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1.
Alsiagy A. Salama Reda A. Alarabawy Mohammed M. Dawoud Hanaa A. Zayed Ahmed Soliman Ahmed El-Tantawy 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):189-199
Objectives
The objectives of our work were to determine disability and study MRI findings of occupational-related lumbar disc degeneration and also to show the relationship between MRI grading of nerve root compromise with surgical grading.Participants and methods
The study included 103 workers with lumbar disc prolapse. Nerve roots were assessed on MRI and during surgery for the degree of compromise. Oswestry Disability Index and Visual Analogue Scale were used for assessment of disability and pain intensity pre- and post-operative respectively.Results
The majority of workers was less than 40 years and suffered from moderate to severe disability. 73.8% had grade IV disc degeneration mostly at the level of L4/L5. Nerve root compromise was found in 86.4% of workers. 48% of nerve roots were deviated and 32% were compressed, with significant correlation between MR grading of nerve root compromise and surgical grading (r = 0.89, P < 0.0001).Conclusion
Disability of occupational-related lumbar disc degeneration is a grave health problem between construction workers. MR imaging is a reliable tool for grading nerve root compromise in disc degeneration. Nerve root compromise is a significant factor to explain pain than the morphologic extension of disc material outside the intervertebral space. 相似文献2.
Sherif El-Sayed Mahmoud Hegab Maged Mohamed El-Sayed Eissa Amr Aly Aly Abdel-Kerim Mohamed Said Abel Aziz 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):133-139
Purpose
This study was done targeting the role of streptokinase injected through pigtail catheter in treatment of pleural empyema in pediatric.Subjects and methods
15 patients were involved in this study of age ranged from 5 months to 15 years were subjected to STK injection once daily until the drainage don’t exceed 100 ml/day and managed by ultrasound guided insertion of pigtail catheter. Broad spectrum antibiotics were given to all patients, after that the antibiotics were adapted according to result of microbial culture because of failed chest tube drainage intrapleural STK is recommended.Results
13 cases show significant improvement, as the total amount of fluid before streptokinase injection was 5 cc in average and significantly rose to 220 cc after streptokinase instillation, while 2 cases do not response to this treatment.Conclusion
Imaging guided streptokinase injected through a pigtail catheter provides a powerful protocol for managing of complicated empyema in pediatrics. 相似文献3.
Nesreen Mohey Tamir A. Hassan 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):1-6
Perianal fistula is a common disorder with high tendency to recur in spite of satisfactory surgery. Pelvic MRI is the preferable imaging modality for recognition and assessment of perianal fistulas.
Aim of the work
To evaluate the effectiveness of MRI in grading of primary perianal fistula and verification of its associated findings in correlation with surgical outcome.Subjects and methods
This prospective study included 30 patients with age range 14–44 years. Preoperative MR grading was correlated with surgical outcome.Results
The sensitivity, specificity, PPV, NPV and weighted Kappa of MR grading in correlation with surgery was 95.8%, 83.3%, 95.8%, 83.3% and 0.79 respectively with P value = 0.000Conclusion
MRI is a valuable modality for grading of primary perianal fistula and its complications. Accurate pre-operative grading may reduce the surgical complications and possibility of recurrence. 相似文献4.
Ahmed Elsammak S.M Shehata Mona Abulezz Ghada Gouhar 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):751-759
Objectives
To assess the role of DW-MRI and ADC values in distinguishing benign from malignant endometrial disorders.Patients and methods
Pelvic ultrasound, conventional MRI, DW-MRI and histopathologic examinations were done for 42 female patients with abnormal vaginal bleeding. Mean ADC values of endometrial lesions were calculated and compared.Results
Endometrial malignancies showed significant low ADC values (0.82 + 1.09 × 10?3 mm2/s) compared to benign lesions (1.44 + 0.15 × 10?3 mm2/s) (p: 0.000). Using 1.19 × 10?3 mm2/s as cut-off value for distinguishing malignant from benign lesions achieved 88.9% sensitivity and 100% specificity.Conclusion
DW-MRI is useful in distinguishing malignant from benign endometrial lesions and tumor staging as well. 相似文献5.
Youssriah Yahia Sabri Marian Fayek Farid Kolta Mostafa Ahmed Khairy 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):569-580
Background
Diffusion-weighted imaging is a fundamental tool integrated in MR protocols useful in differentiating benign from malignant mediastinal masses, assessing mediastinal lymphadenopathy and investigating central bronchogenic carcinoma. This method is an excellent alternative to CT or PET/CT in the investigation of mediastinal masses. Current applications of diffusion MRI in malignancies include monitoring the treatment response and detecting recurrent cancer.Aim of the work
This study aims to assess the value of using MRI diffusion in differentiating benign and malignant mediastinal masses, differentiating central masses from post obstructive collapse and differentiating lymphoma versus sarcoidosis.Patients and methods
This study included 30 patients; 16 males and 14 females in the period from June 2013 to July 2014. The mean age was 49.3 ± 16.85 (range: 22–82 years).Cases were referred for MRI assessment and were approved by the ethical committee in our department.The complaints varied between dyspnea, chest pain, cough, hemoptysis, fatigue and loss of weight. A superconducting 1.5 T MRI machine with a four-channel body phased-array coil was used for the examination. Biopsy and histopathological assessment was done after that.Results
MRI examination with diffusion imaging was able to differentiate between benign and malignant mediastinal and hilar lesion confirmed by the biopsy and histopathology.Conclusion
MRI with diffusion weighted images can detect and stage lung cancer, differentiate benign from malignant mediastinal masses and differentiate lymphoma from sarcoidosis in mediastinal/hilar lymphadenopathy. 相似文献6.
Haisam Atta Gehan S. Seifeldein Momen AlMamoun Hisham Imam 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):107-113
Purpose
To evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaks and skull base defects in correlation to operative findings.Materials and methods
Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and 12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is considered accurate if correctly determine the site and size of bony defect as matched with operative findings.Results
MDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity 95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases categorized as Keros type II. The consensus image with fair agreement (K = 0.38) shows that coronal reformat has the highest diagnostic performance in 75% of cases while the least diagnostic value is encountered with the axial plane in 15% of cases (p = 0.095). There is almost a perfect agreement (K = 0.810) between the MDCT measurements and operative size of bony defect with minimal difference in 10% of patients (P < 0.001).Conclusion
Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperative evaluation of CSF rhinorrhea. 相似文献7.
Rania E. Mohamed Mohamed A. Amin Hazem M. Omar Mohamed Y. Rabea Mona A. Abd Elazeem 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):31-42
Introduction
Hepatic fibrosis is the underlying pathological condition in chronic hepatitis C virus (HCV) infection. Shear wave elastography (SWE) with elastography point quantification (ElastPQ) feature is a recently developed method for measuring tissue elasticity.Aim of this study
To evaluate the diagnostic value of SWE with ElastPQ feature for the quantitative assessment of liver fibrosis in patients with chronic HCV infection.Patients and methods
This prospective study included 60 patients with chronic HCV infection and 50 healthy controls. All participants underwent imaging with ElastPQ technique for evaluation of the liver stiffness (LS). All patients underwent ultrasound guided liver biopsy. The METAVIR scores of fibrosis were illustrated.Results
The study participants included 50 controls (mean LS 3.12 ± 0.40 kPa), 5 patients with F0 score (mean LS 3.77 ± 1.44 kPa); 10 patients with F1 score (mean LS 7.50 ± 0.68 kPa), 23 patients with F2 score (mean LS 8.45 ± 0.62 kPa), 17 patients with F3 score (mean LS 9.64 ± 1.20 kPa) and 5 patients with F4 score (mean LS 12.61 ± 1.41 kPa). There was a highly significant correlation between the METAVIR scores of liver fibrosis and LS measurements assessed by ElastPQ SWE (p > 0.0001).Conclusion
The ElastPQ SWE technique appears as a reliable non-invasive tool that can provide an optimal way to monitor liver tissue stiffness in patients with chronic HCV infection with high accuracy (97.6%) in recognition of the earlier fibrosis stage (F2). 相似文献8.
Mona El-Kalioubie Wessam Abdelrahman Elzayat Hassan Ali El-kiki Mohamed Alaa Eldin Thabit 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):695-700
Purpose
The aim was to evaluate post-operative changes in the Ivy sign on unenhanced fluid-attenuated inversion-recovery (FLAIR) following surgical intervention in pediatric Moyamoya disease (MMD) and assess its clinical utility as an indicator of hemodynamic improvement.Patients and methods
Fifteen pediatric patients with MMD were included in this retrospective study. Surgical revascularization had been done in all patients on the cerebral hemisphere with reduced cerebral vascular reserve (CVR); one of them had bilateral surgery (n = 16). FLAIR examinations were reviewed in each patient, pre and post-operative. We compared the pre and post-operative total Ivy score (TIS) for each of the 16 hemispheres and correlated them with the clinical status.Results
FLAIR images depicted the Ivy sign pre-operatively in all 16 hemispheres and a strong positive correlation between the TIS and the grade of clinical hemispheric symptom (p < 0.00001). Following surgery, reduction of the TIS was seen in 13 (81.25%) out of the 16 hemispheres while the TIS remained unchanged in 3 (18.75%) hemispheres. All patients with reduced Ivy signs post-operatively showed improvement of pre-operative clinical symptoms with moderate positive correlation (p = 0.01).Conclusion
A change in the postoperative Ivy sign can be an indicator of effective cerebral reperfusion in MMD. 相似文献9.
Samira Saraya Lamia Adel Asmaa Mahmoud 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(2):547-552
Objective
To assess the efficiency of dual energy contrast enhanced mammography in the assessment of the indeterminate breast lesions (BIRADS 3 and BIRADS 4).Materials and methods
34 female having 39 indeterminate breast lesions (BIRADS 3 and BIRADS 4) by digital mammography were further examined by dual energy contrast enhanced mammography. Two images were acquired at low and high energy in MLO view after 2 min and in CC view at 4 min post iodinated contrast injection (1.5 ml/kg with flow of 4 ml/s). Images were processed to obtain subtracted images to enhance the areas of the contrast uptake.Results
Results from pathology were detected for all cases. Contrast enhanced digital mammography showed specificity, sensitivity, PPV, NPV, FDR, FPR and accuracy of 93.75%, 91.3%, 88.2%, 95.4%, 11.7%, 8.6% and 92.3% respectively compared to full field digital mammography which were 68.75%, 69.5%, 61.1%, 76.1%, 38.8%, 30% and 69.2% respectively.Conclusion
Contrast-enhanced digital mammography is a useful tool to be used for breast cancer detection especially in indeterminate lesions (BIRADS 3 and 4). 相似文献10.
Samira Saraya Rehab El Bakry 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):687-694
Aim of the study
To evaluate the ultrasound efficiency in the assessment of pneumonia in pediatric age group compared to CT as a trial for radiation exposure reduction.Materials and methods
56 patients of pediatric age group were included (4 months to 10 years). They presented to ER with respiratory distress, and pneumonia was suspected clinically. Human ethics committee approval for this study was obtained from the institutional review board of the private center where these cases were done. Both ultrasound and CT were done for all patients by 2 different radiologists being blind to the results of the other examination to minimize the bias. Follow up US was done after adequate medical treatment (7–14 days) to detect its ability for following the patients up.Results
Ultrasound was able to detect efficiently different pulmonary pathological conditions as consolidation and pleural effusion. Compared to CT, ultrasound showed a sensitivity and specificity of 72.2% and 95% for pneumonia detection respectively with 96.3% PPV, 5% NPV, 3.7% FDR and 80.3% accuracy.Conclusion
Ultrasound could be considered as a good diagnostic and follow up tool when pneumonia especially in pediatric age group is suspected yet well trained radiologists and high resolution equipments are required. 相似文献11.
Ahmed A. Baz Ahmed M. Gad Mohamed R. Waly 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):125-132
Chronic plantar fasciitis (PF) is, by far, considered one of the commonest causes of foot complaints; constituting up to 15% of the foot symptoms that needs medical care in adult and active subjects.
Purpose
Is to confirm the clinical diagnosis of plantar fasciitis by ultrasound and to depict the effect of ultrasound guided injection of PRP in such cases.Methods
The study was conducted on 44 patients with chronic plantar fasciitis not responding to conservative treatment, they were diagnosed and were treated by ultrasound guided PRP injection then followed-up after 4 months by both clinical and ultrasound examinations.Results
By ultrasound mild improvement in plantar fascia thickness from 6.04 mm (mean of pre injection) to 4.93 mm (mean of 4 months post last injection). By VAS, significant improvement from 8.14 (mean of pre injection) to 2.59 (mean of 4 months post injection). By Roles and Maudsley score, significant improvement from 81.8% of patients who were acceptable and 18.2% were poor (pre injection) to 59.1% became excellent, 31.8% good, 4.5% acceptable and 4.5%poor (4 months post injection).Conclusion
Ultrasound is a confirmatory diagnostic tool of PF and PRP ultrasound guided injection is recommended after failure of conservative treatment. 相似文献12.
Objective
The aim of this study was to explore the predictive value of CT enterography-based simple measurement tools for Crohn's disease activity.Patients and methods
During one and half year duration 54 patients diagnosed with CD were retrospectively evaluated. All patients underwent CT enterography examinations following a preset protocol prior to endoscopic biopsy or surgery. The images obtained were reconstructed using dedicated software and workstations. The length of affected segments was calculated (L) and distance from ileocecal junction till first affected segment was measured (D). Results of CTE examinations were compared with histopathology.Results
Out of 54 cases, 38 cases had single segment involvement (70.4%) and 16 cases had multiple affected segments (29.6%). The histological inflammatory activity score scored 1 in 10 cases (18.5%), 2 in 25 cases (46.3%) and 3 in 19 cases (35.2%). L varied from 1.4 cm to 20.6 cm while D varied from 0 to 6.7 cm. Spearman rank order correlation coefficient showed a strong uphill linear relationship of L (RHO = 0.663) and weak correlation of D (RHO = 0.222) with the histological inflammatory activity score.Conclusion
CTE provides accurate data regarding length of affected ileal segments that positively correlated with histopathological score of disease activity. 相似文献13.
A.H. Elmokadem A.M. Abdel Khalek T. Amer 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(4):921-926
Purpose
This retrospective study was constructed to assess the beneficial effects of preoperative transarterial particulate embolization of juvenile angiofibroma (JA) with intracranial extension in terms of intraoperative blood loss and local tumor recurrence.Patients and Methods
This study included 20 male patients (mean age ± SD: 14.6 ± 7.2 years) with radiologically documented and histologically proved JA. All patients had intracranial extension and underwent surgical resection of the tumor after preoperative transarterial particulate embolization. The amount of blood loss was estimated and follow up scans were assessed for tumor recurrence.Results
The mean amount of intra-operative blood loss was 560 ml and the mean amount of blood transfusion was 944.4 ml. Local residue/recurrence of tumor was seen in 5 patients (5/20); two patients with intracranial residual tumor (2/20), one patient with intracranial recurrence (1/20) and 2 patients (2/20) with extracranial recurrence. The technique of embolization was safe with no procedure related mortality. Minor complications were seen in all patients and major complication only in one patient.Conclusion
Preoperative transarterial particulate embolization of JA with intracranial extension helped to perform surgery with mild amount of blood loss compared to the literature. 相似文献14.
Kunwarpal Singh C.L. Thukral Kamlesh Gupta 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):653-660
Background
Characterization of tendo-ligamentous pathologies of wrist remains problematic, despite advances in imaging. By using clinical history and imaging appearance, one can determine the diagnosis. USG is used as first imaging modality whereas MRI aids in making a specific diagnosis of few of the lesions.Aims
To investigate the etiological spectrum of tendo-ligamentous pathologies of wrist on USG & MRI with statistical correlation.Patients and methods
80 patients (male/female = 46/34) with complaint of swelling or pain in wrist were included and underwent USG and MRI of both the wrists.Results
The spectrum included ganglion cysts, vascular malformations, tenosynovitis, tendinopathy, ligament tears and fibrosis. The analysis was done using kappa coefficient and spearman's rho correlation coefficient. The strength of agreement between USG and MRI for the diagnosis of ganglion cysts, vascular malformations, tenosynovitis and tendinopathy was found to be very good.Conclusion
USG provides detailed depiction of superficial structures, is less expensive, and allows dynamic examinations of the wrist. It should be the first choice of investigation for majority of the cystic, tendinous, vascular, and fibrotic pathologies of the wrist. However, less promising results were observed for ligamentous pathologies on USG in our study. 相似文献15.
Ahmad Hafez Ahmad Afifi Eman Mohamad Ahmad Ashraf Naguib Etaby Mohamad Adel Atta Sherif Farouk Elzawawi 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):677-685
Purpose
To demonstrate role of PET-CT (positron emission tomography-computed tomography) in screening for local and distant metastatic deposits from primary renal cell carcinoma and enhancing its advantages over other imaging modalities.Materials and methods
Twenty patients were evaluated as post nephrectomy screening for renal malignancy. Positive cases were interpreted whenever a focal area of FDG uptake more than the surrounding tissue whether in or outside abdominal cavity. Final diagnosis after correlation with other conventional radiological modalities as CT, MRI with the gold standard was histopathological diagnosis.Results
In current study, there were different sites of distant metastasis of renal cell carcinoma as follow: lung was the commonest (8 patients = 40%), followed with bones (7 patients = 35%), lymph nodes (6 patients = 30%), liver (4 patients = 20%), suprarenal gland (4 patients = 20%) and last were peritoneal deposits (2 patients = 10%).Conclusion
PET-CT had limitations in evaluating RCC metastasis due to its inability for adequate characterization of small metastatic lesions, however positive PET-CT results as a good predictive for evaluating metastatic deposits. PET-CT acts mainly as a complementary anatomy-based imaging modality and hence it may decrease or exclude the need for biopsy in some situations. 相似文献16.
Wael Hamza Kamr Amir Monier El-Tantawy Manar Moustafa Osama Ahmed Abd-Elsalam 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):215-223
Acute disseminated encephalomyelitis (ADEM) is an inflammatory disease affecting the central nervous system (CNS) with multiple and variable neurological signs.
Aim of the study
To assess the diagnostic value of MR Diffusion in diagnosis of ADEM and its outcome predilection.Patients and method
A prospective study included 35 patients conducted for accurate history taking and meticulous clinical examination, radiological imaging including CT in 23 cases, contrast enhanced MRI and MR Diffusion for all cases. Further CSF laboratory investigations were done for all cases. All patients were followed up after I month from the first presentation, after 6 months, 12 months and after 18 months with repeated MRI examination.Results
Thirty-five patients were included in our study over a period of 3 years; 9 patients with no abnormality in diffusion WI, 10 patients with T2 shine through effect and 16 patients with restricted diffusion. On follow up, patients with no abnormal diffusion or T2 shine through effect respond to medication and shows complete recovery within 6 months. While the other 16 patients with initial restricted diffusion, 7 of them showed recovery within 6 months and other 9 patients showed other attacks and complete recovery on long run follow up till 18 months.Conclusion
MR Diffusion provides a great help in detection of the brain tissue changes in ADEM in addition to the predilection of the course and outcome of the disease. 相似文献17.
Mohammed M. Dawoud Khaled Abd Al Wahab Abo Dewan Shaimaa Ahmed Zaki Magdy Abd Al-Raoof Sabae 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):717-727
Aim and objectives
To evaluate the role of dual energy computed tomography in renal stones.Methodology
40 patients (18 male and 22 female) with renal stones were included, their age ranging from 24 to 65 years (mean age 33 years), all patients were scanned first with a standard low-dose renal stone CT, then Dual energy CT examinations were performed by using a single-source dual energy with fast switching between two kilovoltage setting using 80 kV and 140 kV focusing on the region of the stone.Results
Dual energy CT provide reliable distinction between uric acid, Ca oxalate and Cystine stones, it predicted chemical composition of the stones as 22 stones composed of calcium oxalate, 10 stones composed of cystine and 8 stones composed of uric acid. DECT failed to distinguish Ca oxalate from Ca phosphate in 4 stones also failed to identify the mixed composition stones in 3 stones comparing with result of crystallography after passage or extraction of the stone which misdiagnosed as ca oxalate stones.Conclusion
Dual-energy CT has been shown to be effective for characterizing chemical composition of the urinary stones and it will be replace helical non contrast CT as the standard imaging modality. 相似文献18.
Mohamed Ahmed Moharram Noha Mohamed Abd-El Maboud Heba A. Elaziz Ahmed 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(2):381-391
Purpose
Evaluation of the role of real-time elastography in differentiating between benign and malignant cervical lymph nodes (LNs), comparison with B-mode and Doppler Ultrasonography.Patients and methods
This prospective study included 30 patients, with cervical lymphadenopathy, their age ranged from (18–79 years). The total number of the examined lymph nodes (LNs) was 75 LNs. These (LNs) subjected to B-mode US followed by Doppler evaluation, then elastographic evaluation including strain ratio which was calculated for each lesion, and compared with the histological results after fine needle aspiration cytology.Results
We evaluate the size, shape, echogenicity, and hilum on the B-mode images. The presence of the hilum showed the highest accuracy & sensitivity. Doppler Ultrasonography evaluation of nodal vascular pattern was of high sensitivity & specificity. The calculated sensitivity of elastographic pattern and scoring was 86%, specificity was 100%, PPV and NPV were 100% and 78.1% respectively, and the total accuracy was 90%. The mean elastographic strain ratio for malignant LNs (3.4 ± 1.2) was significantly greater than that for benign LNs (mean, 1.2 ± 0.3).Conclusion
Elastography is a promising improvement for differentiation between benign and malignant cervical lymphadenopathy. Sensitivity and specificity of elastography increased especially if combined with gray scale US and Doppler US. 相似文献19.
Mohamed D. Homos Seif Aldin Abaza Ayda Youssef Ashwaq Alsabri 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):75-79
Purpose
To demonstrate the hemodynamic changes of pulmonary arterial hypertension using cardiac MRI and to determine which parameters are best representative of the pulmonary artery pressure.Patient and methods
We examined 44 patients with pulmonary arterial hypertension using cine cardiac imaging and phase-contrast velocity encoding sequence to obtain data regarding ventricular morphology, function and pulmonary artery flow. The resulting parameters were correlated to echocardiography-derived mean pulmonary artery pressure.Results
We found increased right ventricular end diastolic, end systolic volumes and mass with decreased stroke volume and ejection fraction. The left ventricular end diastolic volume and stroke volume decreased and the end systolic volume increased while the ventricular mass index has increased compared to normal populations. The mean pulmonary artery pressure had significant positive correlation with the ventricular mass index (r = 0.61; p = 0.02) and right ventricular mass (r = 0.40; p = 0.02) with significant negative correlation with right ventricular ejection fraction (r = ?0.48; p = 0009).Conclusion
MR-derived ventricular mass index, right ventricular mass, and right ventricular ejection fraction had the strongest relation with the pulmonary artery pressure, and hence they could be reliable parameters on monitoring patients with pulmonary arterial hypertension. 相似文献20.
H.M. Etman A. Mokhtar M.I. Abd-Elhamid M.T. Ahmed T. El-Diasty 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(1):153-160