Humans ; Otolaryngology ; Periodicals as Topic ; trends

China ; Otorhinolaryngologic Surgical Procedures

BACKGROUND: There are two methods to evaluate the vestibular function, the rotation test and the water caloric test. What is the relativity between the test results with these two methods?OBJECTIVE: To observe the consistency between the vestibular functional evaluations with the rotation test and the water caloric test.DESIGN: A comparative study on the advantage of the evaluation methodologies with patients as the objects.SETTING: Department of Otolaryngology of Chinese PLA General Hospital.PARTICIPANTS: The patients with vertigo, deafness and tinnitus were chosen, who were picked up in the inpatient department and outpatient department in the Otolaryngology Department of the Chinese PLA General Hospital from April 1990 to December 1996. With the permission, the vestibular functions of all the patients were tested to be abnormal by the Hallpike caloric test. There were 68 males and 32 females, whose ages varied from 16 to 74, and the average age was 37 ± 3. There were 91 cases with unilateral abnormality and 9 cases with bilateral abnormally. The judging standard of the abnormal vestibular function is that slow phase velocity (SPV) of the nystagmus on the normal side-SPV on the abnormal side /SPV on the normal side-SPV on the abnormal side × 100% ] ≥ 15%, and the ratio ＜ 15% means normal.METHODS: The rotation test was done to the patients with the sine swing stimulation and rotation sudden pause stimulation respectively . The stimulation scope of the sine swing stimulation was 90° and the frequency was 0. 167 Hz; In the rotation sudden pause test, when the peak velocity reached 90°/s at the acceleration of 1°- 2°/s2, the velocity was maintained until the disappearance of the nystagmus, then sudden pause was done for the further test.MAIN OUTCOME MEASURES: The results of the sine swing test and the rotation sudden pause test.RESULTS: According to the actual disposal, in the rotation test, there were 9 cases with bilateral abnormality, among them the nystagmus was induced in 8 cases and no nystagmus was induced in 1 case with bilateral acoustic neuroma, and in the other cases the nystagmus was induced. In the water caloric test, there were 91 cases with unilateral abnormality, 2 cases refused to take the rotation sudden pause test. In the sine swing test, 64% (58/91)cases had abnormal vestibular function, and in the rotation sudden pause test 61% (54/91) cases had abnormal vestibular function.CONCLUSION: The abnormality of the vestibular function can be found in the sine swing test and the rotation sudden pause test of the rotation test, but the results do not completely conform to that in the water caloric test.

Objective To analyze and determine the genetic characteristics of a large Chinese family with autosomal dominant nonsyndromic deafness(named pedigree Z029).Methods A hereditary deafness family was found from the profuse genetic resource established in the Otolaryngology Institute of PLA General Hospital.A sequence of bilateral sensorineural hearing impairment transmitted through five generations was found by investigating 47 individuals in the pedigree.The genetic forms of hearing loss in 18 members of the Z029 pedigree were diagnosed by otologic,audiologic,and physical examination,as well as by the study on their family history.Pedigree map was drawn by using Cyrillic2.1 software.Results The phynotype of Z029 family showed that most affected individuals had sensorineural hearing impairment with subsequent gradual progression covering all frequencies.The phynotype was transmitted from 1 to 5 generations.One of the parents of every patient was definitely a patient of the same disease.The affected ratio was same in both sexes,and the incidence of deafness declined through the first to fifth generation.Conclusion The phenotype characteristics of Z029 family were of autosomal dominant nonsyndromic hereditary deafness.In this pedigree,hearing impairment occurred in the majority of affected individuals after their twentieth year of age,and the penetrance of the impairment appeared to be age-correlated.No obvious vestibular dysfunction and other associated abnormalities were found.It may provide a foundation for the study of gene mapping and gene cloning of the pathogenic gene to analyze and determine the phenotype characteristics of this pedigree.This pedigree also provided an excellent model for the further study on the pathological and molecular mechanisms of hereditary hearing impairment related to age.

Objective To explore the best way for reconstruction of local defect after subtotal or extended resection of the temporal bone. Method The reconstruction of 33 patients who had undergone subtotal or extended resection of temporal bone between July 1993 to June 2003 in our hospital were retrospectively analysed. Results Thirty-three patients, aged 14-69 years old (average 45.0) were enrolled. Among them, 26 were suffering from malignancy (12 with recurrences, undergoing several operations). Subtotal resection of temporal bone was performed in 22 cases and extended resection in 11. Total survival rate of reconstructive tissues was 81.8%(27/33), in which pectoralis major island musculocutaneous flap accounted for 77.8%(7/9), temporalis musculocutaneous flap survived 100% (9/9), pedicled temporalis musculocutaneous flap associated with other local musculocutaneous flap survived 100%(4/4), 60.0% (3/5) of upper sternocleidomastoid musculocutaneous flap survived, and 66.7% (4/6) of fat transplantation survived. Nature and extent of the diseases, preoperative radiotherapy, relapse and postoperative leakage of cerebrospinal fluid were important influential factors for postoperative healing. Conclusions Reconstructive measures depended on the nature and extent of diseases, necessary size of tissue, local circulation, and influential factors of healing. The optimum way for the repair of a small defect after resection of non-malignant tumor was fat transplantation with dermis, and pedicled temporalis musculocutaneous flap for malignant tumors. Pectoralis major island musculocutaneous flap was employed in large defect and that with lack of blood supply. Skin grafting met several failures in these patients. Theoretically, free scapular skin flap is the optimum way for defects after subtotal or extended resection of temporal bone.

Objective To investigate the common complications related to glomus jugulare tumors surgery,their influencing factors,and to search for the effective treatments of these complications.Methods A retrospective study was undertaken on the complications observed in 47 patients with glomus jugulare tumors who underwent 51 times of operation via trans external auditory canal approach,the retroauricular approach,and modified infratemporal fossa approach type A.All cases were followed up over 1 month after surgery.Results Of 51 cases,the most frequent complication was total conductive hearing loss which occurred in 21 cases(41.2%),facial paralysis was found in 15 cases(29.4%) and lower cranial nerve palsy was found in 14 cases(27.5%) after one month.Other complications were cerebrospinal fluid(CSF) leak,hearing disability and vertigo,each in 3 cases(5.9%);cerebral infarction,partial auricle necrosis and parotid gland fistula,each occurred in one case(2.0%).Pre-operative selective embolization of feeding vessels can reduce intraoperative blood loss significantly in most cases.Effective hemostasis and hypotensive anesthesia during operation were the important ways to prevent complications and hematoma within operating field.CSF leak in this series was an uncommon complication.Two cases with CSF leak from the wound had been successfully controlled with conservative treatment.One case with CSF leak required surgical management.None of these patients developed meningitis.Conclusions There is a low level of serious post-operative complications in operation on glomus jugulare tumor.Factors found to be relevant to post-operative complications are tumor type and tumor size.The key factors to avoid the complications include surgical experience,surgical skill and preoperative evaluation of patients′ imaging information.

Objective To determine the frequency of GJB2 mutations in the China hearing loss population, and to screen the GJB2 gene in both hearing loss and normal populations. Methods 141 patients with hearing loss and 150 normal persons (control) underwent mutation screening of single coding exon of GJB2 with bidirectional sequencing to identify sequences alterations. Results Three polymorphisms were found: 79G→A, 109G→A, and 341A→G; and four pathologic mutations were identified: 235delC, 455A→G, 176-191del16 and 504insGCAA. Conclusion The 235delC mutation was found to be the significant cause of hearing loss in Chinese population.

Objective To evaluate Test-retest reliability of Mandarin monosyllable lists with equivalency in audibility in hearing loss group. Methods Mandarin monosyllable lists were used to test 18 adults with moderate-to-severe sensorineural hearing loss. Each people was tested twice with an interval of several days and with same test conditions including same lists order, same presentation level, and same tester. List number to begin with was different between people. All test lists for one patient were presented by 30 dB above his hearing threshold levels. Recognition scores were recorded in both tests. The results were analyzed using SPSS. Results Pearson product-moment correlation between the scores of two tests was 0. 931 (P<0. 001). The average critical difference was 16.3 % at the 95 % confidence level after the scores transformed into "rationalized" arcsine unit (RAU). Conclusion The average critical difference is 16. 3% at the 95% confidence level which is less than in the normal hearing group. All the lists have good test-retest reliability, and can be used in extensive clinical practice.

BACKGROUND: The patients with hemiplegia of stroke commonly appear balance disturbance and the mean of assessment on it is applied in quality commonly. But the implementation of assessment on rehabilitation schedule and therapeutic results requires much more quantitative standards on balance function.OBJECTIVE: To probe into interrelationship between every parameter of stabilometer test and variables in other function evaluations in the patients with hemiplegia of stroke as well as the value of evaluation on functional recovery in the patients with hemiplegia of stroke.DESIGN: Quantitative assessment based on the qualitative assessment.SETTING: Department of Otolaryngology and Department of Rehabilitation Medicine in General Hospital of Chinese PLA.PARTICIPANTS: Nineteen first-attack cases of hemiplegia of stroke received rehabilitation treatment in Department of Rehabilitation Medicine of General Hospital of Chinese PLA from September 2002 to April 2003, diagnosed as disorder of cerebral hemisphere on lateral internal carotid artery. Of those, 14 cases were males, 5 cases females; aged varied from 33 to 55 years and the course of sickness was at the range from 0.5 to 4 months.METHODS: Nineteen patients with hemiplegia of stroke received functional independence measures(FIM), timed up-go test(TUGT), Berg balance scale (BBS) and evaluation on balance measure with stabilometer. Of those, stabilometer is a kind of quantitative analysis method, including the parameters of total length of locus, speed, peripheral area, average central changing site of X wavering direction, average central changing site of Y wavering direction, etc.MAIN OUTCOME MEASURES: Pearson correlation analysis was used to determine the interrelationship between every parameter measured with stabilometer and other measured functional variables.RESULTS: By intention-to-treat management analysis, 19 cases of hemiplegia of stroke all entered analysis on results. Among the parameters of stabilometer test, the moderate negative correlation presented in the comparison of total length of locus, speed and peripheral area with BBS during eyes opened and closed ( r = - 0. 475 to - 0. 705, P ＜ 0.05), of which, the correlation between peripheral area and BBS score during eyes closed was better(r= -0.475, P ＜ 0. 05) . Correlation did not present in the comparison of average central changing site of X wavering direction and average central changing site of Y wavering direction with BBS during eyes opened and closed( r = - 0. 346 to 0. 234, P ＞ 0.05) . Moderate positive correlation presented in the comparison of TUGT result with total length of locus, speed and peripheral area during eyes closed( r = 0. 508 to 0. 583, P ＜ 0.05). The correlation did not present in the comparison of the parameters determined with stabilometer and FIM ( r = - 0. 048 to - 0. 296, P ＞ 0.05).CONCLUSION: Stabilometer test can determine balance function in quantity in patients with hemiplegia of stroke, and reflect the severity of balance disturbance, of which, total length of locus speed and peripheral area during eyes opened and closed can judge balance function of patients sensibly and reliably.