Early treatment of middle ear disease in cleft palate infants / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To explore the effect of myringotomy with insertion of tube and tympanocentesis on alleviating secretory otitis media (SOM) and hearing loss in cleft palate infants.</p><p><b>METHODS</b>Nineteen cleft lip and palate infants with SOM and hearing loss (38 ears) were treated with myringotomy with insertion of ventilation tube at the same time of repair of the cleft lip, who were performed averagely at 6.9 months of age. Fifteen cleft lip and palate infants with SOM (30 ears) were treated with tympanocentesis at the same time of repair of the cleft lip averagely at 6.6 months of age. All cases were followed up from 1 week to 12 months and estimated by auditory brainstem response (ABR) and acoustic immitance audiometry.</p><p><b>RESULTS</b>The average wave V reacting thresholds of ABR were separately 55.41 dBnHL and 28.48 dBnHL, and 79.17% tympanogram B changed to tympanogram A in cleft palate infants with insertion of tube before and after operation. The average wave V reacting thresholds of ABR were separately 40.63 dBnHL and 26.50 dBnHL, and 40.91% tympanogram B changed to tympanogram A in cleft palate infants with tympanocentesis preoperatively and in 1 week postoperatively, in whom the average hearing thresholds and tympanograms had no significant difference preoperatively and in 1 or 3 months postoperatively (P>0.05).</p><p><b>CONCLUSION</b>The early myringotomy with insertion of tube is effective to restore the function of the middle ear in cleft palate infants with SOM, so to suggest to be performed at the same time of the repair of cleft lip within the first 1-year of life. The tympanocentesis should not be used as a regular management in the cleft palate infants with SOM.</p>

Clinical characteristics of myasthenia gravis with dysphonia as the initial symptom / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To identify clinical features and diagnostic tests that would alert the otolaryngologist to consider myasthenia gravis (MG) in the differential diagnosis of dysphonia, we reviewed the clinical characteristics of MG whose initial symptom is dysphonia.</p><p><b>METHODS</b>31 patients who presented with dysphonia as their initial and primary complaint are reported, their symptoms and signs are observed and analyzed.</p><p><b>RESULTS</b>Patients with dysphonia as their initial symptom of MG may complain of vocal fatigue, difficulty sustaining or projecting their voices, breathy voice or intermittent hoarseness. These symptoms are characterized by fluctuating weakness and abnormal fatigability. Flexible fibroendoscopic examination revealed that patients had incomplete adduction of the vocal folds, fatigue of the tensors of the vocal fold, incomplete glottic closure, vocal cord paralysis, saliva pooling over the bilateral or unilateral pyriform sinus. Neostigmine test revealed dramatic improvement in all patients. Serum levels of anti-Ach-R antibodies were tested in 19 cases, only 5 cases were abnormality. All patients had improved after treatment</p><p><b>CONCLUSIONS</b>Voice changes can be the first sign of early MG. Based on fluctuating weakness or weak voice at the end of the day, a positive neostigmine test, significantly higher circulating antibody to acetylcholine receptor, a diagnosis of MG could definitively be made.</p>