听性稳态反应和短声诱发的听性脑干反应在客观听阈评估中的作用

目的探讨听性稳态反应(auditory steady-state responses,ASSR)和短声诱发听性脑干反应(ABR)在感音神经性聋人群客观听阈评估中的作用及其在耳聋鉴定中的价值。方法对感音神经性聋组(35耳)及正常组(22耳)分别进行纯音听阈、ABR及ASSR测试,并记录0.5、1、2及4kHz ASSR反应阈(dBHL)、纯音听阈(dBHL)及ABR反应阈(dBnHL)。结果正常组在0.5、1、2、4kHz的ASSR反应阈与纯音听阈相比差异无统计学意义(P>0.05),ABR反应阈与各频率纯音听阈差异有显著统计学意义(P<0.05);耳聋组各频率ASSR反应阈与纯音听阈差异无统计学意义(P>0.05),ABR反应阈与0.5kHz纯音听阈差异有统计学意义(P<0.05),与1、2、4kHz纯音听阈差异无统计学意义(P>0.05)。结论ASSR与ABR联合测试是临床工作中用于客观听阈评估的有效方法。     

周围听功能障碍与认知障碍程度的相关性研究

目的探讨周围性听功能障碍程度与认知障碍程度之间的关系。方法利用临床痴呆量表(clinicdementiarating, CDR)检测轻度认知障碍(mildcognitiveimpairment,MCI)患者24例,轻度老年性痴呆(Alzheimer′sdisease, AD)患者31例,健康老年人50例,评定受试者测听可信度,统计测试结果,并将其得分同受试者的纯音测听、言语测听、声导抗、听觉脑干反应(auditorybrainstemresponse, ABR)结果进行对照分析,寻找二者之间的关系。并进一步将受试者按其听力损失程度分成4级(纯音听阈<25dB为0分, 25~30dB为1分, 31~35dB为2分, >35dB为3分),分别依其CDR得分不同(正常人0分,MCI患者0 5分,轻度AD患者1分),应用Kendalls等级相关法分析。结果受试者2耳间听力差异无统计学意义,以右耳听力结果进行统计,发现MCI组周围听功能检查结果与对照组之间的差异无统计学意义(P>0 05),轻度AD组听力障碍与其他两组相比差异有统计学意义,且发现随着听力损失的加重,轻度AD患者的CDR得分也明显增加(Kendallstaub=-0 285, P=0 018)。而测听可信度、声导抗和ABR阈值两组间差异无统计学意义(P>0 05 )。结论MCI患者与正常老年聋纯音测听、言语测听结果相似,轻度AD患者与MCI及正常对照组相比差异有显著性,受试者听力障碍程度与其CDR量表得分呈正相关(     

听神经病患者的多频听觉稳态反应特点

目的探讨听神经病患者的多频听觉稳态反应阈与纯音听阈之间的关系。方法对26例经纯音测听、声导抗、言语测听、听性脑干反应(ABR)和畸变产物耳声发射(DPOAE)确诊为听神经病的患者，行多频听觉稳态反应检查，并与纯音听阈进行比较。结果26例听神经病患者中多频听觉稳态反应同纯音听阈之间存在有明显的不一致性。多频听觉稳态反应阈较纯音听阈平均高44dB以上。结论多频听觉稳态反应阈同纯音听阈之间明显的不一致性是听神经病的又一项较为显著的听力学检查特征。     

ABR、40Hz-AERP和ASSR与主观纯音听阈测定的相关性研究

目的分析听性脑干反应(ABR)、40 Hz听觉相关电位(40 Hz-AERP)、多频稳态听觉诱发电位(ASSR)电反应阈与纯音测听各频率主观听阈的相关性。方法运用纯音测听、ABR、40 Hz-AERP、ASSR为一组测试组合,对55例(84耳)患者进行检测,分析ABR、40 Hz-AERP(500 Hz、1 kHz)、ASSR(500 Hz、1 kHz、2 kHz、4 kHz)客观电反应阈与纯音测听500 Hz、1 kHz、2k Hz、4 kHz的主观听阈的差值及相关性。结果 ABR与纯音测听2 kHz+4 kHz均值的相关系数最高,为0.829。40 Hz-AERP的500 Hz、1 kHz电反应阈与纯音测听500 Hz、1 kHz听阈的相关系数分别为0.507和0.667。ASSR 500 Hz、1 kHz、2 kHz、4 kHz的电反应阈与纯音相应频率听阈的相关系数分别为0.507、0.715、0.793和0.816。以上相关性均有统计学意义(P0.01)。84耳纯音测听听阈均值为39.8±22.9 dB HL, ABR、ASSR电反应阈均值分别为41.1±18.0 dB nHL和42.4±22.9 dB nHL,40 Hz-AERP/500Hz和1 kHz均值分别为39.5±18.0dB nHL和40.2±19.4 dB nHL。结论 ABR、40 Hz-AERP、ASSR电反应阈与纯音测听各频率主观听阈显著相关,测试结果准确可靠。测试组合可以推断听力曲线的形态,对不能主动配合完成主观测听的婴幼儿及伪聋患者的听力学的辅助诊断非常有价值。     

耳科正常成人短纯音及切迹噪声掩蔽短纯音诱发的ABR比较

目的在耳科正常成人中比较短纯音（tone burst）及同侧切迹噪声（notched noise）掩蔽短纯音诱发的听性脑干反应（ABR）反应阈对纯音听阔的预估;研究短纯音及两种不同强度切迹噪声掩蔽短纯音诱发的ABR（分别命名为tb—ABR、amtb—ABR和bmtb—ABR）的波形特点及差异。方法对20例（40耳）耳科正常人行纯音测听,并记录短纯音ABR和两种不同强度切迹噪声掩蔽短纯音诱发的ABR,对结果进行分析比较。结果①相同频率tb—ABR、amtb—ABR、bmtb—ABR的反应阈接近,无统计学差异。②各频率tb—ABR、amtb—ABR、bmtb—ABR反应阚与相应频率纯音听阈之差的平均值均在15dB以内。在相同频率,三种测试方法所得的反应阈与纯音听阈之差的平均值接近,无统计学差异。③在相同刺激强度,无论采用哪种测试方法,波V潜伏期均随频率升高而缩短。当刺激强度和频率相同时,波V潜伏期均表现为tb-ABR最短,amtb—ABR次之,bmtb—ABR最长,差异具有统计学意义。结论短纯音及同侧切迹噪声掩蔽短纯音诱发的ABR的反应阈均可用于预估纯音听阚。     

游戏测听与听觉诱发脑干反应评估小儿听力

目的 通过对60例3～6岁感音神经性耳聋小儿听性脑干反应(auditory brainstem response,ABR)与小儿游戏测听(play audiometry,PA)测试结果比较,综合评估小儿听力.方法 选择60例3～6岁门诊患儿,均经声导抗测试及耳声发射测试排除传导性耳聋及听神经病,将60例3～6岁小儿120耳分别进行ABR测试.根据ABR测试结果.选择ABR波V反应阈为50～90 dB nHL的小儿30例为A组,ABR最大输出97 dB nHL未引出波V反应阚的小儿30例为B组;之后两组小儿分别进行游戏测听,将两组的ABR反应阈与游戏测听测试结果进行比较.结果 A组ABR的波V反应阈与小儿游戏测听中2 kHz～4 kHz最小听闻相差均无显著差异:B组ABR最大输出97 dB nHL未引出波V的小儿,游戏测听绝大部分均能获得行为听阈.结论 ABR的波V反应阈与小儿行为测听的高频听阈一致性较好;ABR最大输出97 dB nHL未引出波V的不等于无听力.     

老年性痴呆患者的听觉损害

目的　确定老年性痴呆患者 (seniledementiaoftheAlzheimer′sdisease ,AD)有无周围性听功能障碍及其与认知障碍的关系。方法　利用纯音测听、言语识别率、声导抗、听觉脑干反应检测AD患者 43例 ,健康老年人 50例 ,评定受试者测听可信度 ,统计测试结果 ,并将上述结果同受试者简易精神状态量表 (mini mentalscaleofequastionnaire ,MMSE)得分进行对照分析 ,寻找二者之间的关系。结果　受试者两耳间周围听力差异无显著性 ,以右耳听力结果 ( x±s)进行统计。AD组纯音听阈为 (2 6 3± 8 5)dBHL和 (2 9 1± 8 7)dBHL ,言语识别率为 (85 5± 5 5) % ;对照组纯音听阈为 (2 3 2± 1 0 6)dBHL和 (2 6 2± 1 1 8)dBHL ,言语识别率为 (87 6± 6 8) %。虽然AD组周围听功能检查结果低于对照组 ,但无统计学意义 (P >0 0 5)。测听可信度、声导抗和ABR阈值两组间差异无显著性 (P >0 0 5)。结论　老年性痴呆患者纯音听阈和言语识别率与老年聋相似 ,其周围听功能障碍与MMSE认知量表得分无关。     

先天性外耳和中耳畸形患者的听力学分析

目的探讨不同程度的先天性外、中耳畸形患者的听力学表现。方法对55例(双耳15例,单耳40例,共70耳)先天性外、中耳畸形患者行纯音测听、听性脑干反应(ABR)和颞骨CT检查,其中45耳行外耳或中耳成形术,10耳单纯行耳廓成形术,并结合术中所见按不同程度的畸形分组,比较其听力学改变。结果63耳纯音测听显示为传导性聋,骨导听阈正常,70耳ABR反应阈升高,耳廓和听骨链畸形严重者纯音听阈值大于70dB(其中镫骨和卵圆窗畸形严重者纯音听阈大于80dB),与畸形程度较轻者差异有统计学意义(P<0.05)。乳突气化差、外耳道骨性闭锁者纯音听阈值大于70dB(其中外耳道口处无骨性小凹者纯音听阈值大于70dB),较外耳道、乳突发育好者差异有统计学意义(P<0.05)。结论对先天性外、中耳畸形患者术前进行纯音测听、ABR检查,并结合临床和颞骨CT检查,可初步评估外耳、中耳发育程度,进而指导手术治疗。     

感音神经性听力损失成年人短音诱发的听性脑干反应阈研究

目的 研究感音神经性听力损失成年人气导和骨导短音诱发的ABR反应阈与纯音听阈的关系,探讨短音ABR在估计纯音听阈方面的应用价值.方法 对24例(27耳)感音神经性听力损失成年人行耳鼻咽喉科常规体检、纯音测听、声导抗测试后,应用SmartEP听觉诱发电位仪记录受试者气导和骨导短音ABR.结果 感音神经性听力损失成年人短音ABR的反应阈与纯音听阈呈线性相关,气导的线性相关性好于骨导.500、1 000、2 000、4 000 Hz气导的线性相关系数分别为0.80、0.88、0.92、0.85,骨导的线性相关系数分别为0.58、0.49、0.54、0.84.500、1 000、2 000、4 000 Hz短音ABR气骨导反应阈差分别为2.1±10.2、-3.9±10.6、0.9±7.0、3.4±3.3 dB,除4 000 Hz外,各频率气导与骨导短音ABR反应阈差异无显著统计学意义.结论 短音ABR的反应阈可以用于估计纯音听阈.     

阻塞性睡眠呼吸暂停低通气综合征的听觉功能评价

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea—hypopnea syndrome，OSAHS)患者听觉功能有无损伤。方法对19例OSAHS患者及16例正常对照者分别进行纯音测听、声导抗及听性脑干反应(ABR)检测，将两组结果进行统计学分析。结果 纯音听阈及声导抗测试两组无显著性差异；OSAHS患者ABR的波Ⅲ及波V潜伏期延长，两组之间有显著性差异；OSAHS患者．ABR I-Ⅲ和I—V波间期延长，两组之间有非常显著性差异。结论 OSAHS患者长期的夜间反复缺氧会导致听觉功能的损伤，ABR可监测OSAHS患者听觉功能的早期损害。     

A Decrease in Maxillary Sinus Pressure,as Seen in Upper Airway Allergy or Infection,Results in an Increase in Upper Airway Nitric Oxide Levels

The paranasal sinuses are connected to the nasal cavity via small osties. Ostial occlusion, caused by mucosal swelling, will result in a slowly increasing negative pressure inside the sinus cavity. In parallel, the oxygen content in the sinus will decrease, resulting in the development of relative hypoxia. Hypoxia is a powerful inducer of nitric oxide (NO) synthase, and inducible NO synthase has been shown to be present in considerable amounts in the upper airways, including the sinuses. The present study was designed to investigate whether a reduction in sinus pressure would affect upper airway NO production. Thirteen healthy volunteers were investigated. A pressure chamber was used to lower the ambient pressure to-4.9 kPa. NO was sampled from one nostril or via a drainage tube inserted into the maxillary sinus before, during and after the hypobaric exposure. When the pressure was decreased, NO levels increased from 256 &#45 15 to 316 &#45 19 ppb ( n =13, p <0.001). The NO levels remained elevated (282 &#45 21 ppb; p <0.05) when measurements were repeated 20 min after leaving the chamber. The nasal airway resistance (V2 tot ) also increased as a result of the chamber session (from 16 &#45 2° before to 21 &#45 3° after; p <0.05). An increase in NO levels was also found when the experiments were repeated with NO sampled directly from the maxillary sinus (225 &#45 6 before and 265 &#45 9 ppb after; n =6, p <0.001). For control purposes the nasal analyses were repeated again, this time under hyperbaric conditions (+4.9 kPa). This resulted in a slight decrease in the NO levels (from 273 &#45 22 to 241 &#45 17 ppb; n =10, p <0.001), but there was no change in the nasal airway resistance. We conclude that a reduction in sinus pressure, as seen in upper airway allergy or infection, may result in an increase in upper airway NO production.     

One‐stop neck lump clinic: phase 2 of audit. How are we doing?

One‐stop neck lump clinic: phase 2 of audit. How are we doing? Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one‐stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral.     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

A simple objective evaluation and grading for facial paralysis outcomes

Matrix metalloproteinase (MMP)-2 and -9 degrade type IV collagen, which is one of the major components of the basement membrane in normal tissue and expressed in the surroundings of the cancer nest in squamous cell carinoma. The degeneration of type IV collagen is an essential step in the metastasis to lymph nodes and distant organs. In this study, we examined MMP-2 and -9 levels of cancer tissue and serum obtained from patients with head and neck squamous cell carcinoma (HNSCC) in order to evaluate the relationship between the clinicopathologic features and MMPs. We examined the production of MMP-2 and -9 in cancer tissue homogenates of 73 patients who had HNSCC and the serum MMP levels of 16 patients with HNSCC and 8 healthy volunteers. We also studied the localization of MMP-2 in the carcinoma using an immunohistochemical approach. The concentrations of MMP-2 and -9 in the tissue homogenates and serum were measured by means of a sandwich enzyme immunoassay using a monoclonal antibody. Immunohistochemical analyses were performed with monoclonal antibody to MMP-2. The concentration of MMP-2 in the tumor tissue homogenates was unrelated to tumor size, but that in patients with lymph node metastases was significantly higher than in those without lymph node metastases. The concentration of MMP-9 was unrelated to lymph node metastasis and tumor size. The levels of both MMP-2 and -9 in serum were unrelated to lymph node metastasis. Immunohistochemistry indicated that MMP-2 was mainly expressed in cancer cells. Because MMP-2 degrades type IV collagen, the level of MMP-2 in carcinomas may be a useful indicator of the degree of invasion and metastasis.     

A case of cortical deafness and anarthria

The nasal epithelium protects the underlying tissue from damage. Epithelial cell growth is controlled by epidermal growth factor (EGF) and is possibly affected by toxic proteins, e.g. eosinophil cationic protein (ECP). The aims of this study were to examine nasal fluid epithelial cell counts and their relations to EGF, eosinophils and ECP in 23 patients with seasonal allergic rhinitis and 20 healthy controls. Nasal fluid epithelial cell counts were lower in patients than in controls. EGF levels did not differ between patients and controls, and correlated with epithelial cell counts in controls but not in patients. Eosinophils and ECP were higher in patients than in controls, but did not correlate with epithelial cell counts. The role of growth factors, such as EGF, in regulating epithelial cells merits further study.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Bilateral versus unilateral cochlear implantation in young children

Objectives

To compare the preverbal communication skills of two groups of young implanted children: those with unilateral implantation and those with bilateral implantation.

Material and methods

The study assessed 69 children: 42 unilaterally and 27 bilaterally implanted with age at implantation less than 3 years. The preverbal skills of these children were measured before and 1 year after implantation, using Tait Video Analysis that has been found able to predict later speech outcomes in young implanted children.

Results

Before implantation there was no significant difference between the unilateral group and the bilateral group. There was still no difference at 12 months following implantation where vocal autonomy is concerned, but a strongly significant difference between the groups for vocal turn-taking and non-looking vocal turns, the bilateral group outperforming the unilateral group. Regarding gestural turn-taking and gestural autonomy, there was a strongly significant difference between the two groups at the 12 month interval, and also a difference before implantation for gestural autonomy, the unilateral group having the higher scores. Multiple regression of non-looking vocal turns revealed that 1 year following implantation, bilateral implantation contributed to 51% of the variance (p < 0.0001), after controlling for the influence of age at implantation and length of deafness which did not reach statistical significance.

Conclusions

Profoundly deaf bilaterally implanted children are significantly more likely to use vocalisation to communicate, and to use audition when interacting vocally with an adult, compared with unilaterally implanted children. These results are independent of age at implantation and length of deafness.