Value of allergen nasal provocation test in assessment of the efficacy of house dust mites specific immunotherapy / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the value of nasal provocation test（NPT） in evaluating the efficacy of allergen immunotherapy（AIT） in patients with dust mite induced allergic rhinitis（AR）. Methods:A total of 83 patients with dust mite induced AR with/without asthma were included. Symptom score（SS）, daily medication score（DMS）, combined symptom and medication score（CSMS）, rhinoconjunctivitis quality of life questionnaire（RQLQ）, NPT and skin prick test（SPT） were assessed before and after 1 year AIT. Results:There were statistical differences in SS（P<0.000 1）, DMS（P<0.000 1）, CSMS（P<0.000 1）, and RQLQ（P<0.000 1） after 1 year of AIT compared with pre-treatment. The effective rate of CSMS was 73.49%, and the effective rate of NPT was 42.17%. CSMS was consistent with NPT in efficacy assessment（Kappa=0.437, P<0.001）; while in 54 patients with pre-treatment NPT concentrations other than the original concentration, CMSM and NPT showed better consistence（Kappa=0.895, P<0.001）. Among the 48 patients with ineffective NPT assessment in the first year, 25 patients completed the second-year follow-up, and 12 patients（48.00%） showed effective in NPT. However, 10 out of 12 patients（83.33%） with NPT concentration other than original solution pre-treatment showed effective NPT at the second year. Conclusion:NPT can be used as one of the indicators for efficacy evaluation for dust mite induced AR patients, especially for patients with positive NPT induced at lower concentrations before treatment.

Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.

Analysis of inhaled allergens in the patients with chronic rhinosinusitis in Hainan province / 实用医学杂志

Objective To understand the distribution of inhaled allergens throughout Hainan province and explore effective preventive measures against allergen by examining the serum allergen of patients with chronic rhinosinusitis (CRS), which will provide evidence for specific immunotherapy for treating CRS. Methods Three hundred and eighteen CRS patients underwent Phadiatop blood test by using the UniCAP 100 , a completely automatic autoanalyser. Allergen-specific IgE of 7 common allergens were tested and the concentration of total immunoglobulin E (TIgE) was collected and evaluated. Results The positive rates of the serum TIgE and inhaled allergens were 64.15% and 37.74% respectively. The incidences of the positive serum SIgE is 33.96%. Among the positive cases, 28.30% of the inhaled allergens were dermatophagoides pteronyssinus, 27.36% for tropical mites, 21.07% for dermatophagoides farinae, 13.52% for cockroach, 11. 64% for house dust, 7. 86% for cat dander and 0.63% for dog dander. The incidences of positive TIgE and SIgE were not significantly different between patients with nasal polyps and sinusitis only. Conclusions Dermatophagoides pteronyssinus, tropical mites and dermatophagoides farinae are the main inhaled allergens for CRS patients in Hainan.

Paraglottic space primary paraganglioma: a case report and review / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical feature, diagnose and therapeutic methods of paraglottic space primary paraganglioma.@*METHOD@#One case of paraglottic space primary paraganglioma was reported and the relevant literatures were reviewed.@*RESULT@#One case showed a hoarse voice, who was cured after the surgery of neck incision. NSE and CgA were positively expressed.@*CONCLUSION@#Paraganglioma of the paraglottic space is very rare. The diagnosis of paraglottic space primary paraganglioma bases on histopathology and immunohistochemistry. The immunohistochemistry and clinical character must be comprehensively analyzed to increase the diagnosis accuracy.

A double-blind RCT of the hemostatic effects of local packing of Nasopore combined with hemocoagulase injection for postoperative management of FESS / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the hemostatic effects of local packing of Nasopore combined with hemocoagulase injection and local packing of Nasopore combined with saline injection for postoperative management of functional endoscopic sinus surgery by a double-blind, randomized control clinical trial.@*METHOD@#Sixty-eight cases of chronic sinusitis needed functional endoscopic sinus surgery were randomly divided into the experimental group of 40 cases and control group of 28 cases, respectively. For the experimental group, 1 U of hemocoagulase dissolved in 0.5 ml saline was injected into Nasopore which was packed into the nasal cavity after operation. For the control group, 0.5 ml of saline was injected. The postoperative bleeding of the two groups were scored by visual analogue scale.@*RESULT@#There was statistically significant difference between the bleeding VAS scores assessed 6 hours and the ones assessed 1, 2 and 3 days after the operation in the control group (P < 0.05). There was the statistically significant difference between the bleeding VAS scores of experimental group and control group assessed 6 h after the operation (P < 0.05).@*CONCLUSION@#The hemocoagulase may improve the hemostatic effect of Nasopore 6 hours after the operation by combined injection with Nasopore as nasal cavity packing.

Diagnosis and management of nasal and pharyngeal dendritic cell tumor-case report and literature review / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical manifestation, pathological characteristics, treatment and prognosis of dendritic cell tumor.@*METHOD@#Four cases of nasal and pharyngeal dendritic cell tumor were described, including two cases of follicular dendritic cell sarcoma (FDCS), one case of Langerhans cell histiocytosis (LCH) and one case of Langer hans cell sarcoma (LCS). One of the patients with FDCS received multimodality therapy (surgery combined with chemotherapy), and the other patient only received chemotherapy and radiotherapy. The patients with LCH or LSC were treated by surgery.@*RESULT@#Of the two FDCS patients, one achieved complete remission after treatment by surgery combined with four cycles of CHOP chemotherapy regimen and concurrent radiotherapy (50 Gy), and the other who only received chemotherapy and radiotherapy survived with tumor for more than seven months of follow up. The patient of LCH was followed up for more than 2 years after surgery without recurrence or metastasis. The patient of LCS did not undergo radiotherapy or chemotherapy after surgery and died after 10 months of follow up.@*CONCLUSION@#Dendritic cell tumor is a group of very rare tumor and can be easily misdiagnosed in clinic, the confirmed diagnosis of which relies on histopathological features, immunohistochemistry combined with electron microscopy. FDCS, LCH and LCS have different pathological features, immunophenotypes and prognosis.

Clinical features of ocular symptom in patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical characteristics of ocular symptoms in patients with allergic rhinitis (AR) and the impact of the ocular symptoms on patients' quality of life.@*METHOD@#AR patients' history and clinical data were collected and analyzed. One hundred cases were extracted from adult patients with and without ocular symptoms in each group and their quality of life were evaluated using rhino-conjunctivitis quality of life questionnaire (RQLQ).@*RESULT@#Totally 1119 cases were collected and 859 cases had ocular symptoms. Of the patients with ocular symptoms, 582 cases were mild, 234 cases were moderate, 43 cases were severe. Eye itching was the most common symptom, followed by tears, hyperemia and swelling. Patients with ocular symptoms had longer disease history than non ocular symptom group (P < 0.05). There was a positive correlation between ocular and nasal symptoms (P < 0.01); patients with ocular symptoms had more severe nasal symptoms than patients without ocular problems; while patients with moderate to severe AR had more severe ocular symptoms than mild AR patients (P < 0.01). Female patients had higher incidence (P < 0.05) and ocular symptoms score (P < 0.05) than male. Children less than 10 years old had a relative lower incidence and score of ocular symptoms. While the incidence and score had an increasing trend for patients older than fifty. There was no difference regarding the type and number of allergen in the patients with and without ocular symptom. Moreover, patients with ocular symptoms had higher scores in the domains of non-nose/eye symptoms, practical problems, ocular symptoms, emotional function and total score in RQLQ than patients without ocular symptom.@*CONCLUSION@#It was common for the AR patients to have ocular symptoms, and ocular symptoms had obvious influence on the patients' quality of life. So controlling of the ocular symptoms should not be ignored during the diagnosis and treatment of AR.

Diagnosis and management of laryngeal verrucous carcinoma (case report in one patient and literature review) / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical, pathological character and differential diagnosis of laryngeal verrucous carcinoma.@*METHOD@#Clinical data of one case with laryngeal verrucous carcinoma in our hospital were retrospectively analyzed.@*RESULT@#The diagnosis of verrucous carcinoma was difficult and depend on repeated biopsy. Verrucous carcinoma of larynx is a highly differentiated variant of squamous carcinoma that has peculiar clinical and morphological features. The basement membrane is not invaded. It is prone to distant metastasis, than to local recurrence. The case underwent the partial laryngectomy, and was followed up for more than 4 years with no recurrence.@*CONCLUSION@#Verrucous carcinoma of the larynx is a special pattern of the well-differentiated squamous cancer. A correct diagnosis requires close cooperation between the laryngologist and the pathologist. The main treatment of verrucous carcinoma is complete surgical excision to reserve larynx function as far as possible and improve the quality of life.

Clinical analysis of epithelioid hemangioma of the head and neck in six cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical presentation, pathological feature, therapy and outcome of epithelioid hemangioma.@*METHOD@#We reviewed the clinical findings, pathologic changes and outcomes of six cases with epithelioid hemangioma from Aug. 2007 to Sept. 2011.@*RESULT@#There are four males and two females ranged from 18 to 44 years(median year was 29.5). Primary lesions sites included the parotid gland, neck and ear. Four lesions presented as a solitary mass, and no patient had history of trauma. All patients were treated by surgeries, and not complemented by medical. There were four patients relapsed during follow-up, and three of them accepted reoperations (two patients received postoperative radiotherapies), and no recurrence was detected.@*CONCLUSION@#Epithelioid hemangioma represents a benign vascular tumor, accurate diagnosis relies on clinical characteristic, histopathologic appearance and immunohistochemical findings, and it must be differentiated with Kimura's disease. The main treatment is surgery and the prognosis is well, but easy to recurrence.

Diagnosis and management of granular cell tumor of the larynx / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the histogenesis, morphological features and biologic behaviors of granular cell tumor(GCT) of the larynx.@*METHOD@#A retrospective study was performed in three cases of GCT in our hospital, the clinical data were studied with histopathologic analysis, histochemical and immunohistochemical staining, and combining with the analysis of domestic and foreign literatures.@*RESULT@#Histopathologic features of laryngeal GCT were identical to that in soft tissues, but pseudoepitheliomatous hyperplasia was present in 50%-60% cases of the tumor. This disease may originate from the neurogenic Schwann cell, S-100 could be positive in immunohistochemistry.@*CONCLUSION@#Laryngeal GCT is a rare benign tumor and can be cured by local excision.

The Clinical Effect of Recombinant Human Epidermal Growth Factor in Treatment of Chronic Tympanic Membrane Perforation / 昆明医科大学学报

Objective To evaluate the clinical effect of recombinant human epidermal growth factor (rhEGF) on the treatment of chronic tympanic membrane perforation and the function of inner ear. Methods From 2005 to 2008, the outpatients were randomly divided into three groups (A:control group, B:kangfuxin group, C:rhEGF group) . The patients were also divided into three groups (small, medium and large) . The hearing level and the function of inner ear in three groups were compared. Results The hearing level of rhEGF group was 4.5, which was significantly than that of other groups (7.3 and 9.4 respectively, 0.05) . Conclusion rhEGF can decrease the healing time significantly and increase the healing rates in the treatment of chronic tympanic membrane perforation, and it has no obvious adverse effects on the inner ear.

Analysis of misdiagnosis of tuberculosis otitis media and mastoiditis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the misdiagnosis cause of tuberculosis otitis media and mastoiditis.@*METHOD@#The clinical data of 9 cases with tubercular otitis media and mastoiditis were analyzed respect.@*RESULT@#Nine patients, only 1 patient in the preoperative tuberculosis in otitis media and mastoiditis, the remaining eight cases pre-operative misdiagnosed as chronic otitis media the pathologic diagnosis of tuberculous otitis media.@*CONCLUSION@#The clinical features of tubercular otitis media and mastoiditis was similar easily confused with chronic suppurative otitis media. Clinicians should pay attention to the disease, history of tuberculosis, imaging studies, and pathology, and other special examination to confirm the diagnosis, reduce misdiagnosed.

Clinicopathological analysis of sinonasal ectopic meningioma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the diagnostic and therapeutic methods of sinonasal ectopic meningioma.@*METHOD@#The clinical data of 8 patients treated in our department from Jan 1990 to Oct 2011 were retrospectively analysed. Among these patients, 5 cases were treated by lateral rhinotomy approach; 2 cases were treated by endoscopic plus modified Caldwell-Luc technique; 1 case was treated by endoscopic plus modified Caldwell-Luc technique. All patients were followed up postoperatively.@*RESULT@#All patients had no complications after operation. All patients were followed up from six months to 22 years. Among them, two cases had recurred 18 months and one year postoperatively. The two cases did not recur after the second operation.@*CONCLUSION@#Although sinonasal ectopic meningioma is difficult to diagnose because of their infrequent occurrence in this ectopic site and of their non-specific clinical appearance. The final diagnosis rests on the histological examination. Immunohistochemical studies are helpful to establish the accurate diagnosis. Prognosis is excellent after complete surgical resection.

Clinical effectiveness and safety of sanchi tong shu capsule in the treatment of aural vertigo: a multi-center randomized controlled clinical trial / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the clinical effectiveness and safety of Sanchi Tong Shu capsule in the treatment of common aural vertigo.@*METHOD@#A multi-center randomized controlled trial was designed to study 206 vertigo patients who were randomly allocated into one of the two groups. One group was treated with Sanchi Tong Shu capsule for 14 days, another group was treated with betahistine mesilate tablets for 14 days.@*RESULT@#The clinical effectiveness rates of the two groups were 84.86% and 90.92% respectively according to FAS analysis and 84.76%, 90.92% respectively according to PPS analysis. No statistic significance difference was found between the two groups (P > 0.05). After 14 days treatment, total DHI and all the subsection (including body, emotion and function) scores of the two groups were all decreased compared with treatment before (P 0.05). The adverse effective rate of the two groups were 3.29% and 7.84% respectively and there was no statistic difference between the two groups (P > 0.05).@*CONCLUSION@#Sanchi Tong Shu capsule is a safe and effective drug for the treatment of common aural vertigo.

Significance expression and relationships with endothelin-1, matrix metalloproteinase-9 in the laryngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the expression of endothelin-1(ET-1) and matrix metalloproteinase-9 (MMP-9) in laryngeal carcinoma and their correlations with clinical features.@*METHOD@#The expression of ET-1 and MMP-9 was detected by immunohistochemical method in 58 specimens of laryngeal carcinoma, 28 specimens of polyps of vocal cord and 19 specimens of normal laryngeal tissues.@*RESULT@#The expressions of ET-1, MMP-9 in laryngeal carcinoma were remarkably higher,compared to polyps of vocal cord and normal laryngeal tissues (P < 0.05). The expression of ET-1, MMP-9 was associated with clinical stage, T stage and lymph node metastasis. Expression levels of ET-land MMP-9 correlated significantly with each other (r(s) = 0.693, P < 0.05).@*CONCLUSION@#The expression of ET-1 and MMP-9 may be the vital indexes in laryngeal carcinoma.

Reliability and Validity of the Chinese (Mandarin) Tinnitus Handicap Inventory

OBJECTIVES: The Tinnitus Handicap Inventory (THI) is a commonly used self-reporting tinnitus questionnaire. We undertook this study to determine the reliability and validity of the Chinese-Mandarin version of the Tinnitus Handicap Inventory (THI-CM) for measuring tinnitus-related handicaps. METHODS: We tested the test-retest reliability, internal reliability, and construct validity of the THI-CM. Two-hundred patients seeking treatment for primary or secondary tinnitus in Southwest China were asked to complete THI-CM prior to clinical evaluation. Patients were evaluated by a clinician using standard methods, and 40 patients were asked to complete THI-CM a second time 14+/-3 days after the initial interview. RESULTS: The test-retest reliability of THI-CM was high (Pearson correlation, 0.98), as was the internal reliability (Cronbach's alpha, 0.93). Factor analysis indicated that THI-CM has a unifactorial structure. CONCLUSION: The THI-CM version is reliable. The total score in THI-CM can be used to measure tinnitus-related handicaps in Mandarin-speaking populations.

The cytoskeleton and immigration of laryngeal squamous carcinoma cell affected by Fascin-1 expression / 生物医学工程学杂志

This study sought to detect the effect of Fascin-1 expression on the cytoskeleton and immigration of laryngeal squamous carcinoma cell. In the experiment, Fascin-1 expression in Hep-2 cells was inhibited by small interfering RNA. The cytoskeleton of Hep-2 cells was observed with the use of laser scanning confocal fluorescence microscope. Millicell insert was applied to detect the immigration of Hep-2 cells in vitro. The results showed that the integrity of cytoskeleton in Hep-2 cells was broken with the down-regulation of Fascin-1 expression and the immigration ability was decreased significantly (P < 0.05). The inhibiting ratio of cell immigration was 44.6 +/- 6.3%. In conclusion, inhibition of Fascin-1 expression in Hep-2 cells could break the integrity of cytoskeleton and decrease the ability of cellular immigration.

Diagnostic value of middle ear resonant frequency in hydrotympanum / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the diagnostic value of 226 Hz tympanometry and middle ear resonant frequency (RF) in adults with hydrotympanum. Discuss whether the resonant frequency combined with conventional 226 Hz tympanometry could increase the effectiveness for diagnosis of hydrotympanum.@*METHOD@#Prospective study was applied to compare the normal hearing group and the test group. The otoscopic findings, pure tone audiometry and GSI-33 middle ear analyzer were considered standard. A 90% range of RF values from normal hearing group was considered standard to distinguish normal from abnormal RF values in test group. The subjects who had type B, C or abnormal tympanograms were performed with tympanocentesis. Hydrotympanum were confirmed when the results were positive.@*RESULT@#The middle ear resonant frequency in adults range from 900 Hz to 1100 Hz was considered normal. There was found to be a statistically significant decrease in RF values in ears with OME compared to normative data (P<0.01). The positive percentage of tympanocentesis on type "B" tympanograms were 83%, which was significantly higher than that of tympanocentesis on type "C" or abnormal tympanograms (P<0.05). The positive percentage of tympanocentesis was 0 when the resonant frequency was normal. The positive percentage of tympanocentesis which the resonant frequency were less than 500 Hz were significantly higher than the subjects whose resonant frequency were more than 500 Hz.@*CONCLUSION@#Middle ear resonant frequency testing has very important clinic value for diagnosis of hydrotympanum, especially for those patients with type C or abnormal tympanograms.

The clinic anatomy of operation on pterygopalatine fossa through nasal cavity under endoscope / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To provide anatomic data of pterygopalatine fossa(PPF) for endoscopic PPF surgery.@*METHOD@#Fifteen wet adult skull specimen fixed in 10% formaldehyde were studies. From center the skulls were sawed, the middle and inferior turbinate were resected, the anterior and posterior ethmoid sinuses were resected. Then after punch out perpendicular part of palatine bone and posterior wall of maxillary,the pterygopalatine fossa were showed and some related measurements were made.@*RESULT@#This pathway can lead to a good view of pterygopalatine fossa. The main soft structures in PPF were maxillary artery and nerve with their branches. The diameter of artery branches was smaller than 3 mm.@*CONCLUSION@#The endoscopic PPF surgery is safe and practical from the anatomic data.

Applied anatomy study on the lateral wall of sphenoid sinus under transnasal endoscope / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To provide transsphenoidal endoscopic surgery with the anatomic reference through anatomic study on the lateral wall of sphenoid sinus under transnasal endoscope.@*METHOD@#The dissection of the lateral wall of sphenoid sinus were performed on 10(20 sides) damp cadaveric heads of Chinese adults via transsphenoidal approach. The anatomic relationship of the lateral wall of sphenoid sinus and its adjacent structures were observed. The distance and angle from the bony prominence of optic canal and internal carotid artery to the columella nasi and midline of sellar floor were measured by ruler and protractor respectively.@*RESULT@#From the study of endoscopic anatomy, the specific structure of optic canal and internal carotid artery were found, and the lateral wall of the cavernous sinus could be exposed by tracing the internal carotid artery. The mean distance from the midpoint of the medial wall of optic canal orbital aperture and the anterior bony prominence of internal carotid artery to the columella nasi were (75. 33 +/- 5. 59)mm and (81. 02 +/- 5. 29) mm respectively, to the midline of sellar floor were (5. 81+/- 1. 52)mm and (5. 53 +/- l. 47)mm respectively. The angle from the midpoint of the medial wall of optic canal orbital aperture to columella nasi was (53.4 +/- 4. 1) degrees.@*CONCLUSION@#Taken the columella nasi and midline of sellar floor as the reference points, the anatomic observation and measurement under endoscope via transsphenoidal approach can provide a guide for surgeons.