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.     

儿童梅尼埃病与老年梅尼埃病的临床比较研究

目的 儿童和老年梅尼埃病(Meniere’s disease,M D)是该病的两个特殊群体,发病率均较低.本文比较分析两者的差异,增加对两类人群MD诊断的认识水平.方法 本文MD患者均来自解放军总医院耳鼻咽喉-头颈外科眩晕中心.从2004年1月至2007年7月共计586例.其中,儿童10例;老年人13例.患者接受纯音测听、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 (1)发生率:儿童期MD的发生率为1.71％(10/586).老年的发生率为2.22％(13/586).(2)首发症状:儿童首发典型MD症状(耳蜗症状和前庭症状均具备),占40％(4/10),耳蜗症状占30％(3/10);首发旋转性眩晕占20％(2/10),倾倒感10％(1/10).老年典型MD症状占69 2％(9/13),耳聋伴眩晕者15.4％(2/13),旋转性眩晕为7.7％(1/13).倾倒感7 7％(1/13).(3)听力图类型儿童MD听力图有两种类型:低频下降型和平坦型.低频听力下降为主占70％(7/10)平坦型曲线占30％ (3/10).老年MD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.(4)前庭功能:儿童与老年MD前庭功能检查结果同样表现为多样性,前庭功能检查结果正常或异常与病程无关.结论 儿童MD纯音听力的特征为低频下降,前庭功能的特征呈多样性;老年MD的纯音听力高频损失常较低频更为明显,前庭功能检查结果同样也表现为多样性.     

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。     

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。     

梅尼埃病的听-前庭功能诊断的Logistic回归分析

目的:采用多指标的Logistic回归分析方法探讨梅尼埃病临床特征及耳蜗与前庭功能损害的特征.方法:36例梅尼埃病患者和30例其他外周性眩晕对照组进行临床资料分析,完成纯音测听、Metz重振测试、耳蜗电图、甘油试验、ABR等听力学检查以及双温试验、摇头眼震试验、Fukuda踏步试验.对临床体征、耳蜗与前庭功能检查的各项指标进行单因素χ2 分析,然后进行多因素Logistic回归分析.结果:①波动性听力下降、四联征出现的个数、Tullio现象、耳蜗电图-SP/AP幅值比、Metz重振试验、甘油试验在梅尼埃组与非梅尼埃组间差异有统计学意义(P<0.05);②建立了以耳蜗电图(X1)、甘油试验(X2)、症状的个数(X3)、波动性听力下降(X4)为变量的梅尼埃病Logistic回归预测方程:Logit(p)=-9.443+3.110 X1 +5.015X2 +2.506 X3 +3.963 X4.Logistic模型预报正确率为95.5%,ROC曲线下面积为0.993.结论:梅尼埃病的临床表现特征性明显,配合耳蜗-前庭功能的客观检查,可与其他外周性眩晕相鉴别,相关因素的Logistic回归预测方程可对梅尼埃病进行辅助诊断.     

迷路后前庭神经切断术:非梅尼埃病疗效

迷路功能障碍所致眩晕有多种有效的手术方法,对尚有可用听力者,可采用前庭神经切断术(RVNS)。据报告RVNS对梅尼埃病疗效良好,而对非梅尼埃病疗效较差。作者报道一组病例并评价非梅尼埃病RVNS的疗效。 90例药物治疗无效致残性眩晕患者接受RVNS,男43例,女47例,年龄14～66岁,平均42岁。梅尼埃病48例(53%),失代偿性前庭神经炎(UVN)(组Ⅰ)23例(26%),余19例(21%)为各种原因所致迷路功能障碍:又分为伴单侧感音神经性聋(SNHL)或一耳化脓感染8例(组Ⅱ),伴对称性SNHL11例(组Ⅲ)。术前术后均作听力、耳蜗电图、前     

耳蜗电图Sp/Ap面积比在梅尼埃病诊断中的作用

目的:比较耳蜗电图中不同指标Sp/Ap的振幅比和面积比对梅尼埃病辅助诊断的敏感性。方法:通过将梅尼埃病患者耳蜗电图中Sp/Ap的振幅比和面积比分别与其正常水平值相比较,试图寻找更敏感的指标来提高耳蜗电图对梅尼埃病的诊断敏感性。结果:35例梅尼埃病患者中有48.6%的患者Sp/Ap振幅比>0.4,若参照10例(20耳)正常人所得Sp/Ap的振幅比参考值范围(高限0.49,95%置信区间),阳性率只有39.1%,参照10例(20耳)正常人所得Sp/Ap的面积比参考值范围(高限1.92,95%置信区间),35例梅尼埃病患者中有28例Sp/Ap的面积比高于1.92,阳性率为77.1%。结论:采用Sp/Ap的面积比能提高对梅尼埃病的诊断敏感性。     

急性低频感音神经性耳聋和梅尼埃病的耳蜗电位图的比较

急性低频感音神经性耳聋(acute low hearing loss，ALHL)是一种具有特征性听力曲线的疾病，这种特征性听力曲线又同时提示梅尼埃病(Menieres disease，MD)处于早期的内淋巴囊肿胀阶段。人们一直在关注着ALHL的病因及其与MD的关系，但至今仍然没有统一的认识。许多研究用耳蜗电图和甘油实验来研究其发病机理。为了进一步阐明ALHL的发病机理，该将20例ALHL患的耳蜗电图和58例MD患的耳蜗电图相比较，     

单侧梅尼埃病患者双侧耳蜗电图检查的意义

目的分析梅尼埃病患者双侧耳蜗电图,以早期发现一侧梅尼埃病对侧耳膜迷路积水的可能性,了解梅尼埃病患者对侧无症状耳内淋巴积水可能的发生率。方法对明确诊断为梅尼埃病的121例患者行双侧耳蜗电图检查,对其中可统计出明确病程的114例比较其双侧耳蜗电图结果与病程的关系。结果可以统计出梅尼埃病病程的114例中,单侧异常46例,平均病程7.42±7.68年(5天~37年);双侧异常38例,平均病程5.43±5.73年(3个月~20年);双侧正常者30例,平均病程5.37±4.40年(4个月~12年)。三种情况下,病程与耳蜗电图结果无直线相关(P>0.05)。在121例行双侧耳蜗电图检查的病例中,双侧耳蜗电图异常者39例,其中9例有双侧耳鸣,占23.1%(9/39),而单侧耳蜗电图异常者51例中,出现双侧耳鸣的仅有1例,占2%(1/51),双侧耳蜗电图异常伴双侧耳鸣的发生率明显高于单侧耳蜗电图异常伴双侧耳鸣的发生率(P<0.01)。结论耳蜗电图对梅尼埃病诊断的评价应建立在对梅尼埃病动态变化的理解基础之上;耳蜗电图对早期听力正常的梅尼埃病的诊断具有一定的参考价值。     

疏波和密波短声诱发的动作电位潜伏期差对梅尼埃病的诊断价值

目的　探讨疏波和密波短声诱发的动作电位 (actionpotential,AP)潜伏期差对梅尼埃病的诊断价值。方法　采用鼓膜电极耳蜗电图描记术 ,对 5 0例正常听力耳和不同听力损失程度和听力图类型的梅尼埃病 90耳及其他原因感音神经性聋 6 0耳分别记录了疏波和密波短声AP潜伏期 ,并对其计算得出的差值进行分析。结果　梅尼埃病组疏波和密波短声诱发的AP潜伏期差 (0 30± 0 15 )ms( x±s,下同 )明显高于正常对照组 (0 18± 0 0 7)ms和其他感音神经性聋组 (0 2 0± 0 10 )ms ,(P值均 <0 0 1) ;梅尼埃病组轻度和中度聋组AP潜伏期差高于中重度聋组 (P <0 0 1) ;低频型和高频型患者高于平坦型 (P <0 0 1)。正常组和其他感音神经性聋组比较差异无显著性意义。感音神经性聋组AP潜伏期差异常率为 4/6 0 (6 7% ) ,梅尼埃病组 5 8/90 (6 4 0 % )。结论　梅尼埃病患者中疏波和密波短声诱发的AP潜伏期差可出现异常增大 ,这一客观参数可能有助于临床诊断     

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.