面神经

,7147,小儿面瘫甲裳微循环的观察及分析厂李荣一//中国中西医结合耳鼻咽喉科杂志一]996,4(4),一157一159 观察14例贝尔麻痹患儿和200例健康对照组的甲璧微循环变化。发现面瘫患儿大多存在不同程度的甲装微循环障碍(3/14例,92.9%),与对照组间有显著性差异(P<0.05)。主要变化为:清晰度降低、流态异常、红细胞聚集及拌周渗出治疗后,14例患儿面瘫消失的同时,其微循环异常也明显改善。认为临床微循环观测对小儿面瘫的诊断、治疗有一定的指导意义表3参4(秋实),71480 Be一麻痹的BAEp研究/金蕾…//苏州医学院学报.19%.16(2)一231~232 对51例Bell…     

突发性聋LPO、SOD测定及甲襞微循环观察

测定３２例突发性聋发病初期及治疗后血浆过氧化脂（ｌｉｐｉｄｐｅｒｏｘｉｄｅ，ＬＰＯ）水平及红细胞内超氧化物歧化酶（ｓｕｐｅｒｏｘｉｄｅｄｉｓｍｕｔａｓｅ，ＳＯＤ）活性，同时观察甲襞微循环变化，并与正常人对照。结果显示：①突聋发病初期ＬＰＯ水平明显升高，而红细胞内ＳＯＤ活性明显降低，和对照组比较，差异有显著性意义（Ｐ＜０．０１），但二者升降水平与患者的各频率气骨导听力损失程度无相关关系，治疗后ＳＯＤ活性逐渐恢复正常，其恢复程度与患者听力提高相对数呈直线正相关关系（ｒ＝３．９０１，Ｐ＜０．０５），ＬＰＯ水平也呈下降趋势。②突聋发病初期有微循环障碍，甲襞微循环积分值高于正常人（Ｐ＜０．０１），其积分值水平与ＬＰＯ含量呈正相关（ｒ＝４．３２１，Ｐ＜０．０５），与ＳＯＤ活性呈负相关（ｒ＝－４．４１９，Ｐ＜０．０５）。提示自由基的损害作用可能是突发性聋发生的一个重要病理生理环节。     

突发性聋LPO,SOD测定及甲襞微循环观察

测定３２例突发性聋发病初期及治疗后血浆过氧化脂水平及红细胞内超氧化物歧化酶活性，同时观察甲襞微循环变化，并与正常人对照，结果显示：（１）突聋发病初期ＬＰＯ水平明显升高，而红细胞内ＳＯＤ活性明显降低，和对照组比较，差异有显著性意义（Ｐ〈０．０１），但二者升降水平与患者的各率气骨导听力损失程度无相关关系，治疗后ＳＯＤ活性逐渐恢复正常，其恢复程度与患者听力提高相对数呈直线正相关关系（ｒ＝３．９０１，Ｐ〉     

老年聋与甲襞微循环障碍关系的研究

老年聋与甲襞微循环障碍关系的研究张勋１马银霞３苗英章２李秀霞１王玲３刘存３张培俭１季坤景３外周微循环是全身微循环的一部分，外周微循环的改变虽不能完全代表内脏微循环，但在一定程度上可以反映全身微循环的变化。本研究通过对老年聋患者进行甲襞微循环观察（以...     

鼓索神经损伤引起味觉障碍的临床研究

目的：本研究旨在探讨临床药物干预对不同因素引起鼓索神经损伤的味觉改善是否存在可行性和必要性和评价常规中耳炎手术中是否保留鼓索神经的必要性。方法按照House-Brikman（HB）评级入组病人120例分为两组,实验组和对照组各60例。各组再分为二亚组：一亚组贝尔氏面瘫30例,另一亚组鼓室成形术30例。实验组采用神经营养药（甲钴胺）及改善微循环药（复方丹参）治疗,对照组不做治疗。结果实验组味觉恢复病例多于对照组（6月,P=0.02;12月P＜0.01）,实验组有效率高于对照组（P＜0.01）,实验组面瘫味觉恢复病例高于对照组（P＜0.01）,实验组鼓室成形术病例有效率高于对照组（P＜0.01）。结论提示药物治疗周围性面瘫和鼓室成形术中切断鼓索神经皆有效,中耳手术时勿损伤鼓索神经,尤其是双侧中耳炎患者。     

突发性耳聋听力,甲襞微循环与中医辨证关系初探

目的探讨突发性耳聋患者的咱力、甲襞微循环的改变与中医辨证分型之间的关系。方法对５０例突发性耳聋患者进行听力检查,甲襞微循环测试,中医辨证分型,并进行综合分析。结果５０例者共有６５耳有不同程度的听力损失,７４％的患者存在着不同程度的微循环障碍,主要表现在襻周状态和血液流态上,其中,中医辨的肝火上扰型患者的微循环改变较为明显,结论突发性耳聋患者的听力损害与甲襞循环的改变以及中医辨证分型有着一定的内在联     

贝尔面瘫的味觉变化与临床疗效观察

采用电味觉仪和面神经电图对两组各２８例贝尔面瘫患者治疗过程进行了连续、同步观察，通过对味觉的种类（辣、苦、咸、麻）和味觉阈以及面神经功能的动态变化，发现味觉变化先于面神经功能的变化。联合治疗组结合中医味觉辨症，其疗效优于对照组（Ｐ〈０．０５），并为贝尔面瘫的及时治疗和预后提供了客观依据。     

茶色素治疗椎—基底动脉缺血性眩晕的随机对照研究

采用随机抽样，实验对照方法观察了茶色素治疗椎—基底动脉缺血性眩晕的疗效及对微循环的影响，结果表明，治疗组总有效率为90·0％，而对照组总有效率为50·0％，二者差异显著（P＜0·01）。治疗组治疗后甲壁微循环较治疗前明显改善（P＜0．01）。提示：茶色素治疗根－基底动脉缺血性眩晕疗效显著。     

中西医结合治疗贝尔氏面瘫

贝尔氏面瘫是一种常见病。本文通过中西医结合方法治疗贝尔氏面瘫61例，取得明显效果。1临床资料61例患者，男性39例，女性22例。年龄22～65岁，平均年龄33岁，病程最短1天，最长3个月。14天内就诊46例。就诊检查完全性面瘫47例，不完全性面瘫14例。门例中合并糖尿病5例（其中2例伴高血压），单纯高血压病Z例，肺结核病3例，胃十二指肠溃疡5例（对合并上述疾病同时采取相应治疗）。2治疗方法2．1抗病毒药物：使用无环身着200mg，4次／日。聚肌胞Zing肌肉注射，2～3次／周。或病毒华0．Zg，3次’口。2．2扩张血管、营养神经药物：菸酸100mg…     

鼾症病人手术前后微循环检测

鼾症是由于睡眠时上呼吸道间歇性萎陷引起的呼吸障碍。为了从病理生理角度阐述ＯＳＡＳ和鼾症对人体的危害以及寻找一种评价手术疗效的客观指标，本研究对４３例患者手术治疗前后甲皱（ｎａｉｌｆｏｌａ）微循环的加全积分值进行统计学处理，结果表明有极显著的差异（ｐ＜０．０１），即治疗后微循环积分值的下降有非常显著的意义。其中以流速、红细胞聚集、清晰度以及渗出积分值的降低为著，而形态的改变无显著性差异。这说明，手术治疗鼾症短期内对改善血液流态效果较著，氧代谢对微循环形态的影响则是一个慢性的过程。在对合并高血压患者与不伴高血压患者术后微循环变化的分析研究中发现，前者术后微循环改善程度较后者为著（Ｐ＜０．０１）。表明高血压患者微循环对氧的敏感性更大。另一方面说明鼾症对高血压患者的影响大于对非高血压患者。     

Conservative treatment of idiopathic facial palsy--effects of the administration of high-dose steroids in Bell's palsy]

The etiology of Bell's palsy is still obscure and its treatment remains controversial. As a conservative treatment for Bell's palsy, Stennert developed a new treatment method for the purpose of improving microcirculation, and reported an extremely high cure rate of 96%, drawing a great deal of attention. However, since the electrophysiological findings and side effects in these patients were not described satisfactorily in his report, this method has not yet come into wide clinical use. In the present study the efficacy of Stennert's method was assessed by electrophysiological examination in patients, and was compared with patients treated by conventional methods. The subjects of this study were 157 patients with Bell's palsy who were treated with a modification of Stennert's method between September 1987 and August 1990. The treatment protocol for the modified Stennert's method was as follows: hydroxyethyl starch 40 with 20% mannitol is given instead of Dextran 40 and prednisolone is stopped depending on the findings of electrical examinations. Fifty-three patients with Bell's palsy treated by the conventional method used in our clinic between November 1983 and August 1987 were used for the control group. The most remarkable difference between these two methods was the initial dose of prednisolone. In the group treated by the modified Stennert's method, 111 patients (70.7%) showed complete recovery within 1 month, and 154 patients presented (98.1%) showed complete recovery within 6 months, 3 cases presented slight sequelae. In the conventional treatment group, on the other hand, only 2 patients (3.8%) recovered within 1 month, and 43 patients (81.0%) recovered within 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute viral infections in association with idiopathic peripheral facial paralysis

The possible association of some viral infections with the onset of Bell's palsy was examined in a study of 29 patients. The results were compared with a sex- and age-matched control group. The number of probable recent viral infections, as judged by a fourfold increase in antibody titers or the presence of specific IgM antibodies, differed statistically from that found in the control group. In seven patients with Bell's palsy the enzyme-linked-immunosorbent assay (ELISA) indicated an acute viral infection (herpes simplex 4; varicella zoster 2; cytomegalovirus 1). All these infections were due to viruses belonging to the herpesvirus group. Clinical evidence of herpesvirus infection was found in three cases (Herpetic eruption). The aetiological relationship between the virological findings and Bell's palsy is discussed. Reactivated herpes simplex virus and transient demyelination of the facial nerve could be one cause of an idiopathic facial palsy.     

Auditory brainstem and middle-latency responses in Bell's palsy

Patients with acute peripheral facial palsy (Bell's palsy) were examined by auditory brainstem response (ABR) and middle-latency response (MLR) for signs of brainstem involvement. ABR data on 30 patients indicated that wave V latencies were abnormal by greater than 3 SD in only 2 patients, 1 of whom showed abnormality contralateral to the affected side. When the criterion for abnormality was reduced to 2 SD, wave V abnormality was found in only 3 of the 30 patients. All 14 patients tested by MLR showed normal responses. These findings suggest that on the basis of evoked potential measures, brainstem involvement may not be pathognomonic of Bell's palsy.     

Electrophysiological study on pathophysiology of Bell's palsy--distribution of nerve conduction velocities (DNCV) in facial nerve with collision method

The etiology of Bell's palsy is still obscure, but the hypothesis that hypoxia and compression of the nerve induced by edema in the Fallopian canal are the main causes of Bell's palsy is widely accepted. Tojima (1988) reported that the motor nerve conduction velocity (MCV) gradually decreased as degeneration of the nerve fibers progressed in Bell's palsy. The majority of facial nerve fibers are myelinated, and the greater the fiber diameter, the faster the conduction velocity. For this reason, Tojima suggested that Wallerian degeneration in Bell's palsy would begin from the thicker myelinated fibers. The measurement of MCV, however, reveals only the activities of the fastest velocity motor nerve fiber in the nerve trunk. This weak point can be resolved by measurement of the distribution of nerve conduction velocities (DNCV), which was introduced by Hopf in 1962 as the collision method. In the present report, the DNCV of facial nerve was measured using the collision method to estimate the distribution of the diameter of nerve fibers in normal subjects and patients with Bell's palsy and to elucidate the pathophysiology of Bell's palsy. The subjects were 14 normal adults (19 measurements) and 14 patients with Bell's palsy who visited our university clinic within 7 days to 18 days after onset, with no other complications such as diabetes. Results obtained are as follows. 1) The mean DNCV in 14 normal subjects (19 measurements) was unimodal, showing a peak at 20 to 22 m/s. 2) In DNCVs of patients with Bell's palsy, loss of thicker fibers with faster conduction velocity was recognized (11/14, 79%).(ABSTRACT TRUNCATED AT 250 WORDS)     

贝尔面瘫患者血浆内皮素的检测及临床意义

目的:探讨内皮素(ET)在贝尔面瘫发病中的作用及其与预后的关系。方法:采用放射免疫分析法测定21例贝尔面瘫患者治疗前、后及正常者的血浆ET水平。结果:贝尔面瘫患者的血浆ET水平与正常人对比;治疗无效组血浆ET水平明显高于治疗好转组。结论:ET异常增高可引起微循环障碍,在贝尔面瘫发病中起着重要作用;检测ET水平可作为判断患者预后的一个有用指标。     

Serous otitis media. An opportunity for early recognition of nasopharyngeal carcinoma.

In a prospective study of 271 new patients with nasopharyngeal carcinoma, 36 (13.3%) were found to have cranial nerve involvement. Serous otitis media (SOM) was found in 98 (41.4%) of 237 patients who had undergone complete otologic assessment. The local control of tumor and actuarial survival of three subgroups of patients, namely, 80 patients with SOM only, 11 patients with cranial nerve palsy only, and 18 patients with both SOM and cranial nerve palsy, were analyzed. The local control of tumor was better in patients with SOM alone than in those with cranial nerve palsy alone; those patients with both SOM and cranial nerve involvement had worse local control as well as survival. As SOM is not uncommon in the diagnosis of nasopharyngeal carcinoma, and adult-onset SOM is otherwise distinctly uncommon, this provides a good opportunity for early recognition and, perhaps, better control of nasopharyngeal carcinoma.     

Peripheral facial palsy caused by the Borrelia spirochete

Forty-three consecutive patients with peripheral facial palsy were examined to evaluate the incidence of facial palsy caused by the tick-borne Borrelia spirochete in a non-coastal area in the south of Sweden. Six (14%) of the patients were found to have a Borrelia infection. The incidence of Borrelia-induced facial palsy was 0.39/10,000 inhabitants, which is less than in neighbouring coastal areas but still high enough to cause serious concern when dealing with facial palsies. In contrast to Bell's palsy, a Borrelia infection can cause serious generalized illness if not properly treated. Negative Borrelia serology of the serum and the cerebrospinal fluid (CSF) and a normal CSF analysis did not exclude the Borrelia etiology. Tick bites, signs of polyneuropathy, meningeal symptoms and Borrelia-associated erythema proved to be important signs for the diagnosis.     

Search for Herpesviruses in cerebrospinal fluid of facial palsy patients by PCR

CONCLUSIONS: Herpes simplex virus 1 (HSV-1) and varicella-zoster virus (VZV) DNA were not detected in the cerebrospinal fluid (CSF) of patients with acute idiopathic peripheral facial palsy (Bell's palsy). Our results indicate either the absence of these viruses or the presence of technical shortcomings. The role of human herpesvirus 6 (HHV-6) in this disorder and the significance of a positive HHV-6 DNA finding in the central nervous system need further investigation. OBJECTIVE: Our goal was to determine whether DNA of HSV-1, VZV, or HHV-6 can be found by polymerase chain reaction (PCR) in the CSF of peripheral facial palsy patients. MATERIALS AND METHODS: We used PCR to detect the presence of HSV-1, VZV, and HHV-6 DNA in CSF. This was a retrospective case control study with 33 peripheral facial palsy patients (34 CSF samples) in the study group (26 with Bell's palsy, 5 with simultaneously diagnosed herpesvirus infection, 1 with puerperal facial palsy, 1 with Melkersson-Rosenthal syndrome). The control group included 36 patients, most with diagnosed or suspected Borreliosis and facial palsy or sudden deafness. RESULTS: One patient with Bell's palsy had HHV-6 DNA in CSF. Neither HSV-1 nor VZV DNA was detected in patients or controls.     

Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy

Objective: Recent studies provide compelling data for the hypothesis that herpes simplex virus type 1 (HSV-1) is implicated in the pathogenesis of idiopathic peripheral facial palsy (Bell's palsy). The present study analyzed the severity of facial palsy in patients with HSV-1 reactivation and sought to determine the efficacy of acyclovir–prednisone therapy for these patients. Materials and methods: In total, 176 patients, clinically diagnosed with Bell's palsy, were divided into three groups by polymerase chain reaction (PCR) and serological tests — 31 patients with HSV-1 reactivation, 45 patients with VZV reactivation (zoster sine herpete) and 100 patients without HSV-1 or VZV reactivation (Bell's palsy). Results: The difference in the worst grade of facial palsy between patients with zoster sine herpete and Bell's palsy was significant (P=0.01 10, Mann–Whitney U-test). In contrast, no difference in the severity of palsy was observed between patients with HSV-1 reactivation and Bell's palsy. Twelve patients received acyclovir–prednisone treatment within 7 days of onset based on positive PCR results and ten of the 12 (83%) recovered completely. In contrast, 14 patients with HSV-1 reactivation received prednisone treatment because their PCR tests were performed at a later date; ten of these 14 (71%) recovered completely. The difference in the cure rate between the two treatment groups was not significant (P>0.05, Fisher exact test). Conclusions: The results indicate that the severity of palsy in patients with HSV-1 reactivation is similar to that in patients with Bell's palsy and suggest that early diagnosis of HSV-1 reactivation by PCR and subsequent acyclovir–prednisone therapy do not improve recovery from facial palsy.