等离子射频消融术在鼻咽疾病中的应用

目的探讨等离子射频消融技术治疗慢性肥厚性鼻炎、变应性鼻炎、扁桃体肥大、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的治疗效果及临床应用。方法对32例慢性鼻炎、10例变应性鼻炎、12例扁桃体肥大、12例OSAHS进行等离子低温射频消融术,术后均分别在1周、1个月、3个月、6个月予以追踪治疗。结果32例慢性肥厚性鼻炎中,治愈25例,有效6例,无效1例;10例变应性鼻炎中,显效6例,有效3例,无效1例;12例扁桃体生理性肥大病人中,治愈9例,有效3例;12例OSAHS中,痊愈5例,有效6例,无效1例。总有效率97.0%(64/66)。结论等离子射频消融技术治疗鼻咽喉部疾病具有疗效显著,创伤小。     

激光配合中药治疗常年性变应性鼻炎的疗效观察

变应性鼻炎中医称为“鼻鼽”，是机体对某些抗原物质敏感性增高而呈现在鼻粘膜的一种变态反应。中医认为其病因病机主要为肺、脾、肾虚损。变应性鼻炎可以采用多种方法治疗，疗效不一。我科自1993年起初，对变应性鼻炎用激光配合中药治疗，收到良好的效果，现报告如下。一、临床资料本组病例并137例，根据顾之燕关于变应性鼻炎的诊断标准，均确诊为常年性变应性鼻炎，治疗分为中药组，激光组和激光配合中药组3组。1．中药组：50例，男28例，女22例，年龄最小13岁，最大55岁，平均年龄342岁。病程最短1年，最长11年。2．激光组：39例，男21例…     

益气固表中药治疗常年性变应性鼻炎的疗效观察

目的探讨益气固表中药治疗变应性鼻炎的临床效果。方法:采用平行组随机对照试验方法,观察常年性变应性鼻炎患者共60例,中医辨证为肺气虚寒,卫表不固型,随机分成治疗组和对照组各30例。治疗组用益气固表中药自拟抗敏玉屏风汤治疗,对照组用中成药辛芳鼻炎胶囊治疗,连续服药14天为1疗程,于1个疗程结束时观察疗效。结果:治疗组显效13例(43.3%),有效14例(46.7%),无效3例(10.0%),总有效率90.0%。对照组显效5例(16.7%),有效14例(46.7%),无效11例(36.7%),总有效率63.3%。两组疗效经X2检验,差异有显著性意义,P<0.05。结论:益气固表的中药治疗肺气虚寒,卫表不固型的变应性鼻炎有显著的临床疗效。     

低温等离子消融治疗药物治疗效果不理想的常年性变应性鼻炎

目的 观察低温等离子消融治疗药物治疗效果不理想的常年性变应性鼻炎的效果.方法 2009年5月至2012年12月对136例经药物治疗效果不理想的常年性变应性鼻炎患者采用低温等离子黏膜下消融双侧鼻丘、鼻中隔前上部及中、下鼻甲前端,术后随访1年,总结其疗效.结果 136例患者均行一次手术,术后1年总有效率为93.38%,其中显效98例(72.06%),有效29例(21.32%),无效9例(6.62%).结论 低温等离子消融对药物治疗效果不理想的常年性变应性鼻炎有较好的治疗效果.     

常年性变应性鼻炎鼻中隔黏骨膜下切除术后疗效观察

目的 探讨鼻中隔黏骨膜下切除术治疗常年性变应性鼻炎的疗效.方法 回顾2002年12月-2006年12月住院治疗的66例常年性变应性鼻炎患者的临床资料.根据治疗前后临床症状和体征的评分,按海口标准评价近期和远期效果.结果 66例患者均患有常年性变应性鼻炎合并鼻中隔偏曲,并均行鼻中隔黏骨膜下切除术,其中随访1年以上者43例,显效35例,有效6例,无效2例,总有效率95.35%;随访2年以上者31例,显效24例,有效5例,无效2例,总有效率93.55%.平均起效时间术后2.1个月,无并发症发生.随访1年以上,4例变应性鼻炎症状复发.结论 鼻中隔黏骨膜下切除术对治疗常年性变应性鼻炎是有效的,且疗效满意,安全简便.     

内窥镜下YAG激光烧灼筛前神经治疗变应性鼻炎和血管运动性鼻炎的疗效观察

目的研究鼻内窥镜下YAG激光烧灼治疗变应性鼻炎和血管运动性鼻炎的疗效.方法变应性鼻炎80例,血管运动性鼻炎70例,在鼻内窥镜明视下用YAG激光烧灼筛前神经治疗变应性鼻炎和血管运动性鼻炎.结果变应性鼻炎显效32例(40%),有效12例(15%),无效36例(45%),总有效率为55%.血管运动性鼻炎显效49例(70%),有效15例(21.4%),无效6例(8.6%),总有效率为91.4%.结论鼻内窥镜下YAG激光烧灼筛前神经是治疗变应性鼻炎和血管运动性鼻炎的有效方法,治疗血管运动性鼻炎尤为有效.     

卫气虚与变应性鼻炎相关性的初步实验研究

本实验采用制作卫气虚模型和卫气虚变态反应性鼻炎证病复合模型的方法．并采用具有益卫固表作用的“加味苍耳子丸”进行治疗．试图探寻卫气虚体质与变态反应性鼻炎发病的内在联系。在实验中．分别采用健康豚鼠和卫气虚豚鼠(用高温发汗加风寒刺激方法造模．从行为外观，壳温与核温变化、耗氧量变化三方面观察)．以甲苯二异氰酸酯(TDI)作致敏原．对豚鼠行鼻内给药法建立了实验性变应性鼻炎动物模型，观察其鼻部症状、鼻粘膜表面细胞学变化．结果发现两组动物均有典型的鼻超敏反应出现．鼻粘膜出现大量噬酸性细胞及肥大细胞，而且气虚动物上述情况的出现较健康动物显著提前，显示卫气虚动物更易于造成变应性鼻炎模型，并用加味苍耳子丸对卫气虚变应性鼻炎模型进行治疗．一个疗程后分别对两组动物进行鼻粘膜激发试验．发现治疗组鼻部症状较对照组轻．血EOS计数两组有显著差异，显示加味苍耳子丸对卫气虚变应性鼻炎模型有一定治疗效应。建立卫气虚变应性鼻炎证病复合模型．从症状表现及免疫学角度探讨卫气虚与变应性鼻炎发病之同的相关性．一方面把变应性鼻炎动物模型纳入中医基础研究，另方面为中医进一步研究变应性鼻炎，为中医药治疗变应性鼻炎的药理学、药效学打下基础。可以说．本研究在思路和方法上均有一定创新性．     

中药治疗变应性鼻炎的临床观察

应用中药治疗变应性鼻炎50例,其中常年性变应性鼻炎34例,季节性变应性鼻炎16例。给予中药黄防冲剂治疗。治疗结果：显效30例,有效15例,总有效率90％。提示黄防冲剂治疗变应性鼻炎疗效显著而无副作用。     

AA-673点鼻液治疗变应性鼻炎的临床观察

AA-673为一种新药。分子式为 C_(16)H_(14)N_2O_4,具有抑制组胺释放和抑制慢反应物质生成的作用。临床上用于治疗支气管哮喘有效。本文观察其对变应性鼻炎的效果。自1985年9月至1986年1月,对确诊为常年性变应性鼻炎患者20例进行治疗。变应性鼻炎的诊断标准为:1.具有典型的常年性变应性鼻炎的症状,皮内试验(或 RAST)鼻粘膜激发试验或鼻涕中嗜     

P物质神经阻滞疗法治疗变应性鼻炎疗效观察

目的观察P物质神经阻滞疗法(CAP)治疗变应性鼻炎疗效和安全性.方法100例变应性鼻炎患者,用CAP在双侧鼻腔黏膜表面涂布,每日1次,连续15日为一疗程.结果100例在治疗后平均记分均明显降低,统计学分析差异均有显著性意义(P＜0.01),治疗后显效73例(73%),有效19例(19%),无效8例(8%),总有效率92%.无1例毒副反应.结论CAP疗法治疗方便、效果好、无副作用,是治疗变应性鼻炎的理想方法.     

变应性鼻炎患者生活质量研究

目的 采用对照研究的方法,探讨变应性鼻炎(allergic rhinitis,AR)对患者生活质量的影响.方法 以普适性量表--医学结局研究简表36项健康调查(medical outcome study short-form 36-items health survey,简称SF-36)为工具,通过前瞻性对照设计,对101例尘螨过敏的AR患者、97例慢性咽炎(chronic pharyngitis,CP)患者及121例健康体检者进行生活质量的调查,分析AR患者生活质量.以疾病专用昔表--鼻结膜炎生存质量调查问卷(rhinoconjunctivitis quality of life questionnaire,RQLQ)为工具,分析AR患者生活质量最受影响的方面.同时采用Pearson相关分析,对SF-36与RQLQ两量表的相关性进行分析.结果 SF-36调查显示,AR患者在躯体疼痛、总体健康和社会功能3个维度的得分((x)±s,下同;分别为:78.02±18.37,56.13±17.49,78.81±16.47)较健康体检者的相应得分(84.00±18.36,74.69±14.13,83.78±14.31)低(P值均<0.05),但生理功能、生理职能、躯体疼痛、总体健康、社会功能、情感职能和精神健康7个维度得分(分别为:91.78±11.78,79.16±30.23,78.02±18.37,56.13±17.49,78.81±16.47,67.66 4-39.57,68.78±13.65)与CP患者的相应得分(94.12±6.88,80.67±32.38,73.57±17.96,59.73±16.58,80.41±17.01,63.58±39.99,66.43±13.71)相近(P值均>0.05).RQLQ调查显示,AR患者在鼻部症状和实际问题2个维度得分(分别为:2.70±1.29,2.53±1.37)最高.SF-36与RQLQ相父性分析提示,两量表仅呈弱负相关(r=-0.199～-0.526,P<0.05).结论 AR患者生活质量较健康体检者差,与CP患者相近.鼻部症状和实际问题是AR患者生活质量最受影响的方面.SF-36和RQLQ均适用于评价AR患者生活质量.SF-36与RQLQ评价AR患者生活质量的不同方面,两量表联合应用可以更全面、准确地评价AR患者的牛活质量.     

外周血B细胞活化因子水平对变应性鼻炎患者病情严重程度的预测价值

目的 探讨外周血B细胞活化因子(BAFF)对变应性鼻炎(AR)病情严重程度的预测价值。方法 选取2019 年 1 月—2019 年 10 月收治的80例AR患者作为病例组，根据症状评分将患者分为轻度组和中-重度组；同期选取无AR因鼻骨骨折或行鼻中隔偏曲矫正术患者50例作为对照组，分析并比较不同组中血清BAFF的表达水平。采用受试者工作特征曲线分析血清BAFF对AR患者病情严重程度的预测价值。结果 AR组中血清BAFF浓度明显高于对照组(P＜0.05)。相比于轻度AR组患者，血清BAFF浓度在中-重度组明显升高，差异具有统计学意义(P＜0.05)。AR患者血清BAFF水平与外周血嗜酸性粒细胞数目及比例、总IgE水平、视觉模拟评分(VAS)及鼻部症状总评分(TNSS)呈正相关。受试者工作特征曲线结果显示,相比于总IgE水平，血清BAFF在区分AR患者疾病方面具有一定优势，敏感度为0.550，特异度为0.825。结论 AR患者外周血 BAFF 浓度增加，与疾病嗜酸性炎症程度相关，且可作为预测病情严重程度的标志物。     

温州2991例变应性鼻炎患者皮肤点刺试验结果分析

目的　了解温州地区变应性鼻炎患者变应原分布特征。方法　回顾性分析2013年1月～2014年12月具有变应性鼻炎症状、行皮肤点刺试验的患者的临床资料,分析皮肤点刺试验结果的分布特征。结果　①2991例患者总阳性率为82.0%,主要变应原是粉尘螨和屋尘螨;吸入性变应原阳性率高于食入性致敏原（χ2=2006.557,P＜0.01）;变应性鼻炎患者以双重过敏者为主;粉尘螨、屋尘螨反应强度均以（++++）为主,二者间反应强度差异无显著性（Z =-0.391,P =0.696）。②不同季节变应原阳性率有显著性差异（χ2=34.254,P＜0.01）。③不同病程组变应原阳性率差异无显著性（χ2=16.102,P =0.065）。④不同年龄组变应原阳性率差异有显著性（χ2=223.317,P＜0.01）,阳性率随年龄增大而升高,在10～12岁年龄段达高峰,之后减小。结论  尘螨为温州地区变应性鼻炎患者的主要变应原,季节和年龄是影响皮肤点刺试验阳性率及变应性鼻炎发病的重要因素,变应原阳性率与年龄存在一定的关系。     

Efficacy of nasal corticosteroids alone or combined with antihistamines or montelukast in treatment of allergic rhinitis

OBJECTIVE: Topical corticosteroids are recommended as initial therapy in allergic rhinitis (AR) patients. We investigated clinical efficacy of monotherapy with topical steroid and combined therapy in AR patients. METHODS: Ninety-five AR patients sensitive to grass pollens according to skin prick test results were enrolled in this placebo-controlled and open study. Patients were divided to four groups. Group-1 received only intranasal mometasone furoate (MF) 200microg (n=25), group-2 received intranasal MF and oral desloratadine (DLR) 5mg (n=25), group-3 received intranasal MF and oral montelukast (MSK) 10mg (n=25), group-4 received only placebo (n=20). Efficacy was assessed on the basis of total nasal symptom scores, rhinoconjunctivitis quality of life questionnaire scores and nasal inspiratory peak flow rates. RESULTS: All groups that received treatment had better results when compared to the placebo group. Significant improvement in total nasal symptom scores was first evident at the end of the 2nd week in group-2. Group-3 had better results than those of the other groups at the end of the 1st month (p<0.05). Quality of life scores were significantly better in group-2 and -3 when compared to those in group-1 (p<0.05). CONCLUSION: Although corticosteroids are the mainstay of treatment in allergic rhinitis, montelukast may be considered as an additional agent especially in treatment of patients with impaired quality of life and it may be used to reduce nasal symptom scores.     

Ablenkungs- und Entspannungstraining bei akutem Tinnitus

Background

We examined whether training conceptualized as a complement to standard medical treatment (ST) for acute tinnitus to promote patients’ capacity to distract attention from their tinnitus and to relax (distraction and relaxation training) has a positive effect on tinnitus-specific distress (tinnitus loudness, tinnitus-related distress and disability), as well as on general well-being.

Patients and methods

Study participants comprised 29 patients with tinnitus of maximum 4 weeks’ standing (first lifetime tinnitus episode) who were randomized to ST (rheological therapy) or advanced standard treatment (AST) (rheological therapy complemented by distraction and relaxation training).

Results

Tinnitus-specific distress was reduced to a significantly greater extent in the EST group as compared to ST, especially in patients with a striking psychopathology. The improvement in general well-being was comparable in both groups.

Conclusion

In acute tinnitus, distraction and relaxation training should be conducted as a complement to standard medical treatment, especially in high-risk patients demonstrating abnormal psychopathological status, since treatment results can be improved in this way.     

再次鼻内镜手术患者生活质量调查

目的:探讨修正性鼻内镜手术(RESS)对慢性鼻-鼻窦炎鼻息肉患者(CRSwNP)健康相关生活质量(QOL)的影响。方法:采用国内现有的中文版SF-36量表(MOS SF-36)和汉化英文版SNOT-20量表(SNOT-20),分别对60例施行修正性鼻内镜手术组(RESS)的CRSwNP患者和120名健康体检者进行QOL的调查与评估,并将2组的结果进行对比。结果:通过SF-36量表评估显示:RESS组术前CRSwNP患者SF-36的维度计分均低于对照组,差异有统计学意义(P<0.05)。通过汉化SNOT-20评估显示:RESS组术前CRSwNP患者SNOT-20各条目计分和条目总分均高于对照组,差异有统计学意义(P<0.05)。RESS组CRSwNP患者术后6个月SF-36和SNOT-20量表评估得分与对照组差异无统计学意义(P>0.05)。结论:RESS可明显改善CRSw-NP患者的QOL;SF-36和汉化SNOT-20量表能有效调查评估CRSwNP患者的QOL。     

Diagnostic and treatment of lesions of the facial nerve after fractures of the temporal bone

The authors review functional late results of 47 cases of facial palsies due to otobasal fracture by considering the clinical and electrophysiological test results, seen between 1983 and 1988. There were 36 longitudinal, 5 transversal and 6 combined temporal bone fractures. 5 patients suffered from a bilateral facial paralysis. In all cases, an electrodiagnostic examination was carried out in order to determine the pronosis and to indicate a surgical exploration. The electrodiagnostic consisted in electromyographie (EMG) and electroneuromyographie (ENoG). 36 patients got a medical treatment and 6 patients were treated by surgery. All facial nerve paralyses (n = 28), that were incomplete according to the clinical examination as well as the electrophysiological tests, received a medical treatment which lead to good functional late results without exception. 19 facial nerve paralyses seemed to be complete in clinical examination, but in 11 cases electrodiagnostic tests revealed a residual volontary electrical activity. This indicated a conservative therapy with 7 good (66%) and 4 (33%) fair results. So, no poor result had been found in this group. In the other 8 cases, 4 of which had a delayed onset of the paralysis, no electrocal activity could be proved. 4 patients were treated by surgery, and in 2 cases a complete facial nerve transection was found. The reconstruction of the facial nerve led to 1 good and to 1 satisfactory result. In the other 2 cases, the decompression lead to 1 good and to 1 poor late result. In these 4 cases the facial nerve had been completely decompressed, in a combined transmastoidal and enlarged transtemporal middle fossa approach.(ABSTRACT TRUNCATED AT 250 WORDS)     

我国西部四城市变应性鼻炎门诊患者相关情况调查

目的获得我国西部四城市（重庆市、四川省成都市、新疆维吾尔自治区乌鲁木齐市、广西省南宁市）鼻变态反应专科门诊变应性鼻炎（allergic rhinitis,AR）患者临床表现特点、伴发疾病情况、经济支出以及生活质量等流行病学资料。方法2005年3月～2006年12月采用问卷调查、鼻腔专科检查、变应原皮肤点刺试验等对四城市AR门诊患者进行相关调查。采用SAS9.13完成统计分析。结果共完成有效调查2267人次,AR患者打喷嚏、流清涕、鼻塞、鼻痒的发生率分别为88%、89.19%、85.58%、83.58%。被调查人群中43.80%有家族过敏史,其中25.50%有家族性AR史,13.45%有家族性哮喘史。被调查人群中46.98%患者有个人过敏史,合并哮喘的占10.50%。分型分析表明,除乌鲁木齐市以季节性AR和轻度间歇性AR为主外,其他城市以常年性AR和中重度持续性AR为主。约50%的患者出现反复吸鼻、总感到不舒服、总是需要携带纸巾,40%患者睡眠不好,近10%以上的人情绪受影响。结论获得了我国西部四城市AR门诊患者临床表现特点等流行病学资料,为AR标准化防治提供了科学参考。     

The effectiveness of nasal saline irrigation (seawater) in treatment of allergic rhinitis in children

Objective

To evaluate the effect of nasal saline irrigation in the treatment of allergic rhinitis (AR) in children and to assess whether nasal saline irrigation could be used as a complementary therapy for AR in children in combination with the intranasal corticosteroids (INS).

Method

In total, 61 children with AR were divided into three groups: the nasal irrigation, intranasal corticosteroid, and combined treatment groups. Symptoms and signs of AR and eosinophils (EOS) in the nasal secretions were evaluated after 4 weeks, 8 weeks, and 12 weeks of treatment.

Results

In AR children treated with nasal irrigation and a decreased the INS dose, a significant improvement in symptoms and signs and a significant decrease in the mean EOS count in nasal secretions were observed at week 12.

Conclusion

Nasal saline irrigation with physiological seawater is well tolerated and benefits the patients with AR, and can thus be considered a good adjunctive treatment option to maintain the effectiveness of the INS at a lower dose, thus resulting in reduced side effects and a decreased economic burden.     

Evaluation of quality of life questionnaires for adult patients with moderate to severe allergic rhinitis

Purpose

The aim of the study was to compare the efficacy of instruments to assess quality of life (QoL) in patients with moderate to severe persistent allergic rhinitis (PAR) vs intermittent allergic rhinitis (IAR).

Materials and Methods

There were 106 patients with PAR and 99 with IAR and 50 healthy subjects in the control group. Questionnaire results were obtained using the Medical Outcomes Survey Short Form 36 (SF-36), a visual analog scale (VAS), and the rhinoconjunctivitis quality of life questionnaire (RQLQ) and were analyzed using correlational analysis.

Results

Correlations between the total scores and most domains of the 3 questionnaires were stronger in patients with PAR than in those with IAR, although the difference between groups was significant only for the RQLQ (P < .01). The QoL was worse in the PAR subgroup than in the IAR subgroup in the domains of social functioning in the SF-36 and for items of sleeping problems and activity limitations in the RQLQ. There were significant correlations between RQLQ and VAS-eye symptoms in the PAR subgroup but not in the IAR subgroup.

Conclusions

The 3 questionnaires differentiated patients with AR from the healthy population, with significant but weak correlation with each other. The correlations were higher in patients with PAR than in those with IAR. The moderate to severe PAR has a greater effect on quality of life than IAR. Eye symptoms affected the QoL more in patients with PAR than in those with IAR.