Intratympanic dexamethasone injections for refractory Meniere' s disease.

Intratympanic injections or titration is a potential medical therapeutic strategy for patients with incurable inner ear diseases. Dexamethasone represent an attractive steroid source in intratympanic steroids strategies in the treatment of inner ear disorders. Here, we evaluated the effectiveness of intratympanic dexamethasone injections (IDI) in outpatients with refractory Meniere's disease (MD). Vestibular function measured by Vestibular Ocular Reflex (VOR) gain and caloric test revealed that 21 outpatients out of 43 (48.8%) had complete sufficient vertigo control, while 9 (20.9%) of them were attached to fundamental manipulation. Out of the 13 remaining outpatients, 4 (9.3%) had a limit control and 9 had less modification. Therefore, 5 of 9 received re-treatment with IDI and 2 of 9 patients were administered ablative treatment with gentamicin. Meanwhile, audiology data suggested that 3 (7.0%), 4 (9.3%), 32 (74.4%), 4 (9.3%) patients were attached to the level of A, B, C, D, respectively. Furthermore, the symptom of tinnitus in 5 outpatients vanished, 21 (48.8%) diminished, 10 (23.3%) invariable, 7 (16.3%) aggravated. In 4 of 24 cases (16.7%), aural fullness disappeared after IDI, when the aural fullness was alleviated in 11 cases (45.8%) even intensive in 9 patients (37.5%). Together, our results demonstrate that intratympanic dexamethasone injection, as an effective therapeutic strategy for refractory Meniere's disease, could either be used for cascade therapy preoperation or used for patients who couldn't accept the surgery.

Bilateral sudden hearing loss following habitual abortion: a case report and review of literature.

Sudden sensorineural hearing loss (SSNHL) is usually unilateral and can be associated with tinnitus and vertigo. The most common causes of this disease are known to be the vascular and viral agents, but immune disorders are involved in the development of sudden deafness. The antiphospholipid syndrome (APS) is an acquired autoimmune system disorder, which is defined as the presence of antiphospholipid antibodies (APA) in the patient's blood, then cause venous and/or arterial thrombosis in various organs of the body, for example, thrombosis can occur in the placenta and/or the inner ear. As a result, it can cause abortion and/or sudden deafness. Bilateral SSNHL following habitual abortion is a rare clinical event. Here, we report a case of 32-year-old woman who presented with bilateral sudden hearing loss following recurrent pregnancy loss (RPL) as the first manifestation of primary antiphospholipid syndrome. Combine the literature, the diagnosis, clinical implication and treatment are discussed.

An unusual case of complicated temporal lobe abscess following tympanomastoidectomy.

We report a unusual case of complicated temporal lobe abscess following tympanomastoidectomy in a 26-year-old Chinese man here. The patient complained of binaural recurrent purulent discharge accompanied by hearing loss more than 10 years, then he received a right tympanomastoidectomy three months ago, but 3 weeks after surgery, he started to experience fierce headache and nausea and so on. The CT and MRI suggested the diagnosis of right temporal lobe abscess and then right temporal lobe abscess was excised. The patient was successfully treated with a right temporal lobe abscess resection and a radical right mastoidectomy. Although the cerebral abscess following radical tympanomastoidectomy are extremely rare, we should pay attention to it. we suggest the main reasons was still suffering from purulent discharge in the ear after the first tympanomastoidectomy, the granulation and cholesteatoma failed to completely remove during the first operation. and even resulted in substantial bone defect. It is well-known that good drainage is a key to reduce intra-cranial complications.

Evaluation of intratympanic dexamethasone for treatment of refractory sudden sensorineural hearing loss.

OBJECTIVE: To observe and compare the efficacy of intratympanic application of dexamethasone (DXM) for the treatment of refractory sudden sensorineural hearing loss (SSNHL), the DXM was given in three different ways: by tympanic membrane injection, by drip through a ventilation tube, and by perfusion through a round window catheter. METHODS: We conducted a nonrandomized retrospective clinical trial involving 55 patients with refractory SSNHL. For 21 patients (the perfusion group), DXM (2.5 mg/0.5 ml) was perfused transtympanically through a round window catheter using an infusion pump for 1 h twice a day for 7 d giving a total amount of 35.0 mg. For 23 patients (the injection group), DXM (2.5 mg/time) was injected by tympanic membrane puncture at intervals of 2 d on a total of four occasions giving a total amount of 10.0 mg. For 11 patients (the drip group), DXM (2.5 mg/0.5 ml) was dripped via a ventilation tube placed by myringotomy, once on the first day and twice a day for the remaining 6 d giving a total amount of 32.5 mg. Thirty-two patients with refractory SSNHL who refused to undertake further treatments were defined as the control group. Hearing recovery and complications were compared among the groups. Hearing results were evaluated based on a four-frequency (0.5, 1.0, 2.0, 4.0 kHz) pure tone average (PTA). RESULTS: Post-treatment audiograms were obtained one month after treatments were completed. The improvements in average PTA for the perfusion, injection, and drip groups were 9.0, 8.6, and 1.7 dB, respectively. Hearing improvement was significantly greater in the perfusion and injection groups than in the control group (1.4 dB) (P<0.05). In the perfusion group, 8 out of 21 patients (38.1%) had a PTA improvement of 15‒56 dB (mean 29.8 dB); in the injection group, 8 out of 23 patients (34.8%) had a PTA improvement of 16‒54 dB (mean 24.9 dB); in the drip group, 1 of 11 patients (9.1%) had a PTA improvement of 26.0 dB; in the control group, 3 out of 32 patients (9.4%) had a PTA improvement of 15‒36 dB (mean 14.9 dB). CONCLUSIONS: Topical intratympanic application of DXM is a safe and effective method for the treatment of SSNHL cases that are refractory to conventional therapies.

[Clinical features and treatment of closed rupture of cervical trachea].

OBJECTIVE: To study the clinical manifestations and treatments of closed injuries of the cervical trachea. METHOD: We carried out a retrospective study of the clinical manifestations, diagnosis and treatment of patients with closed injuries of the cervical trachea that have been treated in our hospital over the last ten years. We analyzed commonly occurring clinical problems, key points of surgical treatment, and postoperative recovery. Fourty-one patients with acute closed injuries of the cervical trachea underwent emergency tracheotomy or anesthesia orotracheal intubation and surgical repair of the trachea within 24 to 48 hours. Twenty six patients had their tracheotomy tubes extubated after surgery and had their anesthesia orotracheal tubes extubated within 48 hours postoperatively; tracheotomy tubes remained in the airway in 15 patients postoperatively, and of them, 12 had extubation successfully in 2 weeks postoperatively, while the remaining 3 were left intubated due to laryngotracheal stenosis. Among the 3, 2 underwent further surgical repair and recovery, and 1 had a stent inserted. RESULT: Twenty-eight patients fully recovered postoperatively. Ten patients mostly recovered postoperatively exception for hoarseness, and their fundamental phonation function recovered within 2 to 3 months but with poor movement of the vocal cords. The breathing and swallowing function of the other 3 patients recovered after the surgery, but they suffer from hoarseness. CONCLUSION: In the treatment of closed disruption of the cervical trachea, prompt diagnosis and timely surgical repair of the structure and function of the trachea are key to saving the patients' lives and avoiding tracheal stenoses.

[Study on clinical manifestations and treatment of primary cervical tracheal malignant tumor of children].

OBJECTIVE: To study the clinical manifestations and treatment of the primary cervical tracheal malignant tumor of children. METHOD: Five cases diagnosed as primary tracheal malignant tumor with fibrolaryngoscopy, CT scan and pathology were retrospectively analyzed and reviewed. Extraction of malignant tumor was performed with tracheoscopy and nasal endoscope after emergent tracheotomy below the tumor in 4 cases, and tracheotomy after intubation in 1 case. After operation, 4 children received radiotherapy, and 1 case received laser therapy add radiotherapy. RESULT: Five cases were followed up for three to eight years, and no recurrence was found. CONCLUSION: There was no specific manifestation in early tracheal malignant tumor, but it was critical and emergent during symptoms appear. Imaging examination was a very invaluable diagnosis method. Optimal and effective therapeutic protocol is tracheostomy under local anesthesia to keep upper airway patency followed by surgical extraction and radiotherapy. It was not appropriate to have tracheal wall resection for children.

[Prevention and management of blindness following endonasal sinus surgery].

OBJECTIVE: To explore the causes and the management of serious eye complications occurring in the endoscopic sinus surgery. METHOD: Three patients of chronic sinusitis and nasal polyps suffered with blindness in endoscopic sinus surgery and in nasal packing with iodoform and petrolatum gauze were treated. RESULT: Orbital wall and structure were injured in 2 cases during endoscopic sinus surgery, among which, 1 case blinded with deformation of the eyeball during operation underwent optic nerve exploration and orbital muscle reparation immediately. One case developed periocular swelling, eyelid hematoma, conjunctiva edema and blinded 2 days later, and was treated with hematoma clearance and optic nerve decompression. Another 1 case blinded immediately after ethmoid packing, and vision recovered after nasal pack removed. Antibiotics, corticosteroid and nerve growth factor were administered for 4 weeks in all patients. After 6-month follow-up, 1 case was blinded with eyeball atrophy, 1 case was only photonasty, another regained normal vision. CONCLUSION: The causes of blindness in endoscopic sinus surgery are directly related to orbital structure trauma and orbital hematoma. The optic nerve during operation should be protected carefully, if ethmoid sinus over development is demonstrated by CT scan. The application of gauze should be avoided when the medial orbital wall is injured. Decompression of optic nerve should be performed as early as possible, if vision damaged.

[Clinical features and treatment of nasal mucosa-associated lymphoid tissue lymphoma].

OBJECTIVE: To explore the clinical features and treatment of nasal mucosa-associated lymphoid tissue lymphoma (MALTL). METHOD: The data of 11 patients with nasal MALTL were analyzed retrospectively during 9 years, including their clinical features and effectiveness of treatment. Nine cases were male and 2 female, their age arranged from 18 to 49 years with an average age of 39 years. All cases underwent endoscopic sinus surgery, and were diagnosed by HE staining and immunohistochemistry. After operation, 7 cases were cured with immunotherapy and antibiotic therapy. Other 4 patients were treated by chemotherapy, radiotherapy, immunotherapy and antibiotic therapy. RESULT: During follow up 6-36 months, 4 patients died and other 7 patients achieved complete remission. CONCLUSION: Clinical manifestations of nasal MALTL are not typical,which is apt to be misdiagnosed and mistreated. The suspected lesion tissues under endoscopy should be completely resected and submitted to pathology investigation. Nasal MALTL is a subtype of non-Hodgkin lymphoma which is characterized by occult onset, long course, slow progression and low cure rates in the advanced stage.

[Study on the surgery treatments in patients with maxillary osteofibrous hyperplasia of bone].

OBJECTIVE: To explore the clinical features, diagnosis and the surgery therapy of maxillary fibrous hyperplasia of bone. METHOD: The clinical data of 37 cases with maxillary fibrous hyperplasia of bone from 1987-2006 years were retrospectively analyzed. 19 cases of male and 18 cases of female, their average age is 22.5 years (17-35 years). Twenty-one cases were operated by Caldwell-lud or lateral rhinotomy operation. After 1997, 16 cases were operated by Caldwell-lud operation with endoscopy so as to strip hyperplasia bone. RESULT: Thirty-six cases were cured within 2-4 years follow-up, 1 case was reoperated by Caldwell-lud operation with endoscopy after recurrence. The patients who received operation by Caldwell-lud operation with endoscopy had less symptoms in the inflation deformity of maxillofacial region and dysfunction of neighbouring structures than those who received traditional operation. CONCLUSION: The diagnosis can be made by history, signs and radiography. Caldwell-lud operation with nasal endoscopy is more effective treatment, and advocated in clinical practice.

[Round window catheter placement with dexamethasone perfusion for intractable sudden sensorineural hearing loss].

OBJECTIVE: To investigate the efficacy of round window catheter placement with dexamethasone perfusion for 13 patients with intractable sudden sensorineural hearing loss (SSNHL). METHOD: Dexamethasone (2.5 mg) was perfused transtympanically through round window catheter by Micro-infusion pump. The perfusion was taken twice a day and continued for an hour each time, for a total of 7 days. RESULT: Thirteen patients have been followed up for 1 month. Five of them (38.5%) were demonstrated a 17-54 dB improvement in pure-tone threshold average (PTA). The other 8 patients (61.5%) had no effect. CONCLUSION: Round window catheter placement with dexamethasone perfusion is a cost-effective and useful treatment for SSNHL patients who had no effect through conventional therapy, although hearing thresholds of these patients had hardly improved to normal levels.

[Expression of connective tissue growth factor (CTGF), osteopontin (OPN) and clinical significances in the laryngeal squamous cell carcinoma tissues].

OBJECTIVE: To study the expressions of CTGF and OPN and detect their clinical value and correlation in the laryngeal squamous cell carcinoma tissues and paracancerous tissues. METHOD: SP immunohistochemical method was used for the assays of CTGF and OPN on the routinely paraffin-embedded sections of surgical operated specimens of 41 cases with laryngeal squamous cell carcinoma and 20 ones with paracancerous tissues. RESULT: The positive rate of CTGF and the score were significantly lower in cancer tissues than those in paracancerous tissues (61.0% vs 90.0%, P < 0.05; 2.41 +/- 1.60 vs 4.24 +/- 1.42, P < 0.01), but those of OPN were opposite (61.0% vs 15.0%, P < 0.01; 3. 10 +/- 1.63 vs 1.12 +/- 0.84, P < 0.01). The positive rates and scores of CTGF were significantly higher in the cases without-metastasis of lymph node and clinical stage T1 than those in the ones with-metastasis of lymph node and clinical stage T3 (P < 0.01) . The positive rates and scores of OPN were significantly lower in the cases without-metastasis of lymph node, clinical stage T1 and histological grade I those that in the ones with-metastasis of lymph node, Clinical stage T3 and histological grade III (P < 0.01). The closely negative correlation was found between the score of CTGF and that of OPN. CONCLUSION: The expression of CTGF and/or OPN might be important biological markers in reflecting the progression, biological behaviors, metastatic potential and prognosis of the laryngeal squamous cell carcinoma.

[Sinus histiocytosis with massive lymphadenopathy].

OBJECTIVE: To explore the therapeutic strategy of sinus histiocytosis with massive lymphadenopathy (SHML). METHOD: The six patients with SHML were treated with different therapeutic strategies. RESULT: Two of six patients were treated with radiation therapy and chemical therapy resulting in tumor lessened markedly. The tumor of other four cases disappeared after comprehensive treatment including operation, immunity and interferon therapy. CONCLUSION: The comprehensive therapy, mainly including surgical treatment, is effective for SHML.

[Intratympanic dexamethasone injections for intractable sudden sensorineural hearing loss].

OBJECTIVE: To investigate the efficacy of intratympanic dexamethasone injection (IDI) for 23 patients with intractable sudden sensorineural hearing loss (SSNHL). METHOD: Dexamethasone (5 g/ml) was injected into the middle ear. The injection was repeated once two days and had a total of 4 doses (10 mg). RESULT: The 23 patients were followed up for one month. Eight of 23 patients (34.8%) demonstrated a 17 to approximately 54 dB improvement in PTA and 15 of 23 (65.2%) had no response. CONCLUSION: IDI is a simple and effective treatment for SSNHL patient who had not responded to conventional therapy, although hearing was rarely improved to normal levels.

[Intratympanic dexamethasone for sudden sensorineural hearing loss].

OBJECTIVE: To report the effect of intratympanic dexamethasone (ITD) on sudden sensorineural hearing loss (SSNHL). METHOD: The effect of ITD on a case with bilateral SSNHL was presented and the relevant literature was reviewed. RESULT: The patient's hearing was improved more than 40 dB in both ears. CONCLUSION: TID is effective and helpful for SSNHL.

[Clinical observation of sensorineural hearing loss in patients suffering from nasopharyngeal carcinoma after radiotherapy].

OBJECTIVE: To study the extent and incidence of sensorineural hearing loss (SNHL) after radiotherapy (RT). METHODS: Twenty-eight patients with diagnosed nasopharyngeal carcinoma (NPC) were selected. The pure-tone audiography, auditory brain stem evoked response (ABR), impedance audiometry and evoked otoacoustic emissions (EOAE) recordings were performed before RT, 1 month, 1, 2 and 5 years after RT. RESULTS: At 1 month after RT, there were 7.1 and 25.7 dB increased mean bone conduction (BC) thresholds at speech (0.5 - 4.0 kHz) and at high frequency (8.0 kHz), and their BC thresholds were statistically significant increase than those before RT, respectively (P < 0.001). At 1 year after RT, there were 17.6 and 28.1 dB increased respectively, and their thresholds were statistically significant increase than those at pre-irradiation (P < 0.001). There were also significant increases in thresholds than those at 1 month of post-irradiation (P <0.001 or P < 0.05). At 2 years after RT, 21 and 27.4 dB were increased at respective those two frequencies, and there was a statistically difference only at speech frequencies when compared with those at 1 year after RT (P < 0.05). At 5 years after RT, 26.7 and 35.8 dB were increased at these two frequencies, and there were significant increases in threshold than those before, 1 month, 1 and 2 years after RT, respectively (P < 0.001). From 1 month to 5 years after RT, 37. 5% to 94. 7% of ears had a BC hearing threshold of at least 15 dB losses at speech frequency, whereas the percentage at high frequency was 85.4 to 97.4%. Up to 63.2% and 73.7% of ears had 30 dB SNHL at least at speech and high frequency, respectively. Furthermore, the degree of mean threshold loss was greater at high frequency than at speech frequency. The mean value of wave I, III and V latency, and I -V interpeak latency intervals of ABR had no significant difference between at 1 month after RT and before RT (P > 0.05). The wave I , III and V latency, and I - V interpeak latency intervals at 1 year and 2 years were significantly prolonged when compared with those before and 1 month after RT (P < 0.05), but there were no significant difference between 1 year and 2 years after RT (P > 0.05). The wave I, III and V latency, and I -V interpeak latency intervals at 5 years after RT were also significantly longer than those before RT (P < 0.001). There were significant difference in wave I , III and V latency (P < 0.05), and no significant difference in wave I - V interpeak latency intervals (P > 0. 05) between 5 years after RT and 1 year or 2 years after RT. Seven of 10 ears at 1 year after RT and 4 of 7 ears at 5 years after RT had normal EOAE, but they all had abnormal ABR response. CONCLUSIONS: SNHL in NPC patients start soon after completion of RT, especially more commonly in high frequency. The incidence and the extent of hearing loss are increased with time of follow-up. The hearing impairment could occur in the cochlea and/or the retrocochlear auditory pathway, which show that the sensitivity of radiation damage may be different in different patient and anatomic site of auditory system.

[Intratympanic dexamethasone injections for intractable Meniere's disease].

OBJECTIVE: To investigate the efficacy of intratympanic dexamethasone injections (IDI) for 15 patients with intractable Meniere's disease (MD). METHOD: Dexamethasone (2.5 mg/0.5 ml) was injected into the middle ear and followed by a second injection 15 minutes later. The injection was repeated the next day and weekly for 3 weeks. Total dose of dexamethasone was 17.5 mg. RESULT: The 15 patients were followed up for 18 months (average). Complete relief of vertigo was maintained in 10 cases, improved in 2 case, injection wos repeated 3 patients with recurrent vertigo resulted in control of vertigo. Tinnitus disappeared in 5 cases, reduced in 5 cases, unchanged in 5 cases. Hearing was improved in 10 cases, unchanged in 5 cases. CONCLUSION: IDI is effective for intractable MD. The benefits of IDI are avoidance of systemic use of steroids, lower cost, easy application. IDI can be used as an initial surgical treatment for persistent vertigo in MD and indicated for bilateral MD.

[Sudden sensorineural hearing loss in children].

OBJECTIVE: To study the clinical features of the sudden sensorineural hearing loss (SSHL) in children. METHOD: Twenty-one children patients with SSHL and sixty-seven adult patients with SSHL as controls were investigated. RESULT: The possible causes were identified in 11 children cases (52.4%) as 4 mumps, 3 upper respiratory tract infections, 2 ototoxicity from aminoglycoside antibiotics, 1 noise exposure and 1 genetic metabolic encephalopathy. CONCLUSION: The hearing impairment was more severe and the prognosis was more poor in children with SSHL than that in the adults with SSHL.

[Curative effect of transtympanic perfusion of gentamicin on unilateral Ménière's disease].

OBJECTIVE: To investigate the curative effect of transtympanic perfusion of gentamicin on unilateral Ménière's disease. METHODS: Twenty-three patients with unilateral Ménière's disease, 14 males and 9 females, aged 24 - 61, all with vertigo, tinnitus and ear fullness sensation to different degrees, were treated with transtympanic perfusion of gentamicin via the tympanostomy tube, 12 mg per 3 hours and 5 times a day. Pure tone audiometry and caloric test were performed every day before treatment. When destruction type of nystagmus was observed by Frenzel's glasses and the treated ear showed no response to caloric test, the treatment was ceased. After the treatment the patients were followed up for 9 - 11 years (10.2 years on average). RESULTS: The average amount of gentamicin used was 216 mg. The treatment lasted for 1.5 to 5 days (3.6 days on average). Vertigo disappeared in 21 patients (91%) and remained unchanged in 2. Hearing was improved or remained unchanged in 17 patients (73%) and became worse in 6. Tinnitus decreased or disappeared in 15 patients (66%), and increased in 2 patients. Ear fullness sensation decreased or disappeared in 21 patients (91%). and remained unchanged in 2. Twenty-one patients were completely recovered and returned to work (91%). CONCLUSION: Relieving intractable vertigo and preserving hearing, transtympanic perfusion of gentamicin is effective on unilateral Ménière's disease.

[Surgical treatment of inflammatory labyrinthine fistulae 23 cases].

OBJECTIVE: To report the experience of surgical treatment of inflammatory labyrinthine fistula (LF). METHOD: Twenty-three patients with cholesteatomatous otitis media complicated with LF underwent mastoidectomy, surgical repair and obliteration of LF. After removal of cholesteatoma matrix and inflammatory lesion around fistula, the fistulae were treated as following procedures: fistulae less than 2 mm in diameter were overlaid with fascia (7 cases), those 2 to 3 mm were obliterated with bone chips and fascia (13 cases), and for those more than 3 mm, the bony semicircular canal lumen were packed with fascia and bone chips, then overlaid with fascia. RESULT: In 23 patients with LF, which included 22 lateral semicircular canal fistulae (SCF) and one lateral combined with posterior SCF, two patients lost follow-up and 21 cases were observed with an average follow-up period of 2.5 years. In this series of cases, vertigo disappeared in 17 and diminished in 2. With the exception of total deafness in two cases, the average auditory thresholds in speech frequencies remained unchanged, showing that the thresholds of air conduction (AC) and bone conduction (BC) were 67.1 dB HL and 37.1 dB HL prior operation versus 69.1 dB HL and 30.6 dB HL after operation, respectively. CONCLUSION: Because of structural barrier between superior and inferior labyrinth and inflammatory adhesions, surgical treatment of inflammatory LF is feasible and effective. Successful operation depends on excellent microsurgery skill, complete removal of inflammatory lesion, precise obliteration of fistula, post-operative administration of antibiotics and steroids and close follow-up. In addition to fistula test, axial petrous bone CT scan is a good complemental method in preoperative diagnosis of LF.

[Chronic stenosed otitis externa: a report of 14 cases].

OBJECTIVE: To evaluate the clinical features of chronic stenosed otitis externa (CSOE) and its treatment. METHODS: Fourteen patients with CSOE from 1992 to 2000 were analyzed retrospectively. RESULTS: In etiologic study, otitis externa and eczema were found in nine cases, chronic suppurative otitis media in three, acetic acid burn in one, and no apparent precipitating causes in one. Ten cases were cured through single operation, 3 experienced 2 operations and one had had 3 operations. The restenosis of external auditory canal occurred in four ears. CONCLUSIONS: CSOE is a rare disease. Surgical treatment is the main effective method for CSOE. The important items for treatment are: removing all stenotic fibrous tissue, widening bony canal, covering all bare bone with skin, preventing wound infection and close postoperative follow-up.