中耳手术中鼓索神经保护及近期味觉功能变化

目的通过在中耳乳突术中采用神经保护措施,探索术中对鼓索神经(chorda tympanic nerve,CTN)结构及功能的保护,明确中耳乳突术中CTN的正确处理。方法连续选取鼓室成形术患者84例及人工镫骨植入术患者42例。于术后2 d～2周随访所有患者的主观味觉及相关情况。分析CTN保留情况及味觉改变情况。结果 CTN总体保留率为91.4%(96/105)。在人工镫骨植入术组中,42例患者全部保留,保留率100%;在鼓室成形术组中,保留率85.7%。总体术后味觉改变发生率11.9%,人工镫骨植入术组4.8%,鼓室成形术组15.5%。术后最多见症状为术侧舌麻木53.3%和术侧味觉丧失40%。结论在中耳乳突术中应采取保护措施尽可能保护CTN。     

Dysgeusia Due to an Orthodontic Wire: A Case Report

A 14-year-old female developed gustatory disorder due to an orthodontic wire having pierced the right trigonal retromolar. The patient's complaints included traction pain on the right lower jaw, numbness on the right front half of the tongue and hypogeusia with the exception of sweet tastes. Possible causes of dysgeusia in this case were: (i) direct mechanical compression of a gustatory nerve by the orthodontic wire; and (ii) disturbance of blood supply to a gustatory nerve by edema that developed in nerve tissues around the wire. The patient's retention of a normal threshold for the recognition of sweet tastes is not fully understood.     

舌系带延长术后构音障碍患者异常舌尖前音的语音特点及康复训练

目的：探讨舌系带延长术后构音障碍患者异常舌尖前音的语音特点和康复训练方法。方法选择107例（3～26岁,平均7．21±4．55岁）舌系带延长术后构音障碍患者为研究对象,分析舌尖前音的构音障碍特点,再从中选择32例（3～24岁,平均7．59±5．10岁）有舌尖前音构音障碍的患者进行3个疗程的语音康复训练,分析康复效果。结果107例患者中／z／、／s／的构音错误形式主要是与／a／、／o／、／e／、／u／或以其为介母的韵母组合时置换成舌尖中音／d／,分别为35例（32．71％）、28例（26．17％）;／z／与／i／组合时置换成／j／有33例（30．84％）、／s／与／i／组合时置换成／x／有43例（40．19％）;／c／的构音错误形式主要是与／a／、／o／、／e／、／u／或以其为介母的韵母组合时置换成／d／（6例,5．61％）和／t／（27例,25．23％）,／c／与／i／组合时分别置换成／q／（45例,42．06％）、／j／（15例,14．02％）;另／z／、／c／、／s／还分别置换成／zh／（15例,14．02％）、／ch／（17例,15．89％）、／sh／（14例,13．08％）及侧化（分别为11、10、12例）。32例患者经过语音康复训练后,舌尖前音构音错误的个数从训练前的34．53±6．08个减少到训练后的7．97±2．52个,差异有统计学意义（t＝30．035,P＜0．001）。结论本组患者舌尖前音构音障碍错误形式主要为置换及侧化;本研究针对舌尖前音异常患者的训练方法效果显著,值得推广。     

蜗神经发育不良患者人工耳蜗术前影像学评估技术及临床应用

蜗神经发育不良(Cochlear nerve deficiency,CND)是先天性极重度耳聋的原因之一,指蜗神经缺失或蜗神经纤细.CND的诊断主要依靠在3D-核磁中判断蜗神经状态,而由于技术限制,蜗神经往往显示不清.与非CND患者相比,CND患者的人工耳蜗术后效果较差,且部分患者无法从中获益.因此,提高术前CND的诊...     

Agreement between the Facial Nerve Grading System 2.0 and the House-Brackmann Grading System in Patients with Bell Palsy

Objectives

We have analyzed the correlation between the House-Brackmann (HB) scale and Facial Nerve Grading System 2.0 (FNGS 2.0) in patients with Bell palsy, and evaluated the usefulness of the new grading system.

Methods

Sixty patients diagnosed with Bell palsy from May 2009 to December 2010 were evaluated using the HB scale and FNGS 2.0 scale during their initial visit, and after 3 and 6 weeks and 3 months.

Results

The overall intraclass correlation coefficient (ICC) was 0.908 (P=0.000) and the Spearman correlation coefficient (SCC) was 0.912 (P<0.05). ICC and SCC displayed differences over time, being 0.604 and 0.626, respectively, at first visit; 0.834 and 0.843, respectively, after 3 weeks; 0.844 and 0.848, respectively, after 6 weeks; and 0.808 and 0.793, respectively, after 3 months. There was a significant difference in full recovery, depending on the scale used (HB, P=0.000; FNGS 2.0, P<0.05). The exact agreements between regional assessment and FNGS 2.0 for the mouth, eyes, and brow were 72%, 63%, and 52%, respectively.

Conclusion

FNGS 2.0 shows moderate agreement with HB grading. Regional assessment, rather than HB grading, yields stricter evaluation, resulting in better prognosis and determination of grade.     

Evaluation of Greater Petrosal Nerve Function in Patients with Acute Peripheral Facial Paralysis: Comparison of Soft Palate Electrogustometry and Schirmer's Tear Test

We tested sensory and secretomotor function of the greater petrosal nerve (GPN) by means of electrogustometry (EGM) of the soft palate and Schirmer's tear test in 115 patients (59 males, 56 females) with acute peripheral facial paralysis. Facial paralysis was caused by Bell's palsy in 78 cases, Ramsay Hunt syndrome in 27 cases and zoster sine herpetic lesions in 10. All patients had dysfunction of the stapedial nerve. An electrogustometer was used to test taste (GPN sensory function), and elevation of the threshold by > 6 dB on the affected side was considered abnormal. Schirmer's test was used to evaluate lacrimal (GPN secretomotor) function, which was considered abnormal when tear secretion on the affected side was < 50% of secretion on the non-affected side. Of the 78 patients with Bell's palsy, 28.2% had altered taste on the soft palate (sensory dysfunction) and 10.3% had lacrimal dysfunction, indicating that EGM of the soft palate is more sensitive than Schirmer's test for identifying dysfunction of the GPN in patients with facial paralysis due to Bell's palsy. Of the total of 115 patients, 32 (28%) had taste dysfunction and 9 (28.1%) of these 32 patients also had lacrimal dysfunction. This finding indicates that facial paralysis has different effects on the sensory and secretory nerve fibers of the GPN. The results of Schirmer's test were more closely related to the severity of, and prognosis for, facial paralysis than the results of EGM.     

对称性聋患者单耳助听后双耳言语识别率差别探讨

目的通过检测对称性聋患者单耳助听后双耳言语识别率的差别来进一步研究听觉剥夺效应。方法选取右耳助听4～5年的双耳对称性感音神经性聋患者15名,在标准隔声室中,测试其双耳的纯音气导和骨导听闻,然后再采用汉语普通话单音节词表分别进行左右裸耳言语识别率测试,并将所得数据进行对比研究。结果15名受试者右耳配戴助听器前及配戴4～5年后两耳间平均听阈无显著性差异（P〉0．05）;受试者右耳助听前及助听4～5年后左、右耳平均听阀前后无显著性差异（P〉0．05）;右耳助听4～5年后,受试者左、右耳裸耳言语识别率存在显著性差异（t=2．76,P=0．02〈0．05）。结论对称性感音神经性聋患者单耳助听后裸耳平均听阈无显著改变,但非助听耳言语识别能力显著下降。     

Topography of Auditory Nerve Projections to the Cochlear Nucleus in Cats after Neonatal Deafness and Electrical Stimulation by a Cochlear Implant

We previously reported that auditory nerve projections from the cochlear spiral ganglion (SG) to the cochlear nucleus (CN) exhibit clear cochleotopic organization in adult cats deafened as neonates before hearing onset. However, the topographic specificity of these CN projections in deafened animals is proportionately broader than normal (less precise relative to the CN frequency gradient). This study examined SG-to-CN projections in adult cats that were deafened as neonates and received a unilateral cochlear implant at approximately 7 weeks of age. Following several months of electrical stimulation, SG projections from the stimulated cochleae were compared to projections from contralateral, non-implanted ears. The fundamental organization of SG projections into frequency band laminae was clearly evident, and discrete projections were always observed following double SG injections in deafened cochleae, despite severe auditory deprivation and/or broad electrical activation of the SG. However, when normalized for the smaller CN size after deafness, AVCN, PVCN, and DCN projections on the stimulated side were broader by 32%, 34%, and 53%, respectively, than projections in normal animals (although absolute projection widths were comparable to normal). Further, there was no significant difference between projections from stimulated and contralateral non-implanted cochleae. These findings suggest that early normal auditory experience may be essential for normal development and/or maintenance of the topographic precision of SG-to-CN projections. After early deafness, the CN is smaller than normal, the topographic distribution of these neural projections that underlie frequency resolution in the central auditory system is proportionately broader, and projections from adjacent SG sectors are more overlapping. Several months of stimulation by a cochlear implant (beginning at approximately 7 weeks of age) did not lessen or exacerbate these degenerative changes observed in adulthood. One clinical implication of these findings is that congenitally deaf cochlear implant recipients may have central auditory system alterations that limit their ability to achieve spectral selectivity equivalent to post-lingually deafened subjects.