A comparative analysis of laryngeal nerve damage in patients with idiopathic vocal cord paralysis exhibiting different paralytic sides.

Objective: To assess the extent of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) damage in patients with idiopathic vocal cord paralysis (IVCP) exhibiting different paralytic sides. Methods: A total of 84 IVCP cases were evaluated using stroboscopic laryngoscopy, voice analysis, and laryngeal electromyography (LEMG). The results were compared between patients with left-sided paralysis and right-sided paralysis based on different disease courses (less than or more than 3 months). Results: Initially, the average age and disease progression of IVCP patients were found to be similar regardless of the side of paralysis (p > .05). Additionally, there were no significant variations in voice indicators, such as MPT, DSI, and VHI, between IVCP patients with left and right vocal cord paralysis (p > .05). Furthermore, no disparities were detected in the latencies and amplitudes of the paralyzed RLN and SLN, as well as the durations and amplitudes of the action potentials in the paralyzed TM and PCM, among IVCP patients with left and right vocal cord paralysis (p > .05). Notably, the amplitudes of the left paralytic CM were significantly lower than those of the right paralytic CM (0.45 vs. 0.53, Z = -2.013, p = .044). In addition, no disparities were observed in APDs and amplitudes between the ipsilateral PCM and TM, either for patients with left or right vocal fold paralysis (p > .05). Finally, all the IVCP patients were subdivided into two subgroups according to different disease course (less than or more than 3 months), and in each subgroup, the comparison of voice indicators and LEMG results in IVCP patients with left or right vocal fold paralysis were similar with the above findings (p > .05). Conclusion: Overall, the degree of RLN and SLN damage appeared to be similar in IVCP patients with left and right vocal cord paralysis, provided that the disease course was comparable. Level of Evidence: 4.

The effectiveness of various treatment approaches for laryngeal contact granulomas.

OBJECTIVES: To assess and compare the effectiveness of various treatment approaches for laryngeal contact granulomas (LCG). METHODS: A retrospective analysis was conducted on a cohort of 45 patients diagnosed with LCG at the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to May 2023. Based on the treatment modalities administered, patients were categorized into three groups: acid suppression alone, hormone injection combined with acid suppression, and surgery combined with acid suppression. Subsequently, the study compared differences in treatment efficacy and average healing time among these three groups, using various indicators. RESULTS: The findings indicate that the granuloma size in LCG patients with hoarseness (0.126, 95% CI 0.087-0.288) was significantly greater compared to LCG patients without hoarseness (0.047, 95% CI 0.014-0.083) (P = 0.001). However, there were no significant variations in age, morphology (unlobulated/lobulated), laterality ratio (left/right), sex ratio (male/female), history of tracheal intubation (non-intubation/intubation), and RFS score (RFS > 7/RFS ≤ 7) (P > 0.05), regardless of the presence of hoarseness symptoms. At the treatment observation endpoint of 3 months, the curative ratio in the group receiving hormone injection combined with acid suppression was found to be significantly higher compared to the group receiving acid suppression alone (P = 0.018). In addition, the average healing time of patients in the hormone injection combined with acid suppression group was notably shorter than that of the acid suppression alone group (P = 0.007). CONCLUSIONS: The combination of hormonal injections and acid suppression may enhance the curative ratio and expedite the healing time of LCG.

The subglottic involvement is an independent risk factor for recurrence of laryngeal amyloidosis.

OBJECTIVE: To analyze the risk factors for recurrence of laryngeal amyloidosis (LA). METHODS: The clinical data of patients with LA admitted in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2009 to June 2022 were analyzed retrospectively; then, the risk factors for recurrence and their impacts on the recurrence time were also analyzed. RESULTS: Of the 44 patients with LA, the majority (38 cases, 86.4%) only involved one anatomical region and the others (6 cases, 13.6%) involved two laryngeal regions concurrently. Overall, the glottic region was the most commonly affected area (28 cases, 63.6%), followed by the supraglottic region (16 cases, 36.4%) and subglottic region (6 cases, 13.6%). In addition, all the lesions were categorized as isolated nodule (31.8%), submucosal localized deposition (52.3%), and submucosal diffuse deposition (15.9%) according to their morphologies under electronic laryngoscope. Finally, six patients (13.6%) had recurrence after operation with a median recurrence time of 24.5 months, and subglottic involvement was confirmed to be an independent risk factor for recurrence of LA by univariate and multivariate logistic regression analyses (P < 0.05). Meanwhile, the patients with subglottic involvement presented as submucosal diffuse deposition had a considerable shorter recurrence time (t = 5.759, P = 0.005). CONCLUSION: The subglottic involvement is an independent risk factor for recurrence of LA.

Submucosal Clustered Brownish Microvessels Based on NBI Endoscopy: A Characteristic of LPR.

OBJECTIVE: This study aimed to analyze the characteristics of laryngopharyngeal reflux (LPR) by using narrow band imaging (NBI) endoscopy. STUDY DESIGN: A prospective study. SETTING: A large-volume practice with tertiary care providers. METHODS: A total of 67 patients with suspected LPR who underwent 24-hour multichannel intraluminal impedance-pH monitoring were included from June 2020 to March 2022. Manifestations of NBI endoscopy included submucosal clustered brownish microvessels (CBMs), spotted brownish microvessels, and no special microvessels; the latter 2 formed the non-CBM group. The manifestations of all patients and their changes were observed after 8 weeks of proton pump inhibitor and symptomatic treatment for patients with LPR, and symptomatic treatment for patients without LPR. RESULTS: According to the results of 24-hour multichannel intraluminal impedance-pH monitoring, the incidence of submucosal CBMs was significantly higher in patients with LPR (30 cases) than in those without LPR (37 cases, P < .001), particularly in the posterior cricoid area (P < .001). Besides Reflux Finding Score, the incidence of signs such as subglottic edema and vocal fold edema was significantly higher in the CBM group than the non-CBM group (P < .05). Finally, 22 patients with LPR (91.7%) and only 2 patients without LPR (28.6%) underwent a transformation from CBMs to spotted brownish microvessels after continuous medication for 8 weeks in the CBM group (χ2 = 15.916, P < .001), while no significant change was observed in patients with or without LPR in the non-CBM group (P > .05). CONCLUSION: Submucosal CBMs in the posterior cricoid area under NBI endoscopy may be a characteristic of LPR.

Hypoxia in non-rapid eye movement sleep in children with otitis media with effusion.

OBJECTIVE: This study aimed to analyze the status of hypoxia in non-rapid eye movement (NREM) sleep in children with otitis media with effusion (OME). METHODS: A total of 232 children with OME and/or adenotonsillar hypertrophy were enrolled in this retrospective study between August 2020 and November 2021. Polysomnographic monitoring was carried out, and the differences in polysomnographic results between the experimental group (children with OME and adenotonsillar hypertrophy) and control group (children with adenotonsillar hypertrophy only) were compared. RESULTS: The lowest oxygen saturation level during sleep was significantly lower in the experimental group (n = 36) than in the control group (n = 196). However, the apnea-hypopnea index, respiratory disorder index, apnea index, obstructive apnea index, obstructive apnea-hypopnea index, and mixed apnea-hypopnea index were significantly higher in the experimental group than in the control group. More importantly, the apnea-hypopnea index, the oxygen desaturation index, oxygen desaturation events, the average heart rate during NREM sleep, and the NREM stage in total sleep time were also significantly higher in the experimental group than in the control group. CONCLUSIONS: Hypoxia during NREM sleep may affect the severity of OME in children.

The effects of Helicobacter pylori eradication therapy on salivary pepsin concentration in patients with laryngopharyngeal reflux.

OBJECTIVE: To investigate the effect of Helicobacter pylori (HP) eradication therapy on salivary pepsin concentration in laryngopharyngeal reflux (LPR) patients with HP infection. MATERIALS AND METHODS: A total of 477 patients with suspected LPR were enrolled from June 2020 to September 2021. Reflux symptom index, reflux finding score, the positive rates and disintegrations per minute values of HP infection detected by 14C urea breath test and salivary pepsin concentrations analyzed using enzyme-linked immunosorbent assay were compared in LPR patients and non-LPR patients with or without HP infection. HP-positive patients were treated with HP eradication therapy while HP-negative patients with PPI therapy. RESULTS: The scores of nagging cough (0.88 vs. 0.50, P = 0.035), erythema or hyperemia (1.93 vs. 1.78, P = 0.035) and vocal fold edema (1.04 vs. 0.85, P = 0.025) were higher in the LPR (+) Hp (+) subgroup than in LPR (+) Hp (-) subgroup. The concentrations of salivary pepsin in the Hp (+) subgroup were higher than in the Hp (-) subgroup either in LPR patients (75.24 ng/ml vs. 61.39 ng/ml, P = 0.005) or the non-LPR patients (78.42 ng/ml vs. 48.96 ng/ml, P = 0.024). Compared to baseline (before treatment), scores of nagging cough (0.35 vs. 0.84, P = 0.019) and erythema or hyperemia (1.50 vs. 1.83, P = 0.039) and the concentrations of salivary pepsin (44.35 ng/ml vs. 74.15 ng/ml, P = 0.017) in LPR patients with HP infection decreased after HP treatment; yet, this was not observed for the LPR patients without HP infection treated with PPI only (P > 0.05). CONCLUSION: HP infection may aggravate the symptoms and signs of LPR patients, partly by increasing their salivary pepsin concentration.

[Occurrence and Risk Assessment of Organophosphate Esters in Source Water of the Nanjing Section of the Yangtze River].

We explored the pollution characteristics, spatial and temporal distribution, ecological risk, and human health risk of organophosphate esters (OPEs) in the source water of the Nanjing section of the Yangtze River. Thirteen OPEs were determined by solid phase extraction-high performance liquid chromatography-tandem mass spectrometry. The results showed that twelve OPEs were detected to different extents with total concentrations ranging from 85.21 to 1557.96 ng·L-1[excluding tris (2,3-dibromopropyl) phosphate]. Chloroalkyl phosphate was the main compound and tris(2-chloroethyl) phosphate (TCEP) was the most abundant of the thirteen OPEs, which reached up to 447.08 ng·L-1. Seasonal variation of OPEs showed that the concentrations of OPEs in summer ranged from 220-1557.96 ng·L-1, with the average concentration of 493.78 ng·L-1 being 1.7-2.6 times higher than of that in spring and autumn. An ecological risk assessment showed that tricresyl phosphate and 2-ethylhexyl diphenyl phosphate were associated with moderate or high risks to organisms (algae, crustaceans, and fish). At a high exposure concentration, the total non-carcinogenic risk of OPEs in source water ranged from 4.41×10-3-2.91×10-2, with the highest risk being associated with children aged 0-3 months. The total cancer risk value was 5.88×10-7-3.89×10-6, among which TCEP and Tris(1,3-dichloro-2-propyl) phosphate was associated with a potential risk for children. We conclude that the long-term exposure risk for children of OPEs in the source water of the Nanjing section of the Yangtze River deserve more attention.

[Occurrence Characteristics and Risk Assessment of Antibiotics in Source Water of the Nanjing Reach of the Yangtze River].

Occurrence characteristics of antibiotics in the source water of the Nanjing section of the Yangtze River were analyzed preliminarily by solid-phase extraction and high-performance liquid chromatography-tandem mass spectrometry (SPE-HPLC-MS/MS). The results showed that the cumulative concentration of 16 sampling points ranged from 13.37 ng·L-1 to 780.5 ng·L-1, with an average concentration of 92.95 ng·L-1. Four sulfonamides, three fluoroquinolones, one tetracycline, five macrolides, and one chloramphenicol antibiotic were detected with average concentration ranging from 0.14 ng·L-1 to 49.91 ng·L-1,including enrofloxacin (ERX) and clarithromycin (CLR) with the highest detection rate of 100%, and clindamycin (CLI) with the highest concentration of 739.44 ng·L-1. Overall, the concentration levels of antibiotics in the Nanjing section of the Yangtze River were low compared with other rivers and lakes in China. The risk assessment results showed that the largest cumulative risk of S2 was 0.31, and the environmental risk of sulfamethoxazole (SMX), doxycycline (DOX), and roxithromycin (ROX) had lower risk levels;the health risk indexes of nine antibiotics for different age groups were between 2.22×10-6and 4.86×10-3, while CLI and DOX are the main potential health risk factors for humans.

Occurrence, distribution and risk assessment of suspected endocrine-disrupting chemicals in surface water and suspended particulate matter of Yangtze River (Nanjing section).

The occurrence and distribution of eight selected endocrine-disrupting chemicals were investigated in samples of surface water and suspended particulate matter (SPM) in Nanjing section of Yangtze River over a year (the flow period, the wet period and the dry period). All target compounds were detected at least once in surface water with 4-tert-butylphenol (4-TBP), nonyphenol (NP) and bisphenol A (BPA) as the dominant compounds, with concentrations in the range of 225-1121ng/L, 1.4-858ng/L and 1.7-563ng/L, respectively. Except for December, all selected compounds for the other sampling times were not found in all sampling points. NP (mean concentration 69.8µg/g) and BPA (mean concentration 51.8µg/g) were also the dominant estrogens in SPM. In addition, the highest total compounds concentrations were found in December in both phases, which could be due to the low flow conditions and temperature during this season. Meanwhile, a significant positive correlation was found between the total compounds concentrations in the water phase and those in SPM phase. Risk assessment based on the calculated risk quotients (RQ) showed that low and moderate risk for the aquatic environment from presence of the target compounds at all sampling points with exception of 4-TBP and NP which might pose a high risk to aquatic organisms.

[Effect of electrical stimulation of the primary auditory cortex on the spontaneous activities of the external nucleus of the inferior colliculus in a rat model of tinnitus induced by salicylate acid.].

This study aims to investigate corticofugal modulation on spontaneous activities of the external nucleus of the inferior colliculus (ICx) in a salicylate acid (SA) induced tinnitus rat model by the stimulation of the primary auditory cortex (AI). Extracellular recording techniques and stereotaxic method were used. The spontaneous activities of a single unit were recorded from the left ICx after electrical stimulation was given to the left AI of the rats duplicated as acute SA models. The average rate of spontaneous discharge and the interspike interval histogram of spontaneous activities were used as indices. The single unit spontaneous discharges of the same unit of ICx before and after AI stimulation were observed. There was an inhibitory effect of AI stimulation on the activities of the high discharge unit [(8.75+/-2.70) Hz vs (5.06+/-2.01) Hz] and a facilitatory effect on the low discharge unit [(1.41+/-0.45) Hz vs (2.46+/-0.79) Hz]. In the normal group, there was a restraining effect on the average rate of spontaneous discharge of the ICx after AI stimulation. The average rate of spontaneous discharge changed from (3.66+/-0.84) Hz to (2.47+/-0.43) Hz in the first hour after AI stimulation and then recovered within 2-4 h. And the discharge rate of the spike interval within 0-20 ms decreased (17% vs 7.3%, 11.2%) in the first 2 h and recovered 3-4 h after AI stimulation. The discharge rate of the spike interval within 0-6 ms (short interval) recovered 2 h after AI stimulation. In the acute SA model group, the average rate of spontaneous discharge recorded from the ICx decreased from (7.48+/-0.85) Hz to (3.38+/-0.39) Hz in the first hour after AI stimulation and the suppression effect remained 4 h (P<0.05). There was no difference in the average rate of spontaneous discharge between the acute SA model group and the normal group at 2-4 h after AI stimulation. The suppression effect after AI stimulation on the 0-20 ms interval spikes in the ICx lasted 4 h, while that on the shorter interval (0-6 ms) spikes recovered in the 3rd hour after AI stimulation in acute SA model group. It is concluded that the high average spontaneous discharge rate of ICx in acute SA model decreases significantly by AI stimulation, and the suppression effects on the shorter interval spikes recovers in the 3rd hour after AI stimulation. It might be inferred that stimulation of AI, through exciting the auditory descending projections, could remit the increased spontaneous discharge of ICx induced by SA that may relate with tinnitus in a period of time.

[Effects on secretory function of rat gonad by Erxian decoction and its disassembled prescriptions].

OBJECTIVE: To explain functions, differences and coordination of three divided combinations of the "Erxian decoction", the famous traditional Chinese formula, on the effective sites of gonad gland at the cell level. METHOD: The effects of Erxian decoction and its main disassembled prescriptions, "Kidney Warming", "Yin Nourishing" and "Chong-ren Adjusting", on the level of testosterone (T) progesterone (P) estradiol (E2), respectively secreted by the primary culture Leydig cell, luteal cell and granulosa cell, were measured by radioimmunoassay. RESULT: (1) Erxian decoction could stimulate the T secretion while its three main disassembled prescriptions would seem no individual promoting effect on the secretion of T. (2) Erxian decoction and the "Kidney Warming" had the stimulating effect on P secretion, and the action of the whole formula being better than that of the "Kidney Warming". (3) Erxian decoction and its main disassembled prescriptions had the stimulating effect on E2 secretion, especially the whole formula. CONCLUSION: Erxian decoction can stimulate the secretion of T of the Leydig cell, P of luteal cell and E2 of granulosa cell. It can be seen that the effect of the whole formula is better than that of its main disassembled prescriptions.