Humans ; Otolaryngology ; Periodicals as Topic ; trends

China ; Otorhinolaryngologic Surgical Procedures

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 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.

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 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 examine among preschool children the validity, reliability and sensitivity of a new assessment tool of Mandarin sentence recognition in babble noise, consisting of twenty-seven equivalent lists, as well as to investigate the effect of age and gender on children's speech recognition. Methods Fifty-four normalhearing children aged 4 to 6 years were recruited from Beijing and were divided into three age groups (4～, 4.5～,and 5.0～6.0 years) containing 18 children each, half boys and half girls. According to randomized split-plot design, we examined their speech recognition ability with 27 sentence-in-babble-noise lists in a sound-treated booth in a kindergarten (ambient noise ＜40 dB). The sentences were presented at fixed intensity of 65 dB SPL, paired with competing babble noise at three different signal to noise ratios (SNR= +1, -2, -5 dB) by the same loudspeaker with 0° azimuth. Speech recognition score were calculated based on the children's repetition of keySNR functions exhibited that the threshold was -1.96±0. 19 dB SNR and the slope was 15.8%±1.1%/dB for of variance and Post- Hoc Scheffe test indicated that significant differences in performance were most pronounced between the 4～ year group and the other two groups (P＜0.001), while there was no significant difference between 4.5～ year group and 5.0～6. 0 year group (P=0. 90). The girls' performance was also significantly better than boys' (P＜0. 001). Conclusion The 27 lists of Mandarin speech recognition in babble noise were equivalent among children, and the sensitivity of performance versus SNR was 15.8%/dB. Both of them were below the adult averchildren aged 4.5～ up years. Even though the performance differed between boys and girls, the difference was relatively small compared to 24.6%, the critical difference as the reliability indicator.

OBJECTIVE: To assess the clinical effeetiveness of prelingually deaf children after cochlear implantation at different ages so as to provide reasonable expectations for the patients and guidance for the clinical treatment. METHOD: Electronic databases PubMed, YZ365. COM, WANFANG DATA, CMJD, CHKD, CNKI were searched using relevant keywords. Extracted data included author, year of publication, diagnosis, et al. Reported treatment outcomes were clustered into speech discrimination and hearing abilities. Meta-analyses were performed on studies with numerical results using random or fixed effects model. RESULT: There were eight randomized control studies including 442 patients. Comparing speech perception of prelingually deaf children after cochlear implantation younger than three years old (experimental group) and 3-6 years old (control group), three and six months after operation showed that experimental group performed significantly worse than control group; 12 months after operation showed that experimental group performed significantly better than control group. Comparing hearing abilities, three and six months after operation showed that experimental group performed significantly worse than control group; 12 months after operation showed showed that experimental group performed significantly better than control group. Comparing speech perception of younger or older than 4. 5 years old children showed that after 1.5-2 years of operation children implanted younger than 4.5 years of age performed significantly better than children implanted older than 4.5 years old. Comparing speech perception of 7-12 years old children showed that after 3, 6, 12 months of operation patients of 7-12 years old performed significantly better than those children older than 12 years old. Comparing speech perception of implantation younger or older than 18 years old (7-14 yeas old was group A, > 14-18 yeas old was group B, older than 18 yeas old was group C) showed that after one and four years of operation A > B > C, and there were significant differences among them. Comparing warble tone threshold average (WTA) showed that after one year of operation A < B < C, and there were significant differences among them. However, after four years of operation, there was no significant difference among them. CONCLUSION Prelinguistically deafened patients younger than three years old with cochlear implantation, insisting on scienctific rehabilitation training for a long period of time can receive the optimal recovery effect. The older patients are suggested as early as possible receiving cochlear implantation. The longer they are implanted, the better results they will receive. Moreover, the younger age they are implanted, the faster postoperative language progress they will receive. Further controlled studies with longer follow-up periods and more person included may make the effectiveness of cochlear implantaion more reliable.
Adolescent ; Child ; Cochlea ; Cochlear Implantation ; Deafness ; Hearing Tests ; Humans ; Language ; Language Development ; Speech Perception ; Treatment Outcome