Isolated congenital ossicular anomalies

Conclusions: Isolated congenital ossicular anomalies are diverse. Our proposed modified Teunissen and Cremers classification will be helpful for the evaluation of congenital ossicular anomalies as well as the prediction of surgical outcome. Objectives: The aim of this study was to describe isolated congenital ossicular anomalies encountered in patients who have normal eardrums and to evaluate their surgical outcome based on their classification. Patients and methods: A total of 78 patients (94 ears) with congenital ossicular anomalies were reviewed. The preoperative and postoperative audiological findings, surgical findings, and temporal bone CT results were analyzed. Results: Twenty-one types of ossicular anomalies were identified in this study. A stapes footplate fixation was the most common anomaly and this was usually bilateral. However, the anomalies that were associated with the incus and malleus were usually unilateral. The congenital ossicular anomalies were classified into five types according to the status of the stapes footplate. Using this modification of a prior classification system, the more severe anomalies of the stapes footplate could be identified, and the worst postoperative hearing result could be predicted.     

疏肝解郁活血法治疗偏头痛随机平行对照研究

[目的]观察疏肝解郁活血法治疗偏头痛疗效。[方法]使用随机平行对照方法,将70例门诊患者分为两组。对照组35例氟桂利嗪、维生素B6口服。治疗组35例疏肝解郁活血方剂加减(药用柴胡、川芎、香附、当归、僵蚕、钩藤、白芍、枳壳、郁金、陈皮、怀牛膝、甘草)。观察头痛程度、发作频率改善。两组均14d为1疗程。治疗2疗程(28d)随访半年判定疗效。[结果]治疗组痊愈10例,显效12例,有效10例,无效3例,总有效率91.43%。对照组痊愈5例,显效10例,有效12例,无效8例,总有效率77.14%。治疗组疗效优于对照组(P<0.05)。[结论]疏肝郁活血中药治疗偏头痛有满意疗效。     

中药联合针刺治疗突发性耳聋100例临床观察

目的 观察中药联合针刺治疗突发性耳聋的临床疗效.方法 选择突发性耳聋患者200例,随机分为中医组和西医组各100例,中医组中医辨证分风邪外犯、肝火上炎、气滞血瘀3型,分别给予中药银翘散、龙胆泻肝汤及通窍活血汤加减治疗;针刺取穴双侧翳风、耳门、听宫、听会、外关、合谷、足三里、三阴交、太溪、太冲、足窍阴等穴,隔日针刺1次;并用血塞通注射液静脉滴注.西医组给予前列地尔注射液及甲钴胺治疗.两组均以14天为1个疗程.观察两组患者听力、耳鸣及眩晕改善情况,两组患者症状消失时间,不同中医证型主要症状的疗效及不良反应.结果 中医组听力、耳鸣、眩晕总有效率分别为91.00％、94.85％、95.92％;西医组分别为69.70％、90.11％、97.22％.两组听力疗效比较差异有统计学意义(P＜0.05),耳鸣和眩晕比较差异无统计学意义(P＞0.05),两组患者听力、耳鸣、眩晕症状消失时间比较差异无统计学意义(P＞0.05).中医组风邪外犯证22例治疗后听力总有效率95.45％,西医组32例为65.63％,两组比较差异有统计学意义(P＜0.05).中医组风邪外犯证伴耳鸣患者22例总有效率95.45％,西医组27例为74.07％.两组比较差异有统计学意义(P＜0.05).两组其他证型各症状疗效比较差异无统计学意义(P＞0.05).中医组出现1例皮疹反应,两组患者治疗期间无其他不良反应发生. 结论 中药联合针刺治疗突发性聋有确切的临床疗效.     

Two cases of myxoma of the external auditory canal

Myxomas were found in the outer ear canal of a 66-year-old female and a 51-year-old male. Both tumors were soft and sessile and located at the antero-superior part of the external auditory canal near the eardrum. Profuse, clear mucus was seen when the tumor ruptured or was incised. Histology showed spindle-shaped and stellate cells in myxoid extracellular matrix. CT images revealed a small bone defect adjacent to the tumor in the meatal bone. This bony defect was confirmed during surgery. The bony defects seen in both cases may have something to do with the genesis of the tumor. We found only 5 sporadic cases, including ours, reported in the English literature. As myxoma of the outer ear canal is also reported in 18 patients as a symptom of Carney's complex, we must check for accompanying symptoms of the complex such as spotty skin pigmentation, endocrine tumors, or schwannoma. Total removal of the tumor is necessary to prevent recurrence.     

突发性聋患者健康知信行问卷的编制和信度效度检验

目的编制适用于突发性聋患者的健康知信行问卷,了解突发性聋患者健康知信行现状。方法在分析文献、专家咨询及面对面访谈的基础上进行测题的编制和筛选,研制出问卷初稿,包括一般人口社会学资料、突发性聋相关知识、健康信念和健康行为4个部分,知识及信念部分各选项以0、1计分,行为部分按0、1、2计分。以便利抽样的方法对山西省四所三甲医院耳鼻咽喉科138名突聋患者施测,考察问卷的信度和效度。结果问卷总的内部一致性信度为0.876,知识、信念、行为3个项目的内部一致性信度分别为0.843、0.751、0.723,知识部分的复本信度为0.889,信念和行为部分的重测信度分别为0.864、0.876,问卷各条目评定者信度值为0.81～0.93;问卷各条目的内容效度比(CVI)值均在0.76以上,全部条目的平均CVI值为0.91;因子分析共获得3个因子21个问题项目,每个问题项目的共性方差均大于0.5,累积解释率76.023%。结论该问卷具有良好的信度和效度,能较敏感地反映突发性聋患者健康知信行状态。     

聋儿家长对耳聋基因检测的认知分析及对策

目的探讨接受人工耳蜗植入的聋儿家长对耳聋基因检测的认知情况,并在调查分析的基础上制定有效的对策,以正确指导此项新技术的开展。方法对接受人工耳蜗植入的50名聋儿家长进行问卷调查,内容主要包括对耳聋基因检测的内容和检测意义是否了解以及是否能接受此项检测等。结果 50例聋儿家长均能配合问卷调查,填写率100%。其中72%的家长相信耳聋基因检测结果;64%的家长对耳聋基因检测非常感兴趣;60%的家长非常想进一步了解此项检测的内容;48%的家长对此项检测的内容和意义不甚了解。结论聋儿家长对耳聋基因检测的认知态度对遗传咨询工作有着重大的意义,也是转化医学的推动耳科发展的新尝试。责任护士要根据聋儿家长的实际情况和需求制定相应的临床咨询计划和方案,以推动此项新技术的顺利开展。     

阿米卡星致聋大鼠鼓阶壁上皮超微结构的改变

目的观察大鼠经氨基糖苷类抗生素硫酸阿米卡星注射致聋后,耳蜗鼓阶壁上皮超微结构的改变;探索干细胞移植进入鼓阶后,干细胞在内耳发生迁移的结构基础。方法出生7天的SD大鼠30只,随机分为实验组(20只)与对照组(10只)。实验组连续7天经腹腔按照200mg/kg/day的剂量腹腔注射硫酸阿米卡星注射液;对照组注射相同体积的生理盐水。在停药后0天、7天、14天、21天、28天取耳蜗组织,随机选择其中一侧行扫描电镜观察耳蜗底回鼓阶的上皮的变化,另一侧耳蜗做冰冻切片、HE染色进行形态学观察。结果腹腔硫酸阿米卡星在引起大鼠耳聋的同时,鼓阶上皮细胞的超微结构也随着时间发生变化,上皮细胞经历了炎性渗出、细胞间隙扩大和上皮细胞恢复的形态变化过程。结论氨基糖带类抗生素硫酸阿米卡星除引起内耳柯蒂氏器的细胞死亡之外,还可以引起附着在内耳鼓阶骨壁的上皮细胞形态发生超微结构的改变。这种变化规律,有可能成为通过鼓阶进行干细胞移植的结构基础,并且为经耳蜗鼓阶移植干细胞治疗内耳疾病的时间提供参考。     

语前聋患儿一侧人工耳蜗对侧助听器效果分析

目的:通过对人工耳蜗植入对侧耳不同听力损失的患儿联合使用助听器与人工耳蜗语前聋患儿的听觉、语言及学习能力进行评估和比较,探索对患儿更为有效的助听方法,帮助患儿获得最大限度的言语交流。方法:将30例3～6岁语前聋患儿按照植入人工耳蜗对侧耳听力损失程度及是否佩戴助听器,分为一侧人工耳蜗+对侧重度听力损失助听器组(CI+SHA组)、一侧人工耳蜗+对侧极重度听力损失助听器组(CI+PHA组)、单耳人工耳蜗组(CI组)。评估各组在康复3、6、9、12、15、18个月时听觉、语言及学习能力,并记录结果。结果:随着术后康复时间的延长,聋儿听觉、语言及学习能力逐渐提高(P<0.05),CI+SHA组听觉能力优于CI+PHA组及CI组(均P<0.05),语言能力及学习能力无明显差异(P>0.05)。结论:语前聋患儿单耳人工耳蜗植入后,若对侧耳尚有残余听力,佩戴助听器后听觉能力效果显著,长期佩戴有助于患儿的康复。