studies on the postoperative rehabilitation effects of cochlear implantation in the elderly group(≥60 years old)and the young control group(<60 years old)with postlingual deafness, and last include literature that meets the standards and extract data. After all these steps, Meta analysis was conducted on the elderly group before and after surgery, as well as the elderly group and the year group control group, to evaluate the hearing rehabilitation and its impact on quality of life after cochlear implantation. Results A total of 14 literature were included in this study, and corresponding literature was included for Meta-analysis based on different analysis indicators. After cochlear implantation in elderly patients with postlingual deafness, compared to before surgery, in terms of word recognition rate ［SMD=2.20, 95%CI(1.73, 2.67)］, sentence recognition rate in quiet environment［SMD=1.63, 95%CI(1.37, 1.89)］, sentencerecognition rate in noisy environment ［MD=38.91, 95%CI(33.04, 44.78)］, and auditory performance ［MD=2.81, 95%CI(2.72, 2.91)］, there were significant improvements compared to preoperative results,and these differences are statistically significant(all P<0.001). The word recognition rate ［SMD=-0.59, 95%CI(-0.81, -0.36)］, auditory Performance ［MD=2.81, 95%CI(2.72, 2.91)］ and sentence recognition rate in a quiet environment ［SMD=-0.32, 95%CI(-0.57, -0.07)］ after cochlear implantation in elderly patients with postlingual deafness were lower than those in the young control group, and the differences were statistically significant(all P<0.05). However, there was no statistically significant difference in sentence recognition rate ［MD=-6.94, 95%CI(-14.60, 0.71)］ and pure tone hearing threshold test ［MD=1.35, 95%CI(-8.55, 11.25)］ in noisy environment compared to the control group patients. In terms of quality of life, there was no statistically significant difference in the total score of the Glasgow Benefit Scale ［MD=-3.12, 95%CI(-22.89, 16.66, P>0.05)］ between the elderly group and the control group. Conclusion Cochlear implantation can improve postoperative hearing ability in elderly patients with postlingual deafness. In terms of sentence recognition and quality of life scoring in noisy environments, similar postoperative rehabilitation effects can be achieved as young patients. However, the effectiveness of aural rehabilitation in terms of word recognition rate, sentence recognition rate in quiet environments, and auditory performance is lower than that of young patients.

Evaluation of the effect of Messerklinger middle turbinate plasty on chronic rhinosinusitis with nasal polyps based on the expression of Ki67 and GM-CSF in vesicular tissue

FENG Sicong, YU Xiaolan, LOU Dan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  31-39.  doi:10.6040/j.issn.1673-3770.0.2025.119

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Objective To investigate the efficacy of Messerklinger turbinate reduction in treating chronic rhinosinusitis with nasal polyps(CRSwNP)and its effects on Ki67 expression and granulocyte-macrophage colony-stimulating factor(GM-CSF)expression in endoscopic tissue samples. Methods Eighty-six patients with chronic rhinosinusitis with nasal polyps(CRSwNP)were selected and randomly assigned using a random number table to either the control group(43 patients undergoing partial turbinectomy via endoscopic sinus surgery)or the observation group(43 patients undergoing Messerklinger turbinate reshaping). Comparison of clinical efficacy, nasal function ［nasal minimum cross-sectional area(NMCA), nasal cavity volume(NCV), distance from the nostril cavity to the anterior inferior(DCAN), and airway resistance(Raw)］, olfactory function, Ki67 expression in cystic tissue, GM-CSF expression in cystic tissue, complications, and recurrence rates. Results The clinical efficacy in the observation group was higher than that in the control group(P=0.034). At 3 months postoperatively, both groups showed increased NCV and NMCA, with the observation group exhibiting higher values than the control group(P=0.008,0.006). At 3 months postoperatively, both groups demonstrated decreased DCAN and Raw, with the observation group exhibiting lower levels(P=0.006,<0.001). At 3 months postoperatively, the olfactory function of both groups was improved, and the improvement degree in the observation group was higher than that in the control group(P=0.014). At 3 months postoperatively, Ki67 and GM-CSF positive expression levels were lower in the observation group than in the control group(P=0.016,0.023). From the time of surgery to follow-up, the recurrence rate was lower in the observation group than in the control group(P=0.034). Conclusion Messerklinger turbinate reduction significantly improves clinical outcomes in CRSwNP patients, effectively enhancing nasal function and olfactory function while reducing Ki67 and GM-CSF positive expression levels in cystic tissue and recurrence rates. This technique warrants clinical implementation.

Application of electronic nasopharyngoscopy combined with narrow band imaging in traditional Chinese medicine syndrome differentiation of nasopharyngeal carcinoma

LIN Xiaoxue, LIN Baorui, LI Peishan, LU Biaoqing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  40-46.  doi:10.6040/j.issn.1673-3770.0.2025.267

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Objective To investigate the correlation between local features of nasopharyngeal carcinoma(NPC)observed under electronic nasopharyngoscopy combined with narrow band imaging(NBI)and traditional Chinese medicine(TCM)syndrome patterns, providing objective imaging evidence for TCM syndrome differentiation. Methods A total of 197 patients with newly diagnosed NPC treated at Zhongshan Hospital of Traditional Chinese Medicine from May 2023 to May 2025 were enrolled and classified into four TCM syndrome types: Re Xie Fan Fei syndrome(n=49), Xue Yu Zu Luo syndrome(n=48), Tan Zhuo Jie Ju syndrome(n=70), and Zheng Xu Du Zhi syndrome(n=30). Electronic nasopharyngoscopy combined with NBI was used to observe local features including mucosal morphology, color, integrity, as well as microvascular color, density, and morphology. The correlation between these features and TCM syndrome types was analyzed. Results NPC TCM syndrome patterns showed significant associations(P<0.05)with endoscopic characteristics, including lesion border clarity, mucosal color, mucosal integrity, bleeding tendency, secretion properties, and NBI microvascular features(color, density, and morphology). Key manifestations for each syndrome type were as follows: Re Xie Fan Fei syndrome was characterized by marked mucosal congestion and purulent secretions; Xue Yu Zu Luo syndrome featured well-defined borders, absence of secretions, and NBI findings of brownish-green microvessels with dense fusion and serpentine tortuosity; Tan Zhuo Jie Ju syndrome presented with mucosal color similar to surrounding tissue and increased secretions; Zheng Xu Du Zhi syndrome was characterized by irregular borders, pale mucosa, and clear secretions. Conclusion Electronic nasopharyngoscopy combined with NBI technology can objectively reveal mucosal and microvascular alterations in NPC, providing a visual basis for TCM syndrome differentiation and guiding clinical precision treatment.

Association and lag effects of environmental meteorological factors on epistaxis in minors by sex

LIU Di, XIE Yingheng, ZHU Bin, MA Lin, GUAN Bing, WANG Ying, CAO Qing, JIAO Cheng, YAN Qi, SUN Haiyong, MA Wei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  47-54.  doi:10.6040/j.issn.1673-3770.0.2025.393

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Objective To investigate the sex-specific associations and lag effects between environmental meteorological factors and epistaxis incidence in minors, providing evidence for targeted prevention strategies. Methods A retrospective analysis was conducted on minors with epistaxis who visited the outpatient and emergency departments of Northern Jiangsu People's Hospital from January 1, 2015 to December 31, 2023. Data on daily air pollutant concentrations and meteorological variables during the same period were collected. The Mann-Whitney U test was used to compare incidence-related indicators between sexes. Spearman's rank correlation and a lag model(L₀-L₇)were employed to evaluate the correlations and lag effects between daily epistaxis cases and environmental meteorological factors stratified by sex, with significance levels adjusted using the Bonferroni method. Fisher's Z transformation was applied to compare correlation coefficients between male and female groups. Results A total of 18,280 patients were included, comprising 12,000 males(65.65%)and 6,280 females(34.35%). The incidence was significantly higher in males than in females(P<0.001), with both sexes showing a peak in summer. Daily epistaxis cases were strongly positively correlated with O₃ mass concentration and mean temperature, with lag effects persisting to L₇; the differences in correlation coefficients between sexes were statistically significant(P<0.05). Sex differences were observed in the lag effects of PM_2.5, PM₁₀, and CO, with males exhibiting higher correlation coefficients for most pollutants. Temperature difference was positively correlated with case numbers, peaking at L₂, and was higher in females on the day of onset(P<0.05). After Bonferroni correction, NO₂ and SO₂ showed no significant correlations(P>0.05), and the effect of wind speed was limited. Conclusion Epistaxis in minors exhibits significant sex differences and a summer peak. The associations and lag effects between epistaxis and environmental meteorological factors are sex-specific, which should be considered when formulating prevention strategies.

Trend and projection of larynx cancer mortality caused by occupational exposure to sulfuric acid

XIAO Junhua, PAN Qingchun, JIN Shu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  55-61.  doi:10.6040/j.issn.1673-3770.0.2025.193

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Objective To quantify the trend of mortality burden from occupational sulfuric acid exposure causing laryngeal cancer(LC)in China from 1990 to 2021, and analyze the contributions of population growth, aging, and epidemiological changes. This will provide insights for optimizing occupational exposure prevention strategies and public health interventions. Methods To quantify the trend of mortality burden from occupational sulfuric acid exposure causing laryngeal cancer(LC)in China from 1990 to 2021, and analyze the contributions of population growth, aging, and epidemiological changes. This will provide insights for optimizing occupational exposure prevention strategies and public health interventions. Results In 2021, men accounted for 82% of LC deaths(655.82 cases), with the highest mortality peak at ages 65-69. From 1990 to 2021, LC deaths from occupational sulfuric acid exposure increased by 55%, but the age-standardized mortality rate declined by an average of 1.68% per year. The three-factor decomposition showed that aging(135.82%)and population growth(120.96%)were the main driving factors, while epidemiological changes led to a 156.78% reduction in deaths. It is predicted that by 2040, the number of deaths will reach 916, with the age-standardized mortality rate declining to 0.049,6/100,000. Conclusion From 1990 to 2021, China made significant progress in controlling occupational sulfuric acid exposure-related LC, but the aging population has led to a continued increase in the absolute disease burden, particularly among elderly men. Future efforts should focus on strengthening occupational exposure monitoring and health management of high-risk populations to address the challenges of an aging society.

Incidence and correlation of anxiety, depression, and sleep disorders in patients with different types of benign paroxysmal positional vertigo

LYU Dan, LI Ruzhen, LIU Mingqiu, MENG Xinyu, LI Junyi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  62-67.  doi:10.6040/j.issn.1673-3770.0.2025.125

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Objective To analyze and compare the incidence and severity of anxiety, depression, and sleep disorders among patients with different types of benign paroxysmal positional vertigo(BPPV), and to explore the correlations among these conditions. Methods A total of 230 patients diagnosed with BPPV were enrolled, including 45 with anterior semicircular canal BPPV(AC-BPPV), 55 with horizontal semicircular canal BPPV(HC-BPPV), 80 with posterior semicircular canal BPPV(PC-BPPV), and 50 with multiple semicircular canal BPPV(MC-BPPV). All participants completed the Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale(SDS), and Pittsburgh Sleep Quality Index(PSQI)questionnaires. The scores and positive rates of these scales were compared among the four groups, and correlation analyses were performed. Results The comparison of the incidence rates of anxiety, depression, and sleep disorders among the four groups yielded statistically significant differences(χ²=12.899, 11.464, 28.487, P<0.05). The MC-BPPV group exhibited a higher incidence rate of anxiety than both the AC-BPPV and HC-BPPV groups and a higher incidence rate of depression than the HC-BPPV group(P<0.05). Both the MC-BPPV and PC-BPPV groups had a significantly higher incidence rate of sleep disorders compared to the AC-BPPV and HC-BPPV groups(P<0.05). A comparison of SAS, SDS, and PSQI scores among the four groups also revealed statistically significant differences(F=7.081, 11.924, 12.309, P<0.05). The MC-BPPV and PC-BPPV groups had higher SAS, SDS, and PSQI scores than the AC-BPPV and HC-BPPV groups(P<0.05). Correlation analysis indicated a positive association between SAS scores and SDS scores(r=0.548), SAS scores and PSQI scores(r=0.509), and SDS scores and PSQI scores(r=0.550, P<0.05). Conclusion Patients with MC-BPPV are more susceptible to anxiety and depression, while those with MC-BPPV and PC-BPPV are more prone to sleep disorders, and experience more severe symptoms of anxiety, depression, and sleep disturbances. There is a significant positive correlation among anxiety, depression, and sleep disorders.

Effects of continuous positive airway pressure on olfactory and cognitive functions in patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome

ZHAO Chunrong, YANG Sen, LI Chunyan, WANG Donghai, YANG Yu, YANG Xiaoying

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  68-73.  doi:10.6040/j.issn.1673-3770.0.2025.266

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Objective To longitudinally evaluate the effects of continuous positive airway pressure(CPAP)on olfactory and cognitive functions in patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Ninety patients with moderate-to-severe OSAHS received standardized CPAP therapy for 6 months. Olfactory function, including threshold, discrimination, identification, and the total threshold-discrimination-identification(TDI)score, was assessed using the Sniffin' Sticks test at baseline, 3 months, and 6 months. Cognitive function was evaluated with the Montreal Cognitive Assessment(MoCA)at the same time points. Pearson correlation analysis was used to assess the relationships between baseline apnea-hypopnea index(AHI)and improvements(Δ)in olfactory and cognitive functions, as well as the correlation between olfactory and cognitive improvements. Results After treatment, the total olfactory score increased from 19.81±2.88 to 26.49±2.56(P<0.05), and the total MoCA score increased from 19.52±2.48 to 22.58±1.87(P<0.05). Olfactory subdomains showed differential recovery trajectories: threshold and identification improved significantly at 3 months(P<0.05), while discrimination improved only at 6 months(P<0.05). Among cognitive subdomains, visuospatial/executive function, attention, and memory showed significant improvement at 3 months(P<0.05). Improvement in olfactory threshold was positively correlated with baseline AHI(r=0.41, P<0.05), and improvement in total olfactory score was positively correlated with improvement in total cognitive score(r=0.46, P<0.05). Subgroup analysis revealed that non-obese patients, those aged ≤50 years, and females exhibited greater olfactory improvement(P<0.05). Conclusion CPAP therapy effectively improves olfactory and cognitive functions in patients with moderate to severe OSAHS, with functional recovery demonstrating temporal differences and population heterogeneity. Olfactory improvement is positively correlated with cognitive improvement.

Clinical application of FEES-based swallowing function assessment in elderly patients with pulmonary infections

XU Juan, CUI Biao, HUANG Jianping, CHEN Yibiao, SHI Jianfei, WANG Yanwen, LIU Zanhua, ZHANG Jianwei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  74-79.  doi:10.6040/j.issn.1673-3770.0.2025.147

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Objective This study aimed to investigate the use of electronic laryngoscopy to assess swallowing function in patients over 60 years of age suspected of dysphagia within the neurology department. The goal was to enable early intervention to prevent long-lasting lung infections and reduce their rates of recurrence and mortality. Methods Seventy elderly subjects hospitalized in the neurology department for neurological disorders were enrolled and divided into two groups: a pneumonia group(n=35)with a history of pulmonary infection and a non-pneumonia group(n=35)without such a history. All participants underwent a simple screening for dysphagia, the Eating Assessment Tool-10(EAT-10)questionnaire, the Water Swallowing Test, and a flexible endoscopic examination of swallowing(FEES). Detection rates of penetration/aspiration in FEES were compared between groups. Scores from all assessments were compared to assess the correlation between pulmonary infection and dysphagia. Furthermore, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of FEES versus the Water Swallowing Test to detect aspiration were compared to assess the reliability of FEES, particularly for diagnosing silent aspiration. Results Statistically significant differences were observed between the pneumonia and non-pneumonia groups with respect to penetration and aspiration detected by FEES. In all assessments, the number of patients with dysphagia identified by all assessments was significantly higher in the pneumonia group compared to the non-pneumonia group. FEES significantly increased the detection rate of silent aspiration. Conclusion FEES using a laryngoscope is of leading importance for preventing and treating pulmonary infections in elderly neurology patients with silent aspiration.

The effect of local micro-pressure oxygen on the repair and oxidative stress of rabbit corneal epithelial cells after injury

WANG Zhiyuan, HAO Zhongkai, ZHANG Chenming

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  80-86.  doi:10.6040/j.issn.1673-3770.0.2025.278

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Objective To investigate the impact of topical microbaric oxygen therapy on corneal epithelial wound healing and ultrastructural alterations in rabbits, and to elucidate its modulatory effects on corneal oxidative stress levels. Methods A total of 75 healthy adult New Zealand White rabbits(150 eyes)were enrolled to establish a corneal epithelial defect model. Animals were randomly assigned to three groups(n=25 rabbits/50 eyes each). Group A received topical microbaric oxygen therapy for 2h daily; Group B received normobaric oxygen at identical flow and concentration for the same duration; Group C was left to heal spontaneously. Corneal epithelial ultrastructure was evaluated by transmission electron microscopy. Residual epithelial defects were planimetrically quantified with Image-J software. Corneal oxidative stress was assessed by measuring malondialdehyde concentration via enzyme-linked immunosorbent assay. Results At 12, 24, and 36 h post-injury, a significant interaction between group and time was detected for the residual corneal epithelial defect area(F_time=839,828.012, P<0.001; F_group=38,866.823, P<0.001; F_time*group=7,338.970, P<0.001); the defect consistently ranked A<B<C across all intervals. Transmission electron microscopy at 36h revealed better-preserved ultrastructural integrity of corneal epithelial cells in group A relative to groups B and C. In contrast, no significant group-time interaction or inter-group differences were observed for malondialdehyde concentration at any time point(F_group=0.172, P=0.843; F_time*group=1.572, P=0.226). Conclusion Topical microbaric oxygen therapy significantly accelerates corneal epithelial wound closure without inducing a measurable increase in corneal oxidative stress.

Comparison of subjective refraction results between monocular fogging and binocular simultaneous fogging

ZHOU Guimei, GUAN Qi, YANG Rong, DAN Yang, LI Jianhong, LIU Peng, XIONG Xinying, LI Xue, TAN Yunqi, LIAO Xuan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  87-91.  doi:10.6040/j.issn.1673-3770.0.2024.404

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Objective To compare the clinical agreement of subjective refraction results obtained with “monocular fogging” versus “binocular simultaneous fogging”, thereby providing evidence for selecting the fogging method in clinical practice. Methods In this diagnostic test study, 62 volunteers aged 17-23 years from North Sichuan Medical College were enrolled in November 2023 and randomly assigned to two groups. Each participant underwent both “monocular fogging” and “binocular simultaneous fogging” subjective refraction, with a baseline non-fogging subjective refraction performed on the right eye before testing as control. Differences in spherical power, cylindrical power, and astigmatic vector components J0 and J45 between the two fogging methods were compared. Agreement was assessed using the intraclass correlation coefficient(ICC)and Bland-Altman plots. Results No statistically significant differences were found in spherical power, cylindrical power, J0, or J45 between the two fogging methods(P>0.05). Compared with non-fogging refraction, both fogging methods yielded lower spherical powers(P<0.01). The ICCs for spherical power and cylindrical power between the two fogging methods were 0.99 and 0.95, indicating excellent agreement, while those for J0 and J45 were 0.36 and 0.15, indicating poor agreement. Conclusion “Monocular fogging” and “binocular simultaneous fogging” show excellent agreement and interchangeability for spherical and cylindrical power measurements in subjective refraction. Given the higher efficiency, “binocular simultaneous fogging” is recommended for clinical priority.

Runmu ling formula ameliorates ocular surface damage in dry eye rats by activating the LC3-ATG5 autophagy pathway and inhibiting inflammatory factor expression

LI Kai, LUO Dan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  92-101.  doi:10.6040/j.issn.1673-3770.0.2025.217

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Objective The objective of this study is to investigate the mechanism by which Runmu Ling Formula(RML)ameliorates ocular surface damage in rats with dry eye through activation of the LC3-ATG5 autophagy pathway and inhibition of inflammatory factor expression. Methods A dry eye model was established via subcutaneous injection of scopolamine hydrobromide. A total of 60 Sprague-Dawley(SD)rats were randomly assigned to six groups,with ten rats per group: a blank control group, a model group, an RML-treated group, an autophagy activator group, an autophagy inhibitor group, and an RML combined with autophagy inhibitor group. The ocular surface function of the subjects was assessed using a variety of methods, including corneal fluorescein staining(CFS)scores, tear break-up time(TBUT), and the phenol red thread test(PRTT). The corneas were subjected to a comprehensive evaluation that entailed the application of hematoxylin-eosin(HE)staining and transmission electron microscopy. RT-qPCR and Western blotting were employed to measure the expression of autophagy-related markers(LC3, ATG5, P62)and inflammatory factors(IL-1β, IL-18, TNF-α). Results In comparison with the blank control group, the model group demonstrated a significant reduction in TBUT(P<0.001), elevated CFS scores(P<0.001), diminished PRTT values(P<0.001), and augmented vacuolation of corneal epithelial cells. RML intervention led to a significant restoration of ocular surface homeostasis, as evidenced by substantial improvements in TBUT, CFS, and PRTT(all P<0.05). The transmission electronmicroscopy revealed an increase in the formation of autophagosomesin the RML group compared to the model group. Mechanistically, RML significantly activated the LC3-ATG5 autophagy pathway, as evidenced by increased LC3-II/LC3-I ratios(P<0.05)and elevated ATG5 expression(P<0.05). Concurrently, RML potently suppressed the expression of inflammatory factors TNF-α, IL-1β, and IL-18(all P<0.05). Conclusion The efficacy of Runmu Ling Formula in alleviating ocular surface inflammation and injury in rats with dry eye has been demonstrated by its ability to activate the LC3-ATG5 autophagy pathway and inhibit the expression of key inflammatory factors, including TNF-α, IL-1β, and IL-18.

Refractive status of school-aged children aged 6-9 years in Yangpu District, Shanghai, 2022-2024: a cohort study

ZHU Xiqian, WANG Jia, SUN Zuxian, FENG Jianxiu, ZHANG Mengjia, ZHAO Ying, WANG Hong, JIANG Minmin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  102-109.  doi:10.6040/j.issn.1673-3770.0.2025.291

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Objective To investigate the characteristics of refractive status changes and analyze the influencing factors of new-onset myopia among school-aged children aged 6-9 years in Yangpu District, Shanghai from 2022 to 2024, so as to provide scientific evidence for precise prevention and control of myopia by relevant government departments. Methods One primary school was randomly selected from each of the northern, central and southern areas of Yangpu District, Shanghai. All students in grades 1 to 3 from these three primary schools in September 2022 were enrolled as study subjects. Refractive examination data from 2022 to 2024 were collected, including uncorrected distance visual acuity test, non-cycloplegic autorefraction and axial length(AL)measurement. Normality of numerical data was tested by Kolmogorov-Smirnov method. Categorical data were described by frequencies, and comparisons between groups were performed using χ2 test. Generalized estimating equation was used to analyze differences between groups in repeated measurement data and factors influencing new-onset myopia. Results There were statistically significant differences in spherical equivalent(SE)and AL among different follow-up periods and baseline age groups(P<0.05). The detection rates of hyperopia, pre-myopia and myopia among different age groups at different periods showed statistically significant differences(P<0.05). Girls(OR=1.608, 95%CI: 1.218-2.124), pre-myopia(OR=4.447, 95%CI: 2.513-7.871)and baseline axial length(OR=1.505, 95%CI: 1.225-1.850)were independent risk factors for new-onset myopia(P<0.01). Conclusion The myopia rate among school-aged children aged 6-9 years in Yangpu District, Shanghai is relatively high, with insufficient hyperopia reserve being a prominent issue. The prevention and control checkpoint should be moved forward, refractive monitoring in preschool children should be strengthened, and active interventions should be implemented for children with pre-myopia.

Review

Multiple mechanisms and clinical warning signs of deafness caused by hepatitis B virus

WANG Menghui, LI Ao, WEI Hao, JIANG Yue, WU Xingguang, LI Luxi, QIAN Xiaoyun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  110-114.  doi:10.6040/j.issn.1673-3770.0.2025.250

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Hepatitis B virus infection is a global public health concern. The impact of the virus is not limited to the liver, but can affect other systems too. However, the mechanisms and clinical features of auditory system damage have not been systematically clarified. Through evidence-based integration, this study found that the incidence of sensorineural hearing loss in patients with chronic hepatitis B is significantly higher than that in hepatitis B virus carriers, and potential mechanisms were revealed. Meanwhile, it is proposed that sudden sensorineural hearing loss may be a warning sign of acute exacerbation of chronic hepatitis B. This study provides an evidence-based basis for audiological monitoring of HBV-infected individuals. It is recommended that audiological assessment should be included in the management pathway for hepatitis B-infected individuals, and the development of ear-protective antiviral drugs should be promoted.

Advances in the application of artificial intelligence to dry eye disease management

YANG Guanying, LI Yuanbin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2026, 40(3):  115-120.  doi:10.6040/j.issn.1673-3770.0.2025.334

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Artificial intelligence(AI)mimics human cognitive processes to facilitate data analysis and support decision-making. Dry eye disease(DED)is a common chronic disorder of the ocular surface, and conventional diagnosis and treatment rely on manual judgement, which is often subjective, unreliable, and inefficient. However, recent advances in image recognition, deep learning and multimodal data fusion have expanded the role of Al in medicine. This offers new approaches for the early screening, accurate diagnosis and personalised treatment of DED, as well as its long-term follow-up.This technology-focused review summarises recent advances in AI across all stages of DED clinical management. It analyses current technical limitations and implementation challenges, and highlights the value of Al in enhancing diagnostic objectivity, optimising individualised therapeutic strategies, and establishing intelligent monitoring systems. It also discusses future directions in Al-assisted DED management to guide the intelligent transformation of DED care and promote the practice of precision medicine.