Diagnosis and treatment strategies of 56 cases of middle ear myoclonus / 中华耳鼻咽喉头颈外科杂志

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.

Removal of cadmium from extracts of Gentianae Radix et Rhizoma by gamma-mercaptopropyl-modified silica gel / 中国中药杂志

<p><b>OBJECTIVE</b>To study the optimum process of removing cadmium irons from extracts of Gentianae Radix et Rhizoma with gamma-mercaptopropyl-modified silica gel (MPS) and assess its cadmium ion-removing property.</p><p><b>METHOD</b>Static and dynamic adsorptions were adopted to detect the cadmium-removing rate. MPS' cadmium ion-removing property was assessed with such indicators as the cadmium-removing rate, the solid content and the HPLC fingerprint.</p><p><b>RESULT</b>The process parameters of the static adsorption were as follows: 0.20 g x mL(-1) of concentration of extracts, 120 minutes of adsorption time and 15:1 between raw materials and MPS. The process parameters of the dynamic adsorption were as follows: 1:3.5 times between diameter and height, 0.20 g x mL(-1) of concentration of extracts, 0.9 mL x min(-1) of flow rate of the extracts and 50:1 between raw materials and MPS. Before and after the cadmium ion-removing process, the extracts showed no notable difference in solid content and HPLC fingerprint.</p><p><b>CONCLUSION</b>gamma-mercaptopropyl-modified silica gel (MPS) can effectively remove cadmium ion from the extracts of Gentianae Radix et Rhizoma with an excellent cadmium ion-removing property.</p>