声带外侧自体脂肪注射填充术治疗声门闭合不良

目的对声带外侧自体脂肪注射填充术方法选择、预后及其影响因素进行研究,探讨声带外侧自体脂肪注射在声门闭合不良性发声障碍治疗中的价值。方法病例选择:29例声门闭合不良、发声障碍患者,27例为单侧声带麻痹(麻痹时间均超过半年),2例为声带萎缩。手术选择:全麻支撑喉镜下,应用特制Brunning高压脂肪注射器进行自体脂肪声带外侧注射。患者手术前后均行嗓音声学、气流动力学及频闪喉镜检查,确定患者发音质量及疗效。结果术后随诊10～18个月,24例患者发声明显改善,2例发声好转,3例无效。注射1个月后脂肪部分吸收,声门闭合程度及发音逐渐改善。3～6个月声带振动、声门闭合正常,发声明显改善,音质稳定,主、客观声学评价及气流动力学参数改善明显(P<0.01)。结论单侧声带麻痹或声带萎缩引起的声门闭合不良,选择声带外侧声门旁间隙脂肪注射手术,使声带膜部内移,改善声门闭合,并保留声带振动特性,患者可获得良好的发音效果。     

自体脂肪声带内注射术治疗单侧声带麻痹的远期疗效观察

目的　探讨自体脂肪声带内注射术治疗单侧声带麻痹的远期疗效。方法　 2 0例单侧声带麻痹患者将取自体腹部的脂肪颗粒注射到麻痹侧声带 ,使声带隆起 ,声门闭合 ,恢复嗓音功能 ;所有病例均随访 12个月以上 ,并按术前及术后即刻、近期 (3～ 6个月 )、远期 (>12个月 )通过电子喉镜以计算机软件测得患侧与健侧声带上表面面积比为参数代表患侧声带大小变化指标 ,并用嗓音疾病评估仪进行嗓音声学测试分析。按术前嗓音声学测试结果分为轻度、中度、重度 3组 ,采用自身对照统计分析结果。结果　注射后麻痹侧声带相应体积较术前明显增大 ,但随时间推移 ,麻痹侧声带内的脂肪部分吸收 ,麻痹侧声带体积逐渐减小 ,而术后近期各组及远期中重度声嘶组测得的麻痹侧声带相应体积与术前差异有显著性 ,轻度声嘶组远期测得的麻痹侧声带相应体积与术前差异无显著性。声学测试客观分析 ,注射后较注射前嘶哑程度明显好转 ,随时间延长嘶哑程度有所下降 ,但术后近期及远期嘶哑程度接近。直接反映声门闭合程度的噪声能量在注射脂肪后较注射前明显下降 ,达到正常或接近正常 ;随时间延长噪声能量稍升高 ,但与术前差异有显著性 ,且术后近期及远期的差异无显著性。结论　自体脂肪声带内注射治疗单侧声带麻痹是可选择的有效方法 ,其远期     

单侧声带小息肉患者术后声休时间对嗓音功能的影响

目的 探讨单侧声带小息肉患者术后声休时间对嗓音功能的影响。方法 筛选山西医科大学第一医院耳鼻咽喉头颈外科住院部中拟行单侧声带小息肉手术的患者120例,术前予以嗓音卫生宣教,指导患者发声方法训练,并完善相关嗓音声学分析,包括基频微扰(Jitter)、振幅微扰(Shimmer)、最长发声时间(MPT)、嗓音障碍严重指数(DSI)、粗糙声/气息声/嘶哑声(RBH)、嗓音障碍指数量表(VHI)等,所有患者术前各嗓音声学参数差异均无统计学意义(P>0.05)。术后采用随机抽样法将患者分为3组,每组各40例。3组患者在常规治疗(健康教育、手术治疗、药物治疗)的基础上术后行绝对声休,其中A组术后声休3 d, B组术后声休7 d, C组术后声休2周;各组患者声休结束后予以8周的嗓音训练。术后3、6个月复查时对各组患者行嗓音声学分析,分析各组间嗓音声学参数的差异性,并与术前各嗓音声学参数进行对比。结果 (1)术后3、6个月,各分组嗓音训练后Jitter、Shimmer、VHI、RBH均明显下降,MPT、DSI明显上升,与术前相比差异具有统计学意义(P<0.05);(2)术后3个月,A组和B组...     

双侧声带麻痹不同术式治疗前后声门测量及嗓音评价

目的探讨3种不同的双侧声带麻痹治疗术后声门面积及嗓音质量。方法 46例双侧声带麻痹患者分别采用激光杓状软骨切除术(A 组24例),膈神经替代喉返神经吻合术(B 组9例),喉外径路杓状软骨切除声带外移固定术(C 组13例)治疗,手术前后行声门测量及嗓音分析。结果 A、B、C 组拔管率分别为91.7%(22/24)、88.9%(8/9)、100.0%(13/13),3种术式术后最大开放声门面积平均(x±s)分别为:(47.2±7.4)mm~2、(78.3±16.0)mm~2、(48.1±6.5)mm~2。B 组术后声门面积明显大于 A、C 组,差异有统计学意义(t 值分别为4.46和3.85,P 值分别为0.000和0.001)。A、C 组术后声门面积差异无统计学意义(t=1.68,P=0.101)。A 组术后17例能保持术前的嗓音质量,7例恶化;B 组术后5例嗓音好转,1例恢复正常,3例无变化;C 组术后3例嗓音无变化,10例恶化。B 组9例术后膈神经修复侧膈肌均麻痹不动,肺活量及最大呼吸容量为术前的72%～84%及76%～84%;半年后膈肌动度恢复达35%～76%,肺活量及最大呼吸容量为术前的93%～97%及91%～98%。结论膈神经替代吻合术后拔管患者声门面积最大,嗓音最好。激光杓状软骨切除和喉外径路杓状软骨切除声带外移固定术均能建市足够气道,拔除气管套管,但前者嗓音明显优于后者。     

声带沟的手术治疗

目的探讨声带沟的手术修复手段,以提高疗效.方法对经喉动态镜检查确诊的26例声带沟患者,采用喉显微外科手术加嗓音训练的综合方法治疗.其中单纯声带沟切除术9例,黏膜微瓣整复术11例,自体阔筋膜加脂肪声带注射术4例,阔筋膜声带植入术2例.术后10天进行嗓音训练,持续4～6个月.所有患者术前、术后定期行喉动态镜检查及嗓音学分析.结果术后仍有5例患者症状无明显改善,总有效率为80.8%(21/26).有效病例术后1周喉动态镜检查显示声带形态基本恢复正常,声带沟消失;术后1个月声带振动恢复.术后3个月嗓音声学分析显示声学参数较术前明显改善.行自体阔筋膜加脂肪声带注射术和阔筋膜声带植入术的6例患者中,最长观察时间28个月,声带黏膜波动良好.未出现任何并发症.结论喉显微外科手术加嗓音训练的综合治疗方法治疗声带沟效果满意.     

电子喉镜下脂肪注射术治疗单侧声带麻痹

目的 探讨电子喉镜监控下声带黏膜下自体脂肪注射术治疗单侧声带麻痹的疗效.方法 32例单侧声带麻痹患者,取自体脂肪颗粒在电子喉镜监控下自环甲膜穿刺,患侧声带内多角度分层次多点注射,术前、术后即刻、术后6个月、术后12个月分别测量患侧声带的表面积和声门裂隙大小,嗓音质量评估仪对嗓音进行评估.结果注射术后麻痹侧声带表面积增加,声门裂隙缩小,随时间推移,麻痹侧声带内的脂肪部分吸收,声带表面积减小,声门裂隙稍增大,术后各阶段和术前比较差异有显著性统计学意义;但术后6个月和术后12个月比较差异无显著性意义.嗓音声学测试发现,术后声门噪声能量下降,声时延长,与术前比较差异有显著性统计学意义;术后6个月和术后12个月比较,差异无显著性意义.结论电子喉镜下声带黏膜下自体脂肪注射术方法简单、方便,疗效确切,是治疗单侧声带麻痹的有效方法.     

喉癌与声带息肉患者嗓音的计算机定量评估

目的比较喉癌及声带息肉患者主要嗓音参数在不同检测方法中的变化,探讨喉癌与声带息肉对发声功能的影响。方法采用Dr．SpeechScienceforWindows（4．0）软件对正常成人、喉癌患者、声带息肉患者作嗓音声学分析和电声门图检测,并比较其主要参数的变化,分析各自嗓音质量评估的特点。结果①在喉癌和声带息肉患者中,两种嗓音检测方法的嗓音参数,基频微扰、振幅微扰、声门噪声能量均是有价值的,两者的基频微扰、振幅微扰、声门噪声能量可以互相替代,两种方法各参数间比较无统计学差异;②正常成人、喉癌患者、声带息肉患者平均基频之间无统计学意义,基频微扰、振幅微扰、声门噪声能量数值由低到高排列依次为正常成人组、声带息肉组、喉癌组,两两比较均有显著性差异（P〈O.05）;③嗓音质量由好到差排列为正常成人组、声带息肉组、喉癌组。结论计算机声学分析的各项参数可作为嗓音定量评价的客观指标,判断嗓音损害程度。     

自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效观察

目的 探讨自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效.方法 对26例单 侧声带麻痹声门闭合不全患者全麻支撑喉镜下经口行声带内注射术,其中6例采用自体脂肪注射(A组),20例采用自体腹直肌前鞘筋膜加脂肪注射(B组).术前、术后动态喉镜检查和主客观嗓音分析评估疗效,均随访24个月.结果 两组患者术后注射物无外溢,注射侧声带形态饱满;术后3 d注射侧声带出现急性炎性反应,3个月左右消退.术后3个月A组所有患者注射侧声带回复至中线,声门闭合良好,6～24个月声门闭合稍有缝隙;B组所有患者术后6个月回复至中线,声门闭合良好,6～24个月声带形态稳定.术前嗓音声学分析:两组间基频微扰、振幅微扰、标准化噪声能量及最大发音时间差异无统计学意义(P值均＞0.05);A组术后3个月显著改善(P值均＜0.01),6及24个月较术前改善(P值＜0.05或＜0.01),但较术后3个月音质下降(P值＜0.05或＜0.01);B组术后6个月显著改善(P值均＜0.01),6、12及24个月各参数差异均无统计学意义(P值均＞0.05);术后24个月两组的基频微扰、标准化噪声能量及最大发音时间差异有统计学意义(P值＜0.05或＜0.01).B组嗓音听感知评估,总嘶哑度、气息声、发音无力程度评分降低,与术前相比差异有统计学意义(P值均＜0.01).结论 自体腹直肌前鞘筋膜加脂肪声带内注射术治疗单侧声带麻痹声门闭合不全可有效提高患者声音质量,远期效果稳定.

Abstract：

Objective To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. Methods A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold ( group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection ( group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. Results All patients were followed up for 24 months. On the third day after operation,there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later.In all 20 eases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant ( P ＜ 0. 01 ). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 -24 months after operation and were not changed by the length of follow-up. And in the 6 cases,videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P ＜ 0. 05 or ＜ 0. 01 ), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P ＜0. 05 or ＜0. 0l ). The significant differences were not observed between 6 and 24 months (P ＞ 0. 05 ). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months ( P ＜0. 05 or ＜ 0. 01 ). Conclusion The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.     

声带小结及声带局部肥厚患儿嗓音声学及电声门图分析

目的 研究声带小结、声带局部肥厚患儿及正常儿童嗓音声学及电声门图参数之间的差异,为临床诊治提供依据.方法对342例正常儿童及76例声带局部肥厚患儿、52例声带小结患儿进行嗓音声学测试及电声门图分析,对三组参数进行方差分析并作两两比较.结果声带小结与声带局部肥厚患儿的嗓音声学分析的标准化噪声能量（NNE）与基频方差（SDFo）无显著差异,频率微扰（jitter）、振幅微扰（shimmer）在两组间差异有显著统计学意义;声带小结与声带局部肥厚患儿的电声门图频率微扰（jitter）、振幅微扰（shimmer）差异无统计学意义,NNE和SDFo在两组间差异有统计学意义.结论 jitter、shimmer、NNE、SDFo四项参数在区分正常嗓音和病理性嗓音时非常重要而且非常敏感;在病理性嗓音中以上四项参数各有异同;嗓音声学参数较电声门图参数更有意义.     

汉族、纳西族、白族正常儿童嗓音声学和电声门图参数调查及其异同分析

目的 :探索汉族、纳西族、白族正常儿童嗓音声学和电声门图参数正常值及三者间差异。方法 :对 3个民族中 95 1例 4～ 8岁正常儿童用电子计算机及 Dr.speech系统软件进行嗓音声学 6项参数及电声门图 6项参数检测。并对同年龄组的声带小结和局部增厚患儿 30例进行检测。结果 :测出 3个民族的儿童嗓音声学和电声门图主要参数 ( 1基频微扰 2振幅微扰 3平均基频 4基频方差 5噪声能量 ) ,并列表对比分析。结论 :1汉族学龄前儿童和学龄儿童间全部参数无明显差异。但纳西族和白族学龄前儿童和学龄儿童间平均基频、基频方差均有明显差异。汉族与纳西族、白族间学龄儿童的平均基频、基频方差有非常显著性差异 ;2正常汉族儿童与声带小结等疾患儿童间各项参数有非常显著性差异     

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.