咳嗽对良性阵发性位置性眩晕手法复位疗效的影响

目的：分析患良性阵发性位置性眩晕（BPPV）的慢性咳嗽患者经手法复位治疗后的疗效,为BPPV的综合治疗及病因探索提供帮助。方法：分析2009—10—2012—12期间400例BPPV患者的治疗效果,包括观察患者的症状和行体位试验检查。结果：后半规管BPPV的一次治疗成功率为93．4％,水平半规管BPPV治疗成功率为83．0％。在400例BPPV患者中随访到372例,一次治疗成功的复诊患者中,有35例复位治疗好转后又出现阵发性眩晕发作,再次行手法复位仍取得良好效果。追问病史,有29例存在不同程度的咳嗽。控制咳嗽后再行手法复位治疗,眩晕症状消失,随访半年未再发作。结论：BPPV的发生机制可能与咳嗽所致的头部震动有关。     

Acute mastoiditis in infants

We present a retrospective study of 37 infants who were operated for acute mastoiditis during the period 2000–2004 in Mother and Child Health Care Institute, Belgrade, Serbia and Montenegro. About 23 patients (62.2%) were male and 14 (37.8%) were female. Acute mastoiditis developed just after the first infection of the middle ear in 26 patients (70.3%). All patients had local and general symptoms. The most common local symptoms were blurred tympanic membrane in all patients, painful tenderness of mastoid in 21 (57%) and redness of tympanic membrane in 13 (36%). General signs of infection were loss of body weight in 28 (75.7%) patients, fever in 21 (56.8%), vomiting in 19 (51.3%), diarrhea in 19 (51.3%) and severe anemia that requested red blood cell transfusion in 6 (16.2%). Suppuration did not appear in any of the patients. Tympanocentesis had been performed prior to surgery in all patients. The most frequently isolated causative microorganism was Streptococcus pneumoniae which was found in 12 (32.5%) patients, Staphylococcus aureus was found in 8 (21.5%) and Hemophilus influenzae in 2 (5.5%). In 15 (405%) patients there was no bacterial isolation. Eleven patients (29.7%) who had previously had acute otitis media were implanted ventilation tubes during the surgical intervention. All patients were treated with antibiotics prior and after the surgical intervention. The finding on mastoidectomy was positive in all cases. According to the results of our study the combination of antibiotic and surgical treatment is optimal in treating acute mastoiditis. Making a diagnosis of acute mastoiditis might not be easy since there are no specific symptoms. We emphasize that it should always be considered as a differential diagnosis in cases of prolonged acute otitis media with no improvement after 10 days of antibiotic treatment, especially when accompanied with weight loss and general condition worsening.     

Acute sinusitis in childhood

Acute inflammatory disease of the paranasal sinuses is not a common condition of childhood. A thorough understanding of the anatomic, radiologic and etiologic factors is necessary in order for the clinician to make the appropriate diagnosis and initiate the indicated therapy. It is not unusual for patients to present with the complications of sinusitis as their initial complaint.The increased use of chemotherapeutic agents has led to a new type of offending sinusitis in the pediatric population. Fungal invasion in immune deficiency states is now becoming a perplexing entity. Acute inflammation of the paranasal sinuses may well become a more challenging clinical problem in pediatrics than it has ever been in the past.     

Acute epiglottitis in adults

Epiglottitis occurs more frequently in adults than is generally realized. More than 100 adults with epiglottitis have been reported prior to this paper. Sixty-two have been reported in the last 15 years. The mortality rate of these 62 patients was 32 percent. Tracheostomy was required in 45 percent of those who recovered. Seventeen adults with epiglottitis have been managed at the Los Angeles County/University of Southern California Medical Center in the past 10 years; 13 of these were seen in the last four years. Most were males between 20 and 45 years of age. Four required tracheostomy. There were no deaths. An additional adult, treated at a neighboring hospital, who recovered from Hemophilus influenzae epiglottitis and meningitis is reported. He required tracheostomy for acute airway obstruction. The following impressions can be derived from an anlysis of the literature and the patients discussed in this paper: 1. epiglottitis in adults has been reported more often in recent years. This may be due to increased awareness of this condition; or it may be due to actual increased incidence. 2. Epiglottis is more severe when due to Hemophilus influenzae, Type B than when due to other pathogens; and infections due to H. influenzae are being noted more frequently in adults. 3. The primary treatment of adult epiglottitis is: mist tent, intravenous antibiotics, and tracheostomy when indicated. Steroids may benefit some patients by slowing progression of epiglottic edema. 4. The symptoms of epiglottitis are sore throat, dysphagia, respiratory distress, and muffled voice. The characteristic early symptoms are sore throat and dysphagia. Any patient with acute painful dysphagia should have indirect laryngoscopy to rule out epiglottitis.     

三维滚轮耳石复位系统及其临床应用

目的 观察三维滚轮耳石复位系统治疗良性阵发性位置性眩晕的临床效果.方法 回顾性分析40例后半规管和水平半规管良性阵发性位置性眩晕患者的临床资料,其中20例采用三维滚轮耳石复位系统进行复位治疗,20例采用手法复位治疗,对其疗效进行比较.结果 采用三维滚轮耳石复位系统治疗的患者中第1次治疗后有17例(85%)治愈,3例经过第2次治疗痊愈;采用手法复位的患者中第1次治疗后有16例(80%)治愈,4例经过第2次治疗痊愈.应用x2检验二者的差异没有统计学意义.结论 应用三维滚轮耳石复位系统治疗良性阵发性位置性眩晕临床效果可靠,弥补了手法复位的缺陷,效果直观,可重复性强.     

Cochlear implantation in infants: special surgical and medical aspects

Objective: To present medical and surgical aspects of cochlear implantation (CI) in infants and to compare the rate of complications of CI in infants with that of older children. Design: Retrospective study. Method: Fifteen infants and 57 children aged 1 to 2 years at the time of CI with a follow‐up of at least 12 months were studied. Results: Major complications (requiring explantation or revision surgery) occurred in 6.7% infants vs. 17.5% toddlers, P = .297. The rates for minor postoperative problems were 13.3% vs. 21.1%, respectively, P = .502. There were no incidents of surgery‐ or anesthesia‐related complications in the present study. Device failure was found as a most common complication in older children (10.5%). Such patient‐related complications as foreign body reaction, protrusion of the positioner and recurrent otitis media can result in device malfunction. Indeed, the rate of major complications supposed to increase with long‐term follow‐up. Conclusions: The surgical procedure for CI in infants is feasible and patient‐related complications are usually minor and may be managed conservatively. Because most postoperative major problems are implant‐related, improving cochlear implant technology can enhance the reliability of the devices and prevent untoward events that need for explantations and reimplantations. To reduce the risk of general anesthesia in infants we recommended the presence of pediatric anesthesiologist at surgery. Shortening time of surgery with using of nonmastoidectomy techniques for CI can reduce the time of bacterial exposure of the wound and prevent surgical complications related to the facial nerve and chorda tympani damage as well as electrode misplacement.     

局部糖皮质激素治疗慢性鼻-鼻窦炎的疗效研究

目的 观察单独应用局部糖皮质激素治疗中国人慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)的疗效.方法 随机选取2010年11月至2011年12月就诊于中山大学附属第一医院耳鼻咽喉科,未经治疗的CRS伴或不伴鼻息肉患者34例.使用鼻腔局部喷布地奈德规律治疗3个月.以视觉模拟量表(visual analogue scale,VAS)评估治疗前及治疗后第1、2、3个月鼻部症状评分;以鼻腔鼻窦结局测试-20(sino-nasal outcome test-20,SNOT-20)评估治疗前后患者的生活质量;以Lund-Mackay CT评分评估治疗前后影像学的改变.采用SPSS 16.0软件进行统计学分析.结果 34例患者中,脱落4例.患者治疗前鼻塞、鼻漏、头痛、面部压迫感、总体症状的VAS评分分别为(4.84±3.15)、(6.03±2.93)、(1.68±2.66)、(2.04±2.97)、(6.00±2.75)分,治疗后第3个月分别为(2.26±2.27)、(1.96±2.23)、(0.42±0.95)、(0.58±1.42)、(2.71±1.90)分,差异有统计学意义(t值分别为4.386、6.740、2.445、2.980、6.989,P值均＜0.05);嗅觉下降或障碍治疗前后差异无统计学意义(t=0.902、P＞0.05).治疗后第1个月鼻塞、鼻漏、总体症状的VAS评分较治疗前差异有统计学意义(P值均＜0.05);而治疗后第1、2、3个月之间各种鼻部症状的VAS评分差异无统计学意义(P值均＞0.05).治疗后SNOT-20得分较治疗前差异有统计学意义(t=3.687,P＜0.01).从CT表现上评估总体治愈率为22.2％.结论 局部糖皮质激素治疗中国人CRS有明确疗效,22.2％的患者能达到CT的痊愈,症状改善出现在第1个月.     

全频突发性聋的分型探讨

目的 了解全频突发性聋的分型及其治疗效果的差异.方法 对2005年8月至2008年3月就诊的87例全频突发性聋患者进行研究.所有病例均采用甲基泼尼松龙+巴曲酶注射液(东菱迪芙)+血栓通治疗.结果 根据听力下降的速度将全频突发性聋分为缓降型和骤降型,缓降型的有效率及显效率分别为84.4%(27/32)及68.8%(22/32),骤降型的有效率及显效率分别为52.7%(29/55)及32.7%(18/55);缓降型预后明显好于骤降型(P<0.01).根据听力下降的程度将全频突发性聋分为平坦型和全聋型,以平均听阈90 dB作为划分标准时平坦型的有效率及显效率分别为73.3%(44/60)及53.3%(32/60),全聋型的有效率及显效率分别为44.4%(12/27)及29.6%(8/27);平坦型预后明显好于全聋型(有效率P<0.01,显效率P<0.05).结论 全频突发性聋有必要进一步分型.根据听力下降的速度可分为缓降型和骤降型,缓降型预后明显好于骤降型;根据听力下降的程度可分为平坦型和全聋型,全聋型预后较差,以平均听阈90 dB作为平坦型和全聋型的划分标准更为合适.     

咽异感症405例病因分析

目的研究初步诊断咽异感症病因的方法。方法回顾分析405例迁延不愈的咽异感症患者临床资料。结果405例咽异感患者中,232例次部位恒定,173例次部位游走不定;201例伴失眠多梦,71例伴月经紊乱,97例伴胸闷心慌,129例伴上消化道疾病。痊愈270例（66.67%）,有效101例（24.94%）,无效34例（8.39%）,有效率91.60%。结论临床上依据咽异感症的伴随症状及部位作出初步诊断具有一定的可行性,但由不同病因引发的伴随症状之间存在交叉性,抑或多种病因混合存在,因此,明确诊断咽异感症病因仍有其局限性。     

Cochlear implantation in infants below 12 months of age

ObjectivesTo provide safety and efficacy data on infants implanted below 12 months of age.MethodsWith the wide application of newborn hearing screening programs, infants with deafness are being identified at birth. When a hearing aid trial fails, cochlear implantation is the only option to restore hearing. Mounting evidence suggests that age at implantation is a strong predictor of language outcomes. Using the minimally invasive surgical technique we have employed for nearly two decades, a limited clinical trial was initiated in the year 2000 because this age limitation fell outside of FDA guidelines. The infants were initially assessed using the preferential listening paradigm to confirm that they could learn associations between speech sounds and objects. Sufficient time was allowed to pass to administer more traditional language measures.ResultsNo surgical or anesthetic complications occurred in this group of infants. The pattern of listening skill development mirrored that seen in normal hearing infants. Long-term language assessments using the Peabody Picture Vocabulary Test (PPVT) and other measures have demonstrated that many of infants achieved age appropriate language skills.ConclusionCochlear implantation in children less than 12 months of age is safe and efficacious as demonstrated by long-term PPVT language data.     

Acute dyspnea in malignant melanoma

Metastases to the larynx are rare. The current article presents the case of a 75-year-old patient with a history of shortness of breath due to a supraglottic exophytic lesion that was identified as a metastasis of a cutaneous melanoma treated 2.5 years previously. As a result of our medline analysis we found approximately 30 cases of metastatic melanoma to the larynx published to date. Primary tumors are always cutaneous in origin and spread over the whole integument of trunk and extremities. The time interval between diagnosis of the primary and the laryngeal metastasis is often several years. In most reports a supraglottic exophytic, red coloured lesion is described. Diagnosis can only be proven by histological examination. Laryngeal metastasis is usually an indication of tumor dissemination and always has a fatal prognosis.