Endoscopic management of sinonasal inverted papilloma

Since 1992, 42 patients at the University of Pennsylvania have been treated for inverted papilloma (IP). Thirty-three patients were managed endoscopically with or without a Caldwell Luc approach (CLA) and retrospectively analyzed. The CLA, which involves a gingivobuccal incision for access to the maxillary sinus, is distinguished from a formal Caldwell Luc procedure. These 33 patients with histologically confirmed IP were without evidence of malignancy. They also did not have evidence of intracranial, orbital, or frontal sinus IP. Seventeen of 33 patients (17/33) were without prior treatment (primary). Sixteen of 33 (16/33) presented from an outside institution with recurrent IP (secondary). The recurrence rate using this method to treat primary IP was 6% (1/17), and for secondary IP was 25% (4/16). Scheduled postoperative endoscopic surveillance permitted early detection of recurrence and continued endoscopic control of IP. All 33 patients were endoscopically free of disease at the end of the study. These preliminary data are encouraging for the use of intranasal endoscopy with and without CLA as a means of managing and controlling IP in selected cases.     

Short-fragment PCR assay for highly sensitive broad-spectrum detection of human papillomaviruses in laryngeal squamous cell carcinoma and normal mucosa: clinico-pathological evaluation

The aim of the study was to determine the prevalence and genotypes of HPV infection in laryngeal cancer specimens, normal mucosa obtained from the surgical margin and laryngeal nodules using a novel high sensitive and specific SPF₁₀ HPV DNA test, PCR/DEIA method and INNO-LiPA genotyping assay. The correlation between HPV presence and clinico-pathological features was analyzed. Tissue samples were collected from 93 primary laryngeal squamous cell carcinoma (LSCC), 49 specimens of normal mucosa and from 22 specimens of laryngeal nodules serving as control group. HPV DNA was amplified by the short PCR fragment (SPF₁₀) primer set using HPV DNA enzyme immunoassay (DNA/DEIA) method and INNO-LiPA HPV genotyping assay. Human papillomavirus was detected in 33 (35.5%) of the 93 samples from LSCC, in 4 (8.2%) of 49 samples of the normal mucosa and it was not detected in any of the sample from the control group. Twenty-eight of 33 (81.8%) were positive for HPV-16, 6 of 33 (18.2%) were positive for HPV-18 and 5 of 33 (15.1%) were positive for HPV-33. Multiple infection was found in 5 of 33 (15.1%); 3 samples were positive for HPV-16 and HPV-33, 2 samples for HPV-16 and HPV-18. There was a statistically significant correlation between the presence of HPV in LSCC tumors and in control group samples and between the presence of HPV in the tumors and normal mucosa from the free surgical margin. The presence of HPV infection in 35.5% of the cases suggests a possible role in the etiology of laryngeal cancer and supports the role of high-risk types of HPV (16, 18 and 33) in LSCC. HPV infection is not likely to influence survival rates as an independent prognostic factor in patients with laryngeal cancer.     

Otic drops used to clear a blocked grommet: an in vitro prospective randomized controlled study with blinded assessment

Clinicians often prescribe otic drops anecdotally to try and clear grommets blocked with blood. We carried out an in vitro double-blind randomized controlled study comparing the efficacy of sodium bicarbonate, Locorten Vioform and olive oil drops in clearing Shah grommets placed in 'artificial ears' and blocked with blood in a standardized fashion. There were 33 grommets in each group, and drops were inserted three times a day for 7 days. Olive oil drops cleared 17 of 33 (51.51%), Locorten Vioform cleared one of 33 (3%) and sodium bicarbonate cleared zero of 33 (0%) blocked grommets. Statistical comparison between pairs indicates that olive oil was significantly better than both Locorten Vioform (P < 0.001) and sodium bicarbonate drops (P < 0.001) at clearing grommets blocked with blood.     

变应性鼻炎小鼠鼻黏膜lL-25、lL-33 mRNA表达水平的研究

目的：探讨IL-25 mRNA及IL-33 mRNA在变应性鼻炎小鼠鼻黏膜中的表达及其作用。方法利用Balb/c小鼠建立卵清蛋白致敏的变应性鼻炎小鼠模型,同时使用生理盐水作为对照组,取各组小鼠鼻黏膜组织,使用实时定量PCR法检测两组小鼠鼻黏膜中IL-25 mRNA和IL-33 mRNA的含量。结果IL-25 mRNA和IL-33 mRNA在对照组以及实验组中均有表达,且实验组明显高于对照组,两组比较差异具有统计学意义（P＜0.05）。结论 IL-25和IL-33参与到变应性鼻炎的发病机制中,该结果将有助于提高对变应性鼻炎发病机制的进一步了解,为变应性鼻炎潜在的靶向药物治疗提供了理论依据。     

Complications of acute otitis media in children in southern Finland

BACKGROUND: The incidence of intratemporal and intracranial complications of acute otitis media (AOM) has decreased and the need for operative treatment is declined in developed countries during the antibiotic era. OBJECTIVES: To establish the clinical picture, diagnostic procedures, outcome and current treatment of pediatric patients with intratemporal and intracranial complications of AOM. METHODS: A retrospective chart review with a sent questionnaire. All pediatric patients treated for intratemporal and intracranial complications of AOM over the past 10 years (1990-2000) at the Department of Otolaryngology in the Helsinki University Central Hospital. RESULTS: During the study period 33 children (incidence 1.1/100,000 per year), aged from 3 months to 14.2 years were treated for intratemporal [97% (32/33)] and intracranial [3% (1/33)] complications of AOM. Facial paresis was found in 9% (3/33) of the patients. The only intracranial complication was an extradural abscess with meningitis. Eighteen patients (55%) were on antibiotic treatment because of AOM prior to the diagnosis of complication. Neither the duration or severity of the signs and symptoms of infection at the time of admittance nor a lack of antibiotic treatment before admittance were statistically significantly associated with the need for mastoidectomy or duration of hospitalization. Streptococcus pneumoniae 25% (8/33) and Pseudomonas aeruginosa 22% (7/33) were the most frequently found bacteria in the culture of middle ear and mastoid effusions. Mastoidectomy was performed on 55% (18/33) of the patients. After half a year of follow-up, all the patients had normal hearing and facial function. CONCLUSIONS: Severe complications of AOM are rare today in southern Finland and the need for mastoidectomy has declined significantly. With early recognition and effective treatment of complications, the prognosis is good.     

Expression of interleukin-33 is correlated with poor prognosis of patients with squamous cell carcinoma of the tongue

Objective

The aim of this study was to clarify the role of IL-33 in tumor progression.

Methods

Surgical specimens from 81 patients with squamous cell carcinoma of the tongue were studied using immunohistochemistry. Primary tumor sections were analyzed for IL-33 and ST2 expression. To examine the influence of IL-33 on the microenvironment of the tumor, we determined the mast cell density (MCD) and microvessel density of the stroma.

Results

Patients with high IL-33 expression had a significantly worse prognosis (p = 0.004). IL-33 expression was significantly elevated in patients with local and nodal recurrence (p = 0.014 and p = 0.019). ST2 expression was also associated with a worse prognosis (p = 0.024) and was significantly elevated in patients with nodal recurrence (p = 0.004). MCD was associated with worse prognosis (p = 0.038) and correlated significantly with IL-33 expression (r = 0.626, p < 0.001). Micovessels in the stroma were significantly increased in the high IL-33 group (p < 0.001).

Conclusion

These data suggest that the IL-33/ST2 axis contributes to tumor aggressiveness and affects the tumor microenvironment. Immunohistochemical evaluation of IL-33 and ST2 is useful for identifying patients at a high risk for poor prognosis.     

IL-31、IL-33及其受体ST2在难治性鼻-鼻窦炎中的表达及意义

目的 研究IL-31、IL-33及其受体ST2在难治性鼻-鼻窦炎(RRS)患者鼻黏膜组织中的表达,初步探讨其在RRS发病机制中的作用及意义。 方法 研究设立难治组、初治组及对照组。采用HE染色方法观察组织形态和检测嗜酸性粒细胞数(EOS);采用免疫组织化学法检测组织中IL-31、IL-33及ST2蛋白的相对含量;采用实时荧光定量PCR技术在mRNA水平检测IL-31、IL-33及ST2蛋白的表达;外周血检测血清总IgE的表达水平。 结果 (1) 难治组、初治组的嗜酸性粒细胞数均高于对照组,难治组高于初治组;(2)免疫组织化学染色中,IL-31、IL-33在难治组、初治组及对照组均有表达,难治组、初治组表达量高于对照组,难治组高于初治组。ST2表达量难治组、初治组均高于对照组,但难治组与初治组之间差异无统计学意义;(3) 在mRNA表达水平上, IL-31、IL-33在难治组及初治组中的表达较对照组上调,难治组高于初治组;ST2表达量难治组、初治组均高于对照组,但难治组与初治组之间差异无统计学意义;(4)外周血总IgE值三组间差异无统计学意义。 结论 IL-31、IL-33及其受体ST2可能在慢性鼻-鼻窦炎患者,尤其在难治性鼻-鼻窦炎患者发病机制中发挥重要作用;嗜酸性粒细胞浸润可能在难治性鼻-鼻窦炎的发展中有重要作用。     

Human papilloma virus and carcinoma of the laryngopharynx

The presence of human papillomavirus (HPV) genomes 6, 11, 16 and 33 in 16 patients with laryngopharyngeal carcinomas was examined by means of a polymerase chain reaction. HPV genomes were detected in 75 per cent of cases. In hypopharyngeal carcinoma, HPV 6 and 11 were present in adjacent tissue but absent from the tumour. HPV 16 and 33 were present in 40 per cent of laryngeal tumours and adjacent tissue. These results suggest that HPV 16 and 33 may be closely associated with the development of some laryngopharyngeal carcinomas.     

辛芩颗粒联合康宁克通-A穴位注射治疗变应性鼻炎疗效分析

目的观察辛芩颗粒联合康宁克通-A治疗变应性鼻炎的疗效.方法78例变应性鼻炎患者随机分成两组.治疗组(48例)给予辛芩颗粒联合康宁克通-A治疗;对照组(30例)给予息斯敏和2%色甘酸钠滴鼻剂(DSCG)治疗,3周后进行评分,计算治疗后积分改善率.结果治疗组临床控制16例(33.33%),显效22例(45.83%),有效8例(16.67%),总有效率95.83%;对照组临床控制0例,显效3例(10.00%),有效13例(43.33%),总有效率53.33%.两组疗效比较差异有显著性意义(P＜0.01).结论辛芩颗粒联合康宁克通-A迎香穴位注射能提高疗效,是一种安全实用的治疗方法.     

高频超声与喉镜诊断声带麻痹的对照研究

目的探讨超声诊断声带麻痹的价值及局限性。方法分析33例声带麻痹的超声表现,并与喉镜对照。结果超声诊断为单侧和双侧声带麻痹者各为30和3例。单侧者声像图表现为单侧声带变形18例,运动和振动减弱或固定27例,声门裂扩大19例,杓状软骨运动减弱或固定30例,伴前移12例,梨状窝扩大25例,环杓后肌变薄、回声增强10例。双侧者声像图均表现为双声带变形、声门裂扩大、杓状软骨运动减弱。喉镜诊断单侧声带麻痹28例,双侧5例。超声诊断声带麻痹的符合率达93.9%。结论超声是诊断声带麻痹的一种无创、便捷、有效的方法,尤其可借助观察杓状软骨的运动来判断声带麻痹。     

Narrative content as described by individuals with Down syndrome and typically developing children.

Narratives of the wordless picture story, Frog, Where Are You?, by 33 individuals with Down syndrome and typically developing children (33 matched for mental age, 33 for syntax comprehension, 33 for mean length of utterance) were analyzed for expression of plot line, story theme, and the protagonists' misadventures in the story. Despite their restricted expressive syntax and vocabulary, the group with Down syndrome expressed more plot line and thematic content and more of one of the protagonists' misadventures than the MLU controls; they most resembled the syntax comprehension control participants. We conclude that the group with Down syndrome had a conceptual understanding of the picture story similar to that of the TACL-R group and a strategy for expressing that understanding despite expressive lexical and syntactic limitations; this resulted in the expression of more narrative content than formal measures of expressive language would predict. We propose that the higher syntactic comprehension skills of the group with Down syndrome, combined with their experience with story content (listening to stories), may have contributed to their developing higher-level story schemas than would be expected given their MLUs.     

A prospective controlled study of high-resolution thyroid ultrasound in patients with globus pharyngeus

The sensation of a lump in the throat may be the presenting symptom of thyroid enlargement, but the majority of thyroid abnormalities are undetectable by clinical examination. The thyroids of 43 patients with globus pharyngeus and 33 controls were prospectively examined by high-resolution ultrasound, to test the hypothesis that a higher incidence of impalpable thyroid abnormalities exists in patients with globus pharyngeus than in the normal population. Abnormalities were present in 31/43 (72%) patients with globus and in 11/33 (33%) controls (P < 0.001). Of the patients with globus, 17 had solitary nodules or cysts, 10 had multiple abnormalities and diffuse abnormality was present in four patients. Solitary nodules ranged from 4 to 29 mm. Impalpable, ultrasound-detectable abnormalities are significantly more common in patients with globus pharyngeus than in controls. Abnormalities of the thyroid gland may be responsible for globus symptoms.     

Laryngeal fractures: clinical findings and considerations on suboptimal outcome

CONCLUSION: We recommend early surgical exploration and fixation for patients with dislocated or comminuted laryngeal fractures to avoid long-term voice complications. One-third of 33 fracture patients rated their voice after the fracture had healed as fair but altered. OBJECTIVES: To examine the indications for and the outcome of surgical management in patients with laryngeal fractures. PATIENTS AND METHODS: The study was carried out in a tertiary care referral university hospital and was a retrospective study of case series. Thirty-three consecutive patients, aged 14-84 years, presented with various types of laryngeal fractures. Patients were staged according to the type of the fracture and surgical correction was performed when indicated. Voice outcome was documented and patients with subjectively suboptimal result were further evaluated by phoniatric specialist. RESULTS: In all, 32 of 33 laryngeal fracture patients had blunt trauma and the main causative factors were sport injuries (39%) and physical assault (33%). All of the 33 laryngeal fracture patients had a good airway outcome. The subjective voice outcome was good for 20 (61%) and fair for 13 (39%) patients. The mean follow-up time was 39.5 months (range 2-114 months). In phoniatric evaluation most (six of eight) patients with fair voice outcome could not produce high pitched voices because of inability to stretch the vocal folds.     

喉癌组织Rb、P53、C-myc和HPV基因测定及意义

采用PCR技术检测了33例喉癌及4例正常喉组织Rb、P53、C-myc、HPV基因的异常状况，结果：P53基因突变率为69.69%(23/33)(P＜0.01)，Rb基因突变率为48.48%(16/33)(P＜0.01)，C-myc基因扩增率为58.62%(17/29)(P＜0.01)，HPV阳性率为72.72%(24/33)(P＜0.01)。结合病毒感染和重度吸烟探讨发生喉癌因素的相互关系，研究表明：HPV感染和吸烟与C-myc基因激活和Rb、P53基因突变失活有关，是导致喉癌发生发展的多因素、多基因、多阶段的相互作用。     

Sphenoid sinus development in choanal atresia

Objectives

To study the growth and size of the sphenoid sinuses in choanal atresia patients.

Study design

Case-control single blinded retrospective study.

Methods

Fifteen non-syndromic patients (ages 0-26 years old) were selected because they had at least one suitable CT scan (nine bilateral and 11 unilateral = total 20 scans). Twenty age-matched CT scans were used as controls. The following linear measurements were obtained: (1) fronto-zygomatic width, (2) zygomatic width, (3) width of the maxillary sinuses, (4) width of the sphenoid sinuses. Statistical analysis was performed with the exact permutation test in the framework of a parametric analysis of a randomized completed block.

Results

The width measurements of the choanal atresia CT scans did not show any statistically significant difference when compared to their control CT scans except for the zygomatic width in the bilateral choanal atresia patients. In the latter, the width was smaller (p = 0.03).

Conclusions

In unilateral and bilateral choanal atresia patients, there is normal growth of the width of the sphenoid sinuses.     

两种途径鼓室注入地塞米松治疗分泌性中耳炎的临床研究

目的 探讨两种途径进行鼓室注入地塞米松治疗分泌性中耳炎的有效性和安全性,方式分别为电子鼻咽喉镜下咽鼓管注药、鼓膜穿刺鼓室注药。方法 将药物治疗1周~1个月但疗效欠佳的分泌性中耳炎患者65例(69耳),分成两组进行治疗,治疗组32例(33耳)行电子鼻咽喉镜下咽鼓管注药治疗,对照组33例(36耳)行鼓膜穿刺鼓室注药治疗,每2~3 d注药1次, 共治疗3次。随访10~12个月,比较两组患者的疗效以及并发症的发生情况。结果 疗程结束后3个月,治疗组和对照组总有效率分别为93.9%(31/33)和83.3%(30/36)。随访10~12个月,治疗组和对照组复发率分别为15.2%(5/33)和33.3%(12/36),治疗组总有效率高于对照组,复发率低于对照组,但差异均无统计学意义(P>0.05),两组病例未见并发症发生。结论 电子鼻咽喉镜下经咽鼓管注药和鼓膜穿刺注药两种方法鼓室注入地塞米松治疗分泌性中耳炎有相同疗效,电子鼻咽喉镜下咽鼓管注药疗法可作为分泌性中耳炎治疗的新途径。     

Connexin 26 gene mutations in congenitally deaf children: pitfalls for genetic counseling

OBJECTIVE: To evaluate difficulties encountered in genetic counseling in deaf children carrying connexin 26 gene (CX26 or GJB2) mutations. DESIGN: Prospective study. SETTING: Outpatients, tertiary referral center. PATIENTS: Ninety-six unrelated deaf children in whom CX26 mutations had been detected consecutively. Children were recruited to a center for genetic counseling for deaf children, and all had congenital deafness, sporadic or familial. RESULTS: In 63 children, deafness was clearly a DFNB1 form with autosomal recessive inheritance: 47 of the 63 were homozygous for the most frequent mutation, the deletion of G at position 35 (35delG); 16 of 63 carried on both alleles of CX26 frameshift or stop mutations, or missense mutations affecting a critical region of the gene. In 33 of 96 children, genetic counseling was difficult: 21 of 33 had a single mutation detected, 11 of 33 had new missense mutations or mutations whose pathogenicity remains debated in the literature, and 1 of 33 had a genotype with both a recessive mutation (35delG) and a mutation acting as a dominant mutation. CONCLUSIONS: Interpretation of results for the molecular diagnosis of mutations in the connexin 26 gene is difficult in almost one third of cases. Close collaboration between geneticists familiar with deafness and otolaryngologists is essential to provide a high standard of genetic advice.     

Evaluation of cochlear involvement by transient evoked otoacoustic emission test in children with Crimean-Congo hemorrhagic fever

Objective

The aim of this study was to investigate cochlear involvement in child patients with Crimean-Congo hemorrhagic fever (CCHF) disease.

Methods

Twenty-eight CCHF disease patients (56 ears) and 26 sex- and age-matched healthy control subjects (52 ears) were included in the study. Pure-tone audiometry at frequencies 0.25, 0.5, 1, 2, 4, and 6 kHz, immittance measures including tympanometry and acoustic reflex testing, and transient evoked otoacoustic emission (TEOAE) testing were performed in the patients and controls.

Results

The proportion with a result of ‘fail’ for the TEOAE test in the CCHF patients was not statistically significant from the control group (p > 0.05).

Conclusions

CCHF disease does not impair cochlear function in children. The clinical course of CCHF among children seems to be milder than in adults.     

慢性鼻-鼻窦炎术后应用黏液调节剂的临床疗效观察

目的:观察2种不同的黏液调节剂在鼻内镜围手术期的作用。方法:97例慢性鼻-鼻窦炎患者随机分为3组:对照组(A组)33例、盐酸氨溴索组(B组)31例、桉柠蒎组(C组)33例。在常规治疗基础上,A组患者不服用任何黏液调节剂;B组术后3 d开始口服盐酸氨溴索片30 mg,3次/d,连续应用8周;C组术后3 d开始口服桉柠蒎肠溶软胶囊300 mg,3次/d,连续应用8周。3组患者均随访6个月,观察治疗效果。结果:B组有效率90.3%,C组有效率97.0%,2组比较差异无统计学意义;A组有效率75.8%,与C组比较差异有统计学意义(P<0.05),与B组比较差异无统计学意义(P>0.05)。结论:应用黏液调节剂可以明显改善术后黏膜分泌、上皮化,缩短术后换药时间,提高功能性鼻内镜手术的成功率,有良好的临床应用前景。     

Auditory function in whiplash-associated disorders

This was a consecutive, prospective clinical study on 153 ambulatory patients in a tertiary referral center (i.e., a county hospital). All patients had whiplash-associated disorders (WAD) of at least grade II, according to the Quebec classification. All patients underwent pure-tone audiometry, and their audiograms were compared with ISO standards. Fourteen percent of patients with WAD had a hearing impairment exceeding the 90th percentile of the ISO standards. However, in most cases the hearing was not associated with whiplash injury. A subgroup (33 patients)--with normal hearing or slight hearing impairment according to the audiogram--was selected from the total group of patients with WAD. The 33 selected patients and 33 matched controls were tested with the speech-in-noise test (SRN test). However, 40% of this subgroup of patients with WAD reported hearing problems. As many as 30% of the patients with WAD had an abnormal SRN test result, as against 5% of the controls. Significant relations were found between the SRN test and self-assessed hearing loss, but not between the SRN test and tinnitus.