Advancements in prevention and intervention of sensorineural hearing loss.

The inner ear is a complex and difficult organ to study, and sensorineural hearing loss (SNHL) is a multifactorial sensorineural disorder with characteristics of impaired speech discrimination, recognition, sound detection, and localization. Till now, SNHL is recognized as an incurable disease because the potential mechanisms underlying SNHL have not been elucidated. The risk of developing SNHL is no longer viewed as primarily due to environmental factors. Instead, SNHL seems to result from a complicated interplay of genetic and environmental factors affecting numerous fundamental cellular processes. The complexity of SNHL is presented as an inability to make an early diagnosis at the earliest stages of the disease and difficulties in the management of symptoms during the process. To date, there are no treatments that slow the neurodegenerative process. In this article, we review the recent advances about SHNL and discuss the complexities and challenges of prevention and intervention of SNHL.

Assessing Agreement between Frequency-Specific Chirp Auditory Steady-State Response and Pure Tone Audiometry in Adults by Intraclass Correlation Coefficient.

INTRODUCTION: Chirp auditory steady-state response (ASSR) can be used to assess frequency-specific hearing thresholds. However, its reliability has not been confirmed yet. The purpose of this proposed study is to analyze the agreement of thresholds measured by chirp-ASSR and pure tone audiometry (PTA) to investigate the value of chirp-ASSR in hearing threshold evaluation. METHODS: Participants with normal hearing (age: 18-66, 108 ears) and patients with sensorineural hearing loss (age: 22-82, 75 ears) were tested using PTA and chirp-ASSR at 0.5, 1, 2, and 4 kHz, respectively. Intraclass correlation coefficient (ICC) and Bland-Altman plot were introduced to analyze the agreement between the 2 methods. RESULTS: One-hundred eight participants underwent both chirp-ASSR and PTA to estimate their thresholds. The ICCs yielded by these 2 methods are 0.757, 0.893, 0.883, and 0.921 (p < 0.001) at 0.5, 1, 2, and 4 kHz carrier frequency, respectively. However, there is a significant difference between the 2 methods at 2 kHz: the mean value of the ASSR thresholds is 5.27 dB HL higher than the value of PTA thresholds. Additionally, the 95% limits of agreement range from -27.48 to 26.66 dB HL at 0.5 kHz, from -18.19 to 17.87 dB HL at 1 kHz, from -12.01 to 22.55 dB HL at 2 kHz, and from -21.29 to 19.17 dB HL at 4 kHz, which are large enough to affect clinical decision-making. CONCLUSION: In this study, we have confirmed good to excellent correlation between chirp-ASSR and PTA in threshold estimation for adults with and without hearing loss. The degree of correlations is higher for participants with hearing loss and for measurements at high frequencies. However, significant systematic difference and large limits of agreement between the 2 methods have been found. These findings show that chirp-ASSR can be treated as a supplementary method to PTA when evaluating the hearing level, but the 2 methods are not interchangeable due to their systematic difference and large limits of agreement.

Quantification of endolymphatic hydrops and its correlation with Meniere's disease clinical features.

OBJECTIVE: We aimed to quantitatively evaluate the degree of endolymphatic hydrops and its correlation with the clinical features of Meniere's disease. METHODS: We retrospectively collected data from patients with Meniere's disease who underwent gadolinium-enhanced magnetic resonance imaging (MRI) at our department from January 2018 to December 2019. Mimics software was used to perform three-dimensional modelling of the labyrinth, and volume information was obtained to calculate the endolymphatic hydrops index (EHI). A correlation analysis was conducted with data from pure tone audiometry, electrocochleography (EchoG), vestibular myogenic-evoked potential (VEMP) testing, caloric testing and video head impulse testing (vHIT). A two-dimensional method was also employed to calculate the hydrops ratio (HR) of cochlea and vestibule. The test-retest reliability of EHI/HR from different operators was evaluated. RESULTS: A total of 23 affected ears were examined, and the EHI was significantly correlated with Meniere's disease stage, low-frequency hearing threshold, EchoG summating potential/action potential ratio (-SP/AP) and VEMP binaural asymmetry ratio, but no significant correlation was observed between EHI and the caloric test or vHIT. The Intraclass correlation coefficient (ICC) of EHI data calculated by two otologists was 0.946 (p < .001). And the ICC of cochlea and vestibule HR were 0.844 and 0.832 (p < .001). CONCLUSION: Mimics software can be used to quantitatively evaluate the degree of endolymphatic hydrops and have shown higher test-retest reliability than traditional two-dimensional evaluation method. Endolymphatic hydrops correlates with clinical data, such as Meniere's disease stage, low-frequency hearing threshold, EchoG and VEMP asymmetry ratio.

Application and practice of a step-by-step method combined with case-based learning in Chinese otoendoscopy education.

BACKGROUND: Standardized training allows more physicians to master otoendoscopic surgery. However, the lecture-based learning (LBL) applied in otoendoscopy teaching may not be conducive to training students in clinical thinking and surgical ability. It is necessary to explore innovative methods for otoendoscopy teaching. This study aimed to determine the effect of a step-by-step (SBS) method combined with case-based learning (CBL) in otoendoscopy teaching. METHODS: Fifty-nine physicians who participated in otoendoscopy training were selected as the study subjects and randomly divided into two groups (A and B). Group A underwent training with the SBS & CBL method, while Group B underwent training with the LBL & CBL method. The effects of these two methods for otoendoscopy training were compared by evaluation of professional skills and questionnaires before and after the training. RESULTS: Proficiency in otoendoscopic anatomy and grades for both professional knowledge and otoendoscopic skills were significantly higher in Group A than in Group B(P < 0.05). In terms of learning interest, surgical ability, acting capacity during surgery, reducing surgical complications, and satisfaction with learning experience, all responses from Group A were better than those from Group B(P < 0.05). CONCLUSIONS: The SBS & CBL method may help to improve ability in otoendoscopic surgery and clinical thinking and appears suitable for endoscopy teaching.

A 181 GOPS AKAZE Accelerator Employing Discrete-Time Cellular Neural Networks for Real-Time Feature Extraction.

This paper proposes a real-time feature extraction VLSI architecture for high-resolution images based on the accelerated KAZE algorithm. Firstly, a new system architecture is proposed. It increases the system throughput, provides flexibility in image resolution, and offers trade-offs between speed and scaling robustness. The architecture consists of a two-dimensional pipeline array that fully utilizes computational similarities in octaves. Secondly, a substructure (block-serial discrete-time cellular neural network) that can realize a nonlinear filter is proposed. This structure decreases the memory demand through the removal of data dependency. Thirdly, a hardware-friendly descriptor is introduced in order to overcome the hardware design bottleneck through the polar sample pattern; a simplified method to realize rotation invariance is also presented. Finally, the proposed architecture is designed in TSMC 65 nm CMOS technology. The experimental results show a performance of 127 fps in full HD resolution at 200 MHz frequency. The peak performance reaches 181 GOPS and the throughput is double the speed of other state-of-the-art architectures.

Detection of MMP-9 and TIMP-3 mRNA expression in the villi of patients undergoing early spontaneous abortion: A report of 30 cases.

The aim of the present study was to investigate the correlation of matrix metalloproteinase (MMP)-9 and tissue inhibitor of matrix metalloproteinase inhibitor (TIMP)-3 expression with spontaneous abortion (SA) during early pregnancy. The villus tissues of 30 SA cases and 20 requested abortion cases were collected during surgery and constituted the SA and normal abortion (NA) groups, respectively. The total villous RNA was extracted and the expression levels of MMP -9 and TIMP-3 mRNA were detected by reverse transcription-polymerase chain reaction (RT-PCR) assay to calculate the MMP-9/TIMP-3 mRNA ratio. The MMP-9 mRNA expression level and MMP-9/TIMP-3 mRNA ratio of the SA group were significantly higher than those of the NA group (P<0.01), while the TIMP-3 mRNA levels of the two groups were similar (P>0.05). The MMP-9 mRNA expression level of the SA group was higher than that of the NA group; thus, the MMP-9/TIMP-3 mRNA ratio was higher. These results suggest that the expression level of MMP-9 mRNA and the MMP-9/TIMP-3 mRNA ratio are associated with SA.

A Novel 2D-to-3D Video Conversion Method Using Time-Coherent Depth Maps.

In this paper, we propose a novel 2D-to-3D video conversion method for 3D entertainment applications. 3D entertainment is getting more and more popular and can be found in many contexts, such as TV and home gaming equipment. 3D image sensors are a new method to produce stereoscopic video content conveniently and at a low cost, and can thus meet the urgent demand for 3D videos in the 3D entertaiment market. Generally, 2D image sensor and 2D-to-3D conversion chip can compose a 3D image sensor. Our study presents a novel 2D-to-3D video conversion algorithm which can be adopted in a 3D image sensor. In our algorithm, a depth map is generated by combining global depth gradient and local depth refinement for each frame of 2D video input. Global depth gradient is computed according to image type while local depth refinement is related to color information. As input 2D video content consists of a number of video shots, the proposed algorithm reuses the global depth gradient of frames within the same video shot to generate time-coherent depth maps. The experimental results prove that this novel method can adapt to different image types, reduce computational complexity and improve the temporal smoothness of generated 3D video.

Acupuncture for adolescents with mild-to-moderate myopia: study protocol for a randomized controlled trial.

BACKGROUND: Myopia is a public health problem worldwide and its incidence increases with age. The use of acupuncture to treat myopia is a common practice in China, however, the use of acupuncture to treat myopia is disputed in other parts of the world. This study aims to determine the safety of acupuncture to treat myopia and its efficacy over six months. METHODS/DESIGN: A randomized, parallel, single-center, assessor- and statistician-blinded, controlled clinical trial will be performed. A total of 100 teenagers, between seven and 12 years of age, with mild-to-moderate myopia and spherical lenses <-6.00 D and cylindrical lenses <-1.50 D will be selected from the Xinjiang Uygur Autonomous Region Institute of Traditional Chinese Medicine, a grade III level A teaching hospital in Urumqi, Xinjiang, China (Xinjiang Medical University Affiliated Hospital of Traditional Medicine). The subjects will be randomly assigned to two different groups (control and acupuncture groups), each group containing 50 subjects. The subjects in both groups wear single-vision corrective lenses. In the acupuncture group, acupuncture will be performed daily for nine consecutive days on five points (bilateral Cuanzhu, Tongziliao, Sibai, Muchuang, and Hegu), followed by no treatment for one day. Six cycles of treatment will be undertaken continuously for a total of 60 days. Following 60 days of treatment, a follow-up period of six months will be included. The primary outcome will be diopter determination. The secondary outcomes will include distance visual acuity, axial length, lens thickness, ciliary body thickness, and subjective symptoms of the eyes and entire body. The main time points for the evaluation of clinical efficacy will be the first, third, and sixth months after treatment. DISCUSSION: This study will provide clinical observations of various indices following the use of acupuncture to treat adolescents with mild-to-moderate myopia, as well as information on the safety of acupuncture. TRIAL REGISTRATION: Chinese Clinical Trial Registry (identifier: ChiCTR-TRC-13003448; registration date: 7 August 2013).

Identification of fungi in fungal ball sinusitis: comparison between MUC5B immunohistochemical and Grocott methenamine silver staining.

CONCLUSION: MUC5B immunohistochemical staining was a valuable method for identifying fungi in fungal ball sinusitis, especially in distinguishing aspergillus and mucor. Combined infection with Aspergillus and Mucor fungi was the most common pattern in fungal ball sinusitis. OBJECTIVE: To assess the value of MUC5B immunohistochemical staining in identifying fungi in fungal ball sinusitis by comparing it with conventional Grocott methenamine silver (GMS) staining. METHODS: GMS staining and MUC5B immunohistochemical staining were used to identify fungi in mucopurulent cheesy or clay-like tissues from sinuses in 180 fungal ball sinusitis patients, and the examination results were compared. RESULTS: In 180 samples of fungal ball sinusitis, GMS staining showed Aspergillus in 130, Mucor in 88, and Candida albicans in 6, while MUC5B immunohistochemical staining identified Aspergillus in 166, Mucor in 172, and Candida albicans in 16. The fungal detection rate for MUC5B immunohistochemical staining was markedly greater than that for GMS staining (p < 0.01). This implies that MUC5B immunohistochemical staining was more sensitive than GMS staining in identifying fungi in fungal ball sinusitis. Mixed infection of Aspergillus and Mucor was present in 146 of 180 patients (81.1%).

Low dose macrolide administration for long term is effective for otitis media with effusion in children.

OBJECTIVE: To explore the clinical effect and possible mechanism of macrolides on otitis media with effusion in children. METHODS: Children with otitis media with effusion were recruited and prescribed for macrolides according to a designed scheme, and followed up for 8-12 weeks. Middle ear effusion samples were collected from the participants to assess the presence of biofilm. RESULTS: Macrolides were found to have significant effect on the therapy of early stage otitis media with effusion for 88.7-92.5% of participants compared with 50.9-60.3% in control group after 8-12 weeks. Almost 72.1% of chronic otitis media with effusion patients recovered after an 8 weeks' course low dose macrolides prescription. Biofilm occurred in 30.8% (4/13) of middle ear effusion. CONCLUSIONS: The results indicate that macrolides are effective for otitis media with effusion in children. Bacterial biofilm may play an important role in the pathogenesis of otitis media with effusion.

[Change of airflow patterns inside the maxillary sinus influenced by uncinate process].

OBJECTIVE: to study the change of the airflow patterns inside the maxillary sinus that influenced by uncinate process. METHODS: Two kinds of cadavers were used, one had a normal uncinate process and the others had an out-gressin uncinate process. The airflow patterns inside the maxillary sinus were compared between them. Also compared were the airflow patterns inside the maxillary sinus before and after the excision of the uncinate process. RESULTS: The airflow patterns inside the maxillary sinus in cadavers with a normal uncinate process exchanged actively. The smoke easily entered the maxillary sinus and could be found easily. It entered in the maxillary sinus with a whirlpool form. It cost about (11.4 +/- 1.4) s till the smoke dissipated from the maxillary sinus. On the other hand, in cadavers with an out-gressin uncinate process, the airflow patterns inside the maxillary sinus exchanged inductively. The smoke entered in the maxillary sinus and could be observed, but it was less than that in cadavers with a normal uncinate process. The form of the smoke could not be judged. It cost (24.2 +/- 1.6) s till the smoke dissipated from the maxillary sinus. The airflow patterns inside the maxillary sinus became inactive after the excision of the uncinate process in all kinds of cadavers. CONCLUSIONS: The normal uncinate process permits the physiological commutation of air inside the maxillary sinus.

[Influence of uncinate process on aerodynamic characteristics of nasal cavity and maxillary sinus].

OBJECTIVE: This study aimed to investigate the influence of uncinate process on air flow velocity, trace, distribution, air pressure, as well as the air flow exchange of nasal cavity and paranasal sinuses. METHODS: Fluent software was used to simulate two nasal cavity and paranasal sinus structures following CT scanning, one had normal nasal cavity, the another had the nasal cavity with uncinate process removed. Air flow velocity, pressure, distribution and trace lines were calculated and compared by Navier-Stokes equation and numerically visualized between two models. RESULTS: Air flow of two models in the common and middle meatus accounted for more than 50% and 30% of total nasal cavity flow. Flow velocity of two models were maximal in the common meatus, followed by the middle meatus. The maximal velocity existed on the left nasal district between limen nasi and head of inferior turbinate. The flow traces of two models were similar. In the normal model, the air flow velocity of the district around uncinate process was almost the same in inhale and exhale. In the model with the uncinate process removed, the air flow velocity of the district around uncinate process was faster, the air flow velocity in expiratory phase was quicker. Compared with the normal nasal cavity, there was more exchange of maxillary sinus in the model with cut uncinate process. CONCLUSIONS: In the view of flow dynamics, the uncinate process effects the air flow velocity of the district around uncinate process and the exchange of maxillary sinus, the contribution of nasal flow is connected with the morphosis of the uncinate process.

[Effect of endoscopic sinus surgery on airflow of the nasal cavity and paranasal sinuses: a computational fluid dynamics study.].

OBJECTIVE: To study the airflow velocity, trace, distribution, pressure, as well as the airflow exchange between the nasal cavity and paranasal sinuses in a computer simulation of nasal cavity pre and post virtual endoscopic sinus surgery (ESS). METHODS: Computational fluid dynamics (CFD) technique was applied to construct an anatomically and proportionally accurate three-dimensional nasal model based on a healthy adult woman's nasal CT scans. A virtual ESS intervention was performed numerically on the normal nasal model using Fluent 6.1.22 software. Navier-Stokes and continuity equations were used to calculate and compare the airflow characteristics between pre and post ESS models. RESULTS: (1) After ESS flux in the common meatus decreased significantly. Flux in the middle meatus and the connected area of opened ethmoid sinus increased by 10% during stable inhalation and by 9% during exhalation. (2) Airflow velocity in the nasal sinus complex increased significantly after ESS. (3) After ESS airflow trace was significantly changed in the middle meatus. Wide-ranging vortices formed at the maxillary sinus, the connected area of ethmoid sinus and the sphenoid sinus. (4) Total nasal cavity resistance was decreased after ESS. (5) After ESS airflow exchange increased in the nasal sinuses, most markedly in the maxillary sinus. CONCLUSIONS: After ESS airflow velocity, flux and trace were altered. Airflow exchange increased in each nasal sinus, especially in the maxillary sinus.

[Model of nasal cavity and paranasal sinuses created for studying the dynamics of the nasal airflow].

OBJECTIVE: To create a model from an adult cadaver's nasal cavity and verify whether it can be used to study the airflow dynamics in the nasal cavity and paranasal sinuses. METHODS: (1) The model was made by the material of transparent resin and Bengal gelatin according to a nasal cast of a cadaver. (2) The model was check by Acoustic Rhino-meter, CT scan and nasal endoscope, then compared with the normal. (3) To observe the smoke flow in the model and record it by a digital camera RESULTS: It was succeeded in creating a model of the nasal cavity and paranasal sinus. The model was good at simulation and transparency. The structure of the model, the cross-sectional areas of the nasal passage and the CT scan results of the model were similar to the normal. The airflows in the model could be recorded by a digital camera. It showed that there were two types of airflows in the nose. The majority of airflows were found in the common and middle nasal meatus, the little part of the airflows passed through the upper of the nose like a parabola. There was an increasing proportion of airflows in the olfactory region when elevated the airflow rates. A relatively large vortex formed in the upper part of the nose, just behind the nasal valve, and another one was in the pharynx nasals. CONCLUSIONS: (1) The transparent resin and Bengal gelatin are suitable for making the model of the nose. The model can be used to study the airflows dynamics of the nasal cavity and paranasal sinuses. (2) The majority of inspired airflows go straightly to the pharynx nasals through the combined middle and inferior airways, a little part of inspired airflows through the olfactory region like a parabola. (3) The inspired airflows first arrived at the front position of the middle and inferior turbinate. The airflows can go into the maxillary sinus, a vortex can be see in the maxillary sinus during breath.

[A study of applied microanatomy by endoscope-assisted via retrolabyrinthine approach].

OBJECTIVE: To study the microanatomy by endoscope-assisted via retrolabyrinthine approach. METHOD: Nineteen cadaveric heads fixed with formalin were dissected in our study. The data that endoscope could be extent and the distance between the important point were measured. By simulated the retrolabyrinthine approach, endoscope was placed to observe the nerves and vessels, the distance between nerves and the central point of the anterior edge of sigmoid sinus were measured. RESULT: The distance from the inferior margin of petrous ridge to the upper bound of endolymphatic sac was (9.93+/-1.52)mm; and from superior margin of petrous ridge to the inferior margin common bony crus was (4.64+/-0.91)mm;and from the intersection of posterior semicircular canal to the anterior wall of sigmoid was (7.85+/-1.47)mm on the left, and (5.69+/-1.68)mm on the right. The distance from inferior margin common bony crus to the anterior wall of sigmoid was (13.9+/-1.71)mm on the left, and (11.31+/-2.03)mm on the right. The trochlear nerve and abducent nerve could be observed under endoscope. The relationship between the trigeminal nerve, acoustic nerve and the vessels could be identified clearly. The distance from the central point of the anterior edge of sigmoid to the roots of the trigeminal nerve, facial nerve, vestibulocochlear nerve and glossopharyngeal nerve were (29.88+/-2.77) mm, (32.04+/-2.04) mm, (29.17+/-1.65) mm, (35.49+/-1.53) mm respectively. CONCLUSION: The visual field of the cerebellopontine angle appear wider by the endoscope assisted retrolabyrinthine approach. Nerves, vessel, internal acoustic pore, jugular foramen region can be clearly seen. Some minimal invasive surgery can be done by this approach.