分泌性中耳炎误诊漏诊分析

分析１９８８－１９９０年资料完整的２３０耳分泌性中耳炎中曾发生误诊、漏诊的病案共２３耳。认为症状不典型，询问病史及观察鼓膜不仔细是引起误诊、漏诊的重要原因之一，对听力图应结合患者年龄及过去病史进行分析。“Ｂ”型鼓室导抗图的阳性诊断符合率为８８％。应作为小儿听力测试常规方法之一。即使患儿有明确的耳毒性药物史亦不例外。     

分泌性中耳炎误诊漏诊原因分析

目的减少分泌性中耳炎的误诊和漏诊.方法对1999年1月-2003年10月资料完整的382耳分泌性中耳炎中曾发生误诊、漏诊的38耳进行回顾分析.结果误诊原因有四方面:1症状不典型;2病史询问不详细;3检查鼓膜不仔细;4综合分析不全面.结论应根据年龄、病史,结合听力图进行综合分析;声导抗测试对分泌性中耳炎的诊断符合率达99%,怀疑本病时应进行常规检查.     

易漏诊的隐匿性中耳炎

目的探讨隐匿性中耳炎的临床特点,避免误诊。方法回顾分析13例隐匿性中耳炎患者的临床资料,从病史、鼓膜检查、听功能检测、颞骨CT及手术所见等方面总结分析其特征。结果所有病例无明显耳漏病史,鼓膜和外耳道局部无明显阳性体征,均以听力下降、耳闷、耳鸣、耳痛等症状就诊,病程8天～2个月;纯音听阈显示4耳为传导性听力损失,9耳为混合性听力损失,0.5～4kHz气导平均听阈为44.15±4.50dB HL;鼓室导抗图B型12耳,C型1耳;颞骨CT显示鼓窦、乳突区密度增高;术中见2耳上鼓室有包裹性积液及肉芽,9耳上鼓室、鼓窦、乳突腔有肉芽组织,部分听骨链中断,2耳乳突腔见胆脂瘤。手术清除病变,解除引流通道的阻塞,13例均治愈,随访6个月至3年,无复发。结论易漏诊的隐匿性中耳炎无明显临床症状,对于有反复原因不明的耳痛、耳闷感、耳鸣、听力下降等症状者,无论鼓膜完整与否,均应早期行听力及高分辨率颞骨CT扫描等检查以确诊;手术是该病有效的治疗方法。     

以听力突然下降为特征的分泌性中耳炎（附24例报告）

目的：提高对以听力突然下降为特征的分泌性中耳炎的确诊率。方法：回顾性分析24例（28耳）以听力突然下降为特征的分泌性中耳炎的临床资料,结果：11例患者被误诊或漏诊,各频率的平均气导阈值在60．2－66．5dBHL,平均骨导阈值在40．5－58．6dBHL,听力图示感音神经性聋9耳,混合性聋19耳,鼓室压图为B型,治疗后听力明显改善,结论,鼓室积液影响圆窗及卵圆窗间的相位差,导致听力突下降,它们的听力图无特征,并对产生误诊的原因进行了讨论。     

耳硬化症的诊断问题(附251耳分析)

耳硬化症的发病率在我国较低,由于存在漏诊,实际发病率应高于一般印象。患者提供的其他致聋病史及鼓膜异常发现常引起误诊,因此,对病史和鼓膜异常发现应作具体分析。耳硬化症可表现为传音性聋,更常见的为混合性聋;少数患者或疾病晚期可表现为感音神经性聋。本文讨论了耳硬化症的诊断要点,并阐述诊治晚期耳硬化症的重要性。     

小儿声带麻痹3例报告

文中报告3例小儿声带麻痹，结合文献讨论其病因及临床表现，提出对该病的诊断应提高认识，结合病史、喉部症状及体征综合分析，以防误诊及漏诊。     

听力筛查不通过婴幼儿的听力评估

目的:对2次听力筛查不通过耳进行听力评估,分析其ABR与鼓室导抗图的特征,探讨听力筛查不通过耳的客观听觉状况及听力筛查和评估干扰因素。方法:选取2005年8月~2007年11月因进行耳声发射(OAE)新生儿听力筛查2次筛查未通过而转诊到儿童听力中心的患儿为研究对象,年龄在48 d~6个月,共94例(144耳)。详细询问并记录病史,按首次听力评估时的月龄分为~3个月及~6个月组,并行听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)、鼓室声导抗和蹬鼓肌反射等客观听力测试。结果:①2次听力筛查未通过婴幼儿的鼓室导抗曲线仍以单峰A型为主(77耳,53.4%);双峰次之(23耳,16.0%);单峰Ad型(20耳,13.9%);单峰As型(16耳,11.1%);B型图亦占有一定的比例(6耳,4.2%)。②其ABR以正常及轻度异常为主(分别为44.4%及40.3%),中度、重度及极重度异常比例相对较少(分别为8.3%、2.1%及4.9%),且随着年龄增长,轻度异常比例增加,中度及以上异常比例下降。③ABR正常组单峰A型鼓室图有32耳(50%),考虑存在假阴性结果。正常及轻度听力异常者B型曲线比例分别为4.7%和3.4%,高于中度及以上异常者。结论:中耳因素及低龄婴幼儿听觉神经系统发育的不完善是导致听力筛查未能通过的比较重要的原因,同时,226 Hz的鼓室声导抗在评估婴幼儿中耳疾病时存在较大的假阴性,因此在对2次听力筛查未通过婴幼儿进行听力评估时应充分考虑到上述因素的影响。     

低频感音神经性听力损失的病因分析

目的分析低频感音神经性听力损失的病因,以避免漏诊和误诊。方法对56例低频感音神经性听力损失患者详细了解其病史,进行仔细的耳科常规检查及纯音听阈（PTT）、声导抗、听性脑干反应（ABR）、畸变产物耳声发射（DPOAE）、耳蜗电图（ECochG）及CT和/或MRI检查,综合分析各项结果。结果在56例患者中病因不明的急性低频感音神经性听力损失38例,梅尼埃病9例,听神经病6例,听神经瘤1例,多发性硬化1例,小脑半球旁蛛网膜囊肿1例。结论低频听阈升高的上坡型感音神经性听力损失可见于多种疾病。对低频感音神经性听力损失应采用多项组合的听力学检测方法进行检查和综合分析,必要时辅以CT和/或MRI检查可以及时、有效地作出可靠的诊断和鉴别诊断。     

新生儿普遍听力筛查假阴性分析

目的 探讨耳声发射作为新生儿普遍听力筛查方法的可靠性及出现假阴性的原因，说明对高危儿进行听力监测的重要性。方法 收集2002年1月～2005年12月参加上海市新生儿听力筛查，并在上海儿童医学中心听力障碍诊治中心确诊为听力障碍者的资料，报道分析5例通过新生儿听力筛查、而在6～30月龄期间在该中心诊断为听力障碍者的病史、临床表现、听力学及影像学检查的结果。结果 通过新生儿听力筛查但被确诊为听力障碍者共5例，2例确诊为中重度感音神经性聋，3例确诊为极重度感音神经性聋，其中1例确诊为听神经病。耳声发射作为新生儿听力筛查方法，灵敏度是99．88％，假阴性率是0．12％。结论 耳声发射是灵敏度较高的新生儿听力筛查方法，但是有一定的假阴性率，对于各种原因造成的蜗后听觉通路病变所致的耳聋可能会漏诊。另外，对新生儿听力筛查阴性者，要警惕遗传性聋和迟发性聋的发生，尤其对高危儿应该定期随访。     

先天性中耳胆脂瘤临床诊治及误诊分析

目的　探讨先天性中耳胆脂瘤的诊断、治疗方法以及误诊原因,减少漏诊、误诊。方法　对我院收治的9例先天性中耳胆脂瘤患者临床资料进行回顾性分析。结果  9例均行手术治疗,病理确诊,其中6例行听力重建,随访3个月～2年半,气骨导差为20 dB左右,术后1年者复查颞骨CT均未发现胆脂瘤残留及复发。所有患者均有误诊病史,误诊率100%。结论　先天性中耳胆脂瘤临床少见,起病隐匿,易漏诊、误诊,诊断可根据Levenson诊断标准和影像学检查,早期手术治疗可获得较好听力重建效果。提高对本病的认识,影像学检查和仔细的局部检查可提高诊疗水平,避免误诊、误治,避免严重并发症发生。     

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.     

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.     

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.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.