Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

Objective To investigate correlation between preoperative thyroid-related serological indicators and benign and malignant thyroid nodules.Methods Clinical data of 401 patients with thyroid nodules underwent surgical treatment in Guizhou Provincial People's Hospital from January to December 2020 were retrospectively analyzed.According to the results of postoperative pathological examination,they were divided into benign group(129 cases)and malignant group(272 cases).Clinical data and preoperative thyroid-related serological indicators were compared between two groups.Results Age and preoperative serum thyroglobulin(Tg)level in malignant group were significantly lower than those in benign group,and proportion of males was significantly higher than that in benign group(P<0.05).The receiver operating characteristic(ROC)curve showed that preoperative serum Tg value of 35.41ng/ml was cut-off point for the risk factor of distinguishing benign and malignant thyroid nodules.Subgroup analysis showed that serum Tg level in malignant group of patients≤40 years old was significantly lower than that in benign group,thyroid stimulating hormone(TSH)×thyroglobulin antibodies(TGAb),TGAb/thyroid peroxidase antibodies(TPOAb)values in malignant group of patients≤40 years old were significantly higher than those in benign group(P<0.05).Among patients over 40 years old,serum Tg level in malignant group was significantly lower than that in benign group(P<0.05).Serum Tg and TPOAb levels in malignant group of male patients were significantly lower than those in benign group(P<0.05).Serum Tg level in malignant group of female patients was significantly lower than that in benign group(P<0.05).ROC curve showed that preoperative serum TSH×TGAb value of 15.87,TGAb/TPOAb value of 1.06 were risk factor cut-off points for distinguishing benign and malignant thyroid nodules in young adults,and preoperative serum TPOAb value of 9.40IU/ml was risk factor cut-off point for distinguishing benign and malignant thyroid nodules in males.Conclusion Male,young age and decreased Tg value are independent risk factors for thyroid cancer.Serum Tg value has certain diagnostic value for differentiating benign and malignant thyroid nodules.Decrease of preoperative serum TPOAb level is a risk factor for male thyroid cancer.Preoperative elevated TSH×TGAb and TGAb/TPOAb are independent risk factors for development of thyroid cancer in young adults.

Regression discontinuity design (RDD) is a rigorous quasi-experimental method. Based on the randomness of the distribution of samples around the critical value, the data on both sides are used for regression respectively, so as to avoid the interference of potential confounding factors and provide strong evidence for the inference of causal correlation. This study introduces the RDD and its research progress, and expounds its application in detail combined with cases, in order to provide reference for the application of RDD in epidemiological research.

Regression discontinuity design (RDD) is a rigorous quasi-experimental method. Based on the randomness of the distribution of samples around the critical value, the data on both sides are used for regression respectively, so as to avoid the interference of potential confounding factors and provide strong evidence for the inference of causal correlation. This study introduces the RDD and its research progress, and expounds its application in detail combined with cases, in order to provide reference for the application of RDD in epidemiological research.

Objective: To analyze the therapeutic effect of endoscopic myringoplasty. Methods: A retrospective analysis of 523 patients with chronic otitis media who underwent endoscopic myringoplasty between June 2016 and June 2017 in eight tertiary hospitals in China. Among all the patients, 256 were male and 267 were female, aged from 18 to 68 years old. The grafts used to repair the tympanic membrane were all tragus cartilage-perichondrium complex. All patients were followed up at 1 month, 3 months, 6 months, 9 months, and 12 months after surgery, at least 3 months. The closure rate of tympanic membrane perforation by different factors, the hearing results, and the incidence of postoperative complications were analyzed. SPSS 21.0 software was used to analyze the data. Results: Three months after operation, the closure rates of anterior, inferior, posterior and subtotal perforation were 92.4% (109/118), 94.9% (93/98), 95.6% (129/135), and 89.0% (153/172) respectively, the difference was not statistically significant (χ²=5.779, P=0.123). The closure rates of small, medium and large perforations were 100.0% (82/82), 93.7% (178/190) and 89.2% (224/251) respectively. The difference was statistically significant (χ²=10.927, P=0.004). The closure rates of dry ear and wet ear tympanic membrane perforation were 93.1% (392/421), 90.2% (92/102), the difference was not statistically significant (χ²=1.011, P=0.915). The preoperative pure tone audiometry(PTA) was (38.4±5.3) dBHL, while, the 3-month postoperative PTA was (25.1±5.7) dBHL. The difference was statistically significant (t=39.079, P<0.001). The preoperative air bone gap (ABG) was (22.4±4.3) dB, while 3 months postoperative ABG was (9.1±3.8) dB. The difference was statistically significant (t=53.004, P<0.001). Of all 523 patients, 14 (2.7%) had middle ear infection, 8 (1.5%) had dislocated tympanic membrane, 12 (2.3%) had parageusia, 35 (6.7%) had tinnitus, 28 (5.4%) had hearing loss, 26 (5.0%) had vertigo,33 (6.3%) had reperforation, 2 (0.4%) had secondary cholesteatoma, and none had facioplegia. Conclusions Endoscopic myringoplasty is a safe and effective surgical method with good postoperative outcome.

Objective: To summarize and discuss the characteristics of endoscopic approach to manage the middle ear cholesteatoma, and to evaluate the operative safety and outcomes based on the data from the multicenter study. Methods: The data of 242 cases diagnosed with the middle ear cholesteatoma and received operation through endoscopic approach between June 2016 and June 2017 in six tertiary hospitals in China were analyzed in this work. There were 130 males and 112 females, with the age ranging from 3 to 72 years old. We evaluated the strategy about how to manage the cholesteatoma, discussed the detailed techniques about how to remove the cholesteatoma and to improve the efficiency under endoscopic visualization. Meanwhile, the recurrence rate and residual rate of cholesteatoma as well as the complications in endoscopic approach were summarized. Results: A total of 158 cases were operated in exclusively endoscopic transcanal approach, 72 cases operated in combined approach, and 12 cases operated majorly under microscope and minorly under endoscope. 219 cases were operated in one stage surgery, 23 cases received second look. In the second look, 3 cases were detected with residual cholesteatomas. Among them, 2 cases were found by MRI-DWI examination after the first-stage operation. With endoscopic examination after operation, 17 cases showed retracted pocket recurrence (7%,17/242). With introduction of endoscope in cholesteatoma, 153 cases were achieved canal wall-up operation (63%, 153/242). The complications in endoscopic approach included chord tympani never injury in 27 cases, skin injury of ear canal in 11 cases, tinnitus in 13 cases, vertigo in 7 cases, external ear canal stenosis in 1 case. Conclusions Using otoendoscope in cholesteatoma surgery would help keeping the normal structures of middle ear as much as possible, benefit to remove the hiding pathologies, help reducing residual cholesteatoma and lowering the rate of canal wall-down operation as well. This study showed good safety of otoendoscopic cholesteatoma surgery, however, strict evaluation of indication and quite good surgical techniques and skills are necessary for avoiding unexpected complication.

Objective: To explore the efficacy of ossiculoplasty surgery under oto-endoscope in patients of conductive hearing loss with intact tympanic membrane. Methods: A retrospective study was conducted. The clinical data of 45 patients with conductive hearing loss who had undergone simple ossiculoplasty surgery between October 2015 and December 2017 from five hospitals in China (West China Hospital of Sichuan University, General Hospital of the People′s Liberation Army, Shanghai Ninth People′s Hospital, Shanghai JiaoTong University School of Medicine, Xijing Hospital, Fourth Military Medical University and Shenzhen Sixth People′s Hospital) were collected. There were 28 males and 17 females, with the age ranging from 12 to 69 years old. The tympanic membranes of those patients were intact before surgery. The lesion only occurred in the ossicular chain from CT and intraoperative exploration. The cases of otosclerosis, tympanosclerosis, cholesteatoma of middle ear, chronic suppurative otitis media, and tumor of middle ear were excluded. The postoperative complications, hearing improvements and operation time were observed. SPSS 23.0 software was used for statistic analysis. Results: There was neither sensorineural hearing loss nor facial paralysis after surgery in this group. Seven patients had transient mild tinnitus after surgery and gradually relieved during the follow-up period. Nine patients developed dysgeusia after surgery. Two patients developed dizziness after surgery, and the symptoms were mild and relieved during 1 week without special intervention. The air-bone gap (ABG) range of pre-operation was 22.5-45.7 dB, and the average ABG was (25.3±8.6) dB. The ABG range in the third month after surgery was 5.7-26.8 dB, and the average ABG was (9.3±8.6) dB. The mean value of ABG was significantly lower in the third month after surgery compared with that of pre-operation (t=2.31, P<0.05). The operation time of the surgeons in each research center was similar. The overall average of operation time was (43.56±18.25) min. There was no significant difference in the duration of operation between the centers (F=3.26, P>0.05). Conclusion The ossiculoplasty surgery under oto-endoscope has good efficacy.

Objective: To analyze the safety of endoscopic stapes surgery, and to compare the results with stapes surgery under microscopic approach. Methods: This was a retrospective study. One hundred and thirty seven patients from Eye Ear Nose and Throat Hospital of Fudan University and other seven hospitals were enrolled in this study. Eighty eight patients, in whom 29 were male, and 59 were female, aged from 29 to 66 years old, with an average of 40.1±10.7, underwent endoscopic stapedotomy and 49 patients, in whom 17 were male, and 33 were female, aged from 32 to 64 yeas old, with an arerage of 38.7±9.2, underwent microscopic stapedotomy for otosclerosis. Interventions included endoscopic and microscopic stapes surgeries. Main outcome measures consisted of operating time, preoperative and postoperative hearing, intraoperative findings, and postoperative complications. SPSS 16.0 software was used to analyzed the date (t test and χ² test) . Results: Patients in the group who underwent endoscopic stapes surgery showed a mean operative time of (74.1±26.0) min. Patients in the group treated by microscopic approach had a mean operative time (66.5±15.9) min. Statistical difference was evident (t=1.279, P<0.05) . The average operative time of endoscopic surgery became shorter as the cases increased. The average duration of the last 10 cases was shorter than that of the first 10 cases in both groups. The differences were significant (t value was 3.028, 3.610, both P<0.05). No statistical difference was found in air conduction threshold improvement (t=1.074, P=0.289) , air-bone gap closure (t=-0.135, P=0.893) and bone conduction improvement (t=1.222, P=0.228) between the two groups. No difference regarding the incidence of the postoperative complications (chorda tympanum damage: 6 cases vs 2 cases, χ²=0.08,P>0.05; vertigo:18 cases vs 9 cases,χ²=0.09, P>0.05; facial paralysis: 0 case vs 0 case) between the two groups was found. Conclusion Audiological outcomes achieved by endoscopic surgery are similar to the results obtained through a microscopic approach. Endoscopic stapes surgery is safe.

Disfunction of Eustachian tube will cause negative pressure of middle ear, which may result in tympanic membrane retraction pocket. Severe pocket can consequently cause cholesteatoma. In clinical practice it is not uncommon to find a cholesteatoma limited to epitympanum, with an otherwise normal pars tensa and mesotympanum. This review explains the theory of "selective epitympanic dysventilation syndrome" developed by endoscopic technique. In the majority of the patients, the only ventilation pathway to the epitympanum is through the tympanic isthmus. Even if Eustachian tube function has recovered, an isthmus blockage with selective epitympanic dysventilation may lead to common attic cholesteatoma.