Timing matters: Otological symptoms and Parkinson's disease

IntroductionOtological symptoms contribute to the disability of established Parkinson's disease (PD). We sought to evaluate whether prodromal onset may affect PD progression.MethodsA retrospective cohort design was used to compare time to advanced disease, defined as a Hoehn & Yahr stage ≥3 in consecutive PD patients with history of auditory and/or vestibular symptoms appearing before versus after PD onset. Time from PD onset to H&Y ≥ 3 was determined using Cox proportional hazards, with adjusted results summarized as hazards ratio (HR).ResultsAfter adjusting for age at PD onset, there was a lower risk of progression to advanced disease in patients with prodromal otological symptoms compared to those with otological symptoms after PD onset (HR = 0.34; 95%CI: 0.15–0.75, p = 0.008). This association remained significant after adjusting for age at PD onset and MDS-UPDRS III (HR = 0.25; 95% CI: 0.10–0.63, p = 0.003) and propensity score-adjusted analysis (HR = 0.46; 95% CI: 0.24–0.91, p = 0.025).ConclusionProdromal otological symptoms might be associated with a reduced risk of motor progression in PD.     

葛根素联合纳洛酮治疗椎基底动脉供血不足随机平行对照研究

[目的]观察葛根素联合纳洛酮治疗椎基底动脉供血不足疗效。[方法]使用随机平行对照方法,将40例住院患者按随机数字表法随机分为两组。对照组20例口服阿司匹林,0.4mg/次,3次/d。治疗组20例葛根素,0.4mg/次,1次/d,静滴;纳洛酮,0.8mg/次,1次/d,静滴。均连续治疗20d为1疗程。观测临床症状、体征、不良反应。连续治疗2疗程,判定疗效。[结果]治疗后,治疗组痊愈10例,显效5例,有效2例,无效1例,总有效率95.00%。对照组痊愈8例,显效4例,有效1例,无效7例,总有效率65.0%。治疗组疗效优于对照组(P0.05)。[结论]葛根素联合纳洛酮治疗椎基底动脉供血不足效果显著,值得推广。     

Effects of Betahistine Metabolites on Frog Ampullar Receptors

Conclusion. Our technique can decrease the formation of retraction pockets and improve hearing function. The wheel-shaped cartilage-perichondrium composite graft (Wheel CPCG) can be considered a good material for a drum graft, and it is easy to insert a ventilation tube, in case of initial drum retraction. Objective. The purpose of this study was to introduce the novel surgical technique of a Wheel CPCG with one-stage ossiculoplasty to prevent a retraction pocket and subsequent cholesteatoma after intact canal wall tympanomastoidectomy. Patients and methods. A total of 47 patients were reviewed; 43 cases were selected for audiologic testing. The results of operations were evaluated by comparing preoperative and postoperative hearing results and postoperative drum findings. Results. A retraction pocket was observed in three cases (6.7%). Slight protrusion of partial ossicular replacement prosthesis (PORP) and lateral healing of drum was observed in one case each, and there were two cases of postoperative infection. The number of cases with an air–bone gap (ABG)<20 dB increased from 9 (23%) cases before operation, to 20 cases (51%) after operation. The ABG average statistically decreased from 30.0 dB to 24.0 dB, and the mean air conduction thresholds decreased from a preoperative level of 47.3 dB to a level of 35.7 dB.     

Transcanal endoscopic ear surgery for perilymphatic fistula after electric acoustic stimulation

Transcanal endoscopic ear surgery (TEES) will become a very useful therapeutic option. A perilymphatic fistula (PLF) is defined as sudden sensorineural hearing loss and/or vertigo caused by leakage of the perilymph through a fistula from the oval window and/or round window. We report a case of PLF after electric acoustic stimulation (EAS), a kind of cochlear implant, successfully treated by TEES. A 38-year-old man presented to our hospital with vertigo and hearing loss (HL). His vertigo was induced by Valsalva maneuvers. Eight months ago, he underwent EAS for his right ear for congenital sensorineural HL. Although he maintained his hearing level after EAS, his pure tone audiogram this time showed deterioration of hearing at low frequencies in his right ear. A diagnosis of right PLF was made. After confirming the non-effectiveness of oral prednisolone treatment, PLF repair surgery to patch the oval and round windows by TEES was performed. His vertigo did not recur after the surgery. To the best of our knowledge, this is the first report of PLF repair surgery by TEES without a microscope. The wide-field view of the middle ear by TEES was useful to prevent electrode damage in a PLF patient with a cochlear implant.     

耳石复位联合药物治疗良性阵发性位置性眩晕

目的 观察耳石复位联合药物治疗良性阵发性位置性眩晕( BPPV)的疗效.方法 40例BPPV患者随机分为两组,对照组20例应用西药及中药治疗,治疗组20例在应用西药及中药的同时结合耳石复位法治疗.治疗7d后进行疗效评定,3个月后电话随诊,观察复发情况.结果 治疗组痊愈率90％,总有效率100％,均高于对照组的50％、95％(x2=6.483、4.326,均P＜0.001)；经电话随诊治疗组20例3个月内未复发,对照组有1例复发,予耳石复位法配合药物治疗后症状好转.结论 耳石复位法治疗BPPV有效、简便、安全,可作为BPPV首选治疗方法,配合中西药物综合治疗可明显缓解患者症状,减少复发.     

认识眼震性质是识别眩晕疾病的重要方式

眼震是眩晕疾病的常见体征，识别眼震性质可提供眩晕疾病的重要诊断线索。眼震大致可分类为生理性眼震和病理性眼震。根据常见疾病来源和发生机制，病理性眼震可大致分为3类:耳源性眼震、眼源性眼震及中枢源性眼震。本文重点讨论这3类病理性眼震及其性质特征对识别眩晕疾病来源的意义。     

杜秀娟教授应用花子类中药的临床经验

杜秀娟教授通过30多年临床经验总结，认识到花类中药和仁子类中药对调整升降出入有着很重要的作用，导师在临床中常使用的花类中药和仁子类中药药对有：苏子槐花、茺蔚子夏枯草、冬瓜子菊花，这几组药对对治疗眩晕病有很好的疗效。     

复方天麻蜜环糖肽片联用甲磺酸倍他司汀片治疗颈性眩晕

目的：观察复方天麻蜜环糖肽片联用甲磺酸倍他司汀片治疗颈性眩晕的疗效。方法：将94例以眩晕为主要症状的颈椎病患者,随机分为两组。治疗组47例,用复方天麻蜜环糖肽片联用甲磺酸倍他司汀片;对照组47例,单纯用甲磺酸倍他司汀片治疗,疗程为14d。结果：治疗组总有效率93.6%,显效率70.2%;对照组总有效率87.2%,显效率51.1%。治疗组治疗后血脂和血流变学明显改善。结论：复方天麻蜜环糖肽片联用甲磺酸倍他司汀片治疗颈性眩晕的疗效高于单用甲磺酸倍他司汀片。