Upper airway cough syndrome in 103 children.

BACKGROUND: In China, upper airway cough syndrome (UACS) is only less frequent than cough-variant asthma and accounts for 24.71% of chronic cough. This study aimed to determine the pathogenetic constituents and factors affecting UACS in children of different age groups, and to identify clinical clues for diagnosing UACS and a method for curative effect evaluation. METHODS: A total of 103 children with UACS whose chief complaint was chronic cough were studied from January to November 2013 at Children's Hospital, Capital Institute of Pediatrics. According to their age, children with UACS were divided into 3 groups: nursing children, pre-school children, and school-age children. We analyzed the differences in pathogenetic constituents and factors affecting UACS in children. The effect of UACS treatment was evaluated by the visual analog scale (VAS) and an objective examination. Chi-squared test and analysis of variance were performed with the SPSS 19.0 statistical software. RESULTS: There was a high incidence of UACS in school-age children. Rhinitis with adenoid hypertrophy was the main cause of 103 suspected UACS cases. Adenoidal hypertrophy was the major cause of UACS in the pre-school children group, while rhinitis was the major reason in the nursing children and school-age children groups. Among the 103 children, there were 45 allergen-positive children, with no significant difference among different age groups. VAS scores in the different disease groups after treatment were lower than those before treatment (all P < 0.01). VAS scores in different disease groups showed significant differences, except for 12 vs. 24 weeks after treatment (P = 0.023). Different age groups had different secondary complaints. CONCLUSIONS: There are different pathogeneses in different UACS age groups. Clinical treatment efficacy of children with UACS can be evaluated by the VAS combined with an objective examination. We recommend that the course of treatment should be 12 weeks.

[Micro-CT imaging research of acoustic capsule in mice].

OBJECTIVE: To get the three-Dimensional imaging model of internal ear and middle ear using the Micro-CT equipment, and research the nondestructive imaging of mice acoustic capsule, and investigate the application of Micro-CT inmorphology of acoustic capsule. METHODS: The mice were executed to harvest the acoustic capsules. The acoustic capsules were fixed in trinitrophenol before scanning by Micro-CT .Using this equipment, we obtained a 3D model of reconstruction from 2D images. RESULTS: The 3D model of acoustic capsule and the model was extraordinary clear to show the eardrum, ossicles chain, vestibulum, semicircular canal, and cochlear. The 3D structure model was excellent for look through, and it was free to revolve in any axial direction on the platform of software Amira-5.4. CONCLUSIONS: By using Micro-CT equipment to research the nondestructive three-Dimensional imaging of acoustic capsule, the outside structures and internal details of the acoustic capsule can be observed at the same time. 3D structure model which was good for looking through. Using Micro-CT equipment is easy to operate and also can save a lot of samples, and the images have high resolution ratio. Micro-CT has good prospects for development.

[Clinical analyses of polysomnogram in snoring children].

OBJECTIVE: To analyze the characteristics of sleep structure, heart rate and arousal index (ArI) in children with primary snoring (PS) and mild, moderate or severe obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: A total of 113 children with sleep disorders were enrolled from January 2010 to March 2012 at Affiliated Children's Hospital, Capital Institute of Pediatrics. All of them underwent polysomnogram (PSG) and the data were analyzed statistically by SPSS 19.0. RESULTS: (1) No statistical difference existed in age, sleeping time or sleeping efficacy between PS and all OSAHS groups (all P > 0.05). (2) The proportion of stage I sleeping was 2.6% ± 1.4% in PS group, 5.4% ± 3.2% in mild OSAHS group, 4.7% ± 1.9% in moderate OSAHS group and 8.9% ± 4.0% in severe OSAHS group (F = 6.542, P = 0.000). The proportion of stage IV sleeping was 25.3% ± 5.6% in PS group, 32.4% ± 11.1% in mild OSAHS group, 30.6% ± 9.0% in moderate OSAHS group and 21.4% ± 10.8% in severe OSAHS group (F = 7.544, P = 0.000).The proportion of stage rapid eye movement (REM) sleeping was 21.1% ± 8.6% in PS group, 13.9% ± 4.0% in mild OSAHS group, 14.5% ± 4.9% in moderate OSAHS group and 12.3% ± 6.9% in severe OSAHS group (F = 11.204, P = 0.000).The proportion of stage II and III sleeping had no statistical difference among four groups. (3) The average heart rate in stage REM sleeping of four groups was (85 ± 11), (90 ± 14), (95 ± 10) and (101 ± 18) beats per minute(F = 6.452, P = 0.000) and (79 ± 10), (84 ± 14), (86 ± 7) and (93 ± 16) beats per minute in stage NREM sleeping(F = 5.369, P = 0.002). (4) In four groups, the difference of total count of spontaneous arousal, the spontaneous arousal count in stage REM and non-rapid eye movement (NREM) sleeping were all statistically significant (F = 56.379, 60.781, 44.061, all P = 0.000). And the difference of total count of respiratory arousal, the median of respiratory arousal count in stage REM and NREM sleeping were all statistically significant (F = 79.250, 36.137, 65.239, all P = 0.000). CONCLUSIONS: Heart rate is affected more obviously in moderate-severe OSAHS children. As compared with PS counterparts, OSAHS children had a reduction of spontaneous arousal and an increase of respiratory arousal. But the occurrence of spontaneous arousal of OSAHS children does not decrease with the progress of OSAHS in either stage REM or stage NREM.

[Clinical analysis of abnormal acoustic admittance in preschool children with nasal and nasopharyngeal disorders].

OBJECTIVE: To investigate the risk factors of related disorders, which could lead to potential otitis media by observing the abnormal configuration of drum and abnormal acoustic immittance without symptoms in preschool children. METHODS: Eighty-one cases (162 ears) received flexible pharyngorhinoscopy, skin prick test, CT examination of sinus, and were diagnosed as allergic rhinitis, chronic sinusitis, adenoid hypertrophy. They had no complaints of ear related symptoms, but were observed to have abnormality in ear drum by physical examined. Acoustic immittance measurement were performed, so as to estimate whether they were accompany with potential otitis media. The changes of examination and tests were analyzed before and after the treatment. RESULTS: There were 15 cases (29 ears) with abnormal acoustic admittance among 81 cases (162 ears) who had no ear related symptoms but had different degree abnormality in ear drum. The morbidity rate of these 15 patients was 13.6% (6/44 ears) in allergic rhinitis patients, 18.2% (12/66 ears) in chronic sinusitis patients, and 21.2% (11/52 ears) in adenoid hypertrophy patients, respectively. The differences among the three diseases had statistical significance (χ² = 63.02,P < 0.05). Among 29 ears, 28 ears whose type of tympanic pressure curve were transferred from type C to type A two weeks after treatment. One ear whose type of tympanic pressure curve transferred from type B to type C four weeks after treatment. All cases had been followed up with no recurrent cases. CONCLUSIONS: Some preschool children with nasal and nasopharyngeal disorders had abnormal configuration of drum and abnormal acoustic immittance, and had potential risk for otitis media. Among the disorders, adenoid hypertrophy impact more on middle ear function. The early intervention of related diseases could prevent the developing trend of otitis media.

[Micro-CT imaging of guinea pig cochlear].

OBJECTIVE: To employ micro-CT equipment for nondestructive three-dimensional (3D) imaging of internal ear. METHODS: The guinea pigs were anesthetized by napental and bilateral cochleas harvested. Cochlea was fixed in glutaraldehyde before scanning of micro-CT. Two-dimensional (2D) images were acquired for a 3D model of reconstruction. RESULTS: The 2D images was distinct enough to visualize vestibular gallery, scala media, scala tympani, Reissner's membrane, velum, organ of Corti and spiral ganglion, etc. The 3D structure model was excellent for viewing and free to revolve in any axial direction. CONCLUSIONS: Micro-CT may allow nondestructive three-dimensional imaging of internal ear. As compared with the traditional method of morphology, this approach is able to save samples, easy to operate and has a high resolution. And it is more easily popularized than the synchrotron radiation approach.

[Expressions of c-Fos and NADPH-d in the related brainstem during vestibular compensation].

OBJECTIVE: To study the mechanism of vestibular compensation and to observe the changes of c-Fos and NADPH-d expressions in the brainstem of the vestibular deafferentation rats in static status or following angular acceleration stimulation. METHODS: Totally 60 SD rats were randomly divided into control group (labyrinthine intact), complete unilateral vestibular deafferentation (UVD) group, simultaneous complete bilateral vestibular deafferentation (BVD) group (n = 20 in each group). Subgroups (n = 10 in each subgroup) were set for static status or following angular acceleration stimulation in each group. Double labeling with histochemistry-immunohistochemistry was performed to observe c-Fos/NADPH-d neurons. RESULTS: No positive c-Fos/NADPH-d expression was observed in the both sides of medial vestibular nucleus (MVN) and prepositus hypoglossi (PrH) of normal rats in static status and BVD rats whether following canal rotation or not. c-Fos/ NADPH-d expression was observed in the ipsilesional MVN and the contralesional PrH of UVD rats. However, c-Fos/NADPH-d were detected in both sides of MVN and PrH in UVD rats and normal rats following angular acceleration stimulation. CONCLUSION: In the ipsilesional MVN and the contralesional PrH, c-Fos plays an important role in vestibular compensation, in which nitric oxide acts as a key neurotransmitter.

[Clinical analysis of normal subjects and dizzy patients with postural sway test].

OBJECTIVE: To study the characteristics of the normal subjects with postural sway test and discuss the value of postural sway test in the diagnosis of dizzy patients. METHODS: Totally 112 normal subjects, 72 patients with peripheral vertigo, and 30 patients with central vertigo were examined using a stabilometer (EAB-100, Anima Co., Japan). Items include patterns, length of locus, envelope area, deflection average center displacement, and romberg rate were recorded and compared. RESULTS: The postural sway was classified into the following five patterns: centripetal, forward and backward, right and left, diffuse, and multicentric. Centripetal pattern was the most prominent figure pattern in the normal subjects, while diffuse pattern was the most prominent figure pattern in the patients with central vertigo. When the normal subjects closed their eyes, age was linearly correlated with the length of locus, envelope area, rectangel area, and unit area path length (P < 0.05). Sex was not correlated to all of these parameters. The length of locus and envelope area in the patient groups were significantly increased when compared with the normal subjects (P < 0.0167). Romberg rate was not significantly different between the patients and the normal subjects. CONCLUSIONS: The pattern of postural sway is useful for the diagnosis of vertigo. Age is an important factor that affects the balance function. Sex seems has no influence. Visual input plays an important role in maintaining postural balance. Stabilometer is a useful tool for evaluating balance function, and postural sway test may be a valuable assistant examination.

[Forty-three tracheal stricture with Ni-Ti shape memory alloy stent].

OBJECTIVE: To evaluate the application of Ni-Ti shape memory alloy stent for treating tracheal stricture, including its indications and complications. METHODS: Forty-three patients clinical data were analyzed, among them, 15 suffered from tumor; 7 trauma; 4 granulation; 1 Wegener's granuloma, 2 rhinoscleroma, 1 without clear diagnosis; 7 were relapsing polychondritis; 1 were respiratory amyloidosis; 4 were tracheobronchial tuberculosis, 5 were tracheobronchomalacia. The stricture degree: Level I: 15 patients, Level II:24 patients, Level III:4 patients. The location of stricture in 5 patients extended to the subglottis area. All patients had tracheal stricture and accepted the treatment with Ni-Ti shape memory alloy stent. RESULTS: Forty-two patients breathed freely after the operation, 1 patient died after surgery. The tracheostoma in 18 patients was closed 34 days after operation. Among the remaining 8 patients with tracheostoma:3 patients left hospital with tracheal cannula; 1 patient died,2 patients were found stent shifted and no evident breath improving; 2 patients were found granulation and had secondary operation with laser. CONCLUSION: Ni-Ti shape memory alloy stent can expand the tracheal stricture quickly and thus improve the breath effectively, which is minimally invasive and simple. It can be used as a method in the treatment of tracheal stricture.

[Effect of nitric oxide in vestibular compensation].

OBJECTIVE: To study the effect of nitric oxide (NO) in vestibular compensation after unilateral vestibular deafferentation. METHODS: Eighteen animals were divided into two groups, 6 of group a as control, 12 of group b received gentamicin intratympanic injection in the left ear. Half of the animals were killed respectively after 5 days and 10 days. Vestibular endorgan and brainstem tissue sections were subjected to NADPH-d reactive test of NOS for histochemical examination. RESULTS: In group a, NOS-like reactivity in both sides of vestibular endorgan and nucli. In group b during 5 days, NOS-like reactivity in right side of vestibular endorgan and nucli, those of the left side were negative. During 10 days, NOS-like reactivity only in the right side of vestibular endorgan. CONCLUSIONS: Changes of NOS expression in the contralateral vestibular nucli might have played a role in vestibular compensation.

[Endolymphatic hydrops of both ears of guinea pig produced by aldosterone].

OBJECTIVE: To develop endolymphatic hydrops in both ears of guinea pigs by aldosterone. METHODS: Thirty animals were divided into 3 groups with 10 in each group. Group A received left ears operation following Kimura', with right ears non-operated as control; group B received introperitonal injection of aldosterone (0.1 mg.0.1 kg-1.d-1) for continuous 5 days; group C received introperitonal injection of 0.5 ml 0.9% NS. Five out of group A,B and C were killed 1 month and 2 months later respectively for analysis of blood K+, Ca2+, Na+ and pathological examination of inner ear, heart, lung, brain, liver and kidney. RESULTS: In group A' moderate to severe endolymphatic hydrops developed in the operated ears during 1 and 2 months. In group B, mild endolymphatic hydrops developed in the both ears during 1 month, and within 2 months it was moderate and severe. No endolymphatic hydrops developed in group C. In contrast to group C, No significant changes could be found in blood analysis of group A, but the concentrations of K+ and Ca2+ were declined, and that of Na+ were increased in group B. The heart, lung, brain, liver, and kidney of all animals were normal. CONCLUSIONS: Aldosterone may induce endolymphatic hydrops in both ears.