[Clinical characteristics and etiological analysis of sudden deafness patients with vertigo].

Objective: To explore the possible causes and mechanisms of sudden deafness with vertigo. Methods: Between August 2016 and December 2017, 74 patients with sudden deafness and vertigo were hospitalized in the Department of Otolaryngology, First Affiliated Hospital of Sun Yat-sen University. Among them, 36 were male and 38 were female, aged 18-75 (40.5±6.5) years. According to the results of magnetic resonance imaging (MRI), the patients were divided into two groups: internal ear hemorrhage (IEH) and non-IEH (NIEH). The characteristics of deafness, vertigo, laboratory examination and follow-up results were compared between the two groups. Results: In IEH group, deafness and vertigo occurred simultaneously in 22 cases (84.6%), abnormalities of semicircular canal function, cervical vestibular evoked myogenic potential (C-VEMP), ocular vestibular evoked myogenic potential (O-VEMP) in 26 cases (100%) and benign paroxysmal positional vertigo (BPPV) in 10 cases (38.5%). The total effective rate was 19.2% (5/26) after 14 days of treatment, and 11 cases (42.3%) appeared disturbance after 180 days of treatment. The abnormal rate of lateral vestibular function, C-VEMP and O-VEMP was 69.2% (18/26), 53.8% (14/26) and 57.7% (15/26) respectively. The improvement of hearing threshold was (28.6±9.7) dB. In NIEH group, deafness and vertigo occurred simultaneously in 25 cases (52.1%). The abnormalities of semicircular canal function, C-VEMP and O-VEMP happened in 37 cases (77.1%), 34 cases (70.8%), 26 cases (54.2%), respectively, and 6 cases (12.5%) were of BPPV. The total effective rate was 52.1% (25/48) after 14 days of treatment. After 180 days of treatment, 8 cases (16.7%) were out of balance, and the abnormal rate of lateral vestibular function, C-VEMP and O-VEMP were 31.2% (15/48), 25.0% (12/48) and 20.8% (10/48) respectively. The improvement of hearing threshold was (42.5±10.3) dB. The incidence of stimulantous deafness and vertigo, vestibular dysfunction rate, BPPV incidence rate and the total effective rate after 14 days of treatment were significantly different between the two groups (all P<0.05). The vestibular and cochlear dysfunction in IEH group was more serious than that in NIEH group. After 180 days of treatment, the vestibular dysfunction rate, imbalance rate and improvement of hearing threshold in NIEH group were significantly higher than that in IEH group (all P<0.05). The recovery of vestibular and cochlear function in NIEH group was better than that in IEH group. Conclusions: Sudden deafness with vertigo can cause vestibular and cochlear dysfunction. Different etiologies may lead to different clinical features and prognosis. The vestibular and cochlear function damage caused by inner ear hemorrhage was more serious and the recovery effect was poor.

Motor unit number estimation may be a useful method to evaluate motor function recovery after spinal cord transection in rats.

STUDY DESIGN: Experimental rat study. OBJECTIVE: To investigate changes in motor unit number estimation (MUNE) value of the medial gastrocnemius (MG) muscle after thoracic spinal cord transection in rats and to correlate the MUNE with hindlimb motor function recovery. SETTING: China Rehabilitation Research Center, Beijing, China. METHODS: Twelve rats were subjected to spinal cord transection or sham surgery and then evaluated by MUNE and the Basso, Beattie and Bresnahan (BBB) behavioral scale 56 days after the surgery. RESULTS: The MUNE values of the MG muscle were significantly decreased from baseline at 14-49 days after surgery. However, they returned to near pre-injury levels after 56 days. Rats recovered progressively from the severely impaired hindlimb motor function induced by spinal cord injury, as indicated by a gradual increase in BBB score during days 3-49 after surgery. However, this behavioral recovery was only partial and reached a plateau on day 49. Finally, there was a U-shape-like correlation between changes in MUNE values and BBB scores after thoracic spinal cord transection. CONCLUSIONS: Time-dependent changes in the functional motor unit number may occur in spinal segments caudal to the transection level, and MUNE could be a useful method to evaluate motor function recovery.

[Cochleo-vestibular lesions and prognosis in patients with profound sudden sensorineural hearing loss: a comparative analysis].

Objective: To investigate the characteristics of cochleo-vestibular dysfunction in patients with profound sudden deafness, and the prognosis of inner ear hemorrhage. Methods: From January 2017 to December 2018, 92 inpatients with profound sudden sensorineural hearing loss were enrolled in the Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University. Our studied patients included 47 males and 45 females, aged 20-78 (39.3±6.1) years. According to the results of inner ear magnetic resonance imaging (MRI), the patients were divided into two groups: inner ear hemorrhage group and non-inner ear hemorrhage group. The clinical features, vestibular tests and audiological examination results during follow up were compared between the two groups. SPSS 22.0 software was used for statistical analysis. Results: The inner ear hemorrhage group consisted of 32 cases (34.8%, 32/92), all of whom complained of vertigo (100%, 32/32). Simultaneous vertigo attack and hearing loss occurred in 78.1% of this group (24/32). Neither semicircular canals function, nor cervical vestibular evoked myogenic potential (c-VEMP), nor ocular vestibular evoked myogenic potential (o-VEMP) in the affected side was normal (100%, 32/32). The rates of benign paroxysmal positional vertigo (BPPV) and disequilibrium were 37.5% (12/32) and 25.0% (8/32) respectively. Hearing improved in 28.1% (9/32) two weeks after treatment, and became stable at one month's follow up. In 60 cases without inner ear hemorrhage, 58.3% of them (35/60) experienced vertigo, which occurred simultaneously with hearing loss in 21 patients (60%, 21/35). The abnormal rates of semicircular canals function, c-VEMP and o-VEMP were 71.6% (43/60), 78.3% (47/60) and 66.7% (40/60), respectively. The incidence of BPPV was 16.7% (10/60) and 8.3% (5/60) in cases with disequilibrium. Hearing improved in 58.3% (35/60) two week after treatment, and became stable at three months' follow up. Significant difference was found in either vertigo rate, or simultaneous vertigo/hearing loss rate, or abnormal c-VEMP/o-VEMP rates, or accompanying BPPV, or disequilibrium rates between the two groups (P<0.05 each). Moreover, we observed better hearing recovery in non-inner ear hemorrhage group in the two weeks, one month, three months and six months' follow up, when compared with those in inner ear hemorrhage groups (P<0.05 each). Conclusions: Inner ear hemorrhage is associated with more severe cochlea-vestibular lesion and poorer prognosis, in comparison to the non-inner ear hemorrhage,in patients with profound sudden sensorineural hearing loss.

[Clinical study of inner ear hemorrhage-associated sudden deafness and vertigo].

Objective: To analyze the clinical features and possible pathogenesis of sudden deafenss and vertigo induced by inner ear hemorrhage. Methods: Clinical data of 30 patients with inner ear hemorrhage, from the first affiliated hospital of Sun Yat-sen university during Jan 2016 to May 2017, were retrospectively analyzed. Results: Vergito and profound deafness were seen in all patients. The duration of vertigo ranged from 24 hours to three days in 11 cases, three to 14 days in the remaining 19 cases. Simultaneous occurrence of vergito and deafenss were seen in 24 patients. Semicircular canal hypofunction and abnormal cervical vestibular evoked myogenic potentials(C-VEMP)/ocular vestibular evoked myogenic potentials(O-VEMP) were detected in all cases. Ten patients had benign paroxysmal positional vertigo(BPPV) simultaneously. Hearing recovered in 20% of the cohort posttreatment. Dizziness and balance disturbance disappeared 1 to 2 months after therapy in 16 cases. Long term (6 months) follow up revealed poor hearing outcome and vestibular rehabilitation. Conclusion: Vestibular vertigo and profound sensorineural hearing loss, with unsatisfactory clinical prognosis, constituted the characters of inner ear hemorrhage-associated sudden deafness.

[Small doses of gentamicin drum indoor injection treatment of intractableMénière disease clinical observation of the impact of the hearing].

Objective:To investigate the history,audiology,imaging,and operative characteristics of tympanosclerosis patients with intact tympanic membranes,and to provide theoretical reference for preoperative diagnosis and treatment.Method:A retrospective study was carried out among 9 tympanosclerosis patients (16 ears) with intact tympanic membranes who underwent exploratory tympanotomy.For different patients,the different reconstruction of ossicular chain are in selection.We compared the pre-operative outcomes of pure tone audiometry and otoscope with the post-operative outcomes,and calculated their air-bone gap and improvement value.Result:At 3 month after operation,otoscope showed that the tympanic membrane of all patiens were integrity.Tinnitus disappeared or improved in 5 cases.The mean thresholds of air conduction,bone conduction and air-bone gap were(40.33±11.48)dB,(27.34±8.46)dB,(13.16±9.85)dB respectively.The air-bone gap in 3 months after the operation was significantly smaller than that before operation(P<0.05).Conclusion:Most of the patients with tympanosclerosis suffer mixed hearing loss.In addition to chronic inflammatory stimulation,tympanic membrane incision catheter may be one of the important pathogenic factors.Morphology and imaging are more useful in differentiation of otosclerosis.Early and active surgery interference would attain good effect.

Use of computational fluid dynamics to study the influence of the uncinate process on nasal airflow.

BACKGROUND: Chronic rhinosinusitis is commonly treated by functional endoscopic sinus surgery involving excision of the uncinate process and opening of the osteomeatal complex. METHODS: Computational fluid dynamics were used to compare nasal airflow after two different surgical interventions which involved opening the paranasal sinuses, excising the ethmoid sinus, and excising or preserving the uncinate process, in a cadaveric head model. Cross-sectional computed tomography images were obtained before and after the interventions. Imaging data were used to prepare computer simulations, which were used to assess the airflow characteristics of the nasal cavities and paranasal sinuses during inspiration and expiration, before and after intervention. RESULTS: Significantly larger nasal cavity airflow velocity changes were apparent following the uncinate process excising procedure. Nasal cavity airflow distribution remained relatively unchanged following the uncinate process preserving procedure. There was a significantly greater increase in airflow volume following the uncinate process excising procedure, compared with the uncinate process preserving procedure. CONCLUSION: Preservation of the uncinate process may significantly reduce the alteration of nasal cavity airflow dynamics occurring after functional endoscopic sinus surgery for chronic rhinosinusitis.

Motor unit number estimation of the tibialis anterior muscle in spinal cord injury.

STUDY DESIGN: Case-control study. OBJECTIVE: To investigate the number of motor units from the tibialis anterior (TA) muscle in normal subject and its change after SCI. SETTING: China Rehabilitation Research Center, Beijing, China. METHODS: Motor unit number estimation (MUNE) in 45 control subjects (35 young subjects with an average age of 36 years, and 10 elderly subjects with an average age of 65 years) was performed by using adapted multiple point stimulation method (AMPS). Twenty patients with SCI (10 subacute patients with an average age of 39 years, and 10 chronic patients with an average age of 34 years) were also examined for three times in 3 months with the same method. RESULTS: The mean MUNE value of the TA muscle was 188+/-20 in the control group, and 40+/-33 in subacute SCI patients (P<0.01 vs young controls). A continuous increase in the MUNE value was observed in subacute SCI patients during the later follow-up period. In the chronic SCI group, the mean MUNE value was 173+/-29 which was similar to that of young control group. CONCLUSIONS: AMPS could be a useful procedure for quantifying changes of MUNE values after SCI. Changes in functional motor unit number may occur distal to the site of lesion in SCI patients. These phenomena may be caused by neuronal plasticity in motor units, reversible transsynaptic degeneration and/or local functional depression. Owing to the limited sample size and a wide age range of subjects recruited in this study, future study are warranted for revealing detailed changes of MUNE parameters after SCI and exploring the underlying mechanisms.