Objective:To analyze the disease characteristics, diagnosis and treatment methods of venous pulsatile tinnitus treated by intervention of sigmoid sinus.Methods:Fifty patients (from Shandong Provincial ENT Hospital, Shandong University between February 2014 and July 2020) with venous pulsatile tinnitus treated by sigmoid sinus surgery were analyzed retrospectively. The tinnitus characteristics, imaging findings, surgical methods, intraoperative findings and postoperative tinnitus changes were recorded. The patients were followed up for 6-12 months. The sign rank sum test was used to analyze the difference in tinnitus grading before and after surgery. There were 50 patients with unilateral venous pulsatile tinnitus, including 49 females and 1 male. The age ranged from 17 to 67 years, with a median age of 44 years. There were 45 cases of right tinnitus and 5 cases of left tinnitus. The degree of tinnitus before operation was grade Ⅱ or above, including 4 cases of gradeⅡ, 11 cases of grade Ⅲ, 22 cases of grade Ⅳ and 13 cases of grade Ⅴ.Results:Thirty-seven cases were cured, 8 cases were ineffective (no change in tinnitus), 3 cases were markedly effective (tinnitus grade decreased by 3 in 2 cases, 4 in 1 case), and 2 cases were effective (tinnitus grade decreased by 1). The difference of tinnitus grade before and after operation was statistically significant ( Z=-5.70, P<0.05). Temporal bone CT showed 36 cases of sigmoid diverticulum (including 17 cases with sigmoid sinus dehiscence), 12 cases of sigmoid sinus dehiscence and 2 cases of absence of the temporal bone cortex abutting to sigmoid sinus. Thirty-five cases were performed with closure of sigmoid sinus diverticulum, 4 cases were performed with resurfacing of the sigmoid plate, 5 cases were performed with narrowing of sigmoid sinus, 4 cases were performed with simple opening of pre sigmoid mastoid air chamber, 1 case of opening was performed with pre sigmoid mastoid air chamber combined with narrowing of sigmoid sinus, and 1 case was performed with opening of pre sigmoid mastoid air chamber combined with closure of sigmoid sinus diverticulum. Conclusions:Venous pulsatile tinnitus is common in women. The common causes may be sigmoid sinus wall abnormalities such as sigmoid sinus diverticulum and perisigmoid bone defect. Imaging examinations are helpful for diagnosis. Venous pulsatile tinnitus can be treated with surgery.

Objective:To investigate the relationship between the expressions of serum trans thyroxine protein (TTR) , retinol binding protein 4 (RBP4) and metabolic syndrome of pregnancy (GMS) .Methods:A total of 103 patients with GMS from May. 2017 to Dec. 2019 were selected as the observation group, in addition, 100 healthy pregnant women with single pregnancy and no complications were selected as control group. Before pregnancy, the height and weight were detected. After the diagnosis of GMS, serum markers and blood pressure were detected. The levels of total cholesterol (TC) , triglyceride (TG) , low density lipoprotein cholesterol (LDL-C) , high density lipoprotein cholesterol (HDL-C) and fasting blood glucose (FBG) were detected by Hitachi 7600 automatic biochemical analyzer, and the expression levels of TTR and RBP4 in serum were detected by enzyme-linked immunosorbent assay (ELISA) . Receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of TTR and RBP4 in GMS. Multivariate Logistic regression model was used to analyze the influencing factors of GMS in pregnant women.Results:There was no significant difference in age or gestational weeks between the two groups ( P>0.05) . Compared with those in the control group, the levels of BMI, TC, TG, LDL-C, FBG, systolic blood pressure, diastolic blood pressure, serum TTR and RBP4 expression levels were higher in the observation group before pregnancy ( P<0.05) , while HDL-C was lower ( P<0.05) . The area under the curve (AUC) of TTR and RBP4 alone or combination in the diagnosis of GMS was 0.797, 0.816 and 0.898, respectively. The cut-off value of TTR was 284.91 mg/L, and the sensitivity and specificity were 63.10% and 89.00%, respectively. The cut-off value of RBP4 was 17.89 mg/L, and the sensitivity and specificity were 69.90% and 87.00%, respectively. The sensitivity and specificity of the combined diagnosis were 83.50% and 84.00% respectively. Multivariate Logistic regression analysis showed that high level of TTR and high level of RBP4 were independent risk factors of GMS in pregnant women ( P<0.05) . Conclusions:The expression levels of serum TTR and RBP4 in GMS patients are high, and they have certain diagnostic value for GMS. They are independent risk factors of GMS in pregnant women, which may provide new ideas for the early diagnosis and prevention of GMS.

Objective:To investigate the clinical features, pathological types, imaging features, and surgical strategies of lateral skull base benign tumors with intracranial invasion.Methods:From January 2011 to March 2021, 36 patients of lateral skull base benign tumors with intracranial invasion were included in this retrospective study. Among the 36 patients, 14 cases were male, 22 cases were female, the aged range from 20-67, with the median age of 48. The clinical manifestations, characteristic imaging findings, pathological types, surgical approach selection, and prognosis were analyzed.Results:36 cases of lateral skull base tumors with intracranial invasion were all accepted surgeries. 23 cases were neurogenic tumors, facial nerve tumors ( n=8), neurogenic tumors in jugular foramen with unknown origin( n=6), hypoglossal schwannoma ( n=3), transotic intralabyrinthine schwannoma ( n=3), vestibular schwannoma involving the middle ear( n=2), vagal nerve schwannoma( n=1). Other types of tumors included meningioma ( n=10) and paraganglioma (Di 1 or 2, n=3). Different pathological types of tumors had different clinical manifestations and imaging manifestations. Sixteen cases were subjected to primary resection, while, other 20 cases underwent staged operation. Among the patients with staged operation, 10 patients had completed the second stage operation, five patients were waiting for the second stage operation, the other five patient′s residual intracranial tumor were significantly reduced and the space between tumor and brain tissues widened after the first stage operation, so, the following up with "wait and scan”policy was suggested. The total resection rate of tumors was related to the pathological nature, in which neurogenic tumors were 15/17, and meningiomas were 5/8. The main postoperative complications were cerebrospinal fluid leakage and infection in the operation area. There were two cases of postoperative intracranial infection, and three cases of cerebrospinal fluid leakage occurred in non staged operation cases. Conclusions:Lateral skull base tumors with intracranial invasion are rare. The most common pathological type is schwannoma, followed by meningioma and paraganglioma. For this type of tumor, if there is infection in the operation area and neck invasion is large, it is suggested to choose staged surgery, which can reduce the risk of intracranial infection and the incidence of cerebrospinal fluid leakage. Staged surgery strategy can also reduce the difficulty of second stage surgery, so the operation is much safer than non staged surgery.

Objective: To evaluate the feasibility of combining simultaneous triple semicircular canal plugging (TSCP) and cochlear implantation (CI) to treat vertigo and hearing loss in advanced Meniere's disease(MD) patients, so as to provide an alternative surgical procedure for treating this disorder. Methods: Data from seven patients, who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006), from Jan. 2015 to Jan. 2016, were retrospectively analyzed in this work. Seven patients, in whom the standardized conservative treatment had been given for at least one year and frequent vertigo still occurred, underwent simultaneous TSCP and CI under general anesthesia via mastoid approach. Postoperative follow-up time was more than six months. Vertigo control and auditory function were measured. Pure tone audiometry, speech perception scores, caloric test, head impulse test (HIT), and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular functions. Results: All patients had bilateral severe sensorineural hearing loss preoperatively. One side hearing loss was due to MD and another side was due to reasons including sudden sensorineural hearing loss, mumps and other unknown reason. The total control rate of vertigo in seven MD patients was 100.0% in the six-month follow-up, with complete control rate of 85.7% (6/7) and substantial control rate of 14.3% (1/7). Improved hearing threshold and speech perception scores were observed in all study participants. Postoperative average aided hearing threshold was 32.5 dBHL, the average monosyllabic word score was 42.6% and speech perception scores of sentences tested in quiet was 52.3%. Tinnitus improved in five cases, and no significant change in two patients. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3-5 days, while, an average recovery time of balance disorders was 19.7 days. Six months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP or oVEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Conclusions A combined approach of TSCP and CI which could control vertigo effectively and improve hearing loss and tinnitus represents an effective and safe therapy for some advanced MD patients.

OBJECTIVETo analyze factors relevant to revisional tympanomastoid surgery for chronic otitis media(COM).

METHODSThe clinical data of 159 patients (159 ears), who exhibited either wet ear or relapsed after the initial operation, and were subjected to revisional tympanomastoid surgery, were retrospectively analyzed in this study. Of those 159 consecutive patients, 85 were males and 74 were females, aged 11-64 years, with a median age of 36 years old. The situations in terms of intra-operative findings, surgical procedures, change dressing post-operation, dry ear time, and the improvement of aural ability during the second operation, were recorded and analyzed.

RESULTSThe second surgery found that, of those 159 patients underwent the re-operation, 67 presented with cholesteatoma and 92 had no cholesteatoma. In addition, the inadequate skeletonization and insufficient opening for mastoid cavity accounted for 70.4% (112/159) of all previous operations, the external auditory canal stenosis for 98.7% (157/159), the high facial ridge leading to insufficient drainage for 61.0% (97/159), the lesion in tympanic ostium of Eustachian tube for 34.6% (55/159), the insufficient drainage due to inappropriate post-operating dressing for 5.0% (8/159), the postauricular incision for 30.8% (49/159), and the endaural incision for 69.2% (110/159). As for the re-operation of the canal wall down mastoidectomy, tympanoplasty plus plastic repairing of cavity of concha were performed in 94 cases, the modified Bondy plus plastic repairing of cavity of concha in four cases, the radical mastoidectomy plus plastic repairing of cavity of concha in 59 cases, and the simple cleaning for mastoid cavity in two cases. Since one to two weeks after the revisional operations, the post-operating dressing was performed with aid of microscopy once a week on average. The average dry ear time ranged from 2 to 6 weeks (median=3 weeks). During a period of 6-93 months for the follow-up, all patients presented with dry ears. The epithelialization of the operating cavity was well and the tympanic membranes were integrity. Neither granulation tissue nor cholesteatoma was found to reoccur. Both pure tone hearing thresholds and air-bone gap decreased in 87 cases after the revisional operation, with statistically significant different in comparison to those two parameters before the operation (P<0.05).

CONCLUSIONThe primary causes responsible for the wet ear or reoccurrent cholesteatoma after tympanomastoid surgery may be related to the improper operation procedures and selection of incision, the non-standard operation, inexhaustive removal of pathological tissues, as well as the irregular postoperation change dressing, and other factors.

Adolescent ; Adult ; Child ; Cholesteatoma, Middle Ear ; surgery ; Chronic Disease ; Ear Auricle ; surgery ; Eustachian Tube ; pathology ; Female ; Humans ; Male ; Mastoid ; surgery ; Middle Aged ; Otitis Media ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; Reoperation ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane ; pathology ; surgery ; Tympanoplasty ; Young Adult

Objective To investigate the prognostic factors relevant to acute low-tone sensorineural hearing loss (ALHL).Methods 196 adult ALHL patients,including 82 males and 114 females with mean age of (43.1 ± 14.3)years old were included.All patients received the same therapy and were evaluated the curative effect.To evaluate the impact factors on the prognosis of hearing,inclusive of age,gender,time delay before the first visit,degree of deafness,vestibular function,electrocochleogram,and the serum levels of thyroxines by SPSS 18.0 software.Results Of those 196 patients with ALHL,124 (63.3％) were recovery,5(2.6％) were excellent better,42(21.4％) were better,and 25 (12.8％) were poor,with a total effective rate of 87.2％.Among 15 (12.1％) who recurred the hearing loss,2 developed into Meniere's disease during the follow-up.The mean age of patients with poor hearing effect was significantly older than that of other patients (P ＜ 0.05).No relativity was found between gender and hearing curative effect.There existed a statistical difference in total effective rate among subjects with different histories (P ＜ 0.05).In addition,the recovery rate was significantly different between groups,i.e.,the course of disease was less than 14 days,between 14 days and 6 months,and between 6 months and 2 years (P ＜0.05).There was no statistical significance in total effective rate among different degrees of deafness (P ＞ 0.05).However,in term of the recovery rate,the difference was statistical significance (P ＜ 0.05).The recovery rate in patients with mild hearing loss was higher than that in middle or heavy hearing loss (both P ＜ 0.05).Among patients with mild deafness,the recovery rate in patients whose history was less than 3 months was significantly higher than that more than 3 months (P ＜ 0.05).For moderate deafness patients,the recovery rate in patients whose history was less than 7 days was significantly higher than that more than 1 month (P ＜ 0.05).There were statistical differences in hearing effect of 130 (66.3％) patients with abnormal vestibular function in comparison to that with normal vestibular function (x2 =15.1,P ＜ 0.05).There were 17(8.7％) patients with abnormal electrocochleogram combined with abnormal vestibular function,and the hearing effects were all poor.There were 45 (23.0％) patients with abnormal thyroxine levels in serum,which was significant higher than that in health adults of 5.9％ (x2 =7.26,P ＜ 0.01).There was no significant difference in hearing prognosis between patients with abnormal and normal thyroxine levels (x2 =2.51,P ＞ 0.05).Conclusions With respect to ALHL,the hearing effect is associated significantly with the history.The severity of hearing loss is negative prognostic factor for hearing recovery.Age,vestibular function,and electrocochleogram might predict hearing recovery.Gender and thyroxine levels couldn't predict the hearing prognosis,although there is a high incidence rate in patients with ALHL.

OBJECTIVE: To explore the factors related to the occurrence of otitis media with effusion (OME) in patients with long-term tracheal intubation. METHOD: This retrospective study included 47 cases with endotracheal intubation more than 7 days (endotracheal intubation group) and 20 cases without mechanically ventilated in the same period(control group). The relationships between secretory otitis media with age, gender, intubation method,duration of intubation, breathing patterns, consciousness, gastric tube position were analysed. RESULT: The study showed 27 out of 47 patients in endotracheal intubation group had OME, 9 cases had negative pressure in the middle ear and 11 patients were normal. No OME was found in control group, and 2 cases with negative pressure in bilateral middle ear were detected. The incidence of OME was significantly increased in patients with the application of ventilator in PEEP mode or nasotracheal tube, and with conscious disturbance or tracheal intubation using for more than 10 days. The presence of OME had a significantly higher rate in patients with nasal intake subjects than the oral intake subjects. The incidence of OME decreased significantly in patients using glucocorticoid. CONCLUSION The incidence of OME increased in patients applied with tracheal intubation for more than 7 days. Ventilator in PEEP mode, nasotracheal tube, and conscious disturbance were closely related with OME. Application of glucocorticoids reduced the incidence of OME.
Ear, Middle ; Glucocorticoids ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal ; Otitis Media with Effusion ; Pressure ; Retrospective Studies

Objective To explore the long-term efficacy and safety of triple semicircular canal occlusion (TSCO) in the treatment of intractable Meniere's disease (MD) so as to provide an alternative surgical procedure for treating this disorder.Methods Data from Forty-nine patients,who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006) from Dec.2010 to Jul.2012,were retrospectively analyzed in this work.Forty-nine patients,in whom the standardized conservative treatment was given at least one year and frequent vertigo still occurred,received TSCO.Vertigo control and auditory function were measured.Pure tone audiometry,caloric test,and cervical vestibular evoked myogenic potential (cVEMP) were performed for evaluation of audiological and vestibular function.Magnetic resonance hydrograph of inner ear was performed in patients received TSCO after 2 years for the observation of morphology of membranous labyrinth.Postoperative follow-up period was more than 2 years.Results According to the preoperative staging of hearing,among these 49 patients,there were 2 cases in stage Ⅱ (with an average hearing threshold of 25-40 dBHL),40 in stage Ⅲ (41-70 dBHL) and 7 in stage Ⅳ (over 70 dBHL).Vertigo was controlled effectively in all 49 cases in two-year follow-up,of which 40 cases (81.6％) were completely controlled and 9 cases (18.4％) were substantially controlled after surgery.The rate of hearing preservation was 69.4％ and the rate of hearing loss was 30.6％.Post-operatively,all patients suffered from temporary vertigo and balance disorders.Vertigo was disappeared in all patients within 3-5 days,while averagely recovered after 13.5 days.Two years afer treatment,loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP test was noted.All patients had no facial paralysis,cerebrospinal fluid leakage,and other complications.Magnetic resonance hydrograph of inner ear showed that endolymph fluid in the position of plugging had no water after 2-years of TSCO.Conclusions TSCO,which can reduce vertiginous symptoms effectively in patients with intractable MD in long-term follow-up,represents an effective and safe therapy for this disorder.TSCO is expected to be used as an alternative procedure for the treatment of MD in selected patients suffering from severe hearing loss or recurrence after endolymphatic sac surgery.

OBJECTIVE: To study the changes in facial nerve function, morphology and neurotrophic factor III (NT-3) expression following three types of facial nerve injury. METHOD: Changes in facial nerve function (in terms of blink reflex (BF), vibrissae movement (VM) and position of nasal tip) were assessed in 45 rats in response to three types of facial nerve injury: partial section of the extratemporal segment (group one), partial section of the facial canal segment (group two) and complete transection of the facial canal segment lesion (group three). All facial nerves specimen were then cut into two parts at the site of the lesion after being taken from the lesion site on 1st, 7th, 21st post-surgery-days (PSD). Changes of morphology and NT-3 expression were evaluated using the improved trichrome stain and immunohistochemistry techniques ,respectively. RESULT: Changes in facial nerve function: In group 1, all animals had no blink reflex (BF) and weak vibrissae movement (VM) at the 1st PSD; The blink reflex in 80% of the rats recovered partly and the vibrissae movement in 40% of the rats returned to normal at the 7th PSD; The facial nerve function in 600 of the rats was almost normal at the 21st PSD. In group 2, all left facial nerve paralyzed at the 1st PSD; The blink reflex partly recovered in 40% of the rats and the vibrissae movement was weak in 80% of the rats at the 7th PSD; 8000 of the rats'BF were almost normal and 40% of the rats' VM completely recovered at the 21st PSD. In group 3, The recovery couldn't happen at anytime. Changes in morphology: In group 1, the size of nerve fiber differed in facial canal segment and some of myelin sheath and axons degenerated at the 7th PSD; The fibres' degeneration turned into regeneration at the 21st PSD; In group 2, the morphologic changes in this group were familiar with the group 1 while the degenerated fibers were more and dispersed in transection at the 7th PSD; Regeneration of nerve fibers happened at the 21st PSD. In group 3, most of the fibers crumbled at the 7th PSD and no regeneration was seen at the 21st PSD. Changes in NT-3: Positive staining of NT-3 was largely observed in axons at the 7th PSD, although little NT-3 was seen in the normal fibers. CONCLUSION Facial palsy of the rats in group 2 was more extensive than that in group 1 and their function partly recovers at the 21st PSD. The fibres' degeneration occurs not only dispersed throughout the injury site but also occurred throught the length of the nerve. NT-3 immunoreactivity increased in activated fibers after partial transection.
Animals ; Facial Nerve ; metabolism ; pathology ; physiopathology ; Facial Nerve Injuries ; classification ; metabolism ; pathology ; physiopathology ; Neurotrophin 3 ; metabolism ; Rats ; Rats, Wistar

OBJECTIVE: To detect the influence of heat coagulation of middle meningeal artery (MMA) on plasma CGRP and SP levels in migraine rat triggered by nitroglycerin (NTG). METHOD: Twenty-four female Wistar rats were randomly divided into four groups, with six rats in each group. In group A, rats were treated with isotonic saline; in group B, rats were injected subcutaneously with 10 mg/kg nitroglycerin to set up the animal model of migraine; in group C, rats were subjected to sham surgery by merely exposing MMA and then injected with nitroglycerin (10 mg/kg); and in group D, rats were firstly subjected to heat coagulation of MMA and, subsequently, injected with nitroglycerin (10 mg/kg). Following the injection, the animal's behavior was continuously recorded by an observer. Radioimmunoassay was employed to measure the amounts of CGRP and SP in venous plasma. RESULT: Injection of 10 mg/kg nitroglycerin was able to trigger the animal model of migraine as evidenced by the appearances of a series of symptoms, such as, scratching head frequently, climbing cage and red ear. Rats in group A occasionally showed off scratching head, whereas, rats from group B and group C presented with much severe symptoms. Of note, rats in group D appeared slightly scratching head and climbing cage, without red ear compared with group B and C. At the same time, the amounts of plasma CGRP and SP in group B, group C, or group D were increased significantly compared with that of group A (P < 0.05). Furthermore, the plasma CGRP and SP levels in group D were much lower than that in group B and group C (P < 0.05), but there was no statistical difference between group B and group C (P > 0.05). CONCLUSION Heat coagulation of MMA may relieve symptoms of rats following nitroglycerin infusion, possibly by inhibiting the release of CGRP and SP.
Animals ; Calcitonin Gene-Related Peptide ; blood ; metabolism ; Electrocoagulation ; Female ; Meningeal Arteries ; Migraine Disorders ; chemically induced ; metabolism ; therapy ; Nitroglycerin ; adverse effects ; Rats ; Rats, Wistar ; Substance P ; blood ; metabolism