Various surgical procedures are widely used for treating obstructive sleep apnea hypopnea syndrome (OSAHS) currently. The most prominent advantage of surgery is the excellent long-term adherence, which is just the main limitation for the first-line treatment of continuous positive airway pressure (CPAP). However, nearly all the surgical procedures used now usually could not cure this disease completely. The success rate of the uvulopalatopharyngoplasty, which is the most widely used procedure, can only reach to 40% - 50% in terms of AHI Therefore, there are some opinions that the surgery should not be applied for treating this disease. In fact, the outcomes of surgical treatments should not be only evaluated basing on some of the objective results. In this article, the clinical significance of surgery based on objective and subjective data, and the effects on long-term consequences, the combination of surgery with CPAP, and the possible prospects of surgical treatments for this disease will be discussed. This may help us to redefine the clinical efficacy of surgery for the treatment of OSAHS.
Continuous Positive Airway Pressure ; Humans ; Palate ; surgery ; Pharynx ; surgery ; Sleep Apnea, Obstructive ; surgery

Humans ; Laryngopharyngeal Reflux ; diagnosis ; therapy

Mean flow rate (MFR) ,vocal intensity (I) ,pitch frequency(P) ,pitch perturbation (PP) and vocal efficiency (I/F) were measured simutaneously during sustained phonation of the vowel [i] at wide range levels of intensities in 158 nor mal subjects and the same parameters were measured at moderate vocal intensity level in 136 patients with various kinds of laryngeal diseases. PP indicates the amount of irregular vibration of vocal folds and I/F represents efficient transition from MFR to acoustic energy. When phonation at different intensities ,MFR,P and I/F increase but PP decreases when I increases. At moderate intensity phonation, there are positive correlations between MFR and I,and between I and P but negative correlation between MFR and I/F,between I(male) and PP,and between P(fe-male) and PP.Most of the patients with laryngeal diseases showed higher MFR and PP but lower I/F than normal subjects.MFR, PP and I/F could be used as objective and quantitative parameters with I and P as reference parameters in assessing laryngeal function of phonation.

OBJECTIVE: The purpose of this study was to analyzed the histopathologic spectrum and clinical features of the tumors originated from the inferior nasal turbinates. METHOD: Clinical data of 34 patients with tumours of the inferior nasal turbinates, treated from Jan. 1998 to Dec. 2012, were retrospectively reviewed. Of the 34 patients, 18 male and 16 female, aged from 25 years to 76 years (mean: 45.6yr). RESULT: (1) Pathology : Of the 34 patients, 23 (67.6%) were benign and 11 (32.4%) were malignant. Hemangiomas were the most frequent benign tumour accounting for 18/23 (78.3%) in benign tumour and for 52.9% in all the tumors originated from inferior nasal turbinates. Other benign tumours included inverted papilloma, squamous papillomas and extrapleural solitary neurofibroma tumor. The most common malignant tumour was non-Hodgkin's lymphoma accounting for 6/11 (54.5%) in malignant tumour and for 17.6% in all the tumors. Other malignant tumour included squamous cell carcinoma, melanoma and undifferentiated carcinoma. (2) Distribution: Most tumors (31/34) arose from unilateral turbinates. Hemangiomas is the commonest tumor originated from anterior part of the turbinate in 14 cases of 18 (77.8%). NHL and melanoma involved through turbinates. 3. Symtoms: Nasal obstruction was the most common symtom (25/34, 73.5%). Epistaxis and bloody nasal discharge were the chief complaint in hemangiomas. CONCLUSION 1. The most common benign and malignant tumors of the inferior turbinate were hemangioma and NHL. The majority of the hemangiomas (14/18) arose from the anterior part of the inferior turbinate. NHL or melanoma often presented progressive, unilateral or bilateral diffuse enlargement of the inferior turbinate with poor vascular contractile reactivity to the ephedrine.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Nose Neoplasms ; pathology ; Retrospective Studies ; Turbinates ; pathology

Congenital median dermoid is an uncommon disease. Surgery is the main curative treatment. To review a clinical case and to summarise the characteristics and treatment experience of this disease, referring to the related literature, it is expected that we can provide more clinical thought and therapeutic method for congenital median dermoid fistula of nasal dorsum.
Dermoid Cyst ; congenital ; therapy ; Fistula ; congenital ; therapy ; Humans ; Nose ; pathology ; Nose Neoplasms ; congenital ; therapy

OBJECTIVE: To evaluate the function of tubomanometry (TMM) in forcasting the progonosis of acute otitis media with effusion (OME). METHOD: We used the technique of TMM to quantify the degree of eustachian tube (ET) dysfunction in 65 patients with OME. The opening of the ET and the transportation of gas into the middle ear were registered by a pressure sensor in the occluded outer ear after applying the stimulus of a controlled gas bolus into the nasopharynx during swallowing. Three excess pressure values were tested subsequently (30, 40, and 50 mbar). If tube opening was registered, the time of opening in relation to pressure applied was measured. The TMM calculated the opening latency index or index R. An R value of < 1 indicated early opening of the tube at the start of application of the stimulus, which was considered optimal. A value > 1 indicated late opening of the tube occurring after the initial stimulus and was interpreted as suboptimal. Inability to calculate the index R value indicated that the tube was unable to actively open at all. The TMM results, were weighted as follows: no R with 0 points, R > 1 with 1 point and R < 1 with 2 points for the measurements at 30, 40, and 50 mbar, respectively. The points of these three tests were added so the ET score (ETS) ranges from 0 (worst value) to 6 (best value). According to the medical history, the patients were divided into two groups, chronic OME group (defined as positive control group), 30 cases with 38 ears; and acute OME group, 35 cases with 46 ears. The healthy ears of all patients were defined as normal control group, 46 cases with 46 ears. The same regular treatments, including classic medical treatments and intratympanic dexamethasone injections, were used to acute OME group in the following 1-2 months. On the basis of therapeutic effect, acute OME group was subdivided into valid group (26 cases with 33 ears) and invalid group (9 cases with 13 ears). RESULT: The ETS of normal control group was 5.11 ± 1.32 while it was 1.08 ± 1.32 in positive control group. It was found marked differences between the two groups (P < 0.01). The ETS of both valid and invalid subgroup of actue OME group were significantly lower than normal control group (P < 0.01), but in valid subgroup it was significantly higher than positive control group (P < 0.01), and no marked difference was found between the invalid subgroup and positive control group. After treatments, a significant improvement of the ETS was found in both valid and invalid subgroup (P < 0.05) there was no marked difference between valid subgroup and normal control group. But in invalid subgroup it was still significantly lower than normal cohtrol group (P < 0. 01). CONCLUSION TMM could forecast the prognosis of acute OME. Patients with acute OME suffered from ET dysfunction of varied degrees. Those with high ETS could be cured by classic medical treatments and intratympanic dexamethasone injections. But those with poor ETS could not be cured in short period, tube insertion should be considered. If ETS could not be improved by ventilation tube placement, more active treatment, for example, balloon Eustachian tuboplasty (BET), should be used to prevent transforming into chronic OME.
Acute Disease ; Ear, Middle ; Eustachian Tube ; physiopathology ; Humans ; Injection, Intratympanic ; Manometry ; Middle Ear Ventilation ; Otitis Media with Effusion ; diagnosis ; Pressure ; Prognosis

OBJECTIVE To investigate the expression and significance of Fas, FasL and FADD in laryngeal carcinoma. METHODS Immunohistochemical method was used to examine the expression of Fas, FasL and FADD in laryngeal carcinoma specimen and adjacent normal tissues. RESULTS The positive rates of Fas and FADD in laryngeal carcinoma tissue were significantly lower than that in adjacent normal tissue, while FasL in laryngeal carcinoma tissue was higher than that in adjacent normal tissue(P

OBJECTIVE To compare coblation inferior turbinate reduction with inferior turbinectomy by evaluating the differences in the degree ofintraoperative bleeding,degree of post-operative pain,and short-term efficacy in treating inferior turbinate hypertrophy. METHODS Thirty-nine patients were involved in this study. Twenty-five underwent coblation inferior turbinate reduction,and fourteen were treated with inferior turbinectomy with debrider. Subjective symptoms and the inferior turbinate scores were assessed prior to and at 1,3 and 6 months after treatment. In the coblation group,4-6 tunnels were made in each inferior turbinate with Reflex 45 wand under local anesthesia with endoscope. In the control group,debrider was used to remove the hypertropic mucosa of inferior turbinates under endoscope, after which nasal package were used for 2 days to stop the bleeding. RESULTS Coblation inferior turbinate reduction resulted in little intraoperative bleeding and a significant reduction in post-operative pain. At the month 1 follow-up,the severity and the frequency of nasal obstruction were significantly improved in both the coblation and control group. The inferior turbinates were found to have significantly decreased in size in both groups. There was no significant difference between the two groups. At the month 3 follow-up,these improvements were also significant,and the frequency of nasal obstruction was significantly more reduced in the coblation group. The results from the month 6 follow-up conformed to those from the month 3 follow-up. CONCLUSION Coblation inferior turbinectomy is a safe procedure that is easily performed under local anesthsia and results in a significant improvement of nasal obstruction in patients with turbinate hypertrophy. The volumes of the inferior turbinates were alsosignificantly reduced. This procedure is as effective as inferior turbinectomy with debrider. The clinical benefitpersists at 6 months after the procedure.

OBJECTIVE: To investigate the method of surgical management for cervical esophageal carcinoma and the feasibility of the operation with preservation of laryngeal function. METHOD: Sixteen patients with cervical esophageal carcinoma who received surgical treatment were reviewed in our retrospective study. Removal of total hypopharynx and larynx and the inversion stripping esophagectomy were conducted in thirteen patients, of which one underwent the reconstraction with residual larynx and tracheal flap and the other twelve patients underwent the reconstraction with gastric-pharyngeal anastomosis. One patient received the cervical esophagectomy and partial hypopharyngectomy with laryngotracheal flap. The inversion stripping esophagectomy with laryngeal function preservation were conducted in two patients, who received the reconstraction with gastric-pharyngeal anastomosis and preserved total larynx. All the patients were carried out the bilateral neck dissections. RESULT: The surgical resection rate was 100% and no operative death occurred. The postoperative complications included pulmonary infection in two cases, anastomotic fistula in two cases, anastomotic stenosis in two cases and congestive heart failure in one case. The retained rate of the laryngeal function is 12.5%. The 3-year survival rate is 30.7%, and the 5-year survival rate is 23.1%. CONCLUSION The surgical treatment of cervical esophageal carcinoma is possible. The inversion stripping esophagectomy without thoracotomy is performed to resect the tumor. The esophageal defect could be reconstructed by laryngotracheal flap or gastric-pharyngeal anastomosis. The laryngeal function should be remained as far as possible according to the location and extension of the tumor.
Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Male ; Middle Aged ; Neck ; Retrospective Studies

The aims of this study were to evaluate the expression of enhanced green fluorescent protein (EGFP) driven by 6 different promoters, including cytomegalovirus IE enhancer and chicken beta-actin promoter (CAG), cytomegalovirus promoter (CMV), neuron-specific enolase promoter (NSE), myosin 7A promoter (Myo), elongation factor 1alpha promoter (EF-1alpha), and Rous sarcoma virus promoter (RSV), and assess the dose response of CAG promoter to transgene expression in the cochlea. Serotype 1 adeno-associated virus (AAV1) vectors with various constructs were transduced into the cochleae, and the level of EGFP expression was examined. We found the highest EGFP expression in the inner hair cells and other cochlear cells when CAG promoter was used. The CMV and NSE promoter drove the higher EGFP expression, but only a marginal activity was observed in EF-1alpha promoter driven constructs. RSV promoter failed to driven the EGFP expression. Myo promoter driven EGFP was exclusively expressed in the inner hair cells of the cochlea. When driven by CAG promoter, reporter gene expression was detected in inner hair cells at a dose as low as 3 x 10(7) genome copies, and continued to increase in a dose- dependent manner. Our data showed that individual promoter has different ability to drive reporter gene expression in the cochlear cells. Our results might provide important information with regard to the role of promoters in regulating transgene expression and for the proper design of vectors for gene expression and gene therapy.
Animals ; Cochlea/cytology/*metabolism ; Dependovirus/*genetics ; Dose-Response Relationship, Drug ; Female ; Genetic Vectors/*genetics ; Green Fluorescent Proteins/metabolism ; Humans ; Mice ; Mice, Inbred C57BL ; Promoter Regions, Genetic/*genetics ; *Transgenes