桥小脑角点位性病变的临床听力学表现

本文总结了经ＣＴ或ＭＲＩ证实以及部分经手术证实的１０１例桥小脑角点位性病变的纯音测听，听性脑干反应（ＡＢＲ），耳蜗电图以及前庭功能的表现。结果显示：ＡＢＲ多表现为Ⅰ－Ⅴ间期延长，仅Ｉ波存在或ＡＢＲ各波均消失。未见波Ⅴ幅度小于波Ⅰ。当肿物较大时，可见对侧ＡＢＲ异常，极重度聋患者（３５．５％），仍可引出异常ＡＢＲ波形，故仍不可忽视ＡＢＲ检查；听力轻度下降，甚至正常者ＡＢＲ仍有改变，ＡＰ出现率随肿物增大     

听神经瘤切除术后耳蜗电图的异常改变

耳蜗电图（ECochG）与听性脑干诱发电位（ABR）的结合已被广泛应用在桥小脑角肿瘤术中的听功能监测。手术中听神经机械损伤会立即在ABR中表现为阈值升高，振幅下降和潜伏期延长或出现复合动作电位（CAP）的消失。然而术中ECochG表现并不总能预测术后听力学情况。该文报告一例听神经瘤患者的术前，术中和术后ECochG表现并讨论术后ECochG波形的异常改变。病例为女性43岁。因双耳鸣，伴左耳听力下降加重半年就诊。既往有较严重眩晕病史。首次纯音测听检查听阈IkHZ为65dB，ZkHZ为60dB，言语分辨率7O％，ZkHZ和4kHzBekesy听力曲线…     

颅内压升高对耳蜗总和电位的影响

目的：了解颅内压升高对耳蜗总和电位（SP）的影响。方法：对31例颅内压升高的患者行纯音测听、听性脑干反应（ABR）和AP－SP复合波的检测，计算－SP和AP的比值（－SP／AP）。结果：所有患者纯音听力正常，ABR波Ⅰ-Ⅴ间期均小于4．5ms；所有患者的－SP／AP均大于0．27，其中22例大于或等于0．4，结果：颅内压升高的患者也可能出现优势－SP，因此，－SP／AP≥0．4，并不一定是梅尼埃病患者或蜗性病性病变的特性，也许可用来作为诊断颅压力高的辅助手段。     

听神经病的临床及基础研究

关于“听神经病”的命名经历几个不同的认识阶段。我国学者顾瑞将其称之为“中枢性低频感音神经性听力减退”,依据是：①纯音听力正常或轻度减退而言语听力显著减退;②镫骨肌反射不能引出或反射衰减阳性;③多数耳蜗电图（electrocochleogram,ECochG）可引出SP,AP振幅降低或消失;④听性脑干反应（auditory brainstemre．sponse,ABR）引不出或不能重复,特别是不能引出Ⅰ～Ⅴ波,提示病变在听觉传导的中枢通路。提出“Ⅰ型传入神经元病”概念,其依据的是患者有双侧进行性听力损失,严重的言语听力障碍,纯音测听以低频为主的上升型听力图,言语测听和ABR改变比纯音听阈改变严重,耳声发射多正常且幅度增大,不被对侧抑制。     

异常听性脑干反应分析

为了解听性脑干反应（ＡＢＲ）异常的临床诊断价值，报道５６例ＡＢＲ异常的病因和特点，包括手术和／或影像学证明桥小脑角病变２５例，颅内或桥小脑角附近的肿瘤３例，脱髓鞘病变７例，脑梗塞２例，多发性颅神经麻痹１例，肝豆状核变性１例，影像学检查无改变６例，１１例未作进一步检查。这些患者的ＡＢＲ改变多样，即使同一种病变也不尽相同，总的倾向是桥小脑角占位性病变以潜伏期和波间期改变为主，脑干或颅内弥漫性病变以波形     

听力学及前庭功能检查在桥小脑角肿瘤诊断中的意义

目的 :探讨听力学及前庭功能检查在桥小脑角肿瘤诊断中的意义。方法 :回顾性分析 2 0例 (2 1耳 )桥小脑角肿瘤患者的听力学及前庭功能资料。结果 :2 0例 (2 1耳 )纯音测听、听觉诱发电位均异常 ,19例镫骨肌声反射及前庭功能异常。结论 :听力学及前庭功能检查有助于桥小脑角肿瘤的诊断。     

梅尼埃病耳蜗及前庭功能损害程度的相关性研究

目的探讨梅尼埃病耳蜗与前庭功能损害程度的相关性及不同程度病变的临床特征。方法对符合诊断标准的44例梅尼埃病患者进行纯音测听、畸变产物耳声发射、Metz重振试验、听性脑干反应(ABR)、耳蜗电图(ECochG)、甘油试验等听力学检查及双温试验、Fukuda踏步试验等前庭功能检查。将测试结果用耳蜗与前庭功能损害的综合评价函数进行评价,同时根据0.5、1、2kHz平均听阈,将病例分成I组6例(平均听阈<25dBHL)、Ⅱ组13例(平均听阈25～40dBHL)、Ⅲ组25例(平均听阈41～70dBHL)。结果Ⅰ、Ⅱ、Ⅲ组-SP/AP阳性率和CP异常率呈上升趋势,各组间差异有统计学意义(P<0.05)。半规管功能异常者(25例)中纯音听阈值、-SP/AP值和耳蜗电图阳性率明显高于半规管功能正常者(19例)(P<0.05)。ECochG阳性者(28例)Metz重振试验、甘油试验阳性率显著高于ECochG阴性者(16例)(P<0.05)。耳蜗功能损害的综合评价函数为f1=0.212Ⅹ11+0.259Ⅹ12+0.429Ⅹ13+0.367Ⅹ14,前庭功能损害的综合评价函数为f2=0.275Ⅹ21+0.375Ⅹ22+0.398Ⅹ23+0.119Ⅹ24,综合评价函数f1与f2呈正相关性(r=0.395,P<0.05)。结论梅尼埃病耳蜗功能与前庭功能损害程度呈较弱正相关性,运用主成分分析法构建的综合评价模型可以较全面综合原始变量信息,合理反映耳蜗和前庭功能损伤程度,为疾病诊断、治疗选择和疗效评价提供依据。     

不对称的感音神经性听力障碍诊断上的配套检查

作者统计普通耳鼻喉科门诊病人115例,年龄16～80岁,平均53岁。93例(81％)诉一侧听力障碍,常伴耳鸣或眩晕;18例(16％)双耳难听,骨导听阈两侧不对称;4例(3％)耳鸣或眩晕,两侧听阈不对称。11例(10％)受检耳纯音听阈大于90dBHL。115例均需排除桥脑小脑角肿瘤,其中4例确诊为听神经瘤,经手术证实。全部病例均行ABR、听反射、ABLB、冷热试验和CT检查。结果:听神经瘤病例,ABR均异常(双耳闻Ⅰ～Ⅴ波间潜伏期大于0.2秒,双耳间Ⅴ波潜伏期差大于0.3秒或Ⅴ波缺如),无听神经瘤病例66％ABR正     

新生儿神经听觉监测系列

本文基于1022个病例的检查结果，提出新生儿神经听觉监测系列（简称系列）的模式，理论和策略。（2）听功能监测结果表明，89例显示单耳或双耳之ABR或40Hz-AERP反应阈值异常。（2）75例具有异常ABR或40Hz-AERP反应阈的患儿，神经听觉评价的检验表明，在异常反应阈范围内ABR之V波潜伏期异常的发生率（41．2％，52．63％）高于I波潜伏期异常发生率（37．73％，31．57％），二者均有显著性差异（P＜0．05）。（3）早产儿听系神经发育生物学的研究结果表明：ABR之I波潜伏期在低刺激强度下（30dBnHL)的发育早于高，中刺激强度下（80、60dBnHL)的发育，但是，ABR之Ⅲ，Ⅴ波潜伏期在同样条件下却表现出相反的发育特征。（4）缺血缺氧性脑病（HIE）和颅脑出血（IH）新生儿ABR监测结果表明：当两组（HIE和IH）患儿和对照组比较时，上脑干和下脑干的相应参量（Ⅰ，Ⅲ和Ⅴ波潜伏期Ⅰ-Ⅴ波间期）均有显著和高度显著性差异（P＜0．05，P＜0．001），但是；40Hz-AERP监测结果却表明，HIE新生儿比IH新生儿更能显示出脑干和中脑相应参量的显著变化。     

听觉诱发电位（AEP）的神经生物学基础及临床应用（12）

听神经瘤可引起同步前庭功能障碍，最常见的前庭症状是行走不稳、偏倒，重者出现眩晕，因此前庭功能检查，特别是冷热试验对诊断具有较大的价值。在本组病例中，患者半规管功能异常者占92％，ABR表现正常的5例患者均出现半规管功能低下，因此前庭功能检查对于桥小脑角占位病变的诊断具有参考意义。     

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.