Assessment of dysphagia: report of 37 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the assessment methods of dysphagia.</p><p><b>METHODS</b>The data of 37 patients with dysphagia were retrospectively analyzed. These patients took the Kubota drinking test, Tengdao's evaluation, videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES).</p><p><b>RESULTS</b>Fourteen out of thirty-seventh patients showed abnormal results during Kubota drinking test. Tengdao's evaluation results showed that 29/37 patients were abnormal. There 27/37 and 33/37 patients showed abnormalities in positive-aspiration score and swallow dysfunction score of VFSS. The number of abnormal patients in aspiration score of FEES was 19/21. The Kappa values were 0.137, 0.416 between Kubota drinking test. Tengdao's evaluation and VFSS. The FEES was measured against the VFSS for sensibility, specificity, positive predictive value, and negative predictive value, the values were 88.9%, 66.7%, 94.1% and 50.0%.</p><p><b>CONCLUSIONS</b>Kubota drinking test and Tengdao's evaluation can be applied for screening purpose and evaluating result after treatment; VFSS and FEES can be used as more accurate assessments, they can study the dysphagia's character, position and severity. The combination of a variety of dysphagia evaluation methods is the most important basis for diagnosis and treatment of deglutition disorders.</p>

MRI features of olfactory bulb volume in healthy middle and old-aged persons / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the differences of olfactory bulb (OB) volumes between younger and older, male and female, left-side and right-side in healthy middle and old-aged persons by MRI.</p><p><b>METHODS</b>Ninety five healthy middle and old-aged volunteers (male:female = 45:50) were divided into 2 groups, group one included persons aged from 50 to 69, group two included persons elder than 70. The left-side, right-side and both-side volumes of OB, the volumes of brain and the ratio of OB/brain were measured by MRI.</p><p><b>RESULTS</b>(1) The left-side and both-side volumes of OB (x(-) +/- s), the volumes of brain [(39.89 +/- 8.7) mm(3), (81.70 +/- 16.8) mm(3) and (1281.86 +/- 140.2) cm(3)] in 50 - 69 years old group were respectively larger than those in >/= 70 years old group [(34.45 +/- 10.4) mm(3), (72.10 +/- 19.3) mm(3) and (1165.77 +/- 165.3) cm(3)], and the differences reached statistical significance (t were respectively 2.649, 2.449, 3.516, all P < 0.05). There were no significant differences of right-side OB volumes and the ratio of OB/brain between 50 - 69 years old group and >/= 70 years old group (t were respectively 1.904, 0.616, each P > 0.05). (2) The male's OB volumes of left-side, right-side and both-side, the brain volumes and the ratio of OB/brain were respectively larger than females', and the differences reached statistical significance (t were respectively 4.461, 3.630, 4.399, 3.800, 2.400, all P < 0.05). (3) The right-side OB volumes were larger than left-side's and significant differences were found in female group, 50 - 60 years old group and >/= 70 years old group (t were respectively 2.732, 2.117, 3.516, all P < 0.05). There were no significant differences of OB volumes between left-side and right-side in female (t = 2.649, P = 0.110). The ratio of right-side OB/brain were larger than the ratio of left-side's and the differences reached statistical significance (t = 3.183, P = 0.002).</p><p><b>CONCLUSIONS</b>MRI could be used to measure the volume of OB. The older the people, the smaller the OB volumes. There was no influence of age on the ratio OB/brain. The OB volumes of right-side were larger than those of left-side. The OB volumes of male were larger than those of female.</p>

Clinical analysis of otogenic intracranial complications / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and treatment protocols of otogenic intracranial complications in Peking Union Medical College Hospital.</p><p><b>METHODS</b>Retrospective study of 14 patients (10 males and 4 females, aged between 12 - 62 years, mean age 32.1 years) hospitalized from 1982 - 2006. Twelve cases were otitis media (OM) with cholesteatoma, the other 2 cases were non-cholesteatomatous OM. All the otogenic intracranial complications located at the same sides as otologic disorders. Brain abscess was the most common type of otogenic complications and Proteus was the most common microorganism detected. Suppurative ear discharge, headache, high fever and nausea with vomiting were the most common clinical manifestations with very high incidences. All the patients received combined protocols of mastoid surgeries and antibiotics treatment.</p><p><b>RESULTS</b>All the 14 patients recovered clinically. For patients discharged before 1987, there were 4 patients followed up for 22.5 - 24.4 years with a mean time of 23.8 without recurrence, 1 patient died of cardiovascular disease 19.2 years later after discharge, 4 patients lost follow-up. For the 5 patients discharged after 1997, brain abscess recurred in one patient with pseudo-recovery after 24 days and he fully recovered after re-hospitalization and treatment. All the five patients were followed up for 1.5 years to 10.6 years with a mean time of 6.5 years without recurrence.</p><p><b>CONCLUSIONS</b>Youngsters and males seemed to be more vulnerable. Brain abscess was the most common intracranial complication and Proteus was the most common pyogenic microorganism. Combination of mastoid surgery and antibiotics were essential for effectively controlling the intracranial complications and improving the recovery. CT and MRI were essential for correct diagnosis bedtimes and MRI seemed to have a better performance.</p>

Management of nasopharyngeal stenosis following uvulopalatopharyngoplasty / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Severe nasopharyngeal stenosis (NPS) is a rare complication of uvulopalatopharyngoplasty (UPPP) and very difficult to manage. This report presents our successful treatment experience.</p><p><b>METHODS</b>From Nov 1997 to Feb 2006, 6 adults patients with NPS secondary to UPPP were treated in Peking Union Hospital. Two cases was grade II stenosis, received surgery of local pharyngeal and soft palate mucosa flap rotation to enlarge nasopharyngeal airway with stenosis; For the remaining 4 cases with more severe NPS (grade III) who had received 1-3 times unsuccessful repair procedures previously, prolonged nasopharyngeal hollow obturators were used for 6 months after stenosis repair surgery.</p><p><b>RESULTS</b>With 9-48 months follow-up, All cases results were satisfactory. Nasal obstruction symptom was eliminated, NPS corrected, no velopharyngeal insufficiency complication happened. Daytime removable nasopharyngeal hollow stent obturators with palate support device is more comfortable for patients.</p><p><b>CONCLUSIONS</b>Local flap rotation to enlarge stenosis airway and prolonged use nasopharyngeal hollow obturators are reliable methods of correction NPS following UPPP.</p>

Comparison of diagnosis and localization methods in obstructive sleep apnea syndrome: apneagraph vs polysomnography and apneagraph vs endoscopy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>ApneaGragh is a new device for simultaneous determination of obstructive sleep apnoeic events and continuous pressure measurements for localization of upper airway obstructive site. This study is to evaluate the clinical value of it.</p><p><b>METHODS</b>From April to October in 2006, 32 obstructive sleep apnea (OSA) patients diagnosed by polysomnography (PSG) were examined by two methods: Endoscopy with müller's maneuver at daytime and continuous upper airway pressure recording with ApneaGraph at night in Peking Union Medical College Hospital. The upper airway obstructive sites determined by the two methods were compared. ApneaGraph transducer catheter contains two pressure sensors and two temperature sensors used for obstruction site determination and detection of apnoeic events during sleep. Obstructive sites were divided into upper (retropalatal oropharynx) or lower level (retroglossal region). The lower limit of upper airway obstruction was determined by observed pressure pattern. Used constituent retio to reflect the obstructive proportion of different levels. The apnea hypopnea index (AHI) measured by PSG and ApneaGraph were also compared.</p><p><b>RESULTS</b>Two patterns of obstruction were observed in our group: 1. The site of obstruction was located only at the upper level. 2. The obstruction of upper and lower level all present. Site of obstruction determined by Apneagraph: 28 (87.5%) cases had predominant sites of obstructions in upper level (the constituent retio of retropalatal obstruction > 50%), the others in lower level (the constituent retio of retroglossal obstruction > 50%). Endoscopy localization of obstruction: 18 cases had retropalatal obstructions alone, 13 cases had obstructions of retropalate combined with retroglossa, only 1 patient didn't have obstruction. Defined the constituent retio higher than thirty percent the criteria of obstruction, then identical results were obtained by both methods in retropalatal segment in 27 (84.4%) of the patients, while in only 17 (53.1%) obstructions was determined by the both methods in retroglossal areas. The polysomnograpic AHI (x +/- s) was 52.2 +/- 18.1, versus 50.2 +/- 16.0 obtained by ApneaGraph. There was a significant correlation between them (r = 0.876, P < 0.001).</p><p><b>CONCLUSIONS</b>ApneaGraph can identify the level of upper airway obstruction more accurate than fiberoptic pharyngoscopy. In the meantime, it also can serve as a portable PSG to diagnose sleep disordered breathing qualitatively.</p>