编辑导读

本期重点号内容是"变应性鼻炎(AR)免疫治疗(AIT)"。述评《过敏原特异性免疫治疗——现状与未来》通过AIT的作用机制、患者选择、不同治疗方案的介绍等, 对AIT的研究现状与未来发展进行了论述。论著《标准化螨过敏原提取物皮下冲击免疫治疗的短期疗效和安全性观察及相关因素探讨》比较了3种不同剂量递增模式的AIT的早期的临床疗效、不良反应、炎性因子的变化, 以期为临床更加安全有效地开展加速AIT提供参考。《变应性鼻炎皮下过敏原特异性免疫治疗过长延迟注射的剂量调整新方案疗效分析》探究了AR尘螨皮下免疫治疗(SCIT)维持期中断治疗超过16周的新型剂量调整方案的有效性及安全性, 发现相较于指南推荐剂量调整方案, 新方案的有效性及安全性无显著差异。《成人变应性鼻炎经颈部淋巴结内免疫治疗远期疗效的随机对照研究》通过与SCIT对比, 观察了经颈部淋巴结内免疫治疗(ICLIT)对于成人AR的远期疗效及安全性, 指出ICLIT是今后AR AIT的一种新型的补充选择。《标准化尘螨过敏原SCIT对儿童AR患者治疗期间的疗效及安全性分析》提出标准化尘螨SCIT具有良好的安全性, 治疗期间对不同临床特征的儿童A...     

儿童变应性鼻炎中新2代抗组胺药的地位

变应性鼻炎及其对哮喘的影响（Allergic Rhinitis and itsImpactonAsthma,ARIA）2008指南指出将口服第2代H1抗组胺药作为治疗变应性鼻炎（AR）的一线药物推荐。在间歇性AR及持续AR中其推荐等级均为“A”。儿童AR使用口服H1抗组胺药也已被证明是安全、有效的。新2代抗组胺药较第2代组胺药具有口服吸收快、起效快、作用持久、代谢率低、不良反应少等优势。对于儿童AR的临床应用具有明显优势。     

变应性鼻炎冲击免疫治疗的安全性研究

目的：探讨变应性鼻炎（AR）冲击免疫治疗和常规免疫治疗的安全性差异及AR冲击免疫治疗的可行性。方法：将病例募集时间定为1年,根据个体本身意愿将87例AR患者分为冲击组（52例）和常规组（35例）分别进行标准化屋尘螨变应原疫苗免疫治疗。除观察治疗期间局部和全身不良反应外,还观察治疗前（W0）、治疗第2周（W2）、第5周（W5）、第17周（W17）的外周血如白三烯（L-B4）等指标,并采用Mann-Whitney u秩和检验、Kruskal-Wallis检验和Y。检验进行统计学分析。结果：冲击组52例中49例完成了既定的治疗研究,余3例脱落;常规组35例中32例完成了既定的治疗研究,余3例脱落。2组患者局部和全身不良反应相似。2组外周血LT-B4均平稳下降。结论：通过药物预先处理后的国人AR,冲击免疫治疗与常规免疫治疗的安全性相似。     

局部变应性鼻炎的研究进展

局部变应性鼻炎（LAR）是近年来新提出的一种变应性鼻炎（AR）表型,为非特应性患者中出现的鼻腔局部I型变态反应。患者有鼻痒、喷嚏、流涕、鼻堵等症状及鼻腔局部特异性IgE（sIgE）和（或）鼻腔变应原激发试验（NPT）阳性,可向AR转化并合并哮喘、结膜炎。虽皮肤点刺实验（SPT）及血清sIgE无阳性结果,但该类患者对变应原免疫治疗有效。目前对于LAR这一概念的认识还较初步,本文对LAR的概况、诊断、病理、免疫机制、治疗及与其他特异性疾病的关系等方面的研究进展作一综述。     

新型冠状病毒感染疫情期间一种新的延误注射剂量调整方案在变应性鼻炎皮下免疫治疗中的应用

目的　探索新型冠状病毒感染（简称新冠感染）疫情期间一种新的延误注射剂量调整方案在尘螨过敏变应性鼻炎（AR）患者常规皮下免疫治疗（subcutaneous immunotherapy,SCIT）中的应用。方法　收集2020-01-01～2020-06-01新冠感染疫情期间广东省佛山市第一人民医院耳鼻咽喉头颈外科门诊行阿罗格常规SCIT延误注射的AR患者,将其数量与2017～2019年同期延误注射的AR患者数量进行比较;并将2020-01-01～2020-06-01疫情期间不伴哮喘的早期延误注射患者（剂量累加阶段延误2～4周以及维持阶段延误6～8周的患者）随机分为观察组和对照组两组,观察组采用本团队设计的新剂量调整方案,对照组采用阿罗格常规SCIT参考剂量调整方案,比较两组患者剂量调整时严重局部不良反应、全身不良反应发生率;剂量调整前及调整后治疗6个月时患者鼻眼部总症状评分、药物评分差异;患者对所采用剂量调整方案的满意度评分。结果  2020-01-01～2020-06-01疫情期间阿罗格常规SCIT延误注射患者共83例,显著高于2017～2019年同期数量。疫情期间不伴哮喘且完成连续6个月及以上治疗的早期延误注射患者60例,共发生72次延误注射,其中观察组30例,共发生37次延误注射,对照组30例,共发生35次延误注射,两组延误注射患者进行剂量调整时均无严重局部不良反应发生,全身不良反应发生率差异无统计学意义（P =0.486）;两组患者剂量调整前、调整后6个月时症状总评分差异均无统计学意义（P =0.424,P =0.773）,相应时间的药物评分差异均无统计学意义（P =0.593,P =0.571）;观察组对新剂量调整方案的满意度评分显著高于对照组对参考剂量调整方案的满意度评分（P =0.000）。结论　疫情期间阿罗格常规SCIT延误注射患者数量明显高于往年同期;新剂量调整方案在延误注射患者中应用安全性高、满意度评分高,其安全性、调整后短期临床疗效与参考剂量调整组相当。当延误时间在一定范围内,当次注射可以重复使用末次耐受剂量,将注射液平分两臂先后注射,之后常规步伐继续免疫治疗,避免减量、重新剂量累加的过程,达到治疗效率和安全性的良好平衡,但该方案仅适用于很好耐受末次注射剂量的患者。     

变应性鼻炎的特异性免疫治疗

变应性鼻炎（allergic rhinitis，AR）是特应性个体接触致敏原后由IgE介导的介质（主要是组胺）释放，并有多种免疫活性细胞和细胞因子等参与的鼻黏膜慢性炎症反应性疾病。AR的治疗原则包括变应原回避、药物治疗、免疫治疗以及对患者的宣教。毫无疑问，避免暴露于变应原是AR理想的防治措施，但通常难以做到。以第2代抗组胺药和鼻内皮质类固醇为主的药物治疗是目前临床上最常用的对症治疗方法，     

新2代抗组胺药：鼻用与口服的疗效比较

抗组胺药是治疗变应性鼻炎（AR）最常用药物，占据不可替代的位置。近年来，除新2代口服抗组胺药外，还研发了鼻用抗组胺药（鼻用剂）。变态反应学家、药理学家、国际组织、药物研发企业都在努力探索怎样才能充分发挥抗组胺药的最佳效果，又能避免药物的副作用（中枢镇静、心脏毒性等）。众多研究结果为患者和医师带来了最新知识和切实利益。     

基于新冠肺炎潜在威胁下的耳鼻咽喉科诊疗防护模式的转变

新型冠状病毒肺炎(新冠肺炎)已经进入全球大流行,鉴于新冠病毒的高传染性,作为在日常诊疗活动中与患者有密切接触的耳鼻咽喉科,既往的诊疗模式无疑将会给医务人员及患者带来极大风险。基于新冠肺炎的潜在威胁,如何正常开展耳鼻咽喉科诊疗活动,本文将从新冠病毒传染的各个环节入手,探讨一个安全有效的诊疗模式,以期现在及将来可以减少耳鼻咽喉科医务人员的感染,并保障患者就医安全。     

口服抗组胺药物与变应性鼻炎的治疗

从1937年第1个抗组胺药开发至今,H1抗组胺药（H1antihistamines,以下简称抗组胺药）逐渐成为变应性鼻炎（AR）治疗一线用药,在AR药物治疗中占有重要地位。第2代抗组胺药具有起效迅速、维持时间长、1次,d用量、抗胆碱作用与抗组胺作用相分离的特点。AR及其对哮喘的影响（AllergicRhinitisanditsImpactonAsthma,ARIA）指南2010修订版强烈推荐使用口服第2代或新型抗组胺药治疗AR,可有效缓解流涕、喷嚏、鼻痒和眼部症状,对鼻塞有一定程度的改善。     

2019冠状病毒病感染流行期分泌性中耳炎患病人口统计学特征分析

目的 评估2019冠状病毒病（corona virus disease 2019,COVID-19）感染流行期分泌性中耳炎患病年龄构成比的变化特征。方法 回顾性分析2018年12月1日～2019年1月31日在首都医科大学附属北京同仁医院耳鼻咽喉头颈外科就诊的符合诊断与排除标准的分泌性中耳炎病例,称为新冠前组;2022年12月1日～2023年1月31日在该科就诊的符合诊断与排除标准的分泌性中耳炎病例,称为新冠期组。收集患者年龄、性别、发病侧别和听力学检测结果等。并将这两个时期纳入本研究的分泌性中耳炎患者总数、年龄构成比、性别构成比、患病侧别比和听力学检测结果等数据进行统计学分析。结果 新冠前组的患者总人数为1 872例,年龄（30.45±23.17）岁,男性949例,女性923例,其中儿童患者910例,成年患者962例。新冠期组患者总人数1 194例,年龄（48.31±18.92）岁,男性623例,女性571例,其中儿童患者95例,成年患者1 099例。新冠前组与新冠期组之间,总体患病年龄分布不同（Z=-20.820,P<0.001）。儿童患者与成年患者的构成比具有显著性差异（χ2...     

The role of allergic rhinitis in the development of otitis media with effusion: effect on eustachian tube function

PURPOSE: The pathogenesis of otitis media with effusion (OME) is considered multifactorial, with viral upper respiratory tract infection and eustachian tube dysfunction. Allergy may be related to the pathogenesis of OME or to another etiological factor. We investigated the role of allergic rhinitis (AR) in children with OME and evaluated eustachian tube function in patients with AR. MATERIALS AND METHODS: We prospectively analyzed the prevalence of AR, serum eosinophil count, and serum total IgE concentrations in 123 children with OME and in 141 controls. IgE concentration in middle ear effusion was compared in children with OME with and without AR, and eustachian tube function after a nasal provocation test was compared between patients with AR and controls. RESULTS: The prevalence of AR in children with OME (28.4%) and control subjects (24.1%) did not differ significantly. These 2 groups also showed no differences in total eosinophil count and serum and middle ear effusion IgE concentration. Abnormalities in eustachian tube function were the same in patients with AR and controls. CONCLUSIONS: Allergic rhinitis may not be related to the development of OME in children.     

Can SARS-CoV-2 positive pregnant women affect the hearing of their newborns: A systematic review

The 2019 coronavirus disease (COVID-19) pandemic has caused over 500 million confirmed cases (including pregnant women) worldwide. Recently, hearing status in newborns born to mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has received attention. This systematic review outlines the current knowledge regarding the effects of maternal SARS-CoV-2 infection during pregnancy on newborn hearing. Intrauterine SARS-CoV-2 infection has the potential to affect the auditory system of the newborn due to intrauterine hypoxia and vertical transmission. SARS-CoV-2 might have a greater influence on hearing loss (HL) in newborns during the second and third trimesters of pregnancy. Therefore, all newborns whose mothers had COVID-19 during pregnancy should be evaluated for cochlear function, regardless of whether their mothers were symptomatic at the time of the disease. However, the understanding of this issue is not consistent and remains controversial. Since early identification and intervention of congenital HL are crucial to the language development of newborns, newborns should be provided with audiological evaluation by various approaches, including Tele-audiology, in the COVID-19 era.     

Sialadenitis: A Possible Early Manifestation of COVID-19

Acute sialadenitis may be caused by viruses, including coronaviruses. Although there are anecdotal reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) salivary gland infections, there have been no well-documented cases of sialadenitis in patients with COVID-19 described in the literature. We report a case of parotitis and submandibular gland sialadenitis, as well as an isolated case of parotitis, in two patients with concurrent SARS-CoV-2 infections. Computed tomography imaging demonstrated parotid and submandibular gland enlargement with heterogenous enhancement and attenuation, consistent with sialadenitis. Medical management was sufficient for successful resolution of the acute sialadenitis. Laryngoscope, 130:2595–2597, 2020     

Hat die SARS-CoV-2-Pandemie die Lehre verbessert? – Virtueller Unterricht im Fach HNO-Heilkunde aus Sicht der Studierenden

HNO - Die Severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)-Pandemie hat die Ausbildung von Medizinstudierenden grundlegend verändert. Die Notwendigkeit von...     

阿司匹林耐受不良三联征肺通气功能的改变及哮喘病情控制情况

目的 观察阿司匹林耐受不良三联征对肺通气功能的改变及哮喘控制情况。方法 收集2007年1月至2012年10月住院的阿司匹林三联征患者36例(AIT组),收集合并变应性鼻炎的支气管哮喘患者和一般的支气管哮喘患者各35例(鼻炎合并哮喘组和哮喘组)。比较三组用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占用力肺活量的百分比(FEV1%FVC)、呼气峰流速(PEF)、哮喘控制测试(ACT)、哮喘控制问卷(ACQ)。结果 AIT组FVC、FEV1、FEV1%FVC、PEF均低于哮喘组,两组差异有统计学意义(P<0.05)。AIT组与鼻炎合并哮喘组比较,FVC、FEV1、PEF差异无统计学意义,但两组FEV1%FVC差异有统计学意义(P<0.05)。AIT组ACT评分为14.2±4.5,ACQ评分为2.7±1.5,与哮喘组比较差异有统计学意义(P<0.05),与鼻炎合并哮喘组比较差异无统计学意义(P>0.05)。结论 AIT患者有较严重的气道炎症和较高的气道反应性,其肺功能明显下降且对哮喘控制不佳。FEV1%FVC是一个有效、灵敏的观察指标用来检测和评价AIT。     

Society of swallowing and dysphagia of Japan: Position statement on dysphagia management during the COVID-19 outbreak

On April 14, the Society of Swallowing and Dysphagia of Japan (SSDJ) proposed its position statement on dysphagia treatment considering the ongoing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).The main routes of transmission of SARS-CoV-2 are physical contact with infected persons and exposure to respiratory droplets. In cases of infection, the nasal cavity and nasopharynx have the highest viral load in the body. Swallowing occurs in the oral cavity and pharynx, which correspond to the sites of viral proliferation. In addition, the possibility of infection by aerosol transmission is also concerning.Dysphagia treatment includes a broad range of clinical assessments and examinations, dysphagia rehabilitation, oral care, nursing care, and surgical treatments. Any of these can lead to the production of droplets and aerosols, as well as contact with viral particles. In terms of proper infection control measures, all healthcare professionals involved in dysphagia treatment must be fully briefed and must appropriately implement all measures. In addition, most patients with dysphagia should be considered to be at a higher risk for severe illness from COVID-19 because they are elderly and have complications including heart diseases, diabetes, respiratory diseases, and cerebrovascular diseases.This statement establishes three regional categories according to the status of SARS-CoV-2 infection. Accordingly, the SSDJ proposes specific infection countermeasures that should be implemented considering 1) the current status of SARS-CoV-2 infection in the region, 2) the patient status of SARS-CoV-2 infection, and 3) whether the examinations or procedures conducted correspond to aerosol-generating procedures, depending on the status of dysphagia treatment. This statement is arranged into separate sections providing information and advice in consideration of the COVID-19 outbreak, including “terminology”, “clinical swallowing assessment and examination“, “swallowing therapy”, “oral care”, “surgical procedure for dysphagia”, “tracheotomy care”, and “nursing care”. In areas where SARS-CoV-2 infection is widespread, sufficient personal protective equipment should be used when performing aerosol generation procedures.The current set of statements on dysphagia management in the COVID-19 outbreak is not an evidence-based clinical practice guideline, but a guide for all healthcare workers involved in the treatment of dysphagia during the COVID-19 epidemic to prevent SARS-CoV-2 infection.     

Epidemiology and a course of allergic rhinitis in children

The authors present the results of a clinico-epidemiological trial of allergic rhinitis (AR) in children according to the ISAAC program (International Study of Asthma and Allergy in Childhood). AR symptoms occurred in 12.1+/-0.8% children including in 9.7+/-1.1% first-formers and 14.5+/-1.3% eight-formers. AR is represented by mild (49.4%), moderate (31.4%) and severe (19.2%) forms. Prevalence of AR in children by active diagnosis is 4.7 times higher than by reference and reaches 9.8+/-0.7%. Six-year follow-up shows that 59.6% children developed bronchial asthma, more frequently boys aged 3-7 years. Progression of AR occurred in 25.5% children while a favourable course of the disease with a complete clinical remission was observed in 14.9%.     

Audiological and vestibular symptoms following SARS-CoV-2 infection and COVID-19 vaccination in children aged 5–11 years

PurposeThe present study assessed the prevalence of audio-vestibular symptoms following SARS-COV-2 infection or COVID-19 vaccination among children, comparing the two groups. A further aim was to evaluate whether children with pre-existing unilateral hearing loss were more prone to adverse events.Materials and methodsThis retrospective study included children aged 5–11 years with normal hearing or a proven history of unilateral hearing loss who contracted SARS-CoV-2 or received two doses of COVID-19 vaccine. Tinnitus, hyperacusis, aural fullness, otalgia, otorrhea, new-onset hearing loss, vertigo and dizziness were investigated as possible complications of SARS-CoV-2 infection or the COVID-19 vaccine.ResultsThis study included 272 children (143 boys, 129 girls), with a mean age of 7.8 ± 2.3 years. Among these, 120 were affected by pre-existing unilateral hearing loss.The most common audio-vestibular symptoms reported by children following SARS-CoV-2 infection and COVID-19 vaccination were aural fullness (33/132, 25 %) and dizziness (5/140, 3.6 %), respectively. All symptoms following COVID-19 vaccination resolved within 24 h.Compared to children who received the COVID-19 vaccine, those infected with SARS-CoV-2 had a higher prevalence of tinnitus (p = 0.009), hyperacusis (p = 0.003), aural fullness (p < 0.001), otalgia (p < 0.001), otorrhea (p < 0.001), and vertigo (p = 0.006). Two girls also experienced new-onset unilateral sensorineural hearing loss following SARS-CoV-2 infection.Children with a known history of unilateral hearing loss did not have a higher prevalence of audio-vestibular symptoms than children with normal hearing.ConclusionsOur results suggest that the COVID-19 vaccine is safe and can be recommended for children with unilateral hearing loss without fear of possible audio-vestibular sequelae.     

A multicenter study to investigate the positive rate of SARS-CoV-2 in middle ear and mastoid specimens from otologic surgery patients

ObjectiveSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus, causes coronavirus disease 2019 (COVID-19). Otologic surgeries with drilling by powered instruments induce significant aerosols, which may induce SARS-CoV-2 transmission to medical staff if SARS-CoV-2 exists in the middle ear and mastoid cavity. During a COVID-19 pandemic, therefore, confirming a negative COVID-19 test prior to otologic surgery is recommended. However, previous coronavirus studies demonstrated that coronavirus was detected in the middle ear in some patients even though the polymerase chain reaction (PCR) test using their nasopharyngeal swab was negative. This study aimed to elucidate the probability of a positive SARS-CoV-2 PCR test in the middle ear or mastoid specimens from otologic surgery patients in whom SARS-CoV-2 was not detected by preoperative PCR test using a nasopharyngeal swab.MethodsWe conducted a prospective, multicenter clinical study. Between April 2020 and December 2021, during the COVID-19 pandemic, 251 ears of the 228 participants who underwent otologic surgery were included in this study. All participants had no symptoms suggesting COVID-19 or close contact with a confirmed COVID-19 patient two weeks prior to the surgery. They were also negative in the SARS-CoV-2 PCR tests using a nasopharyngeal swab before surgery. We collected mucosa, granulation, bone dust with mucosa or fluid from the middle ear or mastoid for the SARS-CoV-2 PCR tests during each otologic surgery.ResultsThe median age of the participants at surgery was 31.5 years old. Mastoidectomy using a powered instrument was conducted in 180 of 251 otologic surgeries (71.8%). According to intraoperative findings, active inflammation in the middle ear or mastoid cavities was evident in 20 otologic surgeries (8.0%), while minor inflammation was observed in 77 (30.7%). All SARS-CoV-2 PCR tests of otologic specimens showed a negative result. No patient suffered from COVID-19 within two months after otologic surgery. Furthermore, no hospital-acquired infections associated with otologic surgery occurred in our institutionsConclusionsOur results showed that PCR testing did not detect SARS-CoV-2 in middle ear and mastoid specimens, suggesting that the risk of transmission of SARS-CoV-2 is not high in otologic surgeries even using powered instruments when both clinical and laboratory tests are confirmed to be negative for COVID-19.     

COVID-19 and the Otolaryngologist: Preliminary Evidence-Based Review

The SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), has rapidly swept across the world since its identification in December 2019. Otolaryngologists are at unique risk due to the close contact with mucus membranes of the upper respiratory tract and have been among the most affected healthcare workers in Wuhan, China. We present information on COVID-19 management relevant to otolaryngologists on the frontlines of this pandemic and provide preliminary guidance based on practices implemented in China and other countries and practical strategies deployed at Stanford University. Laryngoscope, 130:2537–2543, 2020