[Characteristics of responsiveness of cochlear nerve to electrical stimulation in patients with cochlear nerve deficiency].

Objectives: This study aimed to evaluate the responsiveness of cochlear nerve to electrical stimulation in patients with cochlear nerve deficiency(CND), to compare their results with those measured in implanted children with normal-sized cochlear nerves, and to investigate the characteristics of the cochlear nerve injury of children with CND. Methods: Participants were children who underwent cochlear implantation at Shandong Provincial ENT Hospital from January 2012 to January 2020, including CND group and control group. The CND group included 51 subjects (male:20; female: 31) who were diagnosed with CND and had normal cochlea. For the CND group, four children had been bilaterally implanted, the mean implantation age was (2.7±1.5) years old. The control group included 21 subjects (male:10; femal:11) who had normal-sized cochlear nerve and normal cochlea. For the control group, all children had been unilaterally implanted except one, and the mean implantation age was (3.0±1.9)years old. Three subjects in the CND group used CI422 electrode arrays, and all the other subjects used CI24RECA/CI512 electrode arrays. The electrically evoked compound action potentials (ECAP) had been tried to record for each electrode using Custom Sound EP software (v. 4.3, Cochlear Ltd.) at least six months post first activation. Furthermore, ECAP amplitude growth functions (AGF) were measured at multiple electrode locations across the electrode array. Generalized linear mixed effect models with the subject group and electrode location as the fixed effects and subjects as the random effect were used to compare results of ECAP measurements. Results: In the control group, ECAP could been recorded at all electrodes (100%), but it could only be recorded in 71% (859/1 210) electrodes in the CND group. Additionally, the percentage of electrodes with measurable ECAP decreased from electrode 1 to electrode 22 in the CND group. Compared to the control group, the ECAP thresholds significantly increased, the ECAP amplitudes and AGF slopes significantly decreased, and the ECAP latency significantly increased in the CND group (P<0.01). GLMM showed that the stimulating site had a significant effect on the ECAP threshold, maximum amplitude, and AGF slope (P<0.01), but had no significant effect on the ECAP latency (P>0.05) in the CND group. However, the stimulating site had no significant effects on the ECAP measurements in the control group. Furthermore, the functional status of cochlear nerve varied greatly among CND group. From electrode 1 to electrode 22, the ECAP thresholds gradually increased, the ECAP maximum amplitudes and AGF slopes gradually decreased in the CND group. Conclusion: Compared with patients with normal-sized cochlear nerve, not only the number of residual spinal ganglion neurons reduce,but also the function of spinal ganglion neurons damages in CND patients. The degree of cochlea nerve deterioration varies greatly among CND patients. Generally, the deterioration of cochlear nerve tends to increase from the basal to the apical site of the cochlea.

[Diagnosis and treatment strategies of 56 cases of middle ear myoclonus].

Objective: To analyze the clinical characteristics and treatment of middle ear myoclonus. Methods: Fifty-six cases of middle ear myoclonus were enrolled in Shandong Provincial ENT Hospital, Shandong University from September 2019 to August 2021, including 23 males and 33 females. The age ranged from 6 to 75 years, with a median age of 35 years; Forty-seven cases were unilateral tinnitus, nine cases were bilateral tinnitus. The time of tinnitus ranged from 20 days to 8 years. The voice characteristics, inducing factors, nature (frequency) of tinnitus, tympanic membrane conditions during tinnitus, audiological related tests, including long-term acoustic tympanogram, stapedius acoustic reflex, pure tone auditory threshold, short increment sensitivity test, alternate binaural loudness balance test, loudness discomfort threshold, vestibular function examination, facial electromyography, and imaging examination were recorded. Oral carbamazepine and/or surgical treatment were used. The patients were followed up for 6-24 months and the tinnitus changes were observed. Results: Tinnitus was diverse, including stepping on snow liking sound, rhythmic drumming, white noise, and so on. The inducing factors included external sound, body position change, touching the skin around the face and ears, speaking, chewing and blinking, etc. Forty-four cases were induced by single factor and 9 cases were induced by two or more factors. There was no definite inducing factor in 1 case. One patient had tinnitus with epilepsy. One case of traumatic facial paralysis after facial nerve decompression could induce tinnitus on the affected side when the auricle moved. Tympanic membrane flutter with the same frequency as tinnitus was found in 12 cases by otoscopy, and the waveform with the same frequency as tinnitus was found by long-term tympanogram examination. There were 7 patients with no tympanic membrane activity by otoscopy, the 7 cases also with the same frequency of tinnitus by long-term tympanogram examination, but the change rate of the waveform was faster than that of the patients with tympanic membrane flutter. All patients with tinnitus had no change in hearing. One case of tinnitus complicated with epilepsy (a 6-year-old child) was treated with antiepileptic drug (topiramate) and tinnitus subsided. One case suffered from tinnitus after facial nerve decompression for traumatic facial paralysis was not given special treatment. Fifty-four cases were treated with oral drug (carbamazepine), of which 10 cases were completely controlled and 23 cases were relieved; 21 cases were invalid. Among the 21 patients with no effect of carbamazepine treatment, 8 patients were treated by surgery, 7 patients had no tinnitus after surgery, 1 patient received three times of operation, and the third operation was followed up for 6 months, no tinnitus occurred again. The other 13 cases refused the surgical treatment due to personal reasons. Conclusions: Middle ear myoclonus tinnitus and the inducing factors manifestate diversity. Oral carbamazepine and other sedative drugs are effective for some patients, and surgical treatment is feasible for those who are ineffective for medication.

[Short-term observation of electrical acoustic stimulation in patients with low frequency residual hearing after cochlear implant].

Objective: To analyze the effects of electrical acoustic stimulation (EAS) on speech and tone recognition as well as music perception in children with low-frequency residual hearing (LFRH) after cochlear implant (CI). Methods: A total of twelve Mandarin patients with LFRH who underwent unilateral CI from January 2017 to October 2020 were recruited, including 8 males and 4 females. There were 5 cases of pre-lingual deafness and 7 cases of post-lingual deafness. The median age at implantation was 12 years old (3-62 years). All patients had residual hearing (RH) before surgery, wore hearing aid (HA) timely, had an effective rehabilitation and the duration of use of electrical stimulation was 37.0±16.2 months. On the implanted side, the thresholds of 125 Hz and 250 Hz were less than and equal to 80 dB HL after implantation. A two-month follow-up clinical study was conducted with the EAS devices. The EAS effects were evaluated before, immediately after and 2 months after upgrade, including speech recognition rate, tone recognition and music tests. SPSS 23.0 software was used for statistical analysis. Results: A total of ten patients completed a two-month clinical follow-up and efficiency evaluation. Compared to the electrical stimulation, the recognition rate of spondee word significantly decreased after the immediate use of EAS (71.7±4.3 vs 79.6±3.1, P=0.018). Compared to the electrical stimulation as well as immediate use of EAS, the results of sentence in noise, tone in noise, and SRT of sentence in noise were all significantly improved at 2 months after use of EAS (P<0.05). The pitch discrimination was significantly improved at 2 months after the use of EAS compared with that before the use of EAS (P=0.042). Compared with before (P=0.021) and immediately (P=0.017) use of EAS, the ability of rhythm resolution was significantly improved. There were no significant differences in other test results (P>0.05). Conclusions: The low-frequency acoustic information provided by EAS as well as the electrical-acoustic stimulation mode can provide rich auditory cues of speech perception in noise, tone recognition in noise, and musical discrimination for CI subjects. It can promote the improvement of complex listening ability of CI patients undergoing long-term electrical stimulation in a short time and comprehensively improve their hearing capacities.

[The changes of blood-labyrinth barrier in idiopathic sudden sensorineural hearing loss and the relationship with clinical features and prognosis].

Objective: To investigate the clinical features and prognosis in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) with blood-labyrinth barrier breakdown (BLB-B). Methods: Clinical data of patients with unilateral ISSNHL hospitalized from December 2017 to December 2018 were retrospectively analyzed. According to the results of 3D-FLAIR MRI and enhanced MRI scanning, these patients were divided into two groups, i.e., normal and abnormal inner ear groups. The patients in abnormal inner ear group were further divided into two subgroups: BLB-B and BLB-B with exudation. The differences and correlations among the groups in clinical characteristics, in terms of gender, age, deafness side, basic diseases, dizziness/vertigo, vestibular function, hearing loss degree, as well as classification of hearing curve, and prognosis were analyzed by statistical software SPSS 23.0. Results: Data were collected from 150 cases, in which 68 were male and 82 were female, aged (46.2±14.6) years, including 67 cases with normal inner ears and 83 cases with abnormal inner ears (13 cases with BLB-B; 70 cases with BLB-B and exudation). The dizziness/vertigo incidence, side ratio, hearing loss degree, classification of hearing curve, vestibular dysfunction (vestibular double temperature test, HIT and VAT) and therapeutic effect were different between normal and abnormal inner ear groups (P<0.05). The dizziness/vertigo incidence, side ratio, hearing loss degree, classification of hearing curve, vestibular dysfunction (vestibular double temperature test, o/cVEMP, HIT and VAT) and therapeutic effect were different among normal inner ear, BLB-B and BLB-B with exudation groups (P<0.05). Pairwise comparison between groups revealed that vestibular dysfunction (vestibular double temperature test, o/cVEMP, HIT and VAT) and therapeutic effect were different between normal inner ear and BLB-B groups (P<0.05); The dizziness/vertigo incidence, side ratio, hearing loss degree, classification of hearing curve, vestibular dysfunction (vestibular double temperature test, o/cVEMP, HIT and VAT) and therapeutic effect were different between normal inner ear and BLB-B with exudation groups (P<0.05). There was no significant different between BLB-B and BLB-B with exudation groups. Conclusion: BLB-B displayed by 3D-FLAIR MRI manifestation in ISSNHL patients indicates more serious cochlear and vestibular dysfunction, and worse therapeutic effect.

[The surgical management of benign tumors of the lateral skull base with intracranial invasion: experience from a single centre over ten years].

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.

[Preliminary analysis of pulse-step-sine test results in healthy population].

Objective: To analyze the characteristics of pulse-step-sine (PSS) test in healthy people of different ages and to discuss its clinical value. Methods: From July 10, 2018 to December 9, 2020, a total of 78 healthy volunteers, including 40 males and 38 females, were enrolled and divided into youth group, middle age group and old age group. The I Portal NOTC rotational-chair system (NKI) was applied for PSS detection to analyze the clinical characteristics of gain, phase, asymmetry, and slope of step and sinusoidal components. Statistical analysis was performed using SPSS17.0 software. Results: In the same age group, there were no statistically significant differences in left and right step gain, slope gain and sine gain (All P values were greater than 0.05). Pairwise comparison between different age groups showed that there was no significant difference in the corresponding parameters between the youth group and the middle age group. Compared with young group, the old age group had a significantly lower step gain value in their left side (P<0.01) but not in the right side (P>0.05).The left and right slopes of the old age group were significantly lower than those of the young group and the middle group, and the differences were statistically significant (All P values<0.05). Conclusion: The PSS test can detect bilateral and unilateral horizontal semicircular canal function with good tolerance in different age groups, better than the traditional rotational chair examination to determine the well-compensated unilateral vestibular function. PSS test is a new vestibular detection method.

[Correlation analysis of 3D-FLAIR MRI characteristics of the inner ear and vestibular function in the patients with vestibular neuritis].

Objective: The characteristics of 3D-FLAIR MRI images of the inner ear of patients with vestibular neuritis were preliminarily studied to explore the possible pathogenesis of vestibular neuritis, and the correlation analysis was conducted in combination with vestibular function to provide a basis for accurate diagnosis of vestibular neuritis. Methods: A total of 36 patients with vestibular neuritis (VN) from December 2019 to October 2020 were collected from the Vertigo Department of Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University. There were 36 cases (18 females, 18 males) with unilateral acute vestibular neuritis, 17 cases of left ear and 19 cases of right ear. According to the results of 3D-FLAIR MRI in the inner ears, the patients were divided into the enhanced group and the non-enhanced group (the health side served as the normal control group). The results of vestibular function examination in the two groups were compared. SPSS19.0 software was used for statistical processing to analyze the relationship between the vestibular function and the characteristics of 3D-FLAIR imaging in the inner ears. Results: Abnormal enhancement of 3D-FLAIR was found in 31 cases (86.1%) of the 36 cases, including 14 cases of both vestibular nerve and vestibular terminal organ enhancement, eight cases of superior vestibular nerve enhancement alone, seven cases of vestibular terminal organ enhancement alone, and two cases of cochlear enhancement alone. Observation of abnormal reinforcement of vestibular nerve showed: twenty-one cases of superior vestibular nerve reinforcement, one case of superior and inferior vestibular nerve reinforcement. No abnormalities were found in 3D-FLAIR of inner ear in 5 cases. According to the analysis of vestibular function results, there were 19 cases (52.8%) with total vestibular involvement, sixteen cases (44.4%) with superior vestibular involvement alone, and one case (2.8%) with inferior vestibular involvement alone. Comparison of vestibular function between the five cases (non-enhancement group) and the 31 cases (enhanced group) in the 3D-FLAIR group of the inner ears showed that the CP values of caloric tests in the enhanced group were higher (60.81±3.49 vs 34.12±7.37), with statistically significant difference (t=-2.898, P<0.01). Conclusion: In patients with vestibular neuritis, 3D-FLAIR MRI scan of the inner ear provides visual imaging evidence for clinical practice, considering that the lesion site of vestibular neuritis is not only in the vestibular nerve, but also in the vestibular end organ. Patients with 3D-FLAIR enhanced in the inner ear may have more significant vestibular function damage.

[The imaging characteristics and prognosis of patients with cochlear implants whose cochlear nerves are not shown on MRI].

Objective: To analyze the temporal bone CT and inner ear magnetic resonance imaging characteristics of cochlear implant patients with no cochlear nerve display in the inner auditory canal under MRI. To retrospectively analyze the long-term hearing and speech rehabilitation effects of such patients after cochlear implant. And to analyze the correlation between the results of imaging examinations and the postoperative effects of cochlear implant patients with this type of cochlear nerve deficiency. Methods: A total of 88 children with cochlear nerve deficiency, who underwent cochlear implantation in Shandong Provincial ENT Hospital from May 2014 to October 2018, were enrolled. Patients with cochlear malformations were excluded,only the patients with cochlear nerve deficiency whose cochlear structure was normal and no cochlear nerve displayed in inner auditory canal under MRI were enrolled. There were 64 patients, including 4 bilaterally implanted, 68 ears in total, with an average age of (2.8±1.7) years (range 1-6 years) at the time of implantation. The implanted product was Cochlear, including 24RECA and 512 models. All patients underwent inner ear magnetic resonance imaging and temporal bone CT scan before operation. Auditory speech function assessments were performed at 12 months, 24 months, and 36 months after surgery, including categories of auditory performance (CAP), speech intelligibility rating (SIR) and hearing aid threshold test. The imaging evaluation content included the width of the cochlear nerve canal of temporal bone CT, the width of the internal auditory canal, the width of the auditory nerve at the cerebellopontine angle of the inner ear MRI, and the ratio of the facial nerve to the width of the auditory nerve at the cerebellopontine angle. The correlations between the results of postoperative hearing aid hearing threshold, CAP, SIR and imaging results were analyzed. Results: Among the 64 cases of cochlear nerve not shown under MRI, 56 ears with CT data showed that the width of the cochlear nerve canal in temporal bone CT was (0.72±0.30) mm (mean±standard deviation, the same below), and the width of the internal auditory canal was (4.07±1.10) mm; 66 ears with MRI data showed that the diameter of the auditory nerve at the cerebellopontine angle of the inner ear MRI was (1.58±0.27) mm, the diameter of the facial nerve was (1.57±0.27) mm, and the ratio of the diameter of the facial nerve to the auditory nerve was (1.02±0.23). The average hearing thresholds at 12, 24, and 36 months after surgery were (46.8±2.5) dB HL, (40.7±0.8) dB HL, and (36.8±1.5) dB HL, respectively. The preoperative and postoperative CAP scores at 12, 24 and 36 months were (1.0±1.0), (3.8±1.4), (4.5±1.4) and (5.1±0.7) points, respectively. The preoperative and postoperative SIR scores at 12, 24, and 36 months were (1.1±0.3), (1.9±0.9), (2.5±0.9), and (2.9±0.6) points, respectively. The hearing threshold at 24 months after surgery was negatively correlated with the width of the internal auditory canal of temporal bone CT (r=-0.349, P=0.037), and the hearing threshold at 36 months after surgery was positively correlated with the ratio of the diameter of the facial nerve to the auditory nerve at the cerebellopontine angle of the inner ear MRI (r=0.740, P=0.001). Conclusions: Children with cochlear implants whose cochlear nerves are not shown on MRI can benefit from cochlear implantation, and their speech and auditory functions can improve significantly after surgery. The width of the internal auditory canal in the temporal bone CT and the ratio of the diameter of the facial nerve to the auditory nerve at the cerebellopontine angle of the inner ear MRI may be related to the long-term hearing threshold after surgery.

[Frequency characteristics of horizontal semicircular canals damage and the ultrastructure analysis of crista ampullaris in patients with Meniere's disease].

Objective: To investigate the frequency characteristics and the pathological characteristics of the horizontal crista ampullaris in patients with Meniere's disease,and to analyse its structural basis. Methods: Between March, 2019 and November, 2019, seventy-two patients diagnosed as Meniere's disease (27 males and 45 females, aged from 13 to 74 years, with a course of disease ranging from 4 months to 32 years)in Shandong Provincial ENT Hospital were included.Caloric test, sinusoidal harmonic acceleration test (SHA), video-head impulse test (v-HIT), Gadolinium-enhanced inner-ear 3D-FLAIR MRI and pure tone audiometry were conducted in the patients. The function of the horizontal semicircular canal in these patients were analysed as well as its relationship with the degree of endolymphatic hydrops,clinical stage and duration. Light microscopy and transmission electron microscopy were used to observe the ultrastructure of horizontal semicircular canal crista ampullaris from six patients with refractory Meniere's disease who underwent labyrinthectomy. The number of type Ⅰ and type Ⅱ vestibular hair cells, the common pathophysiological changes of horizontal semicircular canal crista ampullaris were investigated in these patients. Statistical analysis was performed using SPSS 19.0. Results: With the increase of detection frequency, the abnormal rate decreased gradually. The abnormal rate of caloric test was 69.4% (50/72), SHA 51.4% (37/72), V-HIT 36.1% (26/72), comparation of the positive rate among the three tests showed statistically significant differences(P<0.05).Neither caloric test nor SHA had correlation with the degree of hydrops(P>0.05), but v-HIT(r=0.434,P<0.01).There was correlation with clinical stage to SHA and v-HIT(r=0.338,0.462,P<0.01), except caloric test(P>0.05).No significant relation was found with caloric test, SHA, v-HIT and course of disease(P>0.05).Morphological observation found abnormal monolayer epithelialization of the horizontal semicircular canal crista ampullaris significantly decreased number of type Ⅱ hair cells compared with type Ⅰhair cells. Hair cells showed perinuclear vacuolization, cytoplasmic vacuoles, mitochondrial electron density increasement and loss of stereocilia. Conclusions: The horizontal semicircular canal damage in the patients with Meniere's disease has a frequency-dependent characteristic, mainly occurres in low frequency area. With progress of the disease, the high frequency area of ampulla will be impaired gradually, and it is related to the degree of endolymphatic hydrops and hearing level. Hair cell injury would be observed,the frequency characteristics may be more associated with the disorder of type Ⅱ hair cells.

[Analysis of incidence characteristics of occupational chronic benzene poisoning under two diagnostic criteria].

Objective: To analyze the incidence characteristics of occupational chronic benzene poisoning under two diagnostic criteria. Methods: In March 2020, 126 patients who were divided into the old criteria group (74 cases) and the new criteria group (52 cases) were retrospectively analyzed. These patients were diagnosed with occupational chronic benzene poisoning, and were diagnosed in our hospital during the period of January 2009 to December 2019. The gender composition, age of onset, years of benzene exposure, industry distribution, work type, benzene concentration in working environment and diagnostic grade of the two groups of patients were analyzed and compared. The follow-up of 22 benzene poisoning observation subjects under the old criteria were retrospectively analyzed. Results: There were no statistically significant differences in gender composition, age of onset, years of benzene exposure, industry distribution and work type between the old criteria group and the new criteria group (P>0.05) . In the old criteria group and the new criteria group, 41.9% (31/74) and 17.3% (9/52) of the patients' workplace benzene concentration exceeded the maximum allowable concentration, respectively. The composition of different benzene concentration in the workplace between the two groups showed statistically significant (P<0.05) . In the old criteria group, the proportion of mild poisoning (79.7%, 59/74) was the majority, while in the new criteria group, the proportion of moderate and severe poisoning (51.9%, 27/52) were the majority, and there was statistically significance in the composition ratio of diagnostic grade between the two groups (P<0.05) . Under the old criteria, after folow-up of 22 cases of benzene poisoning observation subjects, we observed that 8 cases (36.4%) progressed to the level of chronic benzene poisoning. Conclusion: The revision of diagnostic criteria for benzene poisoning may affect the composition of diagnosis classification. Based on the rights and interests of workers, formulating more complete diagnostic criteria and system policies will be more conducive to the development of occupational benzene poisoning prevention and control.

[3D-FLAIR MRI findings in idiopathic sudden sensorineural hearing loss and the correlations with clinical features and prognosis].

Objective: To explore the correlations of different appearances of labyrinthine 3D-FLAIR MRI with clinical features and prognosis in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: Clinical data of patients with unilateral ISSNHL hospitalized from May 2017 to January 2019 were retrospectively analyzed. According to the results of 3D-FLAIR MRI, the patients were divided into three groups including hyperintense with absorption, hyperintense without absorption and normal. The differences and correlations among the three groups in clinical characteristics (gender, age, deafness side, duration, treatment days, dizziness/vertigo, basic diseases, vestibular function, deafness classification and typing) and prognosis were analyzed by SPSS 20.0 software. Results: Data were collected from 1 245 cases, including 739 (59.36%) with normal signal, 288 (23.13%) hyperintense without absorption, and 218 (17.51%) hyperintense with absorption. The side ratio, treatment days, dizziness/vertigo incidence, vestibular dysfunction, deafness classification and typing were different among the three groups (P<0.001). The incidence of right side was significantly higher in both the hyperintense with and without absorption groups than that in the normal. The vestibular dysfunction was more common in the hyperintense with absorption group than in the normal and hyperintense without absorption groups. It showed statistical differences in the dizziness/vertigo incidence, deafness classification, treatment days, and deafness typing compared between groups, which was the most significant in the hyperintense with absorption group, followed by the hyperintense without absorption group. There was no statistical difference in the total effective rate among the three groups (P=0.139), whereas a significant difference in the recovery rate (P<0.001). The prognosis was significantly correlated with duration, age, treatment days and dizziness/vertigo in the normal group (all P<0.001), correlated with duration and treatment days in the hyperintense with absorption group (both P<0.001), only correlated with the duration in the hyperintense without absorption group (P<0.001). Conclusion: 3D-FLAIR MRI manifestation is closely related to the clinical features and efficacy of ISSNHL. It is helpful to clarify the pathology of inner ear, which is expected to be a new imaging indicator for disease evaluation.

[Changes of neuron specific enolase in serum of patients with silicosis].

Objective: To explore the changes of neuron specific enolase (NSE) concentration in serum samples of patients with silicosis. Methods: In January 2020, 455 cases of silicosis diagnosed in Yantaishan Hospital from January 2018 to December 2019 were collected, and 60 healthy cases and 120 cases of lung cancer were selected as the healthy group and the lung cancer group. The serum levels of NSE were detected by chemical immunofluorescence assay and compared. Results: The serum NSE level of silicosis patients was [(22.88±7.86) ng/ml], higher than that of healthy group [(17.96±4.42) ng/ml] (P<0.05) . Serum NSE levels in the first, second and third stage silicosis groups were higher than those in the healthy group (P<0.05) , but there was no statistically significant difference between the silicosis groups at different periods (P>0.05) . The serum NSE level of silicosis patients was lower than that of the small cell lung cancer group (P<0.05) , but there was no statistically significant difference between silicosis group and non-small cell lung cancer group (P>0.05) . The area under curve of silicosis NSE was 0.718 (P<0.01) when the cut-off was 17.49 ng/ml, the sensitivity and specificity of NSE was 78% and 57% respectively. Conclusion: The serum NSE level of patients with silicosis is significantly increased, which can be used as an important reference index for the diagnosis and the differential diagnosis of silicosis.

[Analysis of prognostic factors of low-frequency type of sudden sensorineural hearing loss].

Objective: To investigate the prognostic factors of patients with low-frequency type of sudden sensorineural hearing loss. Methods: From February 2017 to February 2019, adult patients with unilateral low-frequency type of sudden sensorineural hearing loss in Department of Otological Medicine, Shandong Provincial ENT Hospital, Shandong University were selected. All patients were examined by audiology, vestibular function evaluation, imaging examination and serum thyroid function test; the same treatment program was given, the curative effect was recorded and followed up for more than 3 months. SPSS 20.0 software was used to analyze concomitant symptoms (tinnitus, ear tightness, echo, rotatory vertigo), degree of deafness, inducement of deafness, basic disease, vestibular function (caloric test), electrocochleogram, inner ear gadolinium enhanced MRI radiography and thyroid function on prognosis of patients. Results: Among the 155 patients, 76 cases were cured (49.0%), 1 case was markedly effective (0.6%), 19 cases were effective (12.3%), and 59 cases were ineffective (38.1%). The total effective rate was 61.9%. Among them, 24 cases (15.5%) had hearing fluctuations during follow-up, and 1 case (0.6%) developed Meniere's disease. Univariate analysis showed that vestibular function, electrocochleogram and inner ear MRI were correlated with prognosis. Multivariate logistic analysis showed that ear tightness, vestibular function, electrocochleogram and inner ear MRI were correlated with the prognosis of the patients. The two analyses showed that tinnitus, echo, rotational vertigo, degree of deafness, predisposing factors and underlying diseases were not significantly correlated with the prognosis of the patients (all P>0.05). Rotational vertigo was closely related to gender, and women had a high incidence. There was a significant correlation between the degree of deafness and prognosis in patients with course of less than 1 week (P<0.05). The abnormal rate of vestibular function in patients with course of disease ≤ 1 week was significantly different from that>1-≤2 and>2-≤4 weeks (P<0.05). The rate of abnormal thyroid function was significantly higher than that of normal people (P<0.05), but there was no significant correlation between thyroid dysfunction and hearing prognosis (χ(2)=0.009, P=0.923) . Conclusions: The prognosis of low-frequency sudden sensorineural hearing loss is not related to clinical symptoms, inducements, underlying diseases and serological abnormalities of thyroid function, but the degree of deafness is positively related to the prognosis within 1 week from onset. Abnormal thyroid function is one of the risk factors of happening with low-frequency descending sudden deafness. Abnormal vestibular caloric test, electrocochleogram and endolymph hydrops are the factors of poor prognosis.

CHCHD2 decreases docetaxel sensitivity in breast cancer via activating MMP2.

OBJECTIVE: This study aims to clarify the influences of CHCHD2 and MMP2 on docetaxel resistance in breast cancer. PATIENTS AND METHODS: Differential levels of CHCHD2 in breast cancer and para-tumor tissues were detected. The relationship between CHCHD2 and prognosis in breast cancer patients was analyzed. After generating Docetaxel-resistant breast cancer cell lines (MCF-7/DTX and SKBR3/DTX), the regulatory effects of CHCHD2 on proliferative and migratory potentials were assessed by Cell Counting Kit-8 (CCK-8) and transwell assay, respectively. The interaction between CHCHD2 and MMP2 was tested by Western blot and Pearson correlation test. At last, the involvement of MMP2 in CHCHD2-regulated proliferation and migration in Docetaxel-resistant breast cancer cells was analyzed. RESULTS: CHCHD2 was upregulated in breast cancer tissues. It predicted high incidence of distant metastasis and poor prognosis in breast cancer patients. Proliferation inhibition rate was lower in MCF-7/DTX and SKBR3/DTX cells compared with their parental cells. After knockdown of CHCHD2 in MCF-7/DTX and SKBR3/DTX cells, their proliferative and migratory potentials were markedly reduced. MMP2 was upregulated in breast cancer tissues, and its level was positively regulated by CHCHD2. Overexpression of MMP2 could reverse the regulatory effects of CHCHD2 on proliferative and migratory potentials in MCF-7/DTX and SKBR3/DTX cells. CONCLUSIONS: Upregulated CHCHD2 in breast cancer is related to distant metastasis rate and poor prognosis. CHCHD2 and MMP2 are positively correlated to each other. CHCHD2 stimulates proliferative and migratory potentials in Docetaxel-resistant breast cancer cells by upregulating MMP2.

[Normalization in axillary lymph node management after neoadjuvant therapy for breast cancer].

Downstaging of breast cancer primary lesions and metastatic axillary lymph nodes among patients who underwent neoadjuvant chemotherapy (NAC) has raised the new challenges and opportunities on individualized breast cancer surgical treatment. Downstaging of the primary lesion has given patients that were previously deemed inoperable or not suitable for surgery a second chance. While downstaging of the lymph nodes has made it possible for sentinel lymph node biopsy (SLNB) to safely replace axillary lymph node dissection. However, the detection rate and false negative rate of early breast cancer SLNB technique in post-NAC patients barely meet the standard of clinical practice. Therefore, it is required that SLNB in post-NAC patients to be carried out by a medical team with advanced imaging equipments and extensive experiences in SLNB. Furthermore, they should be able to precisely evaluate axillary lymph node status before and after NAC as well as mark metastatic lymph node before NAC. Indications of SLNB should be restricted to patients that are downstaged from cN0 to ycN0 or from cN1 to ycN0. Particularly, it is only safe for patients whose axillary lymph node status become negative after NAC to receive SLNB when dual tracer (blue dye and radionuclide), removing more than 2 sentinel lymph nodes and targeted axillary dissection technique are used.

[Cochlear implantation and early outcomes in children with incompletely partition type â ¢ malformation].

Objective:To analyze the early effect of the cochlear implantation (CI) in children with cochlear incompletely partition type Ⅲ malformation (IP-Ⅲ). Method:Ten children with IP-Ⅲ malformation who underwent CI were recruited in this study. The hearing characteristics, preoperative speech performance and surgery were analyzed retrospectively. The aided hearing threshold with CI, the categories of auditory performance (CAP) score, speech intelligibility rating (SIR) score and speech perception were designed to access the benefits of CI. Ten children with normal cochlea were also enrolled as the control group. Demographic information of children in the control group including hearing loss and speech level before implantation, age at implantation, hearing aids using history, duration with CI were matched with those in the IP-Ⅲ group. The hearing threshold, CAP score and SIR score in the IP-Ⅲ group were compared with the control group using the SPSS 20.0 software. Result:The computed tomography of temporal bones showed typical IP-Ⅲ malformation in all patients. The electrode arrays were properly and totally implanted in all children. Cerebrospinal fluid gusher occurred intra-operatively, and no other complications in all patients. The pure tone average (PTA) threshold at the 3rd, 6th, 9th and 12th month after implantation were (40.8±8.5) dB HL, (36.1±9.1) dB HL, (32.5±6.8) dB HL and (33.0±7.3) dB HL, respectively. The PTA thresholds in the IP-Ⅲ group were similar to those in the control group at all tested time points (P>0.05). At the 3rd, 6th, 9th and 12th month after implantation, the CAP scores in the IP-Ⅲ group were lower than those in the control group, but there was no significantly difference (P>0.05). Furthermore, the SIR scores were lower than those in the control group, and there were significantly difference at the 6 th, 9 th and 12 th month after implantation (P<0.05). Conclusion:CI was an effective treatment for children with IP-Ⅲ malformation. Surgery on IP-Ⅲ was challenging, however, seldom complication would occur with excellent surgical skills. Though the CI was benefit for IP-Ⅲ, the development of hearing and speech ability were slower than children with normal cochlea.

[Simultaneous triple semicircular canal plugging and cochlear implantation in advanced Meniere's disease].

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.