眩晕症与听力学改变的关系

目的探讨眩晕症与听力学改变的关系。方法选择101例眩晕症患者（眩晕症组）和90例健康体检者（对照组）为研究对象。检测2组的纯音听阅、镫骨肌声反射阈,并对结果进行统计学分析。结果眩晕症组双耳250～4000Hz的气导和骨导纯音听阈与对照组相应的听阂值之间比较,差异均有统计学意义（P〈0．05）,双耳8000Hz的气导纯音听阚与对照组相对应的听阈值之间比较差异均无统计学意义（P〉0．05）。双耳各频率同、对侧镫骨肌声反射引出阳性例数比较。眩晕症组与对照组之间同、对侧500、1000Hz差异均有统计学意义（P〈0．05）。结论部分眩晕患者早期就在听力学上有所改变,作为临床耳鼻咽喉科医生应尽早干预,及早参与治疗。声反射衰减和重振试验可作为临床前庭功能检查的一种方法,提示眩晕的病变部位,为眩晕症的诊断提供一定的辅助价值。     

听神经瘤手术之耳科观

听神经瘤是桥脑小脑角区最常见的良性肿瘤,常见症状包括单侧感音性听力下降、耳鸣、眩晕等。手术切除是听神经瘤的主要治疗方式,常用入路包括以耳科为主的经迷路入路、经耳囊入路、扩大经迷路入路、改良经耳囊入路和颅中窝入路,以神经外科为主的枕下乙状窦后入路等。一般建议听力良好的小肿瘤选择颅中窝入路;肿瘤较大、希望保留听力者采用枕下乙状窦后入路;不考虑保留听力且为中、小型听神经瘤者,可采用经迷路入路或经耳囊入路。随着显微外科技术的发展以及术中神经监测设备的广泛应用,中、小型听神经瘤手术的面/听神经功能保留率已有显著提高,未来更多的听神经瘤患者有望在保留面/听神经功能的基础上获得治愈。     

The protective effect of ischemic preconditioning occur in patients with acute myocardiac infarction

Ischemic preconditioning occur refers to the occurrence of many unstable angina pectoris before acute myocardial ischemia(AMI).It is generally recognized that ischemic preconditioning occur has protective effect on heart and can reduce infarction scope and improve contraction function of heart.Recently some authors whinks ischemic preconditioning occur will cause the exacerbation of patients‘ condition during the time of hospitalization and increase the incidence rate of angina and pectoris and death.OBJECTIVE:To explore the effect of ischemic preconditioning occur on prognosis of AMI.     

桥臂综合征循证病例2例报告

INTRODUCTION Brachium potine syndrome is also called potine cerebellum lesion syndrome,is localized at facial, acoustic,trigeminal and vestibule nerve roots.In clinic,lesion in this zone is rare.We met two cases recently. Both of cases were acute onset, with hypertension history. First symptoms were dizziness, unstability of gait,facial hemianesthesia, corneal reflex dullness,poor hearing and dystaxia.Cerebral MRI showed brachium potine with long T1 and T2, signal of focus with clear margin,enhance scan showed slight or apparent reinforcement.To determine in what degree to treat them and how to use method of evidence based medicine to determine their diagnosis and best therapy,we spent less than 3 hours on searching and gaining evidences through computer of provincial medical information center.     

Hearing loss in older adults

Hearing loss affects approximately one-third of adults 61 to 70 years of age and more than 80 percent of those older than 85 years. Men usually experience greater hearing loss and have earlier onset compared with women. The most common type is age-related hearing loss; however, many conditions can interfere with the conduction of sound vibrations to the inner ear and their conversion to electrical impulses for conduction to the brain. Screening for hearing loss is recommended in adults older than 50 to 60 years. Office screening tests include the whispered voice test and audioscopy. Older patients who admit to having difficulty hearing may be referred directly for audiometry. The history can identify risk factors for hearing loss, especially noise exposure and use of ototoxic medications. Examination of the auditory canal and tympanic membrane can identify causes of conductive hearing loss. Audiometric testing is required to confirm hearing loss. Adults presenting with idiopathic sudden sensorineural hearing loss should be referred for urgent assessment. Management of hearing loss is based on addressing underlying causes, especially obstructions (including cerumen) and ototoxic medications. Residual hearing should be optimized by use of hearing aids, assistive listening devices, and rehabilitation programs. Surgical implants are indicated for selected patients. Major barriers to improved hearing in older adults include lack of recognition of hearing loss; perception that hearing loss is a normal part of aging or is not amenable to treatment; and patient nonadherence with hearing aids because of stigma, cost, inconvenience, disappointing initial results, or other factors. (Am Fam Physician. 2012;85(12):1150-1156. Copyright ? 2012 American Academy of Family Physicians.).     

手术和伽马刀治疗较小听神经瘤的Meta分析

目的 比较手术及伽马刀治疗＜3 cm听神经瘤的优劣.方法 由2名研究人员分别检索1990年1月1日-2010年3月31日四川大学网上图书馆CENTRAL、ISI、Medline、Embase、NLM Gateway、CBMdisc等数据库的相关论文,选择证据级别最高的文献,使用Cochrane图书馆提供的RevMan ...     

Immitance audiometry

Immitance audiometry is a safe, simple, reliable, and relatively objective method of determining middle-ear function that provides advantages for examining the difficult patient because minimal cooperation is needed. Acoustic-immitance measurements obtain sophisticated data that give us valuable information about the middle ear mechanism as a whole. It can be used in a quiet office environment. Immitance audiometry can confirm a doubtful otoscopic diagnosis and screen for ear disease. There are limitations to observer reliability with otoscopy, which has good sensitivity but poor specificity, in contrast to immitance audiometry. The tympanogram can be classified into four different patterns on the basis of its characteristics. These patterns are diagnostic, distinguishing normal function from various types of middle ear pathology. Immitance audiometry has very high sensitivity and specificity. The acoustic reflex, a contraction of the stapedius muscle following an intense auditory stimulus, can be valuable in determining a conductive hearing loss and many other otologic diagnoses. As a screening tool, immitance audiometry is most valuable in populations at risk for middle ear effusion, primarily those aged 7 months to 5 years. Significant improvements in measurements of ear function also allow us to be more precise in the diagnoses of otosclerosis, perforation of the tympanic membrane, ossicular discontinuity, facial nerve dysfunction, and brain stem disorders.     

Nasopharyngeal cancer and the Southeast Asian patient

Because of a documented increased incidence, nasopharyngeal cancer should be considered when signs or symptoms of ear, nose and throat disease are present in patients from southern China (in particular, Hong Kong and the province of Guangdong) or Southeast Asia. Environmental factors, the Epstein-Barr virus and genetic factors have been associated with the development of nasopharyngeal cancer. Patients with this malignancy most often present with a cervical mass from metastatic spread to a lymph node. Other possible presentations include ipsilateral serous otitis, hearing loss, nasal obstruction, frank epistaxis, purulent or bloody rhinorrhea, and facial neuropathy or facial nerve palsies. Radiotherapy is often curative. The addition of chemotherapy has produced high response rates in local and regionally advanced disease.     

听神经病听力学特征

目的：探讨听神经病听力学检测特征。方法：对14例（28耳）听神经病患者进行纯音测听、声导抗、听性脑干反应（ABR）和畸变产物耳声发射（DPOAE）、言语识别率检查。结果：纯音测听除1例3岁幼儿未行纯音测试外，13例（26耳）听力图均呈双侧对称性低频损失，听力曲线形态呈上升型20耳（76．9％），覆盆型6耳（23．1％）。28耳鼓室图呈“A”型、同侧及对侧镫骨肌反射消失。28耳DPOAE均正常引出。言语识别率8例双耳为0%．5例为6％～20％，1例为30%。14例（28耳）ABR严重异常。结论：听力学系列检测有助于听神经病的诊断。     

Staged reflexive artificial intelligence driven testing algorithms for early diagnosis of pituitary disorders

BackgroundSellar masses (SM) frequently present with insidious hormonal dysfunction. We previously showed that, by utilizing a combined reflex/reflecting approach involving a laboratory clinician (LC) on common endocrine test results requested by non-specialists, and subsequently adding further warranted tests, previously undiagnosed pituitary disorders can be identified. However, manually employing these strategies by an LC is not feasible for wider screening of pituitary disorders.ObjectiveThe aim of this study was to compare the accuracy and financial impact of an Artificial Intelligence (AI) based, fully computerized reflex protocol with manual reflex/reflective intervention protocol led by an LC.MethodsWe developed a proof-of-concept AI-based framework to fully computerize multi-stage reflex testing protocols for pituitary dysfunction using automated reasoning methods. We compared the efficacy of this AI-based protocol with a reflex/reflective protocol based on manually curated retrospective data in identifying pituitary dysfunction based on 12 months of laboratory testing.ResultsThe AI-based reflex protocol, as compared with the manual protocol, would have identified laboratory tests for add-on that either directly matched or included all manual add-on tests in 92% of cases, and recommended a similar specialist referral in 90% of the cases. The AI-based protocol would have issued 2.8 times the total number of manual add-on laboratory tests at an 85% lower operation cost than the manual protocol when considering marginal test costs, technical staff and specialist salary.Conclusion/DiscussionOur AI-based reflex protocol can successfully identify patients with pituitary dysfunction, with lower estimated laboratory cost. Future research will focus on enhancing the protocol’s accuracy and incorporating the AI-based reflex protocol into institutional laboratory and hospital information systems for the detection of undiagnosed pituitary disorders.     

Effects of facial paralysis after acoustic neuroma surgery in Norway

This survey investigated how individuals with facial paralysis resulting from acoustic neuroma surgery manage self-care needs of daily living. Facial paralysis was defined to include damage from surgery to other cranial nerves located in the same area as the facial nerve. The 40 patients surveyed had surgery performed at the Neurosurgical Department, National Hospital of Norway, Oslo, during a four-year period. The instrument used was a questionnaire based on Orem's universal self-care requisites. Results showed that problems related to eating and drinking and certain physiological problems were accepted over time, while pain, eye problems, and hearing loss remained difficult for patients to cope with. Social and psychological problems related to the facial paralysis were ongoing for many patients and seemed to be mitigated by self-acceptance and acceptance by others.     

Facial expressions of pain and emotions in chronic TMD patients

This research was designed to identify and validate facial expressions of pain occurring in a clinical chronic pain condition. Facial expressions of 28 patients with chronic temporomandibular disorder pain were videotaped during a painful clinical examination procedure and coded using an anatomically based system. Characteristics of the expressions occurring most frequently were compared with self-report measures of pain, anxiety, depression and somatic symptoms. The frequency, duration and intensity of the identified expressions were dependably correlated with pain report, but unrelated to self report of other somatic symptoms, depression or anxiety. A small number of facial expressions of specific negative emotions were also observed; pain report and pain facial expressions were higher for persons showing a greater number of negative affects. These findings support the promise of facial expressions as measures of clinical pain.     

Doppler sonographic assessment of posttraumatic reflex sympathetic dystrophy.

OBJECTIVE: To reveal the arterial Doppler sonographic findings in cases of posttraumatic reflex sympathetic dystrophy METHODS: Eleven patients had hand reflex sympathetic dystrophy, and 9 had foot reflex sympathetic dystrophy. The duration of symptoms ranged from 1 to 28 weeks, and the history of fracture ranged from 6 to 48 weeks. Bilateral brachial or popliteal arteries proximal to injuries were evaluated by Doppler sonography with a 7.5-MHz linear transducer. All patients also had triphasic bone scintigraphy and extremity thermography RESULTS: Two patients had monophasic waveforms and 4 had low-pulsatility triphasic waveforms on the affected limbs when compared with the asymptomatic limbs. All opposite asymptomatic limbs had normal triphasic waveforms in these 6 cases. Spectral analysis revealed a loss or decrease of a normal reversed flow component with a reduced pulsatility index on the affected limb. Fourteen other patients had symmetric triphasic waveforms. We observed that the patients who had stage 1 reflex sympathetic dystrophy and warm limbs with durations of symptoms of more than 2 weeks had positive Doppler sonographic findings, whereas all patients with stage 2 reflex sympathetic dystrophy and all with normal skin temperature, regardless of stage, had normal waveforms. CONCLUSIONS: Doppler sonography revealed loss of normal triphasic arterial waveforms in some of the cases of stage 1 disease, whereas many cases of stage 1 disease and all cases of stage 2 disease had normal findings. Therefore, we think that Doppler sonography cannot be used for the diagnosis of reflex sympathetic dystrophy but may help in assessing hemodynamic stages of the disease.     

The aging ear

Otosclerosis begins in the second and third decades of life but usually does not produce a hearing loss until after the fourth decade. Chalky white plaques in the tympanic membrane may be benign, but when associated with hearing loss may point to tympanosclerosis. Presbycusis is the most common cause of hearing loss. Unilateral hearing loss raises the specter of acoustic neuroma.     

Usher's syndrome with unusual otologic manifestations.

Usher's syndrome is characterized by a congenital hearing loss and retinitis pigmentosa. Ocular symptoms and signs are usually established at adolescence, and the hearing loss, the onset of which is at a young age, generally remains stable. The following case is of interest, therefore, because the hearing loss that had been present since birth progressed suddenly to total bilateral deafness in adulthood. There were no ocular symptoms at any time; the classic findings of retinitis pigmentosa were disclosed only on routine examination of the eyes.     

Effects of a mind-body program on symptoms of depression and perceived stress among adults with neurofibromatosis type 2 who are deaf: A live-video randomized controlled trial

IntroductionNeurofibromatosis type 2 (NF2) is a rare, progressive and incurable genetic disorder associated with progressive hearing loss and eventual deafness. As a group, patients with NF report high levels of stress and depressive symptoms. However, no studies have explored improvement in these symptoms after psychosocial interventions. We have previously shown that a mind-body program tailored to adults with NF2 who are deaf (the Relaxation Response and Resiliency Program for Deaf NF2, d3RP-NF2) improves quality of life and resiliency over and above a Health Enhancement program when both are delivered via live-video and assisted by Communication Access Realtime Translation (CART). Here we tested the effects of the programs on depression and perceived stress.MethodsForty-five patients with NF2 and significant hearing loss were randomized to the d3RP-NF2 or Health-Enhancement program and completed measures of depression (PHQ-9) and perceived stress (PSS-10) at baseline, post-intervention, and six-month follow-up.ResultsPatients randomized to the d3RP-NF2 program, but not to the control condition, experienced significant decreases on both measures from baseline to post-test, which were maintained at follow-up (within group tests). However, improvements following the d3RP-NF2 program was not significantly higher than those observed in the control group (between group tests).ConclusionResults provide the first evidence of improvement in symptoms of depression and perceived stress among deaf patients living with NF2 who participate in a virtual mind-body program.