梅尼埃病与偏头痛性眩晕的听-前庭功能比较

目的探讨梅尼埃病与偏头痛性眩晕的听功能及前庭功能状态的不同特点,进行比较分析,为二者的鉴别诊断提供帮助。方法回顾性分析2007年5月至2008年9月山东省立医院眩晕门诊52例梅尼埃病患者与36例偏头痛性眩晕患者的临床资料,全部患者均在急性期或亚急性期行纯音测听、视频眼震电图、冷热试验、前庭诱发的肌源性电位检查,部分梅尼埃病及全部偏头痛性眩晕患者行高刺激率听性脑干反应检查,对二者的听力与前庭功能检查结果进行比较分析。结果梅尼埃病患者共52例,男24例,女28例,年龄14-70岁,平均45.8岁。纯音测听异常52例,均为单侧感音神经性聋。视频眼震电图检查示中枢性异常眼动10例。冷热试验异常37例,均为单侧半规管反应低下。前庭诱发的肌源性电位检查异常31例。行高刺激率听性脑干反应检查共32例,5例异常。偏头痛性眩晕患者共36例,男8例,女28例,年龄16-62岁,平均43.6岁。纯音测听异常9例,均为单侧轻至中度感音神经性聋。视频眼震电图检查示中枢性异常眼动17例。冷热试验异常8例,均为单侧半规管反应低下。前庭诱发的肌源性电位检查异常18例,高刺激率听性脑干反应检查异常22例。经统计学分析,二者纯音测听、中枢性眼动检查、冷热试验及高刺激率听性脑干反应的检查结果差异有显著性。结论与梅尼埃病相比,偏头痛性眩晕患者纯音测听及冷热试验异常较少见,中枢性服动检查及高刺激率听性脑干反应异常率较高。在结合患者病史及临床表现的基础上.以上检查可为二者的鉴别提供辅助参考。     

老年梅尼埃病(附13例报告)

目的:研究老年梅尼埃病的发病情况及其临床特征.方法:观察586例梅尼埃病患者中老年梅尼埃病的发病情况.分析患者的纯音听力、耳蜗电图、前庭双温试验及前庭诱发的肌源性电位检查结果.结果:≥60岁发生梅尼埃病的患者为13例(2.22%),在患者的首发症状中,耳蜗症状首发者占69.2%(9/13),耳聋伴眩晕者占15.4%(2/13),旋转性眩晕为首发者占7.7%(1/13),倾倒感占7.7%(1/13).首发症状按出现例数排列依次为:耳鸣、耳鸣加耳聋、耳聋加眩晕、单纯眩晕或倾倒.老年梅尼埃病患者的听力图呈现多样性,发病时可呈现为覆盆型、平坦型和高频下降为主型,其中高频下降者在病程长短的患者中均可见到.前庭功能检查结果呈现多样性.结论:老年梅尼埃病患者的听力图中,高频听力损失常较低频更为明显.-SP/AP≥0.4的阳性率较高.前庭功能检查结果同样表现为多样性,其结果正常或异常与病程无关,但首发为倾倒感的患者,前庭诱发的肌源性电位异常.     

甘油对梅尼埃病患者前庭诱发的肌源性电位的影响

目的通过梅尼埃病患者前庭诱发的肌源性电位(vestibulare voked myogenic potential,VEMP)在甘油试验前后的变化情况,了解本项检查在梅尼埃病诊断中的意义。方法对明确诊断为梅尼埃病的10例患者进行甘油试验,比较甘油试验前后前庭诱发的肌源性电位的变化。甘油试验VEMP观察时间段选择两点,服用甘油前及服用甘油后3小时的振幅变化作为指标。结果8例单侧梅尼埃病,其中5例振幅改善(2例振幅增加,3例振幅从无到有),3例甘油试验后VEMP的振幅变差。2例双侧梅尼埃病,1例甘油试验后VEMP振幅从无到有,1例VEMP振幅改善。结论梅尼埃病患者甘油试验后,VEMP变化有以下三种情况:①从无到有;②引出的振幅降低;③引出的振幅提高。甘油试验纯音听力检查结合VEMP的甘油试验有助于梅尼埃病的诊断。     

儿童梅尼埃病

目的梅尼埃病一般认为主要以中年人发病为主,在儿童(≤15岁)中发病率均较低。本文关注儿童梅尼埃病的发病情况,研究儿童梅尼埃病的临床特征。方法观察眩晕诊疗中心2004年1月至2007年7月,共计586例梅尼埃病患者中儿童(≤15岁)梅尼埃病的发病情况,对这些患者进行纯音测听、耳蜗电图、冷热试验及前庭诱发的肌源性电位检查。结果本组梅尼埃病发病最早为3岁。儿童期首发的梅尼埃病占全部梅尼埃病患者的1.71%(10/586)。4例首发为典型梅尼埃病症状(耳蜗症状和前庭症状均具备),占40%(4/10);以耳蜗症状首发的占30%(3/10);以旋转性眩晕或倾倒感为首发者分别占20%(2/10)及10%(1/10)。儿童梅尼埃病听力图有两种类型——低频下降型和平坦型:以低频听力下降为主,共7例占70%(7/10);3例为平坦型曲线,占30%(3/10)。前庭功能检查结果正常或异常与病程无关。耳蜗电图的阳性率较高,达50%(5/10)。首发为倾倒感的患者,前庭诱发的肌源性电位检查异常。头痛和运动病是儿童梅尼埃病的一个常见主诉。结论儿童梅尼埃病的主要首发症状依次为典型梅尼埃病表现、耳蜗症状、单纯的眩晕或倾倒感。听力图多为低频下...     

不同听力检测方法甘油试验的结果比较

目的比较纯音测听甘油试验、耳蜗电图甘油试验、畸变产物耳声发射(DPOAE)甘油试验对梅尼埃病的诊断价值。方法选择63例梅尼埃病和63例非梅尼埃病眩晕患者,分为A、B、C三组,每组包括21例梅尼埃病患者和21例非梅尼埃病眩晕患者,在服用甘油前和服用甘油后1、2、3h分别观察三组患者纯音测听(A组)、耳蜗电图(B组)和DPOAE(C组)的变化,比较三组间甘油试验阳性率。结果 A组梅尼埃病患者纯音测听甘油试验阳性率最高为38.10%(18/21),B组耳蜗电图甘油试验阳性率最高为52.38%(11/21),C组DPOAE甘油试验阳性率最高为57.14%(12/21)。结论耳蜗电图和DPOAE的甘油试验较纯音测听的甘油试验更为准确,能在一定程度上提高对梅尼埃病的诊断率。     

前庭诱发肌源性电位对前庭下神经炎的诊断价值

目的　探讨前庭诱发肌源性电位（VEMP）对前庭下神经炎的诊断价值。方法　回顾分析我科眩晕门诊18例前庭下神经炎的临床资料,尤其是VEMP检测结果。结果　18例患者中,15例表现为旋转性眩晕,3例为平衡障碍,所有患者纯音测听、冷热试验及眼性前庭诱发肌源性电位（oVEMP）正常而颈性前庭诱发肌源性电位（cVEMP）异常。其中14例cVEMP检查不能引出,4例振幅低下。3个月后复诊10例患者症状消失,复查cVEMP 9例恢复正常,1例振幅低下;半年复诊18例患者症状全部消失,复查cVEMP只有2例振幅低下,其余均恢复正常。结论　VEMP检查对前庭下神经炎的精准诊断及判断预后有重要临床价值,值得临床推广。     

听力学检测和内耳磁共振成像在梅尼埃病诊断中的作用

目的探讨多种临床检测方法在梅尼埃病诊断中的应用价值方法回顾性分析2012年1月至2015年12月确诊为梅尼埃病的77例患者的病历资料,分析梅尼埃病患者的听力学检查以及磁共振水成像检查结果。结果共69例纯音测听结果异常(异常率92.3%);接受前庭诱发肌源性电位检测者65例,异常37例,异常率56.9%;接受耳蜗电图检测者22例,结果异常者15例(异常率68.2%);接受冷热气试验者71例,两侧对称比异常者47例,双侧低下者2例,异常率69.0%;接受甘油试验者12例,试验阳性者3例,异常率25.0%;接受磁共振造影者76例,迷路积水者70例,异常率92.1%。结论纯音测听和磁共振造影在梅尼埃病患者中阳性率高,冷热气试验及耳蜗电图假阳性率次之,可作为梅尼埃病观察的参考指标。     

梅尼埃病首发症状的临床分析

目的了解梅尼埃病患者的性别、首发的年龄、症状,并根据首发症状进行临床分类。方法回顾分析准确提供首发症状的145例梅尼埃病患者,按照耳聋和（或）耳鸣（耳蜗症状）、半规管（旋转性眩晕）和耳石器症状（倾到或平衡障碍）进行分类。结果首发症状依次为耳鸣45例、耳蜗加眩晕症状30例、眩晕28例、耳鸣加耳聋27例、听力下降9例、耳石器症状6例。累及耳蜗及前庭系统30例;累及耳蜗81例：累及半规管28例：累及耳石器6例。小于20岁和大于60岁年龄组患者数最少。男性高发年龄较女性高发年龄早10年,男性和女性在30-49岁年龄段发病例数最多。三种类型梅尼埃病临床首发症状与典型症状出现的间隔差异均较大。结论梅尼埃病耳蜗受累明显高于前庭,首发症状耳鸣最常见,其次是听力下降,再次为眩晕,倾倒的出现率最低。对不典型病例的早期诊断酌情选择纯音测听、耳蜗电图、前庭双温试验和前庭诱发的肌源性电位等检查。     

前庭诱发肌源性电位临床研究现状与展望

 前庭诱发肌源性电位与前庭功能的关系逐步被发现并应用于临床检查,并在一部分前庭功能障碍疾病,如梅尼埃病、良性阵发性位置性眩晕、前庭神经炎等病中发挥了协助诊断及评估病情的作用。本文主要概述前庭诱发肌源性电位的历史、原理、方法及其临床应用。     

短纯音在胸锁乳突肌诱发的肌源电位

强短声可在胸锁乳突肌上诱发肌源电位,该电位可能源于前庭球囊,在前庭神经切断后,即使保留听力,该电位也消失,故称前庭诱发肌源电位(vestibularevokedmyogenicpotential)。该作者研究短纯音(shorttoneburst,STB)在正常人及前庭耳蜗病患者中的诱发肌源电位,并分析其来源。受试者分正常组9人和病人组30人34耳,其中梅尼埃病11例,听神经瘤8例,良性阵发性位置性眩晕3例,感音神经性聋3例,迟发性内淋巴积液2例,Hunt综合症1例,测试时受试者仰卧头转向对侧,记录受试耳侧胸锁乳突肌上段的肌电反应。参考电极置于胸骨外上缘。正常组6人次测试0.5、1、…     

HPV and head and neck cancer

Head and neck cancer is frequent worldwide and oropharyngeal locations are presently sharply on the increase, in relation with an increasing incidence of oropharyngeal infection by oncogenic type-16 human papillomavirus (HPV). The clinical and biologic profile of these patients is distinct from that of other oropharyngeal carcinoma patients, with earlier onset, cystic cervical nodes and basaloid carcinoma histopathology. Detection of intratumoral viral DNA is essential to confirm the role of HPV, and E6/E7 mRNA expression is the most relevant indicator for stratification. Several methods can reveal intratumoral oncogenic HPV DNA, but PCR with hybridization is the most sensitive and most widely used. According to several reports, prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in oropharyngeal carcinoma associated with smoking and alcohol consumption. The future lies in vaccination, but further studies will determine whether the rate of oropharyngeal carcinoma falls in women vaccinated against cervical cancer.     

Papillomavirus and head and neck cancer

Tobacco and alcohol consumption are the main risk factors for head and neck cancers. Papillomavirus (HPV) infection was recently associated with the development of malignant tumors of the oropharynx, according to molecular and biological arguments. We describe the oncogenic mechanisms of HPV infections, the epidemiological and clinical aspects of associated head and neck cancers, their prognosis, and issues of specific therapeutic strategies.     

紫杉醇与头颈部肿瘤

为了解紫杉醇治疗鼻咽癌、喉癌及其他头颈部肿瘤的疗效及作用机理，本文分析了近年来的文献27篇。紫杉醇通过稳定微管、阻断细胞的有丝分裂和增殖，从而显著地抑制肿瘤细胞的生长并促进细胞调亡，在头颈部肿瘤同期放化疗中能起到放疗增敏作用，单独或联合其他抗癌药物治疗亦有较佳的疗效。紫杉酵是一种具有良好抗癌活性的药物，随着研究的深入，将会在头颈部肿瘤的治疗中发挥更大的作用。     

Aging and olfactory and taste function

This article focuses on the change in olfaction and taste with aging. It discusses histopathology with an emphasis on age-related changes, causes of chemosensory dysfunction in the elderly, how to evaluate a patient with dysfunction, useful tests and imaging, clinical consequences of chemosensory impairments, and available treatment options.     

Nutrition and taste and smell dysfunction

Food selection plays a pivotal role in maintaining adequate nutrient intake, thus elucidating drivers of food choice is a meaningful strategy to maintain health and manage disease. Taste and smell are key determinants of food choice and warrant careful consideration. In this review, we first discuss how sensory stimulation influences food selection and metabolism. We then review the evidence regarding the relationship between taste and smell dysfunction and food preferences and selection, with attention given to contexts of certain chronic diseases. We conclude with brief recommendations for the management of chemosensory disorders. While sensory abilities influence food selection, the effect of taste and smell dysfunction on long-term consumption patterns and health status must be considered in light of environment, exposure, and culture.     

Pepsin and Laryngeal and Hypopharyngeal Carcinomas

Laryngeal and hypopharyngeal carcinomas are common malignant tumors of the head and neck, and the incidence of both is increasing. Laryngopharyngeal reflux refers to the retrograde flow of gastric contents into the larynx, oropharynx, and/or nasopharynx. It remains controversial whether laryngopharyngeal reflux is a risk factor for laryngeal and hypopharyngeal cancers. The refluxing substances mainly include hydrochloric acid, pepsin, and occasionally bile acids and bile salts, as well as bacteria that colonize the gastrointestinal tract. Loss of epithelium in the mucous membrane of the larynx and hypopharynx is thought to be caused by pepsin. Here, we review the relationships between laryngopharyngeal reflux and both laryngeal and hypopharyngeal carcinomas, as well as the significance of pepsin, methods of clinical detection, and the mechanism of carcinogenesis.