改良中鼻甲部分切除术在功能性鼻内镜手术中的应用

目的探讨改良中鼻甲部分切除术在功能性鼻内镜手术中的应用及其对慢性鼻窦炎症状改善和疗效的影响。方法选择中鼻甲垂直部长度≥25mm的慢性鼻窦炎患者60例,随机分为试验组和对照组,各30例。两组患者术前各项观察指标（鼻塞、流涕、头痛、嗅觉VAS评分,鼻内镜检查Lund Kennedy评分、CT Lund Mackey评分）差异无统计学意义（P>0.05）。试验组实施经鼻内镜鼻窦、鼻息肉手术并清除中鼻甲本身病变（泡甲、肥厚、息肉样变等）后,根据CT测量结果,以保留中鼻甲垂直部长度约21mm为参考值,切除多余的中鼻甲垂直部游离缘（即切除长度＝CT测量长度-21 mm）;对照组完成鼻窦、鼻息肉手术,按传统理念处理中鼻甲病变和变异,需要时切除中鼻甲前下部1/2~2/3。术后随访10~12个月,观察主观症状（鼻塞、流涕、头面痛及嗅觉障碍）、内镜检查Lund Kennedy评分、病情控制及疗效。结果两组术后各种症状VAS评分和内镜Lund Kennedy评分均明显优于术前（P均<0.05）;术后试验组的各项观察指标及总疗效均优于对照组,两组鼻塞及头痛的改善、鼻内镜Lund Kennedy评分及疗效差异具有统计学意义（P均<0.05）;而流涕、嗅觉改善方面,两组差异无统计学意义（P>0.05）;鼻窦炎伴鼻息肉、鼻窦炎伴中鼻甲病变者,试验组的疗效优于对照组（P<0.05）。结论“改良部分切除”主要针对过长的中鼻甲垂直部,必须是在处理中鼻甲病变（泡甲、肥厚、息肉样变等）、保证中鼻道一定宽度后才予切除,有助于术后鼻部症状的改善和减少术腔粘连,提高鼻内镜手术疗效。     

不同年龄慢性鼻窦炎经鼻内镜手术的主客观评估的结果

目的探讨不同年龄段的慢性鼻窦炎伴鼻息肉（chronic rhinosinusitis with polyps,CRSwNP）手术后的主客观病情评估与年龄段、随诊时间的关系。方法对192例CRSwNP行鼻内镜手术：鼻窦开放,息肉切除,下鼻甲射频消融下鼻甲骨骨折外移术,窦口鼻道复合体功能性切除术。将病例分为青少年组、成年组、老年组3个阶段,术后（0.5、1、3、6、12个月）随诊,对不同年龄段不同随诊时间进行主观病情评估（VAS评分）及客观检查及评分（Lund Kennedy内镜评分）。采用统计学分析不同年龄段同一随诊时间和同一年龄段不同随诊时间在术后的主客观病情评估的差异。结果不同年龄段的鼻塞、鼻漏的VAS评分在不同时间（术后3、6、12个月）对比,差异具有统计学意义（P<0.001）。面部胀痛感（术后1、3个月）各组无统计学意义（P>0.05)、而术后6、12个月比较差异具有统计学意义（P<0.05）。Lund Kennedy内镜评分在术后0.5、1个月青少年组与其他组比较无统计学意义（P>0.05）、而术后3、6、12个月比较差异具有统计学意义（P<0.001)。术后复查鼻内镜下水肿、囊泡、分泌物等比年长组要明显。结论术前应着重对不同年龄阶段患者的主观症状、术前检查进行评价,为患者制定个性化手术方案,提高临床疗效。     

应用部分颞肌瓣转位术治疗晚期不全面瘫患者的临床研究

目的探讨部分颞肌瓣转位术对晚期不全面瘫患者的临床应用疗效。方法收集2015年1月—2017年1月接受部分颞肌瓣转位术的患者15例,其中男3例,女12例;年龄26~53岁,平均（32.3±8.6)岁。均为听神经瘤术后并发晚期不完全面瘫患者。依据Terzis量表对患者手术前后口角歪斜程度进行评定,并对患者并发症进行分析。结果所有患者术后随访12～24个月。15例患者术后的静态评分（1.00±0.00）分明显低于术前的静态评分（2.73±0.46）分,差异具有统计学意义（P<0.001）;术后的动态评分（3.93±1.03）分明显高于术前的动态评分（2.00±0.00）分,差异具有统计学意义（P<0.001）。此外,在所有患者中均未观察到颞部凹陷,少部分患者颧弓处出现轻微臃肿。结论部分颞肌瓣转位术可以作为听神经瘤术后并发晚期不完全面瘫的一种有效治疗手段。     

鼻内镜下自体软骨鼻整形同期鼻中隔偏曲矫正治疗外伤性歪鼻畸形的临床分析

目的对鼻内镜下自体软骨（鼻中隔软骨、耳软骨和肋软骨）鼻整形同期行鼻中隔偏曲矫正治疗外伤性歪鼻畸形的临床分析。方法收集2017~2018年20 例陈旧外伤性歪鼻畸形患者的临床资料,所有患者均行全麻下鼻小柱倒“V”型切口暴露松解并切除偏曲的鼻中隔软骨及骨质,针对不同患者设计使用不同软骨（鼻中隔软骨、耳软骨和肋软骨）矫正鼻中隔骨性或软骨性支架,对鼻尖、鼻背及外鼻重新塑形。结果随访3~12个月,行鼻内镜下自体软骨鼻整形同期鼻中隔偏曲矫正术的患者鼻外形及通气均有明显改善,手术效果更好,无鼻腔粘连、鼻中隔血肿及穿孔。结论鼻内镜下自体软骨鼻整形同期鼻中隔偏曲矫正治疗外伤性歪鼻畸形同期解决了鼻部畸形和鼻通气功能,实现了美容和功能的统一,同时减少了手术治疗的次数和费用,可行性高。     

可视支撑喉内镜下喉功能性手术

目的探讨可视支撑喉内镜下喉功能性手术的可行性。方法喉部良性疾病患者160例,随机等分为两组,即可视支撑喉内镜组（研究组）80例,传统显微镜支撑喉镜手术组（对照组）80例。手术显微器械相同,手术由同一人完成。对两组的手术时间、住院时间、发音恢复时间、手术常见并发症及疗效等方面进行统计分析。结果手术时间：研究组（11.38±4.65）min,对照组（20.72±3.23）min,二者比较差异具有统计学意义（P<0.01）。其他手术疗效、平均住院日及手术并发症等均无统计学意义（P>0.05）。结论可视支撑喉内镜功能性手术治疗结果和手术并发症与传统的显微镜功能性手术没有差别,而在手术时间、操作难度等方面具有优势,可视支撑喉内镜功能性手术是可行的。     

耳内镜分离前壁皮瓣修复鼓膜前下象限边缘性穿孔的疗效分析

目的探讨耳内镜下分离前下皮瓣修补鼓膜前下象限边缘性穿孔的临床疗效和应用价值。方法对资料完整的13例鼓膜前下象限边缘性穿孔患者的临床资料进行回顾性分析。对比患者手术前后纯音听阈和耳内镜结果，计算气骨导差及气骨导差改善值。结果术后3个月复查，耳内镜下所有患者鼓膜完整。平均气导为（16.0±15.64）dB，骨导为（12.16±11.92）dB，气骨导差为（3.83±3.73）dB，术后3个月的气骨导差明显小于术前(P<0.05)。结论耳内镜下分离前下皮瓣修补鼓膜前下象限穿孔，具有简单，微创，愈合率高的特点，值得临床推广。     

耳内镜下经外耳道切除上鼓室胆脂瘤35例疗效分析

目的探讨耳内镜下经外耳道入路治疗上鼓室胆脂瘤的可行性、手术方法及疗效。方法回顾分析2014年1月～2017年1月在徐州市中心医院接受耳内镜手术的35例（35耳）中耳上鼓室胆脂瘤患者的临床资料。35例患者中男20例，女15例；年龄22～66岁，平均年龄42.8岁；病程2～20个月，平均10个月。所有患者均在全麻耳内镜下手术，根据胆脂瘤大小决定手术范围。12例行上鼓室重建，10耳听骨链破坏或缺失者，行部分人工听骨重建（partial ossicular replacement prosthesis，PORP）。结果35耳上鼓室胆脂瘤病灶均彻底清除，未出现面瘫及脑脊液漏等并发症。所有患者术后随访1年以上，患者鼓膜愈合良好，移植物形态良好。耳内镜检查或者颞骨薄层CT检查未见胆脂瘤复发，术后听力提高22例（62.8%），听力无变化10例（28.6%），听力下降3例（8.6%），平均气导听阈与气骨导差均有改善，术后0.5、1、2、4 kHz平均气导听阈为（29.234±8.38）dB，与术前的（43.64±8.38）dB比较差异具有统计学意义（P<0.05）；术后0.5、1、2、4 kHz平均气骨导差值为（15.27±6.74）dB，与术前的（28.27±5.94）dB比较差异具有统计学意义（P<0.05）。结论耳内镜下经外耳道上鼓室胆脂瘤切除术是有效的手术方法，复发率低，听力改善明显，与传统显微镜手术相比有优越性。     

男声女调患者与正常男性嗓音参数的对比分析及临床意义

目的探讨男声女调患者嗓音参数与正常男性嗓音参数的区别,为临床诊疗提供参考依据。方法收集30例男声女调及30例正常男性的动态喉镜及嗓音资料,对比分析其嗓音参数。结果26例（86.67%）男声女调患者动态喉镜下表现为声门闭合不全。男声女调患者发音时的基频(F0)为（243.3±42.1）Hz,显著高于正常人的（146.2±25.4）Hz(P<0.01);男声女调患者及正常人发音时的响度分别为（80.0±8.3）dBA、（82.2±9.1）dBA,两者经比较无统计学意义(P>0.05);男声女调患者发音时的振幅微扰(shimmer)为(2.6±1.4)%,与正常人的(1.9±0.7)%比较无统计学意义(P>0.05);男声女调患者及正常人发音时的基频微扰(jitter)均值分别为(0.5±0.2)%、(0.6±0.2)%,两者经比较无统计学意义(P>0.05);男声女调患者的嗓音障碍指数(voice handicap index,VHI)为-0.5±1.6,显著低于正常人的3.8±1.6(P<0.01);男声女调患者的最长发音时间(maxmum phonation time,MPT)为（16.0±7.5）s,较正常人的（32.0±4.9）s显著缩短(P<0.01);音域（range）测量男声女调患者为（288.4±140.8）Hz,显著小于正常人的（611.1±226.1）Hz(P<0.01)。结论大部分男声女调患者存在声门闭合不全。男声女调患者发音时的基频高于正常人,嗓音障碍指数低于正常人,最长发音时间较正常人缩短,音域较正常人变窄,而响度、振幅及基频微扰值与正常人相比无显著差异。     

miR-34b基因在鼻咽癌组织中的表达及意义

目的检测鼻咽癌组织中miR 34b的表达,并探讨其与鼻咽癌临床病理的关系。方法收集2016年1月～2017年10月海口市人民医院经病理确诊的114例鼻咽癌患者标本作为鼻咽癌组,另选取同期行鼻内镜鼻息肉手术切除的良性鼻咽标本40例作为对照组。采用荧光定量PCR检测miR 34b在两组中的表达,并分析其与鼻咽癌临床病理特征的关系。结果鼻咽癌组织中miR 34b的相对表达量2 △Ct值为0.136±0.021,显著低于对照组织的0.294±0.052（P<0.01）;miR 34b的相对表达量2 △Ct值与鼻咽癌患者的性别、年龄和病理分级无显著相关性（P>0.05）;miR 34b的相对表达量2 △Ct值在临床Ⅲ、Ⅳ期患者为0.126±0.015,显著低于Ⅰ、Ⅱ期患者的0.183±0.046（P<0.05）;miR 34b值在淋巴结有转移的患者为0.116±0.013,显著低于无转移的0.162±0.041（P<0.05）。结论鼻咽癌组织中miR 34b呈低表达,其表达变化可能参与鼻咽癌的发生、发展和转移过程。     

阻塞性睡眠呼吸暂停低通气综合征患者血清脂多糖结合蛋白和颈动脉粥样

目的评估阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者血清中脂多糖结合蛋白(lipopolysaccharide binding protein, LBP)和颈动脉内膜中层厚度(carotid intima media thickness, CIMT)的关系。方法选择2015年5月~2017年12月在北京安贞医院耳鼻咽喉头颈外科就诊的117例疑似OSAHS患者作为研究对象，所有患者均接受多导睡眠监测和B超评估CIMT。结果在无OSAHS患者、轻-中度OSAHS患者、重度OSAHS患者中，平均LBP浓度和CIMT均呈增加趋势，LBP浓度分别为（32.1±10.4）、（32.3±10.8）、（38.1±10.5）μg/ml，重度OSAHS与轻-中度OSAHS患者相比，血清LBP显著增高(P<0.05);平均CIMT分别为（0.52±0.08）、（0.58±0.07）、（0.62±0.13）mm，重度OSAHS与轻-中度OSAHS患者相比，平均CIMT显著增高(P<0.05)。氧减饱和度指数(oxygen desaturation index, ODI)是一个独立于年龄、腰臀比、吸烟、高血压、高密度脂蛋白胆固醇、甘油三酯和空腹葡萄糖(P=0.002,R2=0.154)等因素预测血清LBP水平的指标。此外，血清LBP可预测CIMT，而且独立于已知动脉粥样硬化危险因素，如肥胖(P<0.001,R2=0.323)。结论研究结果表明，OSAHS患者LBP和CIMT之间存在相关性，且呈线性相关。     

Does septoplasty improve the quality of life in children?

Objectives

The aim of this study is to evaluate the outcomes of septoplasty and the effects of septoplasty on the quality of life and to determine postoperative patient satisfaction in children using nose obstruction symptom evaluation (NOSE) and visual analog scale (VAS).

Methods

Only pediatric patients who underwent septoplasty were included in the study. Patients who underwent adenoidectomy, endoscopic sinus surgery, or turbinate surgery in addition to septoplasty and total septal reconstruction with open technique septorhinoplasty were excluded from the study. Patients and their parents were inquired about their nasal obstruction symptoms using the NOSE scale before and 3 and 12 months following the surgery. VAS was used to analyze overall satisfaction of the patients and their parents on the outcomes of surgery, at the last follow-up examination 12 months after the surgery.

Results

Thirty-five patients with a mean age of 13.4 ± 2.8 (8–16) were included in the study. There was a very significant improvement in NOSE score at 3 months after septoplasty. The mean subjective satisfaction score measured with VAS at the 12th month postoperatively was 7.9 ± 2.1. Improvement in NOSE score was correlated with patient satisfaction.

Conclusion

Septoplasty is a very effective and satisfactory treatment for nasal obstruction caused by nasal septal deviation in children. The NOSE scale can be used for the evaluation of nasal obstruction symptoms.     

Comparison of visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) score in evaluation of post septoplasty patients

ObjectiveTo compare and correlate the efficacy of the NOSE score & the VAS score in determining the symptomatic benefit in patients undergoing septoplasty.Materials and methodsEighty patients with deviated nasal septum undergoing septoplasty were included in the study. NOSE score & VAS score (out of 100) was documented before and after surgery. Results were correlated and compared statistically.ResultsIn the NOSE score, the most bothersome symptom was trouble breathing through the nose (85.83); followed by Nasal obstruction or blockage (82.50). Wilcoxon test showed significant improvement with NOSE score and VAS score in all patients at 1 month and 3 months. Spearman's coefficient showed a positive correlation between the two, though the score improvement and patient satisfaction rate was significantly high with NOSE score.ConclusionsNOSE score and the VAS score both provide effective framework for evaluating treatment responses after septoplasty. However, the NOSE score showed higher improvement and better patient satisfaction rate when used to measure of nasal obstruction as compared to the VAS score.     

鼻中隔缝合在鼻中隔矫正术后的临床应用

目的评价鼻中隔缝合在鼻中隔矫正术后应用的临床疗效。方法选取40例鼻中隔偏曲患者,随机分成2组。缝合组：术后5-0薇乔线贯穿连续缝合鼻中隔黏膜;填塞组：术后以高膨胀海绵填塞鼻腔。分别于术后第1天、第2天对患者主观不适感以视觉模拟评分法（visual analogue scale,VAS）进行评分,并观察术后鼻中隔血肿、鼻腔粘连等临床指标。结果术后第1天、第2天两组患者在鼻塞、头痛、口干、睡眠困难、吞咽困难5个方面的VAS评分均值比较,差异均有统计学意义（P均<0.05）。两组患者在术后3个月内鼻中隔血肿、鼻腔粘连、感染等方面的发生率比较,差异无统计学意义（P均>0.05）。结论鼻中隔偏曲矫正术后,与鼻腔填塞相比,鼻中隔缝合在降低患者痛苦、提高术后舒适度方面具有明显的优势。     

鼻内镜下鼻中隔矫正术后血肿的预防

目的探讨预防鼻内镜下鼻中隔矫正术后鼻中隔血肿的有效方法。方法回顾性分析安徽医科大学第一附属医院2016年1月—2019年4月收治的行鼻内镜下鼻中隔矫正术的220例患者的临床资料。其中90例患者鼻中隔矫正术后鼻中隔两侧黏膜完整为甲组;90例患者术后黏膜完整,行一侧近鼻底处鼻中隔黏膜水平贯穿切开,长约1 cm,本研究称之为黏膜辅助切口为乙组;40例患者术后一侧或两侧鼻中隔黏膜有不对称破损为丙组。术后3组均予膨胀海绵填塞。结果甲组患者出现鼻中隔血肿5例,乙组和丙组患者皆未出现鼻中隔血肿,所有患者均无鼻中隔穿孔。3组之间的鼻中隔血肿发生率差异具有统计学意义(χ2=9.107,P<0.05)。结论对于术后两侧鼻中隔黏膜完整的患者,鼻中隔矫正后行一侧鼻中隔黏膜切开能有效预防鼻中隔术后鼻中隔血肿的发生。     

Quality of life assessment septoplasty in patients with nasal obstruction

Naasal obstruction is a common complaint in the population. When caused by a deviated nasal septum, septoplasty is the procedure of choice for treating these patients. NOSE is a tool for assessing the disease-specific quality of life related to nasal obstruction.AimTo assess the impact of septoplasty on patients with nasal obstruction secondary to deviated nasal septum based on the disease-specific quality-of-life questionnaire. Design: Prospective.MethodsPatients undergoing septoplasty with/ without turbinectomy after no clinical improvement with medical treatment were assessed by the NOSE questionnaire before and 3 months after surgery. We evaluated the surgical improvement based on total score, the magnitude of the surgery in the disease-specific quality of life and the correlation between the preoperative score and postoperatively improvement.ResultsFourty-six patients were included in the study. There was a statistically significant improvement in the preoperative NOSE score (md = 75, IQR = 26) and after three months (md = 10, IQR = 20) (p < 0.001.T-Wilcoxon). The standardized response mean was 3.07. We found a strong correlation between the preoperative score in the NOSE questionnaire and improvements in the postoperative period (r = -0.789, p < 0.001, Spearman). No difference was found in improvement scores by gender. (p = 0.668, U-Mann-Whitney).ConclusionSeptoplasty resulted in a statistically significant improvement in the disease-specific QOL questionnaire.     

The systolic pulmonary artery pressure and the E/e’ ratio decrease after septoplasty in patients with grade 2 and 3 pure nasal septal deviation

IntroductionNasal septal deviation may contribute to a wide range of symptoms including nasal obstruction, headache, increased secretion, crusting, mucosal damage, and loss of taste and smell. Excessive increase in the respiratory resistance, as seen in nasal septal deviation, results in reduced lung ventilation, thereby potentially leading to hypoxia, hypercapnia, pulmonary vasoconstriction. The deformities in the nasal cavity can be associated with major respiratory and circulatory system diseases.ObjectiveTo investigate cardiovascular effects of septoplasty by comparing pre- and postoperative transthoracic echocardiography findings in nasal septal deviation patients undergoing septoplasty.MethodsThe prospective study included 35 patients with moderate and severe nasal septal deviation (mean age, 23.91 ± 7.01) who underwent septoplasty. The Turkish version of the nasal obstruction symptom evaluation, NOSE questionnaire, was administered to each participant both pre- and postoperatively in order to assess their views on the severity of nasal septal deviation, the effect of nasal obstruction, and the effectiveness of surgical outcomes. A comprehensive transthoracic echocardiography examination was performed both preoperatively and at three months postoperatively for each patient and the findings were compared among patients.ResultsMean preoperative NOSE score was 17.34 ± 1.62 and the mean postoperative score was 2.62 ± 1.68 (p = 0.00). Mean preoperative systolic pulmonary artery pressure value was 22.34 ± 4.31 mmHg and postoperative value was 18.90 ± 3.77 mmHg (p = 0.00). Mean E/e’ ratio was 5.33 ± 1.00 preoperatively and was 5.01 ± 0.90 postoperatively (p = 0.01). The NOSE scores, systolic pulmonary artery pressure values, and the E/e’ ratios decreased significantly after septoplasty (p < 0.05 for all), whereas no significant difference was found in other transthoracic echocardiography parameters (p > 0.05).ConclusionThe decrease in NOSE scores following septoplasty indicated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to nasal septal deviation may be a cardiovascular risk factor and may affect transthoracic echocardiography measurements. Moreover, the significant decrease in the systolic pulmonary artery pressure value and E/e’s ratio following septoplasty indicated that negative echocardiographic findings may be prevented by this surgery.     

Postoperative pain with or without nasal splints after septoplasty and inferior turbinate reduction

PurposeTo determine the effect of intranasal Doyle splints on postoperative pain following septoplasty and inferior turbinate reduction (ITR). Changes in Nasal Obstruction Symptom Evaluation (NOSE) scores were also evaluated.Materials and methodsA prospective cohort study conducted from January 2017 to January 2019. Patients were recruited if they experienced nasal obstruction due to septal deviation and inferior turbinate hypertrophy, and failed a one-month trial of intranasal corticosteroids. All patients underwent septoplasty with ITR, and either had Doyle splints or no splints placed. Patients were prescribed hydrocodone-acetaminophen 5–325 mg and asked to keep a daily log of pain medication use and visual analog scale (VAS) scores. Pain logs and NOSE scores were compared between patients who had splints versus patients who had no splints placed after septoplasty and ITR over the first postoperative week. NOSE scores were also collected at every postoperative visit (1 week, 1 month, and 6 months).ResultsFifty-seven patients were enrolled (37 splints, 20 no-splints). The median postoperative pain VAS score was 3.0 (interquartile range [IQR] 2.0–5.0) for the splint group and 4.0 (IQR 2.0–5.0) for the no-splint group (P = 0.906). The median postoperative pain medication requirement in morphine equivalents at the first postoperative visit was 5.4 mg/day (IQR 2.0–13.3) for the splint group and 8.4 mg/day (IQR 1.8–15.3) for the no-splint group (P = 0.833).ConclusionsThere were no statistically significant differences in postoperative pain VAS scores or pain medication use between the two groups. All patients experienced significant reductions in NOSE scores postoperatively.     

鼻咽癌放疗对口腔和鼻腔pH值影响的分析

 目的分析鼻咽癌放射治疗对患者口腔唾液和鼻腔分泌物pH值的影响。方法用试纸检测法检测正常对照组、鼻咽癌患者研究组和放疗后组口腔唾液和鼻腔分泌物的pH值,每组30例;其中鼻咽癌患者研究组的检测包括放疗前、放疗1、3、5周和放疗结束时5个时段;对检测的结果进行统计学比较分析,并对一些相关问题进行讨论。结果研究组放疗前、放疗1、3、5周和放疗结束患者口腔唾液（咀嚼1 min）的pH分别为6.98±0.94、6.13±0.91、5.50±0.90、5.52±0.94、5.55±1.12,放疗后组为6.11±0.64。研究组放疗前与放疗过程中的各时段及放疗后组的pH比较,差异具有统计学意义（P均=0.000）。研究组放疗前、放疗1、3、5周和放疗结束患者鼻腔分泌物的pH分别为7.14±0.26、7.13±0.26、7.20±0.31、7.33±0.27、7.28±0.34,放疗后组为7.30±0.31,研究组放疗前与放疗5周和放疗后组相比较,差异均具有统计学意义（P=0.016,P=0.014）,其余组间比较差异无统计学意义（P均>0.05）。结论放疗过程中口腔唾液pH值呈现下降的趋势,从放疗的第1周末开始,唾液的pH值就明显下降,第3周就基本达到谷底,放疗后难以恢复。而放疗过程中鼻腔pH值则呈缓慢的上升状态,但变化程度相对较小。放射治疗使口腔唾液和鼻腔分泌物pH值的反向变化以及影响有待进一步研究。