第二十届美国听力学年会报道(Ⅰ)——聆听永远 健康常驻

2008年4月2～5日,美国听力学年会在美国北卡罗莱纳州的夏洛特市召开。2008年恰逢美国听力学学会创建20周年,从最初32名听力学家倡导建会到现     

儿童变应性鼻炎舌下特异性免疫治疗的近期疗效观察

目的　观察舌下特异性免疫治疗（sublingual immunotherapy,SLIT）应用于治疗儿童变应性鼻炎的近期临床疗效。方法　采用前后自身对照,比较44例3～13岁尘螨过敏的变应性鼻炎患者治疗前及治疗3、6个月的症状评分、药物评分、视觉模拟量表（visual analogue scale,VAS）评分及血液嗜酸性粒细胞（eosinophil,Eos）水平,评价SLIT的近期临床疗效。结果　SLIT治疗3个月和6个月后,患者的鼻部症状评分、药物评分及VAS评分较治疗前显著下降,差异有统计学意义（P 均<0.05）;SLIT治疗3个月 与治疗6个月相比,患者鼻塞、流涕、喷嚏症状评分,鼻部总症状评分、药物评分及VAS评分相似,差异无统计学意义（P 均>0.05）,而鼻痒症状评分差异具统计学意义 （Z =-4.185,P <0.05）;SLIT治疗6个月与治疗前相比,血液Eos水平显著下降,差异具有统计学意义（Z=-4.544,P<0.05）。结论　舌下含服标准化粉尘螨滴剂是治疗尘螨变应性鼻炎儿童患者的一种安全有效的治疗方法,可在治疗3个月左右观察到疗效,SLIT治疗6个月后患者Eos百分比显著降低。     

Speech perception in noise: Masking and unmasking

Speech perception is essential for daily communication.Background noise or concurrent talkers,on the other hand,can make it challenging for listeners to track the target speech(i.e.,cocktail party problem).The present study reviews and compares existing findings on speech perception and unmasking in cocktail party listening environments in English and Mandarin Chinese.The review starts with an introduction section followed by related concepts of auditory masking.The next two sections review factors that release speech perception from masking in English and Mandarin Chinese,respectively.The last section presents an overall summary of the findings with comparisons between the two languages.Future research directions with respect to the difference in literature on the reviewed topic between the two languages are also discussed.     

北京地区中小学生常见吸入性变应原的调查分析

目的　了解北京地区中小学生中常见吸入性变应原的种类分布情况。方法　在北京地区参加调查的学生中,对其中1280名学生进行皮肤点刺试验,495名变应原阳性。结果　北京地区中小学生中有49.3%的人对4种及4种以上变应原呈阳性反应,对常年组和夏秋季花粉变应原均呈阳性的最为常见（37.4%）;城区中常见的前3位变应原为粉尘螨、屋尘螨、大籽嵩花粉;郊区为粉尘螨、柳树、大籽嵩花粉;按性别及年龄分组中,粉尘螨、屋尘螨、大籽嵩花粉为最常见的三类变应原,随年龄增长,阳性率降低。结论螨虫及夏秋季花粉是北京地区中小学生中最重要的变应原。     

"肾虚"对老龄豚鼠听觉功能影响的实验研究

目的研究“肾虚”对老龄豚鼠听觉器官形态及功能的影响。方法29只26月龄豚鼠，经ABR检测分为听阈异常的耳聋组和听阈正常的正常老龄组。正常老龄组又随机分为老龄组和造模组。造模组豚鼠制备“肾虚”模型。另取3月龄豚鼠8只作为正常对照组。比较各组豚鼠ABR反应阈、各波潜伏期以及耳蜗外毛细胞数量及“肾虚”相关指标差异，分析老龄豚鼠听功能变化与“肾虚”之间的关系。结果反映“肾虚”状态的各项检测值及“肾虚”总评分显示，造模组的“肾虚”最重，耳聋组其次，老龄组与3月龄组豚鼠在“肾虚”程度上差异无统计学意义。造模组听阈明显提高，ABR各波潜伏期延长，外毛细胞缺失明显（P〈0.01）。结论豚鼠在衰老过程中发生的听觉功能退化与“肾虚”状态有一定的相关性，“肾虚”状态加重时，听觉功能的退化也呈现相应的趋势。     

过敏性疾病免疫治疗国际共识（2015）解读

自2 0 世纪初期特异性过敏原免疫治疗（allergen-specific immunotherapy,ASIT）就已被用来治疗过敏性疾病。尽管大量的临床试验和Meta分析证明ASIT的有效性,但是ASIT仍然得不到广泛的应用。ASIT是唯一能够改变过敏性疾病自然病程的治疗措施,表现在能够预防哮喘的发生和新的过敏原致敏以及诱导机体对特异性过敏原的免疫耐受。因此,制定一个详细广泛的ASIT共识是非常重要的。本文通过对ASIT国际共识的解读,为临床医师采用免疫治疗过敏性疾病提供帮助。     

中耳炎基础及临床研究诊治新进展国家继续教育项目通知

西安交通大学医学院第二附属医院(西北医院)耳鼻咽喉科头颈外科病院、陕西省康复学会听力康复委员会及西安交通大学医学院人体解剖与组织胚胎学系联合主办的第十期国家级继续医学教育项目中耳炎基础及临床研究诊治新进展[No:2011-07-01-114(国)]将于2011年7月26～31日在西安市举办。学习班     

Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases

Introduction:Majority of petrous bone and lateral skull base pathologies are benign in nature.The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary:Two cases of petrous bone cholesteatoma(1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma)and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach.The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches.The mean operative time was approximately 140 min.No CSF otorrhoea was noticed in the post-operative period.The average period of hospital stay was 3.7 days.Conclusion:In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach.It decreases operative time,blood loss,chance of meningitis,morbidity and hospital stay.The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery.This approach can create direct access to cochlea/petrous apex/internal auditory canal(IAC)/Supra-geniculate ganglion region.     

小儿人工耳蜗植入术后调试结果的变化特点

目的 探讨人工耳蜗植入小儿开机一个月调试结果 的变化特点,为其编程调试提供指导和依据.方法 受试对象为使用澳大利亚Cochlear Nucleus 24型人工耳蜗系统的31例儿童.术后一个月起行系列的人工耳蜗编程调试,在调试中运用小儿行为测听法获得阈值(threshold level,TL)、舒适阈(comfortable level,CL)等参数,并将开机及开机后一个月所获得的数据进行比较分析.结果 开机与开机一个月时相比,TL降低而CL升高,其中高频段电极通道的TL下降幅度较低频段电极通道更大,而低频段电极通道的CL增高幅度较高频段大(P＜0.001).各次调试获得的TL及CL结果 均显示高频段通道的电流水平高而低频段通道的电流水平低(P＜0.001).开机时低频段动态范围(dynamic ranges,DR)最大,而开机一个月后高频段DR最大(P＜0.001).开机一个月后高、中、低3个频段电极通道的DR均较开机时大,其中高频段的DR改变较低频段更明显(P＜0.001).结论 人工耳蜗植入小儿开机后的一个月期间,其编程调试结果 变化显著,有必要对患儿进行多次调试.     

Expression of COX-2 and transcription factor CCAAT enhancer binding proteinβin refractory sinusitis with nasal polyps and its significance

Objective To study the expression and significance of COX-2 and C/EBP-βin refractory sinusitis with nasal polyps,and to explore the relationship between them and the recurrence of sinusitis with nasal polyps.Methods The protein expression of COX-2 and C/EBP-βin 20 cases of refractory sinusitis with nasal polyps,20 cases of sinusitis with nasal polyps and 20 cases of normal nasal mucosa were detected by western blot,and the relationship between the two was compared.Results The expression levels of COX-2 and C/EBP-βin refractory sinusitis with nasal polyps were significantly different from those in refractory sinusitis with nasal polyps(P<0.05);The expression levels of COX-2 and C/EBP-βin sinusitis tissues with nasal polyps were significantly different from those in normal nasal mucosa tissues(P<0.05);The expression levels of COX-2 and C/EBP-βin each group were significantly correlated(P<0.05).Conclusions The high expression of COX-2 and C/EBP-βmay be closely related to postoperative recurrence of sinusitis patients with nasal polyps.Both may be used as objective indicators to judge the postoperative follow-up and recurrence tendency of patients with sinusitis with nasal polyps..     

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.     

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。     

Experimental Analysis of Behavior of Homing Pigeons as a Result of Functional Disorders of their Lagena

Behavioral experiments concerning the homing abilities of pigeons were done by sectioning their lagenal nerves or interfering with the function of the lagena using a magnet. Twenty-one birds were treated in this way and 30 birds from the same loft of racing pigeons were used as controls. The results of homing tests clearly revealed a magnetic influence on the function of the lagena in terms of the navigation ability of pigeons: the treated birds were either lost or significantly delayed while the controls returned within 30 min of release. The lagena of birds is a unique organ and it is concluded that it is a key element in the magnetic sensory system of birds.     

鼻窦骨瘤手术进路的选择

目的:探讨鼻窦骨瘤手术进路的选择,分析各种手术的方法和特点。方法:31例患者中鼻 侧切开术14例,其中经典鼻侧切开术3例,扩大鼻侧切开术6例,单纯眉弓切口手术5例;鼻内镜下手术8例;冠 状切口颅骨切开术8例;Caldwell Luc进路手术1例。肿瘤彻底切除26例,部分切除2例。结果:术中出现脑脊 液鼻漏2例,均修补成功;术后出现球后出血,导致右眼失明1例。31例患者中随访28例,失访3例,平均随访时 间3.7年。彻底切除肿瘤的26例均无复发;部分切除肿瘤的2例带瘤生存。结论:鼻窦骨瘤手术进路的选择主要 依据骨瘤的位置、大小及鼻窦局部解剖特点以及有无重要神经、血管的侵犯等,也要考虑器官结构的功能、美容及 术者的经验和技术。     

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。     

咽喉反流与发声障碍的相关性研究

目的:探讨咽喉反流的嗓音学特征及其对患者生活质量的影响,分析主客观评估方法的相关性。方法:对196例可疑有咽喉反流的患者行一般情况调查、电子鼻咽喉镜检查、反流症状指数量表(RSI)和反流检查计分量表(RFS)评估,将其中RSI评分>13分、RFS评分>7分定为阳性。将2个量表评分均为阳性的100例患者作为研究对象,进一步进行嗓音障碍指数量表(VHI)评估、嗓音声学分析及电声门图检查,并与健康对照组比较。结果:男女基频均比健康对照组降低,基频微扰、振幅微扰及标准化噪声能量增高,接触率降低,最大发声时间缩短,与健康对照组比较,差异均有统计学意义(均P<0.01)。VHI量表评估生理P评分最高,其次为功能F评分,情感E评分最低。咽喉反流患者的RSI与VHI有一定相关性(P<0.05),而RFS与RSI、VHI无明显相关性(P>0.05)。咽喉反流患者的嗓音障碍指数评估示生理、功能和情感之间明显相关。结论:嗓音声学分析及电声门图检测从客观上提示咽喉反流相关的嗓音障碍疾病严重影响了喉的发声功能,使基频下降、声带振动不稳定、声门闭合不良及声门接触时间缩短。主客观评估方法的相关性结果提示具有明显咽喉反流症状的患者并不一定具有明显的咽喉反流体征。