WHO关于耳疾与听觉障碍调查方案在贵州省的实施报告

目的：在贵州省开展以人群为基础的耳疾和听力减退患病率、病因和需求的调查。方法：用容量比例概率抽样（PPS）方法对贵州省30个调查点6 626人进行听力和耳疾调查（WHO方案）。结果：听力减退患病率为17.1%,全国标准化患病率为17.6%,其中轻度11.0%,中度4.2%,重度1.4%,极重度0.5%;男性患病663人（20.2%）,女性患病468人（14.0%）。听力残疾患病率为6.1%,全国标化率6.5%;引起听力减退的可能原因：耳疾31.4%,非感染因素42.5%,遗传因素6.7%,传染病0.4%,病因不明29.3%。13.8%的调查对象需要耳科和听力学干预,助听器需求占首位（9.1%）。结论：听力减退和听力残疾患病率较过去20年明显升高,为政府制定预防和控制耳聋计划提供了科学依据。     

贵州省0～14岁儿童听力障碍流行病学调查

目的 了解贵州省0～14岁儿童耳疾和听力障碍现患率、病因和干预需求的情况.方法 根据WHO方案,用容量比例概率抽样(PPS)方法调查贵州省30个点人群的听力和耳疾情况,抽取其中0～14岁儿童2 068人的资料进行统计分析.结果 0～14岁儿童听力减退现患率为3.48%,听力残疾现患率为1.84%,明显高于国内其他省市水平;7～14岁组听力残疾现患率为2.66%,显著高于0～6岁组(0.51%);男性儿童听力减退现患率为4.22%,显著高于女性儿童(2.54%).听力减退的可能原因分别是:耳疾50.00%(其中急慢性中耳炎占37.40%)、非感染因素11.11%、遗传性聋20.83%、病因不明27.77%.3.58%的调查对象需要得到药物或外科手术治疗;2.32%患儿需要佩戴助听器.结论 贵州省0～14岁儿童听力残疾现患率高于国内其他省市水平,中耳炎是引起儿章听力障碍的主要病因,且儿童遗传性聋比例也较高.     

老年人听力减退和耳疾流行病学调查研究

目的明确江苏省老年人听力减退和耳疾流行病学情况，为制订防治和康复计划提供科学依据。方法用容量比例概率抽样方法对江苏省40个调查点进行听力和耳疾调查（WHO方案），抽取年龄≥60岁的老年人共计1261人进行统计分析。结果听力减退患病率为58.1％（标准化患病率：全国59．5％，江苏省60.9％），其中轻度33．1％，中度17．8％，重度5.9％，极重度1.3％；听力残疾患病率为25．0％（标准化患病率：全国26．6％，江苏省28．1％）。年龄、性别、城乡之间的差异有统计学意义。耳疾的患病率为：外耳畸形0.2％，耵聍栓塞1．7％，外耳道炎0.1％，真菌感染0．5％，分泌性中耳炎1．2％，慢性化脓性中耳炎1.6％，鼓膜干性穿孔2.3％。引起听力减退的可能原因：耳疾2．9％，非感染状态92.6％，遗传因素0．3％，病因不明4，2％。干预需求：调查人群中31.1％需要配戴助听器，2．3％需要药物治疗，0.9％需要外科非急诊治疗，1.0％需要其他治疗。结论老年人听力减退和听力残疾患病率较1987年的调查明显升高，应引起政府和全社会的更多关注。制订和执行科学的防治和康复计划是完全必要和十分迫切的。     

贵州省少数民族耳疾与听力障碍流行病学调查报告

目的 调查目前贵州省少数民族人群听力障碍与耳疾的流行病学情况,为该地区耳聋防治提供科学依据.方法 根据WHO方案,用容量比例概率抽样方法调查贵州省30个抽样点共6 626人的听力和耳疾情况,抽取调查人群中17个民族的资料进行统计分析.结果 少数民族听力减退总的现患率为16.77%,其中侗族为25.93%,土家族为19.39%.白族为18.50%,苗族为15.84%,布依族为12.87%,穿青族为11.63%,其他民族为8.22%.少数民族听力残疾总现患率为6.13%,其中土家族现患率(11.03%)最高.贵州省少数民族的听力减退及听力残疾现患率与汉族(分别为17.15%和6.03%)比较差异无统计学意义(P＞0.05).少数民族耳疾现患率为17.11%,明显高于汉族(12.31%)(P＜0.001),其中以分泌性中耳炎和耵聍栓塞现患率最高.中耳炎是贵州省少数民族人群听力残疾的首要病因.结论 贵州省少数民族与汉族听力残疾现患率均明显高于全国平均水平,其中中耳炎致残占相当大的比例,提示有效防治中耳炎是防聋治聋的重要工作.     

吉林省听力障碍及耳疾流行病学调查研究

目的明确吉林省以人群为基础的耳疾与听力障碍的流行病学情况,为吉林省耳疾的防治工作提供科学依据。方法应用《WHO耳疾与听觉障碍调查方案》,通过容量比例概率抽样(PPS)的方法选择40个调查点,实际调查人数为6976人。耳聋残疾的定义和听觉障碍程度的分级采用WHO/PDH97.3推荐的标准,采用EARFORM V6.2(由WHO提供)软件进行资料输入和基本分析。结果911(13.1%)人有听力减退,311(4.5%)人存在听力残疾;城乡人群听力减退率和听力残疾患病率差异无显著性;男性听力减退和听力残疾患病率明显高于女性,差异有显著性;听力减退和听力残疾主要集中在60岁以上人群;患病率较高的耳疾病有耵聍(1.2%),慢性化脓性中耳炎(0.7%),鼓膜干性穿孔(1.4%),分泌性中耳炎(1.0%);19.3%的调查对象需要耳科或听力干预。结论所有听力减退的人群中,老年性耳聋患病率最高。听力残疾的患病率有上升的趋势,急需制定新的预防和治疗听力障碍和耳疾病的政策。     

北京市部分城区听力残疾患者的年龄分布特征及病因分析

目的 通过对近年来北京市部分城区参加听力残疾评定人群在不同年龄段、致病因素的分析,为地区听力残疾政策制定及听力残疾人群各项保障提供依据。方法 对2019年1月～2023年1月北京市朝阳区、海淀区、丰台区和西城区部分参加听力残疾评定患者进行回顾性分析,主要分析患者年龄分布及不同年龄段的病因分布特征。结果 在入组的1339例听力残疾患者中（平均年龄64.18±20.47岁,男性749例,女性590例。）,其中0～6岁组68例（5.08%）、7～17岁组23例（1.72%）、18～59岁组290例（21.65%）、≥60岁组958例（71.55%）。对各年龄组的致病原因分析显示,0～6岁组的首位病因为遗传因素（44.12%）,7～17岁组的首位病因为原因不明（43.48%）,18～59岁组的首位病因为其它原因（25.52%）,60岁及以上组的首位病因为老年性耳聋（55.11%）。结论 北京部分城区参加听力评残的人群中以成年人居多（尤其是老年人）,学龄前儿童也占有一定比例。不同年龄组听力残疾患者的病因分布有所不同。     

老年前期与老年期耳聋的特征：附294例老年人听力普查

报告对福建省建宁县里心村５０－８６岁老年人２９４例进行听力普查，其中１７３例诊断为老年前期和老年期耳聋，根据语频和高频听阀均值，老年聋听力曲线可分为三种类型：高频下降型、型和平坦型。早期老年聋以高频损害为主，对语言频影响较小，不易引起人们重视。因此，对老年人群进行听力普查有助老年聋的早期发现和治疗。     

中国0～17岁听力残疾儿童抽样调查分析

目的了解我国0～17岁聋儿现状,为聋儿听力残疾的防治及康复对策提供依据。方法采用统计描述和统计推理等方法对第二次全国残疾人抽样调查数据进行分析。结果0～17岁儿童听力残疾的现患率为1.80‰。听力残疾儿童接受义务教育率城市高于农村（χ^2=4.008,P〈0.05）。单纯听力残疾儿童的患病率农村高于城市（χ^2=24.250,P〈0.05）。0～17岁这一年龄段儿童听力残疾的主要病因构成为原因不明（29.42%）、遗传（17.32%）、中耳炎（14.19%）和药物中毒（13.23%）。52%的聋儿未曾接受任何康复服务。最主要的康复需求是医疗服务与救助和辅助器具。结论儿童听力残疾的防治和康复应强化政府主导、统筹规划;建立完善的社会保障体系和残疾人保障制度;加大科研投入,加强专业队伍建设;健全听力残疾预防和听力残疾康复服务网络;普及爱耳护耳知识,提高全民听力健康意识。     

江苏省耳科疾病的流行病学调查研究

目的了解江苏省自然人群耳科疾病的流行情况,为制订防治策略提供科学依据。方法依照WHO方案,用按容量比例概率抽样(PPS)方法对江苏省40个调查点8412人进行耳科和听力调查。结果耳科疾病的患病率为26.3%(全国标准化患病率为22.6%),其中外耳病2.4%,中耳病3.5%,内耳病(伴感音神经性听力损失)22.0%。耳疾患病率随年龄增长而增高,男性高于女性,农村高于城镇,其差别均有统计学意义(P<0.01)。干预需求:调查人群中6.9%需要验配助听器,2.4%需要药物治疗,1.2%需要耳外科非急诊治疗,1.0%需要其他治疗。结论耳科疾病的高患病率会严重影响社会发展,应引起政府和全社会的更多关注。制订和执行科学的防治策略是十分重要和迫切的。防治中应更多关注农村、男性和老年人群。     

北京农村老年人听力损失与慢病的相关性研究

目的 调查北京农村老年人听力损失患病率,分析听力损失与慢病的相关性。方法 采用纯音测听筛查设备和健康问卷,对北京市密云区22个行政村943例60岁以上老年人进行测试和调查。根据较好耳的听力状况将人群分为三组,分别为听力正常、轻度听力损失和听力异常,将年龄、性别、糖尿病、高血压、高血脂、冠心病以及噪声接触史等作为自变量,听力损失严重程度作为因变量进行多元有序Logistic回归。结果 943例受试者,年龄（70.3±6.8）岁。以较好耳听力为准,286例（25.0%）为轻度听力损失,632例（67.0%）为听力异常。听力异常组平均年龄高于轻度听力损失人群和听力正常人群,差异有统计学意义（P<0.001）。多元有序Logistic回归表明,总人群中,糖尿病人群听力损失严重程度增加一个等级的可能性是非糖尿病者的1.751倍。女性人群中,糖尿病人群听力损失严重程度增加一个等级的可能性是非糖尿病者的2.156倍。结论 农村老年人群,特别是女性中,糖尿病可能与听力损失严重程度增加有关。     

Oxidants and antioxidants in tonsillar and adenoidal tissue in chronic adenotonsillitis and adenotonsillar hypertrophy in children

OBJECTIVE: The aim of the study is to determine the possible role of oxidants and antioxidants in the pathogenesis of chronic adenotonsillitis and adenotonsillar hypertrophy in children. PATIENTS AND METHODS: The children were divided into infection and hypertrophy groups, which were comparable according to age and gender distribution. The infection group was consisted of 20 children with the diagnosis of chronic adenotonsillitis and the hypertrophy group was made up of 19 children with adenotonsillar hypertrophy to whom adenotonsillectomy was performed. Preoperative blood levels of erythrocyte MDA, serum MDA, erythrocyte catalase and serum catalase, and adenoidal and tonsillar tissue levels of MDA and catalase were studied. RESULTS: There were significant increase in tonsil MDA, adenoid MDA, tonsil catalase and adenoid catalase levels in infection group (p<0.05). CONCLUSION: Oxidants and antioxidants are found to have an important role in the pathogenesis of adenotonsillar hypertrophy and chronic adenotonsillitis. These findings strengthen the hypothesis that indicates adenotonsillar hypertrophy and chronic adenotonsillitis are different diseases of the same tissues.     

Mismatch negativity in aging and in Alzheimer's and Parkinson's diseases

Mismatch negativity (MMN) is an auditory event-related potential (ERP) that reflects automatic stimulus discrimination in the human auditory system. By varying the interstimulus intervals (ISIs), the MMN can be used as an index of auditory sensory memory. This paper focuses on MMN findings in aging and in Alzheimer's (AD) and Parkinson's diseases (PD). The accumulated data suggest that MMN to duration deviance, unlike MMN to frequency deviance, is reduced in amplitude in aging at short ISIs. The attenuated MMN to frequency deviance observed at long ISIs in elderly subjects seems to be caused by age-related memory trace decay. Existing results suggest that automatic discrimination for the frequency change is not affected in the early phase of AD, whereas the memory trace seems to decay faster in AD patients. The present findings on PD are not as conclusive, although they tentatively suggest deteriorated automatic change detection. The MMN appears to offer an objective tool for studying auditory processing and memory trace decay in different neurological disorders.     

Urokinase-type plasminogen activator expression and proliferation stimulation in head and neck squamous cell carcinoma in vitro and in situ

BACKGROUND: Stimulation of proliferative activity by urokinase-type plasminogen activator (uPA) has been demonstrated in vitro for cultured primary and carcinoma cells. OBJECTIVE: To examine the effect of uPA stimulation on cultured squamous cell carcinoma cell lines of the head and neck in vitro and to compare the results with the situation in tumor tissue specimens. DESIGN: The uPA-mediated growth stimulation of 2 head and neck squamous cell carcinoma cell lines after suppression of endogenous uPA production was monitored by measuring (3)H-thymidine uptake into cellular DNA. Alternatively, applications of antibodies against the uPA-binding domain of the urokinase receptor were used to suppress autostimulation. To analyze the situation in situ we performed Western blot and zymographic studies on tissue homogenates of 25 squamous cell carcinoma specimens. We tested the expression of proliferating cell nuclear antigen (PCNA), a marker for proliferative activity, and uPA in tissue lysates and correlated uPA and PCNA expression by regression analysis. RESULTS: High-molecular-weight urokinase had a proliferation stimulative effect on both cell lines in vitro. The uPA autostimulation was decreased by blocking the uPA-binding domain of urokinase receptor with antibodies. Regression analysis of zymographic and Western blot data of tumor tissue lysates revealed no significant coherency between PCNA and uPA expression. Immunohistochemical stainings frequently showed different sublocalization of uPA and PCNA within tumors. CONCLUSION: In vitro uPA-mediated growth stimulation is not necessarily transferable to the in situ situation.     

ATP induces respiratory ciliostimulation in rat and guinea pig in vitro and in vivo.

Adenosine triphosphate (ATP) has been shown to revitalize the disturbed nasal mucociliary function in man. We investigated the effects of ATP on the ciliary beat frequency (CBF) in animals by immersing tracheal explants from rats in various concentrations of ATP, and by infusing ATP intravenously to guinea pigs. CBF was measured with a photodetector technique from the surface of the explants or from the incised trachea. ATP (from 0.01 to 1 mg/ml) in vitro increased CBF in rat tracheal explants up to 10.5% (p less than 0.05). In vivo ATP (1 mg/kg) increased the CBF by 29% (p less than 0.01) in the guinea pig trachea. As the CBF was increased by ATP, both in vitro and in vivo, it can be suggested that the improvement in mucociliary transport by exogenous ATP as shown in previous studies is caused by the ciliostimulatory effect of ATP.     

Trends and Perspectives in Minimally Invasive Surgery in Otorhinolaryngology-Head and Neck Surgery

The roots of minimally invasive surgery (MIS) in otolaryngology-head and neck surgery (ORL-HNS) can be traced to the 1950s. Today, endonasal sinus surgery and endolaryngeal surgery already fulfill the principles of MIS. To widen its spectrum of indications, however, MIS must be able to offer three advantages that conventional macrosurgery and microsurgery already have: free maneuverability for the instrument, sensory feedback, and three-dimensional imaging. Every anatomical region (e.g., paranasal sinuses, upper aerodigestive tract, cerebellopontine angle) requires specific surgical instrumentation. Here, the authors present recently developed steerable instruments that allow two additional degrees of freedom not attainable with conventional instruments. These instruments may permit access to problem zones(e.g., laterally extending frontal and ethmoidal sinus recesses) in the near future. For better control of the instrument and the operative procedure, tactile feedback can be achieved with appropriate microsensor systems. Three-dimensional vision can be realized by three-dimensional video-endoscopes and sequential image processing.     

Changes in otoacoustic emissions and high-frequency hearing thresholds in children and adolescents

With the aim of characterizing the loss of high frequency hearing sensitivity in children, hearing thresholds and otoacoustic emissions were measured in a group of 126 normal hearing children and adolescents aged from 6 to 25 years. The subjects were divided into four 5-year age groups. Hearing thresholds over a range of 125 Hz-12.5 kHz were similar in all age groups, the average hearing threshold at 16 kHz was significantly elevated in the oldest age group. The response values of transiently evoked otoacoustic emissions (TEOAEs) significantly declined with age; the decline was negatively correlated with the hearing loss at 16 kHz. Significantly larger TEOAE responses and average distortion-product otoacoustic emission (DPOAE) values at 6.3 kHz were present in the youngest group in comparison with the other three older groups. Spontaneous otoacoustic emissions (SOAEs) were present in 70.8% of the children (in either one or both ears) with the greatest prevalence in the 11-20-year-old subjects. In the 21-25-year-old group, the hearing loss at 16 kHz was significantly smaller in ears with SOAEs than in ears without SOAEs. The results demonstrate that the increase in the high frequency hearing threshold at 16 kHz, which starts at ages over 20 years, is correlated with a decrease in the TEOAE responses at middle frequencies.