喉内窥镜计算机图像处理系统的临床应用价值

目的 :评价喉内窥镜计算机图像处理系统在诊断喉部疾病时所起的作用。方法 :对 10 0例初诊为喉病患者进行定量的频闪喉镜、声学和电声门图同步测试 ,即通过喉内窥镜计算机图像处理系统获得的定量数据。结果 :该图像处理系统改变了 14例的初诊意见 ,使其中 6例避免了手术 ,8例从初诊决定行嗓音和药物治疗改为手术治疗。结论 :在常规的喉内窥镜检查中 ,将声学和电声门图测试相结合可获得具有实质性诊断价值的补充资料。     

A computer-based test system for implementing pure-tone audiometry, acoustic immittance and tympanic membrane displacement measurements

Valuable information on functional features of the auditory system may be gained by measuring the fine structure and time course of the acoustic stapedial reflex. This type of measurement invariable needs a computer for averaging the reflex response and the analysis of its salient features. This paper describes a 'Computerised Audiometric System' (CAS) which allows an integrated approach to certain audiometric tests, including pure-tone audiometry and tympanometry. In particular, 'tympanic membrane displacement' and acoustic immittance measurements have been combined to allow a comprehensive study of the reflex characteristics to be made. The purpose of this paper is twofold; first to describe the CAS in respect of reflex measurements; secondly, to describe the design of a practical computerised audiometric system which may be used for a wide variety of clinical testing and research. Features of special mention are the modular design strategy used, which makes the system an extremely versatile research tool as well as a potentially valuable addition to the audiology clinic, and menu-driven software written in FORTH, which allows complex test paradigms to be learnt and reliably implemented with a minimum of training. The prototype facility has been used extensively for research over the past 18 months, and a second is now installed in the Wessex Regional Audiology Centre. Both facilities will be linked to a patient data bank now under development.     

Primary pediatric endonasal dacryocystorhinostomy—A review of 58 procedures

Objectives

The objectives of this study are to report the outcomes of pediatric patients with lacrimal system obstruction who underwent primary endoscopic dacryocystorhinostomy (EDCR).

Study design

The authors conducted a retrospective noncomparative case series.

Methods

The operative and postoperative data have been collected in 58 children aged between 3 months and 13 years (mean 4.1 years). The total of 58 primary EDCRs has been performed by two surgeons using a standardized surgical technique. The EDCRs were performed 52 times on one eye, 6 times on both eyes (3 times simultaneously, 3 times at the separate sitting with an interval of 4-6 months). The follow-up evaluations include taking history, clinical examinations including a fluorescein disappearance test.

Results

The follow-up interval ranged from 12 to 36 months (mean 17 months, median 15 months). The success rate was 51/58 (87.9%) in all 58 EDCRs. The success rate was 47/51 (92.2%) in the group of postsaccal obstructions, 3/5 (60.0%) in the group of postsaccal and suprasaccal obstrutions and 1/2 (50.0%) in presaccal obstructions. The procedures were successful in all eight children aged under 1 year old (100%) and in 14 of 15 children between 1 and 2 years old (93.3%). The silicone intubation was used in 54 EDCRs.

Conclusions

The endoscopic DCR is a safe and effective procedure for most children with the success rate comparable to that achieved in the external DCR and in adults. The success rate of the postsaccal obstructions is significantly higher than in presaccal or combined pre- and postsaccal obstructions.     

A classification of parodontal surgical procedures (author's transl)]

Parodontal surgery is a dynamic entity, which has evolved in a continuous manner since the beginning of the century, because of the increasing interest in parodontology itself, the growing importance of surgical treatment for parodontal diseases, and improved knowledge of biological processes involved in cicatrization. A new classification is suggested which should allow a more specific selection of indications for surgical treatment and thus to obtain a stable and long-lasting result.     

单侧声带麻痹的外科治疗

目的比较颈袢喉返神经吻合术与声带外侧自体软骨充填术、声带脂肪注射术的疗效。方法单侧声带麻痹143例,病程6个月至12年。行颈袢与喉返神经吻合术(A组)89例：声带外侧自体软骨充填术(B组)25例;声带自体脂肪注射术(C组)29例。治疗前后以电子喉镜、频闪喉镜、声音评估和嗓音声学参数分析等评价治疗效果。结果A组术后术侧声带均内移至正中位,肌体积增大,发音时声带突明显内收,声门后裂隙消失,声带振动及黏膜波均恢复对称性,声门闭合良好：嗓音恢复正常86例。3例接近正常;声学五参数频率微拢、振幅微拢、标准化嗓音能量、基频及最长声时平均值均在正常范围内,前三项明显小于术前,后两项明显大于术前,差异均具有非常显著性。B组及C组术后声带均不同程度内移,但声带均无运动,声门后裂隙仍较明显。B、C组术后声嘶有不同程度好转,声学前三参数平均值均明显小于术前,最长声时明显大于术前,差异均具有显著性：而基频手术前后差异无显著性。B、C组的声学参数前三项均明显大于A组,而基频及最长声时明显小于A组,差异均具有显著性。B、C组间的声学五参数差异无显著性意义。结论单侧声带麻痹以神经修复术疗效最佳;声带外侧充填术及声带脂肪注射术也有治疗效果,不适合神经修复者仍可选用：脂肪注射术往往须多次注射方能维持疗效。     

Effectiveness of computer-based auditory training for adult users of cochlear implants

Abstract

Cochlear implantation is effective at restoring partial hearing to profoundly deaf adults, but not all patients receive equal benefit. The present study evaluated the effectiveness of a computer-based self-administered training package that was designed to improve speech perception among adults who had used cochlear implants for more than three years. Eleven adults were asked to complete an hour of auditory training each day, five days a week, for a period of three weeks. Two training tasks were included, one based around discriminating isolated words, and the other around discriminating words in sentences. Compliance with the protocol was good, with eight out of eleven participants completing approximately 15 hours of training, as instructed. A significant improvement of eight percentage points was found on a test of consonant discrimination, but there were no significant improvements on sentence tests or on a test of vowel discrimination. Self-reported benefits were variable and generally small. Further research is needed to establish whether auditory training is particularly effective for identifiable sub-groups of cochlear-implant users.

Sumario

La implantación coclear es efectiva para restaurar desde una alteración parcial de la audición hasta una sordera profunda en adultos, pero no todos los pacientes reciben el mismo beneficio. El presente estudio evalúa la efectividad de un paquete de entrenamiento computarizado y auto-administrado que se diseñó para mejorar la percepción del lenguaje en adultos que han utilizado implantes cocleares por más de tres años. Se le pidió a once adultos que completaran una hora de entrenamiento auditivo cada día, cinco dóas por semana, por un peróodo de tres semanas. Se incluyeron dos tareas de entrenamiento, una basada en la discriminación de palabras aisladas y la otra en discriminación de palabras en medio de frases. El cumplimiento del protocolo fue bueno, con ocho de quince participantes que completaron aproximadamente 15 horas de entrenamiento, como se instruyó. Se encontró una mejoría significativa de ocho puntos porcentuales en una prueba de discriminación de consonantes, pero no existió una mejoría significativa en las pruebas de frases o en la prueba de discriminación de vocales. Los beneficios auto-reportados fueron variables y generalmente pequeños. Se requiere investigación adicional para establecer si el entrenamiento auditivo es particularmente efectivo en subgrupos identificables de usuarios de implantes cocleares.     

Comparison of glottal area changes as measured from ultrahigh-speed photographs and photoelectric glottographs.

To determine the relationship of information on glottal area function provided by deviations sensed by the photoelectric glottograph to that derived from a frame-by-frame analysis of ultrahigh-speed photographic film, simultaneous photographic and glottographic recordings were obtained from five subjects. From the investigation, the following results were obtained: (1) the measurements of the light deviations sensed by the photoelectric glottograph during laryngeal vibrations produced curves that approximated those developed from photographic film frame-by-frame measurements of the visual image in vocal fry, modal, and falsetto voice registers, and (2) the Fourier coefficients of the compared data indicated that there was no significant difference between the curves.     

Fractures of the mandible. A critical study of repair procedures

Based on their personal experience of 110 patients operated on for mandibular trauma, the authors analyse the results of the various techniques used. Screwed micro-plates may be very useful but only complete the therapeutic arsenal of the surgeon. In fact classical methods continue to provide satisfactory results. Poorer results may occur with fractures which combine involvement of the articular surfaces with a lesion of the body of the mandible.     

Intranasal ethmoidectomy and concurrent procedures

In this review of 526 intrnnasal ethmoidectomy procedures, there was a complication rate of 2.5% with no blindness, meningitis, or deaths. The rationale for associated concurrent procedures is presented. The use of an absorbable hemostntic sinus sponge and an easily removable Telfa® nasal packing made possible just a two-night hospital stay in over 90% of these patients.     

Stapedectomy: Incus bypass procedures. A report of 203 operations

The records of 203 stapedectomy operations in which we used a prosthesis from the malleus handle or a columella from the tympanic membrane were reviewed; 63 operations were primary stapedectomies, and 85% had a postoperative conductive deficit of 15 dB or less. The most common single indication for an incus bypass procedure was idiopathic malleus head fixation. Sixty-six operations were revision stapedectomies; 65% had a postoperative deficit of 15 dB or less. In 50% the bypass indication was necrosis of the incus. There were 74 stapedectomies in a previously fenestrated ear; 60% had a postoperative deficit of 15 dB or less. Incus bypass procedures in stapedectomy, when indicated, yield satisfactory hearing results. Otolaryngologists who perform stapedectomy must be familiar with these procedures.     

A comparative distribution study of two procedures for administration of nose drops

The intranasal distribution of nose drops has been studied in 12 healthy subjects, comparing an administration followed by two rapid inhalations through the nose, with an administration followed by turning the head to five positions. Insoluble particles of human serum albumin labelled with 99Tcm were suspended in the liquid before administration. A significantly larger area (p less than 0.05) in the nasal cavity was covered by the labelled nose drops when the subjects used the turning-the-head procedure. It appears that this procedure gave a larger passive distribution of the particles. The differences were about 10 to 15% between 3 and 45 min after administration. Some particles were rapidly transported into the pharynx. The retention of the particles at the initial site of deposition did not differ significantly between the two procedures and about 50% of the particles seemed to have penetrated to the ciliated region in the main nasal passages and were cleared. The results indicate that the procedure for administration of the nose drops influences the distribution in the nasal cavity, but the clinical relevance should be studied with respect to the efficacy of the active drug in patients.