慢性化脓性中耳炎骨导听力下降的影响因素分析

目的探讨引起慢性化脓性中耳炎骨导听阈提高的因素。方法回顾性分析240例单侧慢性化脓性中耳炎患者的临床资料,对语频区和4.0kHz骨导听力与听骨链、胆脂瘤、鼓膜穿孔的情况作统计学分析。结果患耳与健耳骨导听力阈值之间差异有统计学意义。听骨链破坏和鼓膜穿孔的部位对骨导听阈有一定的影响。结论慢性化脓性中耳炎可引起骨导听力下降。部分患者是由于中耳病变所致,因此积极的治疗可能提高患者的骨导听力。     

分泌性中耳炎骨导听阈改变的临床观察

目的证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳炎,尤其是顽固的分泌性中耳炎提供依据.方法115例(164耳)分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0.5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数.分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组.结果在164耳中,出现骨导听阈提高的共94耳(57.3%).双侧组与单侧组骨导听力损失程度差异均无显著性(P>0.05);单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;不同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大.结论半数以上分泌性中耳炎可以导致感音神经性聋.在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势.     

分泌性中耳炎骨导听阈改变的临床观察

目的 证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳为,尤其是顽固的分泌性中耳炎提供依据。方法 115例（164耳）分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0．5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数。分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组。结果 在164耳中,出现骨导听阈提高的共94耳（57．3％）。双侧组与单侧组骨导听力损失程度差异均无显著性（P＞0．05）;单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大。结论 半数以上分泌性中耳为可以导致感音神经性耳聋。在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势。     

儿童分泌性中耳炎致骨导听力下降的临床特征分析

目的 探讨儿童分泌性中耳炎致骨导听力下降的特点、病因和预后.方法 回顾性分析75例(82耳)分泌性中耳炎患儿骨导听力下降的临床资料,并对其发病年龄、病程、积液性质和积液量与骨导听阈的关系进行观察.结果 75例患儿(82耳)骨导听力下降,平均骨导阈值在2.0 kHz和4.0kHz处增高最明显.骨导听阈与病程和积液性质显著相关(P＜0.01或P＜0.05),与年龄、积液量无关.75例患儿均采取鼓膜切开置管术和(或)腺样体切除术,术后给予药物治疗.随访6月,听力恢复正常者76耳,气导听阈下降但骨导听阈无改善者6耳.结论 分泌性中耳炎可导致儿童骨导阈值增高,是导致儿童耳聋的危险因素之一,及早干预可避免病情发展.     

8例内耳病变导致患耳气骨导差的临床分析

目的探讨内耳病变导致患耳气骨导差的临床特点。方法回顾性分析8例内耳病变导致患耳气骨导差的临床资料。所有患者行音叉、纯音测听和声反射检查,同时行颞骨CT扫描。结果5例患者颞骨CT扫描及上半规管重建提示上半规管裂孔存在,诊断为上半规管裂综合征,主诉听力下降,时间2个月到10年不等,音叉检查患耳Rinne试验阴性,Weber试验偏向患侧,纯音测听提示低频听力下降,气导平均听阈(0.5、1、2kHz)为50.25dBHL,骨导平均听阈为28.48dBHL;声反射均能引出。其中,3例患者强声能诱导出眩晕和眼震,2例患者变压试验能诱导出眩晕和眼震。其余3例患者为大前庭水管综合征,颞骨CT均证实前庭导水管扩大,中耳乳突无积液,听骨链无畸形,外耳和鼓膜正常,音叉检查患耳Rinne试验阴性,纯音测听患耳有明显的气骨导差,声反射均能引出;均采用激素和高压氧治疗,2例听力明显好转,1例听力无改善。结论上半规管裂和前庭导水管扩大等内耳疾病可导致患耳气骨导差,临床上应予以关注。     

122例慢性化脓性中耳炎患者术前骨导听力分析

 目的探讨慢性化脓性中耳炎对骨导听力的影响。方法回顾性分析122例单侧慢性化脓性中耳炎患者,同期选取对侧正常耳作为对照耳,通过对患耳与健耳、不同年龄组、单纯型与胆脂瘤型中耳炎、听骨链完好与听骨链破坏、细菌培养阳性者与阴性者,不同病理患者的术前骨导听力进行研究。所有患者进行纯音测听检查, 并对各频率骨导听阈进行统计学处理, 对影响骨导听力的因素做相关分析。结果0.5、2、4 kHz处,患耳骨导听阈值高于健耳,而低频0.25 kHz及1 kHz处患耳与健耳骨导听阈值差异不显著;随年龄增长,患耳与健耳骨导听阈值差异有逐渐缩小趋势;中耳胆脂瘤及听骨链破坏者对各频率骨导有明显影响;病程及细菌培养阳性与否对骨导听力损害差异不显著。结论①慢性化脓性中耳炎对骨导听力有明显影响,但在不同频率,损害程度有差异;②慢性化脓性中耳炎可能会影响对侧正常耳的骨导听力;③中耳胆脂瘤及听骨链破坏对骨导听力影响较大。     

多频听觉稳态反应评估听力正常青年人骨导听阈的研究

目的 探讨多频听性稳态反应（MASSR）评估听力正常青年人骨导纯音听阈的可能性,旨在观察听力正常青年人骨导多频听觉稳态反应（ASSR）测试的正常值特点,进一步探讨骨导ASSR的反应阈与骨导纯音听阈的相关性,为临床上对不能配合做纯音测听的患者行听力评估时提供客观参考。方法 对20例（男10例、女10例）听力正常青年人进行骨导ASSR 及骨导纯音听阈检查,记录0.5、1.0、2.0、4.0kHz反应阈及行为听阈,比较二者间的相关性。结果 骨导ASSR 反应阈男组、女组间差异无统计学意义;各频率间骨导ASSR 反应阈比较,4.0kHz较其它各频率差异有统计学意义（P＜0.001）,0.5、1.0、2.0kHz三个频率间差异无统计学意义（P＞0.05）。骨导ASSR 反应阈与骨导纯音听阈在0.5、1.0、2.0、4.0kHz四个频率处相关系数分别为0.95、0.91、0.26、0.29。结论 骨导ASSR反应阈与骨导纯音听阈间只有在0.5、1.0kHz时有较好的相关性,高频的骨导ASSR与骨导纯音听阈差异性比较大,因此目前还不能广泛用于临床评估高频骨导纯音听阈。     

老年慢性化脓性中耳炎患者听力学分析

目的 探讨老年慢性化脓性中耳炎患者的听力学特点。方法 回顾性分析68例≥60岁单侧慢性化脓性中耳炎患者的语频（0.5、1.0、2.0、4.0kHz）纯音测听结果、术中所见中耳病变组织特点和听骨链病变情况、病变组织病理检查结果。结果 语频范围内,患耳气导、除4kHz外的骨导阈值均高于对侧耳;胆脂瘤患者与非胆脂瘤患者的气、骨导阈无明显差异;听骨链完好者与破坏者（中断或固定）的气导、2kHz骨导阈值差异具有统计学意义,0.5、1.0、4.0kHz骨导阈值差异不显著。结论 老年慢性化脓性中耳炎患者的听力改变有其独特性,掌握老年慢性化脓性中耳炎患者的听力学特征有助于疾病的诊治。     

中青年与老年慢性化脓性中耳炎及中耳胆脂瘤患者听力学特点及区别

目的 探讨中青年与老年慢性化脓性中耳炎及中耳胆脂瘤患者听力学特点及区别。方法 回顾性研究单侧慢性化脓性中耳炎或中耳胆脂瘤中青年(18～59岁)患者74例、老年(≥60岁)患者68例(语频段0.5、1.0、2.0、4.0 kHz)纯音测听结果, 分析其患耳与对侧耳、不同年龄组间患者听力学特征和区别。结果 中青年患者患耳各语频气、骨导阈值均高于对侧耳, 老年患者患耳气导、除4.0 kHz外的骨导高于对侧耳。老年患者各语频气、骨导耳间差均明显大于中青年患者。非胆脂瘤组、听骨链正常组老年患者耳间差在0.5、1.0、2.0 kHz气导、4.0 kHz骨导高于中青年患者。胆脂瘤组、听骨链中断组老年患者各语频气、骨导耳间差均明显大于中青年患者。结论 慢性化脓性中耳炎及中耳胆脂瘤对中青年、老年患者的气、骨导均可产生损害, 对老年患者的损害比中青年患者严重。中耳病变越严重, 老年患者比中青年患者听力受损的程度越高。     

感音神经性聋与分泌性中耳炎的相关性研究

目的：探讨感音神经性聋与分泌性中耳炎的关系。方法：对治疗后骨导听力下降仍未恢复的38例分泌性中耳炎患者进行分析，观察健耳和患耳在不同频率的骨导听阈情况，并分别就其发病年龄、病程、积液性质和积液量与骨导听阈的关系进行观察。结果：患耳在不同频率的骨导听阈均大于健耳（均P＜0．01）；年龄愈大、病程愈长，感音神经性聋发生率愈高；积液为黏液者发生率高于浆液者；但与积液量无明显关系。结论：分泌性中耳炎可导致感音神经性聋，其发病原因和机制是多方面的，年龄大、病程长、积液为黏液者更易导致感音神经性聋的发生；应提高认识，早诊断，早治疗。     

以耳部症状首发、合并鼻咽占位的肉芽肿性多血管炎1例并文献复习

目的 探讨1例临床少见的以耳部症状首发、合并鼻咽部占位的肉芽肿性多血管炎(GPA)的临床特征、实验室检查、病理表现及诊疗过程。方法 回顾性分析患者的病例资料,总结病例特点并回顾国内外GPA相关文献。结果 患者以中耳炎、迷路炎症状为首发表现,合并鼻咽部占位,病程中逐渐出现面瘫,三叉神经刺激症状加重。多次留取耳及鼻咽部活检示急慢性炎症细胞浸润。升级抗生素,同时为避免中耳炎侵犯岩骨及颅内行乳突开放术。中耳局部炎症改善后其耳痛、面瘫等仍不缓解,但激素治疗有效,遂进一步完善自免病相关检查并再次行鼻咽部活检,最终确诊为GPA,予激素及免疫抑制剂治疗得以控制症状。术后3个月暂无显著肺部及肾脏受累表现。结论 临床上发现不典型的中耳炎或常规治疗反复不愈,且逐渐进展出现内耳、颅神经侵犯表现如眩晕发作、面神经麻痹等,同时激素治疗有效,且合并鼻咽部占位、鼻窦炎影像学表现,或累及其他器官如肺、肾脏时,均应考虑到GPA的可能。当反复留取病理活检未能取得特异性确诊依据时,动态监测抗中性粒细胞胞浆抗体、红细胞沉降率、尿潜血、胸部CT、血肌酐等也具有重要的提示意义。     

Decreased miRNA-320e correlates with allergy in children with otitis media with effusion

ObjectiveOtitis media with effusion (OME) is a common childhood disease and the main cause of conductive hearing loss in this age group. Many factors predispose to OME but allergy is still widely disputed. The answer may lay in the molecular mechanisms of ear exudate formation and the recent studies showed miRNAs might take part in it. MiRNAs are also potent regulators of allergic response. As miRNAs are present in the middle ear, we hypothesized their expression differs between allergic and non-allergic patients and reflects the difference in pathomechanism of effusion formation between these two groups.Materials and methodsThis study aimed to establish the expression of 5 different miRNAs (miR-223-3p, miR-451a, miR-16-5p, miR-320e, miR-25-3p) in ear exudates in children diagnosed with OME. The allergy group consisted of 18 patients whereas the non-allergic group had 36 patients. MicroRNA was isolated from the middle ear fluid collected during myringotomy and transcribed into cDNA. MiRNA expression was measured with TaqMan™ MicroRNA Assays and analyzed with DataAssist software. The comparative CT method was used for calculating the relative quantification of gene expression based on the endogenous control gene expression (U6 snRNA-001973).ResultsMiR-320e expression was significantly decreased in allergic children with OME. Other studied miRNAs also showed reduced expression in allergic children, but the decrease was not significant.ConclusionsMiRNA expression differs between children with and without allergy in the course of OME, but further studies are needed to explain the exact role of miR-320e and its target genes in OME pathology in allergic patients.     

Experience with vertical partial laryngectomy with special reference to laryngeal reconstruction with cervical fascia

In this paper we report our experience of vertical partial laryngectomy using the superficial cervical fascia; we describe the technique and present the functional and oncological results of this method of treatment. A total of 42 patients with squamous cell carcinoma of the true vocal folds, in stage T(1) (n = 28) or T(2) (n = 14), were treated in our department using vertical partial laryngectomy during the decade 1987-1997. Nine patients had post-operative radiotherapy. The shortest follow-up time was three years. There were six recurrences in all, four in the larynx and two in the neck. All four of the laryngeal recurrences were treated with total laryngectomy and are doing well. Both the patients with neck metastases, who were treated with neck dissection, died. Permanent tracheotomy was necessary in one patient. There were no problems with aspiration. The recurrence rate was 14 per cent, the three-year survival index was 95.2 per cent and the three-year larynx preservation index was 90 per cent. According to our experience, vertical partial laryngectomy, using the method we describe, has a good functional and oncological result for stage T(1) and T(2) tumours.     

Cytokines in children with otitis media with effusion

We assayed 38 middle ear effusions from 23 children aged 4–13 years (mean 7) undergoing tympanostomy tube placements. All fluid was assayed for tumor necrosis factor (TNF) α, interleukin (IL) 1β, IL-8, and IL-10. Cytokine concentrations were measured by means of an enzyme-linked immunosorbent assay. Detectable levels of IL-1β, IL-8, and IL-10 were found in all of the effusions. TNF-α was detected in 18 of the middle ear effusions (47.4%). The mean concentration of TNF-α, IL-1β, IL-8, and IL-10 was, respectively, 0.423 ± 1.39, 30.58 ± 68.7, 7001.9 ± 6743, and 56 ± 58.7 pg/ml. There was a strong, statistically significant correlation between the concentrations of TNF-α and IL-1β (r = 0.87, P = 0.001) and between IL-1β and IL-8 (r = 0.53, P = 0.001). There was no correlation between the concentrations of IL-10 and other cytokines examined or between tympanic membrane pathology and the concentrations of TNF-α, IL-1β, IL-8, or IL-10. The presence of IL-10 in middle ear effusions may be one of the causes of a lack of clinical features of acute inflammation and may lead to a chronic inflammatory state. Received: 25 August 1999 / Accepted: 5 January 2000     

Polymyositis with dysphagia treated with endoscopic balloon dilatation

Polymyositis is characterized by non-specific inflammatory disease associated with an autoimmune disorder involving muscles of the limbs and neck. We report a case of an 80-year-old man who was referred to our clinic with a chief complaint of dysphagia and muscle weakness in all four limbs. The patient was diagnosed with polymyositis based on pathological findings, muscle weakness, electromyogram findings, and an elevated creatine phosphokinase level. The patient was also positive for HLA-DR3. Intravenous predonine administration was initiated, but dysphagia was not improved. We considered a cricopharyngeal myotomy, but this could not be performed because of heart failure. Endoscopic balloon dilation was performed and dysphagia improved on the same day. Therefore, we suggest that this method is a safe and effective approach for polymyositis with dysphagia.     

Otoacoustic emissions in children with otitis media with effusion

OBJECTIVES: Otoacoustic emissions (OAE) are transmitted from the cochlea to the ear canal via the middle ear and the transmission properties of the middle ear directly influence OAE characteristics. The purpose of this study was to establish the mechanisms of changes occurred in middle ear by tympanometric, audiometric and OAE examination. METHODS: Audiometric and tympanometric examination were performed and otoacoustic emissions were recorded from 22 normal ears and 52 ears with middle ear effusions and repeated 3 months later. RESULTS: Results of the air conduction in study group were significantly different from the control group and we found significant recovery in 3 months. When we analysed the DPOAE evaluation results in our study, some of the DPOAE parameters were found to be different between the control and the study group at low frequencies. Changes in the amplitude, especially at low frequencies, were statistically significant after 3 months. CONCLUSION: The results of this study revealed that measurement of otoacoustic emissions, especially distortion product otoacoustic emissions, is helpful in evaluating the condition of middle ear during the treatment.