以耳鸣耳聋为主要症状的自发性颈内动脉海绵窦瘘1例

病人，女，74岁，于2002年6月20日来诊。主诉：右耳听力下降伴搏动性耳鸣1个月，耳鸣呈低调，与心脏搏动一致。该病人1个月前无明显诱因出现右耳鸣，而后出现右耳听力下降，否认外伤史，未予任何治疗。检查：双耳鼓膜外观正常，标志清楚。双侧眼眶周围及面部听诊可闻及血管杂音；按压右侧颈总动脉，耳鸣消失，听诊双侧眼眶周围及面     

引起蓝鼓膜表现的特殊病例报告

病例1男,74岁。右耳进行性听力下降伴耳鸣2年,流脓血2月,于1998年3月3日入院。入院前2年,患者无明显诱因出现右耳堵,进行性听力下降伴博动性耳鸣。2个月前突发右耳剧痛,流出脓血性分泌物后疼痛缓解。以后右耳间断性流脓。无眩晕及其它颅神经受累的症状。入院前1个月就诊时检查发现,右耳鼓膜呈深蓝色,光泽度下降并向外膨隆,鼓膜前下方有一小裂隙,有少许脓血性分泌物。鼻及鼻咽部未见明显异常。纯音测听右耳为混合性聋,骨气导差距约40dB。X线检查示右侧乳突密度增高。CT扫描示右耳中、上鼓室及鼓窦处有软组织影,未见骨质破坏。…     

以突聋为首发症状的小脑扁桃体下疝畸形1例

1 临床资料 男,52岁,于2002年6月26日来诊。主诉:右耳突然听力下降伴阵发性耳鸣半个月。该患者半月前无明显诱因右耳听力突然下降伴耳鸣,耳鸣呈持续高音调,时有眩晕,无头痛,曾在当地医院静脉滴注能量合剂10天,疗效不显。检查:双耳鼓膜外观正常,标志清楚。自发性眼震(+),水平性,无明显快慢相。四肢肌力V级,生理反射存在,病理反射未引出。电测听示:右耳感音神经性聋曲线(平均听力58dB),左耳听力正常。入院诊断:①右耳突发性聋;②听神经瘤?脑CT示:脑积水(图1)。进一步明确引起脑积水形成的原因,检查MRI示:环枕发育畸     

后天原发性胆脂瘤2例

例1,男,25岁。右耳听力下降、耳闷4月。发病前有急性上呼吸道感染史,伴低音调耳鸣,无回吸涕血、鼻塞、耳痛、头痛等症状。按“卡他性中耳炎”治疗,行右咽鼓管吹张,鼓膜穿刺抽液,均无效。2个月前右耳开始有分泌物,呈黏性。患者l0年前右耳曾不适,流血,无流脓史。查体见双鼓膜内陷,右侧充血明显,松弛部有针尖样穿孔。cT示右耳慢性中耳乳突炎,上鼓室、鼓窦区软组织灶。电测听示右耳混合性聋,声阻抗示鼓室轻度负压。术中见乳突硬化型,鼓窦-鼓窦入口-上鼓室肉芽,砧骨豆状突缺失,鼓膜紧张部完整,Pmssak隐窝胆脂瘤囊袋。例2,女,40岁。右耳听力下降1年余,伴耳闷胀感收入院。患者7年前开始有低音调耳鸣,无流脓史。查体见右鼓膜紧张部内陷,呈蓝紫色,松弛部膨隆。外耳道后上壁略下塌。CT示右中上鼓室软组织灶,电测听示右耳混合性聋。术中见乳突气化较好,上鼓室充满胆脂瘤上皮,砧骨长突缺失,鼓膜完整。中鼓室黏膜完整,未见胆固醇肉芽肿,下鼓室蓝色物疑为高位颈静脉球。     

鼻腔鼻窦腺样囊性癌

1临床资料 患者,男,40岁,因右耳听力下降11个月,加重伴颞部疼痛6个月、复视3个月为主诉入院。患者11个月前因劳累、受凉出现右耳听力下降,于当地医院诊为右耳感音神经性聋给予静脉抗炎、针灸等治疗,无明显好转,8个月前无明显诱因出现右侧口唇麻木,渐伴右侧牙、舌体、面颈部麻木,上述症状逐渐加重,并于6个月前出现右颞部疼痛,向右侧面颊部放射,发作间隔20～30天不等,持续3～4小时,     

内淋巴囊低度恶性腺癌一例

患者男,68岁.因右侧面神经麻痹、听力下降20年,右耳流血水、搏动性耳鸣半年,于2006年1月8日入院.查体见右鼻唇沟变浅,右侧额纹消失,右侧上下睑不能闭合,鼓腮漏气;右耳道内可见红色新生物,搏动,触之易出血.纯音测听示右耳各频率平均听阈(听力级)90 dB以上.     

血管压迫前庭蜗神经引起搏动性耳鸣一例报道

患者女,37岁,汉族,因“双耳搏动性耳鸣以左侧为主伴左耳听力逐渐下降3年,右耳听力逐渐下降1年,自觉听声音大,耳堵,咀嚼时听力尤不好,平躺时听力差”,2008年7月15日于我院听力专科门诊就诊。双耳耳鸣节律与脉搏一致,有韦氏误听;无头痛、走路不稳、视物模糊、恶心、呕吐。患者既往无心血管系统疾病史。     

中耳恶性黑色素瘤一例

恶性黑色素瘤是一种能产生黑色素的高度恶性肿瘤,好发于皮肤,粘膜少见,原发于中耳粘膜罕见。现报道如下。患者男,７２岁。因搏动性右耳鸣２年,伴间歇性血性耳漏２个月,于１９９８年３月３日收入院。患者２年前不明原因出现右耳搏动性耳鸣,不伴耳痛、流脓,无耳聋及...     

双侧主动脉体并单侧颈静脉球副神经节瘤一例

患者女，43岁。因右耳搏动性耳鸣伴听力下降12年，左颈肿块8个月于2006年1月8日入院，无心悸，气促等不适症状。无家族史，入院检查：神志清楚，血压130/85mmHg（1mmHg=0.133kPa），心率90次/min，心律不齐；右侧鼓膜向外膨胀，鼓室内樱桃红肿物影，     

鼓膜血管瘤一例

患者,女,32岁,因右耳听力下降3年,于2005年12月10日就诊。患者自3年前开始右耳听力呈渐进性下降,无耳鸣、眩晕、流脓史,双眼视物正常。查体:一般情况良好,心肺、腹部、四肢正常,右外耳道无分泌物,右鼓膜上半部有一园形隆起,面积约1.5cm×1.5cm,基底广,无蒂。在显微镜下肿物呈紫     

耳廓开放性外伤的治疗方法探析

目的 探讨耳廓开放性外伤的治疗方法。方法 23耳耳廓开放性外伤经彻底清创，肝素生理盐水冲洗伤口后，对位缝合。术后用抗生素抗感染、丹参扩张血管、罂粟碱改善微循环。结果 23耳中2耳失访，18耳完全成活，1耳部分成活，2耳完全坏死。结论 耳廓撕裂伤、断伤、带有皮蒂的耳廓离断伤，由于断端双侧血管丰富，经对位缝合后容易成活。但耳廓完全离断伤由于缺乏血供，经对位缝合后不易成活，可采用去皮血管植入包埋法，带肌蒂皮瓣移植法或尝试显微外科技术施行血管吻合，以提高耳廓完全离断伤的成活率。     

诊治7例鼻腔嗅神经母细胞瘤的体会

目的：提高临床对鼻腔嗅神经母细胞瘤的认识及治疗效果。方法：７例患者按Ｋａｄｉｓｈ分期，Ｂ期２例，Ｃ期５例，单纯放疗３例，术前放疗４例，放射剂量为５０００￣７０００ｃＧｙ。均随访至１９９７年１２月，结果：存活５例，存活时间分别为２０，２２，２３，２９及７６个月；结论：放疗对该肿瘤有效；放疗与化疗结合的方法值得探讨，该瘤病理上可能存在不同的亚型。     

急性化脓性耳廓软骨膜炎手术疗效分析

目的 探讨能够缩短化脓性耳廓软骨膜炎疗程,降低耳廓畸形发生率且具个体化的局部治疗方法.方法 回顾分析1 989年4月～2010年2月我科诊治的25例化脓性耳廓软骨膜炎的临床资料.除进行抗生素治疗外,局部治疗方法包括清创术后重新行耳甲腔成行术;脓腔穿刺置静脉留置针进行持续负压引流;清创后创腔置管引流.结果 自定义疗效评定...     

Effects of time of contact and concentration of caustic agent on generation of injuries

OBJECTIVES: Solid caustic soda (CS) ingestion levels continue high in Brazil. The aggressiveness of a caustic agent depends, among other factors, on its concentration and time of contact with mucosa. However, the interdependence of these factors in the production of caustic lesion in the esophageal mucosa is not known, especially regarding CS as the strongest corrosive agent. We analyze the effects of concentration and time of contact on the aggressiveness of CS to the esophagus of live animals. STUDY DESIGN/METHODS: One milliliter of CS at concentrations between 1.83% and 73.33% was applied to rats. The solution was kept in contact with the mucosa for 10 to 120 minutes. Internal and external organ aspects were analyzed and the epithelium, submucosa, muscle layer, and adventitia were analyzed microscopically RESULTS: Epithelial necrosis was observed at all concentrations. Among the necrotic layers, the submucosa was observed starting at the 7.33% concentration, and the muscular layer and adventitia were observed at 14.66% concentration. Damage to the pulmonary parenchyma and trachea occurred at 33.66% after 10 minutes, and perforation of the esophagus was observed only after 120 minutes. After 10 minutes, important corrosive lesions installed in the esophageal layers, expanding in depth and superficial extension. The use of heparin had no effect on the production of lesions. CONCLUSIONS: Ten minutes were sufficient to provoke necrosis, and longer contact increased the area of necrosis. Solution concentration levels were more important in damage production: 1.83% was sufficient for epithelial necrosis, 7.33% caused submucosal necrosis, and 14.66% muscle and adventitia necrosis; 33.66% solutions caused lung and trachea damage after 10 minutes and esophageal perforation after 120 minutes.     

Scales of degree of facial paralysis: analysis of agreement

IntroductionIt has become common to use scales to measure the degree of involvement of facial paralysis in phonoaudiological clinics.ObjectiveTo analyze the inter- and intra-rater agreement of the scales of degree of facial paralysis and to elicit point of view of the appraisers regarding their use.MethodsCross-sectional observational clinical study of the Chevalier and House & Brackmann scales performed by five speech therapists with clinical experience, who analyzed the facial expression of 30 adult subjects with impaired facial movements two times, with a one week interval between evaluations. The kappa analysis was employed.ResultsThere was excellent inter-rater agreement for both scales (kappa > 0.80), and on the Chevalier scale a substantial intra-rater agreement in the first assessment (kappa = 0.792) and an excellent agreement in the second assessment (kappa = 0.928). The House & Brackmann scale showed excellent agreement at both assessments (kappa = 0.850 and 0.857). As for the appraisers’ point of view, one appraiser thought prior training is necessary for the Chevalier scale and, four appraisers felt that training is important for the House & Brackmann scale.ConclusionBoth scales have good inter- and intra-rater agreement and most of the appraisers agree on the ease and relevance of the application of these scales.     

术前使用布地奈德对声带息肉手术疗效的影响

目的 研究术前使用布地奈德雾化吸入治疗对手术疗效的影响。方法 按病程将3个月以内和1年以上患者随机分为两组,一组术前给予布地奈德雾化治疗,一组没有,术后两周复诊。分别于初诊、手术前和复诊时使用嗓音测试仪对病人进行测试并记录参数。结果 病程3个月以内患者术前给予雾化治疗后,其术后声学参数明显改善。结论 病程3个月以内患者术前给予雾化治疗能缩短术后恢复时间。     

A national audit of sinus surgery. Results of the Royal College of Surgeons of England comparative audit of ENT surgery

The results of a national audit of sinus surgery are presented. Forty-six consultant ENT surgeons reported on over 2500 sinus procedures. There has been an exponential rise in the number of surgeons in England and Wales performing functional endoscopic sinus surgery (FESS) in recent years. Sixty-five per cent of surgeons in our study used the FESS technique and 81% had formal or other training. Outpatient sinus endoscopy and CT scans have become more routine pre-operative investigations, whilst the use of plain films has waned. There was a wide variation in the numbers of FESS procedures performed by individual surgeons in the 6-month period (between 5 and 85). The overall complication rate was 0.75% for conventional surgery and 1.41% for functional surgery but no major complications were recorded. The primary symptom of blockage was most successfully treated by both conventional and functional surgery (70% and 84% asymptomatic or improved at 6 months). Pain was relieved in 75% of functional procedures and 47% of conventional procedures and discharge relieved in 76% of FESS procedures and 47% of conventional procedures.     

磷霉素在减轻卡那霉素耳中毒过程中的作用

本文采用磷霉素笔卡那霉素联合应用，经扫描电镜、透射电镜、耳蜗铺片和组织化学反应观察，了解磷霉素减轻卡那霉素耳毒性的机制以及卡那霉素所致耳毒性的发展过程。通过实验可以看到磷霉素有保护溶酶体膜的作用，所以能减轻卡那霉素的耳毒性，但由于它不能直接对抗AmAn耳毒性作用机制，因而不能完全预防其耳毒性。     

CT对鼻腔鼻窦内翻性乳头状瘤起源的探讨

目的 探讨鼻腔鼻窦内翻性乳头状瘤起源的CT影像学特点。 方法 回顾性分析47例经鼻内镜手术及术后病理组织学确诊的鼻腔鼻窦内翻性乳头状瘤患者的CT影像学资料。对肿瘤病变在CT上的骨质变化进行分析,并与术中发现的肿瘤起源根蒂部位进行对比,分析CT影像中骨质改变与肿瘤起源之间的关系。 结果 47例患者中,39例有骨质增生影像表现,其中37例骨质增生部位与肿瘤起源的根蒂部位一致,一致性达78.7%,提示可根据骨质增生部位推测肿瘤起源位置。 结论 CT影像中的骨质增生与鼻腔鼻窦内翻性乳头状瘤的根蒂起源部位有较高的一致性,有助于术前评估肿瘤起源和指导术前制定合理的手术方案。     

慢性鼻窦炎病原学变迁的研究

目的:了解慢性鼻窦炎病原学分布的变迁。方法:术中收集2010年全年111例(实验组)上颌窦或筛窦脓性分泌物,分别进行需氧菌和真菌培养,同时以30例健康受试者作为对照组,其培养结果与2005年的各种数据比较,分析病原微生物的分布变化。结果:实验组共培养出15种病原微生物,主要为肺炎克雷伯菌、甲型链球菌、鲍曼不动杆菌、表皮葡萄球菌、铜绿假单胞菌、白色念珠菌等;需氧菌和真菌培养阳性率为81.8%,其中革兰阳性菌37.8%,革兰阴性菌54.4%,各种真菌7.8%;对照组检测出表皮葡萄球菌、流感嗜血杆菌、甲型链球菌、卡他布兰汉菌和金黄色葡萄球菌5种细菌,与实验组比较差异有统计学意义(χ2=0.009,P<0.01);与2005年数据(革兰阳性菌56.3%,革兰阴性菌43.7%,真菌阳性率1.4%)比较,其分布特征有明显差异。结论:细菌感染是慢性鼻窦炎的重要原因之一;细菌分布结构从原来的革兰阳性菌变成现在的以革兰阴性菌为主,真菌感染也不容忽视。应用抗生素治疗宜先进行细菌培养与药敏试验。