突聋患者耳蜗电图与预后的关系

目的：探讨突发性聋（简称突聋）患者耳蜗电图与预后的关系。方法对139例（148耳）突聋患者进行耳蜗电图测试,测得－SP、AP振幅及－SP／AP值,分析引出耳蜗电图耳的不同听阈曲线类型分布,并比较各型听阈曲线耳中－SP／AP≥0．4与－SP／AP＜0．4者的疗效。结果148耳中47耳（10耳全聋,37耳平均听阈为88．93±16．72 dB HL ）未引出耳蜗电图,101耳引出耳蜗电图（平均听阈为57．90±17．91 dB HL ）,其中听阈曲线为低频听力损失型27耳（低频组）,高频听力损失型38耳（高频组）,平坦型听力损失型36耳（平坦组）;低频组中－S P／A P≥0．4者与－SP／AP＜0．4者疗效比较,差异无统计学意义（P＞0．05）,平坦组及高频组中－SP／AP≥0．4者疗效优于－SP／AP＜0．4者（P＜0．05）。结论突聋患者中全聋及极重度聋者耳蜗电图不能引出,低频听力损失型－SP／AP≥0．4者疗效与－SP／AP＜0．4者无统计学差异,平坦型及高频听力损失型－SA／AP≥0．4者疗效优于－SP／AP＜0．4者。     

阻塞性睡眠呼吸暂停低通气综合征患者血小板平均体积水平研究

目的:通过检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血小板平均体积(MPV)水平,探讨OSAHS与MPV的相关性。方法:将我院2012-01-2014-01期间70例OSAHS患者分为轻中度组(32例)和重度组(38例),以30例健康人作为对照组,比较3组外周血中血小板计数(PLT)、MPV、血小板分布宽度(PDW)的水平。结果:重度组与对照组PLT[(202.8±68.9)×109/L、(235.9±65.2)×109/L],MPV(10.9±0.9、10.4±0.8fL),PDW[(12.9±1.9)%、(12.0±1.4)%],均差异有统计学意义(P<0.05);轻中度组MPV(10.7±0.7fL)与对照组(0.4±0.8fL)比较差异无统计学意义。结论:重度OSAHS患者的MPV水平升高。     

体外反搏联合丹参治疗突聋与血液流变学的研究

本文应用体外反搏联合复方丹参注射液等药物治疗突聋30例（32）耳，同时检测突聋患者治疗前后血液流变学，结果经治疗后，全血比粘度，血小板聚集率等明显下降（P＜0．05或P＜0．01），而听力恢复正常或提高。治疗组总有效率为87．5％，对照组为66．67％。两组疗效差异有显著性（P＜0．05）。因此提示体外反搏联合复方丹参注射液，对突聋具有显著性疗效。本文对体外反搏治疗突聋的机理及疗效和突聋的发病机理进行了探讨。     

老年突发性聋患者临床特征及治疗效果分析

目的：分析老年突发性聋患者的临床特征及治疗效果。方法回顾性分析2013年9月至2015年3月经郑州大学第一附属医院耳科确诊并治疗的66例老年单耳突发性聋患者（年龄60～83岁,老年组）的临床资料,另选择同期住院治疗的291例中青年单耳突发性聋患者（年龄19～59岁）为对照组,比较两组患者的临床特征及治疗效果。结果老年组听阈曲线为低频下降型者占1．51％,低于对照组（14．43％,P＝0．004）;高频下降型（22．73％）和全聋型（50．0％）高于对照组（分别为15．46％、39．52％）;老年组中伴随全身疾病（高血压、糖尿病等,60．61％）及对侧耳存在听力损失（57．58％）的患者所占比例较对照组（分别为17．53％、19．93％）高（ P＜0．05）。两组患者总有效率为70．03％,老年组与对照组的总有效率分别为60．61％、72．16％,差异无统计学意义（ P＞0．05）,老年组痊愈率仅为10．61％,明显低于对照组（29．21％）（ P＜0．05）。结论老年突聋患者多伴有高血压、糖尿病等全身疾病或者发病前患耳可能存在不同程度听力损失;突聋耳听力损失更易发生在高频或全频,治疗总有效率与中青年组相似,但痊愈率较低。     

言语识别率对突聋疗效评估的意义

目的：初步探讨言语识别率（word recognition score ,WRS）用于评估突聋疗效的意义。方法回顾性分析11例突聋患者的临床资料,对治疗前后的纯音听阈和言语识别率进行比较。结果11例（11耳）突聋患者治疗前、后纯音平均听阈（pure－tone average ,PTA）值分别为62．27±15．36和60．23±14．32 dB HL ,言语识别率平均值分别为42．91％±30．83％和72．73％±26．72％;治疗前后各例患者的纯音听阈及言语识别率测试声强度差异均无统计学意义（P＞0．05）,而治疗后言语识别率较治疗前明显提高,差异有统计意义（P＜0．05）。结论部分突聋患者治疗后虽然纯音听阈无改善,但言语识别率可有所提高;言语识别率可辅助纯音听阈评估突聋疗效。     

老年突发性耳聋近期疗效临床分析

目的：分析老年突发性耳聋患者药物治疗的近期疗效。方法：将突发性耳聋患者依据年龄分为老年组（年龄≥60岁,70例）和对照组（年龄〈60岁,70例）,7d一疗程,复查纯音测听结果,比较治疗前后听力改善情况。结果：老年组患者治疗前后患耳言语频率平均听阈提高,差异有统计学意义（P〈0．05）;老年组突聋患者发病时间（≤7d）治疗有效率为61．76％,老年组（发病时间〉7d）治疗有效率为38．89％,差异有统计学意义（P〈0．05）,老年性突聋患者总有效率为49．9％;老年突发性耳聋患者在中度耳聋以下（听阈〈55dB）有效率52％,对照组有效率84．62％,差异有统计学意义（P〈0．05）,而在中重度耳聋患者治疗率差异无统计学意义。结论：病程对于老年突发性耳聋患者预后有重要的影响,尽早的改善末梢血管微循环障碍,可以明显的改善预后;老年突聋患者的预后比年轻患者差。     

低功能He-Ne激光血管内照射加丹参治疗突发性聋临床观察

采用低功能He－Ne激光血管内照射加丹参联合治疗突发性聋34例，与丹参对照组比较，联合治疗组总有效率明显优于对照组（P＜0．05），对联合治疗组24例作治疗前后血液流变学检查，全血粘度、纤维蛋白原及血小板聚集率均有不同程度下降（P＜0．05），为临床治疗突发性聋提供了依据。本文还探讨了低功能激光的作用机理。     

连续鼓室注射糖皮质激素初始治疗突发性聋的效果分析

目的：探讨连续鼓室注射糖皮质激素作为突发性聋初始治疗的疗效。方法将91例（91耳）突发性聋患者随机分为鼓室注射组42例（42耳）和口服组49例（49耳）,鼓室注射组采用甲强龙鼓室注射,每天一次,共7天;口服组采用口服强的松片,疗程14天,两组对象分别于治疗前及治疗后第1、2、4、8周测试纯音听阈,所有病例听力随访至少8周。结果在第1、2周,鼓室注射组纯音听阈均值分别为61．57±24．82、56．76±25．06 dBHL,而口服组分别为71．90±19．22、66．47±19．77 dBHL,差异均有统计学意义（均为 P＜0．05）;在第1、2、4周鼓室注射组（听力分别提高15．38±14．11、20．19±13．83、23．36±13．87 dB ,优于口服组（分别为6．18±8．07、11．57±9．16、17．88±11．76 dB ）（均为 P＜0．05）;在治疗第1周结束后,鼓室注射组痊愈6例（14．29％,6／42）,总有效14例（33．33％,14／42）,口服组痊愈1例（2．04％,1／49）,总有效3例（6．12％,3／49）,差异均有统计学意义（均 P＜0．05）;在第2周,鼓室注射组总有效率（52．38％,22／42）高于口服组（26．53％,13／49）（P＜0．05）,而在第4、8周,两组间痊愈、显效、有效及总有效差异均无统计学意义（均为 P＞0．05）。结论连续鼓室注射糖皮质激素作为突发性聋的初始治疗,可在较短时间内取得更好的听力改善。     

前庭功能检查对突发性聋预后评估的意义

目的 评估突发性聋患者的前庭功能状况，探讨前庭功能与突聋预后的关系。方法 运用视频眼震图（video—nystagmograpy，VNG）技术检查50例突发性聋患者的前庭功能。结果 眼视动系统检查出现一项或以上异常共17例（34％）；变位试验诊断为后半规管良性位置性眩晕3例（6％）；温度试验单侧减弱23例（46％），伴优势偏向15例（30％）。无固视抑制失败。前庭功能与突发聋预后关系：伴发眩晕与否，其预后差异无统计学意义（P〉0．05）；伴单侧半规管功能受损者高频及重度听力损失高于半规管功能正常者，其预后亦差，差异均有显著统计学意义（P〈0．05）。结论 前庭功能检查对突发性聋预后评估具有一定的价值。突聋伴前庭功能损害者其高频或重度听力损失发生率高于突聋且前庭功能正常组，预后亦差。     

突发性聋患者小脑下前动脉、基底动脉与血脂水平关系

目的　探讨突发性聋患者小脑下前动脉（anterior inferior cerebellar artery,AICA）、基底动脉（basal artery,BA）与血脂水平的关系。方法　收集突发性聋86例为观察组,健康对照者123例为正常对照组,测定血清总胆固醇（total cholesterol,CHO）、低密度脂蛋白（low density lipoprotein,LDL-C）、高密度脂蛋白（high density lipoprotein,HDL-C）及甘油三酯（triglyceride,TG）水平,磁共振成像检查AICA和BA,比较突发性聋患者AICA、BA与血脂水平关系。结果　正常对照组AICA、BA及血清HDL-C水平均高于观察组,血清CHO、LDL-C、TG均低于观察组,差异具有统计学意义（P＜0.05）。AICA、BA及血清HDL-C随突发性聋病情加重而逐渐递减,轻度组＞中度组＞重度组＞极重度组;血清CHO和LDL-C随突发性聋病情加重而逐渐递增,轻度组、中度组＜重度组＜极重度组;血清TG随突发性聋病情加重而逐渐递增,轻度组＜中度组、重度组＜极重度组,差异有统计学意义（P ＜0.05）。突发性聋患者AICA、BA与血清CHO、LDL-C、TG呈负相关,与血清HDL-C呈正相关,差异具有统计学意义（P＜0.05）。结论　突发性聋患者AICA、BA与血脂密切相关,随病情变化升高或降低,为突发性聋的病情评估提供参考依据。     

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.