BACKGROUND: Plenty of materials have been used as stent in total auricular reconstruction with varying advantages and disadvantages. The in vitro prepared tissue engineered complex cartilage stent has been not applied in clinic.OBJECTIVE: To observe the ultrastructure changes of surrounding tissues following total auricular reconstruction with nickel-titanium (NiTi) shape memory alloy stent in vivo.DESIGN, TIME AND SETTING: The randomized, controlled, animal experiment was performed in the Central Laboratory of EENT Hospital of Fudan University, Anhui Provincial Hospital and Department of Nuclear Medicine, Huashan Hospital of Fudan University from April 2004 to October 2005.MATERIALS: A total of 12 New Zealand rabbits were randomized divided into the skin-expanded and unexpanded groups, with 6 animals in each group.METHODS: Each animal underwent subcutaneous implantation with a NiTi alloy stent like human auricle. In the skin-expanded group, the stent was implanted after skin expansion, while no treatment in the unexpanded group.MAIN OUTCOME MEASURES: The ultrastructure changes of surrounding tissues were detected by scanning electron microscope at months 6 and 12 after implantation.RESULTS: Structure of nickel-titanium alloy implant stent make fibrovascular ingrowth more easily. The surface of nickel-titanium alloy stent was smooth without corrosion. There was no evidence of infection in the host tissue. Microstructure of Ni-Ti stent wires showed no morphologic and functional changes after subcutaneously implanted in vivo, and the difference between 2 groups had no significance.CONCLUSION: NiTi shape memory alloy stent can smoothly pass the process of fibrovascularization with less complication.According to the examination by SEM, the nickel-titanium stent showed good biocompatibility.

OBJECTIVE: To explore the effective of the new mechanical assistant canalith repositioning procedure (TRV-CRP) to the diagnosis and treatment of the benign paroxysmal positional vertigo (BPPV). METHOD: The data of the cases with suspected diagnosis of BPPV from April to June of 2012 checked and treated by TRV-CRP in our vestibular function checking room were collected and analyzed. All of the cases were followed up to one to three months. RESULT: Total 504 cases of suspected diagnosis of BPPV were collected. Three cases were rejected for un completed procedure. All of the 501 completed procedure cases included 162 male and 339 female with age ranging from 10 years old to 86 years old (52. 8 +/- 14 years old). 169 cases (33.73%) were positive diagnosis and 332 cases were negative diagnosis (66.27%). 135 cases enrolled only one semicircular canal (SC) account for 79.89% of all the positive diagnosis that included 17 cases of left horizontal SC, 4 cases of left superior SC, 29 cases of left posterior SC, 23 cases of right horizontal SC, 4 cases of superior SC and 58 cases of right posterior SC. 25 cases enrolled more than two SC (14.80%). 9 cases of objective BPPV (5.33%) included 5 cases of right posterior SC, 3 cases of left posterior SC and one cases of right horizontal SC. Exception of 163 cases without classic BPPV history in the 332 negative diagnosis cases, 169 cases had classic BPPV history including 14 cases treated by manual canalith repositioning procedure and 33 cases which had released from the vertigo. The rate of treatment effective by TRV-CRP was 100%. There were 20 cases returned for retreatment because their unsatisfied about the release of their symptom but proved to be negative diagnosis again in 10 cases and positive diagnosis in 10 cases, however, only 4 cases proved to be the same SC disease were considered as relapse (2.37%) and others enrolled different SC. After retreated, all cases got release without relapse. CONCLUSION TRV-CRP could diagnosis 34% of the primary diagnosis cases of BPPV. TRV-CRP had high rate of effective and lower relapse which especially fitted to patients suffered from complex BPPV or difficult to finish the manual repositioning procedure. However, due to the expensive of TRV-CRP, it is reasonable to combine TRV-CRP and manual repositioning procedure in clinical.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Benign Paroxysmal Positional Vertigo ; Child ; Female ; Humans ; Male ; Middle Aged ; Otolithic Membrane ; Physical Therapy Modalities ; Treatment Outcome ; Vertigo ; diagnosis ; therapy ; Young Adult

Objective To investigate the synaptopathy of hidden hearing loss mice,and to observe the synapses of the cochlear inner hair cell after temporary threshold shift of noise exposure.Methods Mice were divided into normal control group and experiment group,the latter was exposed under noise of 98 dB SPL for 2 h to establish the model of temporary threshold shift.Mice cochleae of the two groups were dissected and prepared with whole mount and immunostaining.Cellular morphology was observed under confocal laser scanning microscope.Cochlear lengths were measured through cochlear frequency map to localize hair cells in different frequency regions.Then,3-D morphometry of synapses was constructed by Amira software to observe pre-synaptic ribbons,post-synaptic receptors and its pathological changes.Results In control group,each cochlear nerve fiber contacted a single inner hair cell by a single synapse,each inner hair cell had 5-30 synapses contacting cochlear nerve fibers.The larger ribbons patched smaller receptors located in the modiolar side,and the smaller ribbons patched larger receptors located in the pillar side.While in experiment group,noise overexposures caused moderate or completely reversible thresholds shift,i,e.,distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) thresholds increased 30-40 dB.Although returned to normal after 2 weeks,ABR wave Ⅰ amplitudes recovered to only 46.1 ％ of pre-exposure amplitudes.There was 41.3％ synapses loss of inner hair cell,but there was no loss of inner hair cells and spiral ganglion neurons.Conclusions Threshold test is not sensitive to degeneration and loss of synapse in mice inner hair cells,while super threshold test is sensitive to it.

Objective To better understand the MSCT characteristic of superior semicircular canal dehiscence syndrome (SSCDS). Methods A retrospective study was conducted on 8 patients who were diagnosed with SSCD syndrome in the otology and skull base surgery group of fudan university. All the patients CT features, the conventional axial and coronal images base on high-resolution MSCT and the images displayed the whole superior semicircular canal, which were reconstructed by using the technology of MPR, were reviewed. Results All the images that displayed the whole superior semicircular canal exhibited the dehiscence. Six patients' dehiscences occur in the middle of the roof over the superior semicircular (4 of 6 dehiscences also occur in the front of the roof), 2 patients dehiscences occur in the back of the roof over the superior semicircular. The range of the maximal diameter of the dehiscence was 0.8-4.2 mm, (median value: 2.4 mm). Conclusion The technology of MPR based on the high-resolution MSCT scan is very useful in diagnosis of the SSCDS.

Objective To evaluate the imaging diagnosis value of glomus tympanicum tumors.Methods Images of 10 patients with surgically and pathologically confirmed glomus tympanicum tumors were reviewed.The image characteristics and diagnostic value were summarized.Results In 8 patients with high resolution CT scan and 2 patients with routine CT scan,soft tissue nodules within the tympanic cavity were identified on axial or coronal images in 7 of them.And in 3 patients with chronic tympanitis,glomus tympanicum tumors were not differentiated on CT images.Eight patients had undergone MR examination,on T2WI the tumors were moderate hyperintense(n=6)and hyperintense(n=2),and the tumors were enhanced obviously after contrast.In 3 patients with chronic tympanitis,moderate high signal of the tumor can be differentiated with the high signal of tympanitis on T2WI.On contrast MRI,the signal of enhanced tumor or unenhanced tympanitis was identified clearly.Conclusion On diagnosis of glomus tympanicum tumors,MRI is prior to CT,especially in patient with glomus tympanicum and tympanitis.

Objective To modify the method of gavage administration in guinea pigs. Methods Fourty awake guinea pigs were kept rearing on the hind legs and leaning on a vertical fixture to avoid their escaping forward. A 1 mL injector was inserted into the mouth to the depth when the molar teeth were passed. Another fourty guinea pigs under general anesthesia were reversed at trendelenburg position and a children suction tube with an outer diameter of 2 mm was inserted into the stomach. Results All of the 80 guinea pigs were administered by modified gavage smoothly for seven consecutive days by one operator each time. None endured much pain or digestive tract injury, or died from air way perfusion by mistake. Conclusions We successfully modified the gavage method in guinea pigs, which would definitely take guinea pigs involved in intragastical pharmacal experiments besides the routine of rats and mice.

Objective:To analyze the clinical manifestations and the diagnosis of the facial nerve tumor according to the clinical information, and evaluate the different surgical approaches depending on tumor location.Method:Twenty-seven cases of facial nerve tumors with general clinical informations available from 1999.9 to 2006.12 in the Shanghai EENT Hospital were reviewed retrospectively.Result:Twenty(74.1%) schwannomas,4 (14.8%)neuofibromas ,and 3(11.1%)hemangiomas were identified with histopathology postoperatively.During the course of the disease,23 patients(85.2%)suffered facial paralysis,both hearing loss and tinnitus affected 11 (40.7%)cases,5(18.5%)manifested infra-auricular mass and the others showed some of otalgia or vertigo or ear fullness or facial numbness/twitched. CT or/and MRI results in 24 cases indicated that the tumors originated from the facial nerve.Intra-operative findings showed that 24(88.9%)cases involved no less than 2 segments of the facial nerve,of these 24 cases 87.5%(21/24)involved the mastoid protion,70.8%(17/24)involved the tympanic protion, 62.5%(15/24)involved the geniculate ganglion, only 4.2%(1/24)involved the internal acoustic canal(IAC),and 3 cases (11.1%)had only one segments involved. In all of these 27 cases ,the tumors were completely excised,of which 13 were resected followed by an immediate facial nerve reconstruction,including 11 sural nerve cable graft,1 facial nerve end-to-end anastomosis and 1 hypoglossal-facial nerve end-to-end anastomosis.Tumors were removed with preservation of facial nerve continuity in 2 cases.Conclusion:Facial nerve tumor is a rare and benign lesion,and has numerous clinical manifestations.CT and MRI can help surgeons to make a right diagnosis preoperatively.When and how to give the patients an operation depends on the patients individually.

OBJECTIVE: To analyze the clinical manifestations and the diagnosis of the facial nerve tumor according to the clinical information, and evaluate the different surgical approaches depending on tumor location. METHOD: Twenty-seven cases of facial nerve tumors with general clinical informations available from 1999.9 to 2006.12 in the Shanghai EENT Hospital were reviewed retrospectively. RESULT: Twenty (74.1%) schwannomas, 4 (14.8%) neurofibromas ,and 3 (11.1%) hemangiomas were identified with histopathology postoperatively. During the course of the disease, 23 patients (85.2%) suffered facial paralysis, both hearing loss and tinnitus affected 11 (40.7%) cases, 5 (18.5%) manifested infra-auricular mass and the others showed some of otalgia or vertigo or ear fullness or facial numbness/twitches. CT or/and MRI results in 24 cases indicated that the tumors originated from the facial nerve. Intra-operative findings showed that 24 (88.9%) cases involved no less than 2 segments of the facial nerve, of these 24 cases 87.5% (21/24) involved the mastoid portion, 70.8% (17/24) involved the tympanic portion, 62.5% (15/24) involved the geniculate ganglion, only 4.2% (1/24) involved the internal acoustic canal (IAC), and 3 cases (11.1%) had only one segments involved. In all of these 27 cases, the tumors were completely excised, of which 13 were resected followed by an immediate facial nerve reconstruction, including 11 sural nerve cable graft, 1 facial nerve end-to-end anastomosis and 1 hypoglossal-facial nerve end-to-end anastomosis. Tumors were removed with preservation of facial nerve continuity in 2 cases. CONCLUSION Facial nerve tumor is a rare and benign lesion, and has numerous clinical manifestations. CT and MRI can help surgeons to make a right diagnosis preoperatively. When and how to give the patients an operation depends on the patients individually.
Adolescent ; Adult ; Aged ; Child ; Cranial Nerve Neoplasms ; diagnosis ; surgery ; Facial Nerve Diseases ; diagnosis ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the distribution of cells infected by AD5-EGFP infused in different ways in the cochlea of guinea pig. METHOD: AD5-EGFP was infused into the endolymphatic system through a hole on the lateral wall of the scala media or into the extralymphatic system through the round window membrane respectively. The infected cochlear cells confirmed by expression of EGFP were examined on the whole mount or cryostat sections. RESULT: In the cochleae in which AD5-EGFP was infused into the extralymphatic system through the round window membrane, expression of EFGP could be found in the type I, IV and V fibrocyte of the stria vascularis, superlimbal cells of the spiral lip, cells in Ressenal membrane, spiral ganglion neurons in Rosenthal hole and cells lining the inner wall of scala vestibular and scala tympani, indicating that these cells were infected by adenovirus. None of the inner, outer hair or supporting cells was found to be infected in these cochleae. In the cochleae in which AD5-EGFP was infused into the endolymphatic system through a hole on the lateral wall of scala media, expression of EFGP could be found in supporting cells in the organ of Corti and lining cells of the scala media. CONCLUSION Adenovirus5 is a good and effective vector for delivering genes into cells in guinea pig's cochlea. The scope of infected cells will be very different when the vector is applied to the cochlea through different infusion ways. No cells in the endolymphatic system would be infected if the vector is infused into the extralymphatic system.
Adenoviridae ; genetics ; Animals ; Cochlea ; virology ; Gene Transfer Techniques ; Genes, Reporter ; Genetic Vectors ; Green Fluorescent Proteins ; genetics ; Guinea Pigs ; Spiral Ganglion ; virology

OBJECTIVE: To explore the efficacy of small dose of intratympanic gentamicin injection on intractable Meniere's disease. METHOD: Retrospectively study the efficacy of gentamicin intratympanic injection on intractable Meniere's disease. The end-point of treatment was determined based on bedside tests (Spontaneous Nystagmus test, Head shaking test and Head Thrust test), hearing tests, or the improvement of patients symptoms. RESULT: Nineteen patients with Meniere's disease were treated with intratympanic gentamicin injection. Vertigo control was achieved in 17 patients (89%). Of them, vertigo of 5 patients was successfully controlled after single injection. Eight patients need double injections and 4 patients need the third injections to control the vertigo. Endolymphatic sac shunt was performed to 1 patient because he could not tolerate the fullness of ear due to injection. The remainder 2 patients with double injections showed no improvement of vertigo and rejected further treatment. Hearing was improved in two patients after gentamicin injection. Three patients complained of hearing loss after intratympanic gentamicin injection. The hearing of the other patients did not change. CONCLUSION Three weeks after using small dose of gentamicin intratympanic injection to treat intractable Meniere's disease, it was determined whether more injections is required. The results showed that by using this approach, the vertigo could be effectively controlled and the risk of hearing loss following intratympanic gentamicin injection could be reduced.
Adolescent ; Adult ; Aged ; Ear, Middle ; Female ; Gentamicins ; administration & dosage ; therapeutic use ; Humans ; Male ; Meniere Disease ; complications ; drug therapy ; Middle Aged ; Retrospective Studies ; Vertigo ; drug therapy ; etiology ; Young Adult