[Clinical analysis of ear symptoms of 40 patients with ANCA-associated vasculitis].

Objective:To analyze the clinical feature, diagnosis and treatment of Anca-associated vasculitis with ear symptoms. Methods:In this retrospective study, we summarized the clinical and laboratory examination, pure tone audiometry, aural immittance measurement, CT scan of temporal bone and treatment of 40 patients in the First Medical Center of the PLA General Hospital. Results:A total of 11 cases（27.5%） had the initial symptom in the ear. The most common symptoms were hearing loss, and the other symptoms included a sense of ear fullness, otorrhea and tinnitus. There were 35 cases with hearing loss: 19 cases with conductive hearing loss（47.5%）, 9 cases with sensorineural hearing loss（22.5%）, and 7 cases with mixed hearing loss（17.5%）. 5 cases had a sense of ear fullness or tinnitus, and the results of the hearing test were normal（12.5%）. All of the 40 patients had multi-system involvement, and respiratory system accounted for the most. All patients had a positive result of Anti-neutrophil cytoplasmic antibody（ANCA）. Treatment included systemic hormonal, immunosuppressive, or biologic therapy. There were 3 cases recovered（7.5%）, 22 cases with alleviated ear symptoms（55.0%）, 6 cases with recurrent hearing loss（15%） and 9 cases had no significant improvement（22.5%）. Conclusion:Conductive deafness（secretory otitis media） can be the first manifestation in the early stage of otitis media with AAV（OMAAV）, later it may turn to binaural mixed deafness. Otolaryngologists need to consider OMAAV diagnosis when diagnosing and treating patients with recurrent secretory otitis media. Multi-system symptom consultation and ANCA examination can help identify. Early systemic medication and the application of immunosuppressants or biological agents can help relieve the ear symptoms.

Factors influencing rehabilitation effect in prelingually deafened late-implanted cochlear implant users, and the construction of a nomogram.

OBJECTIVES: Our study aimed to identify potential factors that may influence rehabilitation outcomes in late-implanted adolescents and adults with prelingual deafness and to construct a user-friendly nomogram. DESIGN: This cross-sectional study included 120 subjects under 30 years of age who had received cochlear implantation at a single medical centre. The Categories of Auditory Performance (CAP) scale was used to evaluate the rehabilitation outcomes. A nomogram was constructed by using the R and EmpowerStats software. RESULTS: Univariate analysis indicated higher rates of auditory performance improvement in younger aged subjects. Residual hearing and regular implant use were more frequently seen among subjects with auditory performance improvement. Multivariate analysis identified residual hearing (Hazard Ratio, 6.11; 95% Confidence Interval, 1.83-20.41; p < .01), age group (Hazard Ratio, 0.31; 95% Confidence Interval, 0.14-0.83; p = .02) and regular CI use (Hazard Ratio, 7.79; 95% Confidence Interval, 2.50-24.20; p < .01) as independent predictors for auditory performance improvement. The nomogram's predictive performance was satisfactory as shown by the calibration curve and receiver operating characteristic (ROC) curve. CONCLUSIONS: Factors such as residual hearing, younger age and regular CI use are associated with auditory performance improvement in this cochlear implant user population. The nomogram model also demonstrates a satisfactory predictive performance.

[The discussion on the application of simultaneous balloon Eustachian tuboplasty in the hearing reconstruction in patients with chronic suppurative otitis media].

Objective:To explore the application of simultaneous balloon Eustachian tuboplasty（BET） in hearing reconstruction in patients with chronic suppurative otitis media. Method:Twenty-three patients（23ears） who diagnosesd as chronic suppurative otitis media and Eustachian tube dysfunction and underwent hearing reconstruction surgery were retrospectively enrolled, including 12 patients（12 ears） received BET + hearing reconstruction surgery as the case group, 11 patients（11 ears） received hearing reconstruction surgery as the control group. All patients underwent Eustachian tube function score（ETS） and pure tone audiometry before the surgery and one year after the surgery. The subjective improvement degree of symptoms such as ear fullness, muffled hearing, tinnitus and hearing loss were investigated. The differences in test results between the two groups were analyzed. Result:There was no statistically significant difference in ETS and pure tone audiometry between the two groups before the surgery（P>0.05）. The preoperative ETS and postoperative ETS of the case group were 3.75±2.42 and 6.58±2.19, compared to 3.18±1.99 and 4.27±1.79 of the control group. ETS of two groups were improved after surgery（P<0.01）, and the improvement degree of the case group was better than that of the control group（P<0.05）. The preoperative air conduction hearing threshold, bone conduction hearing threshold and air bone gap of the case group were（65.17±11.56） dB, （24.25±12.96） dB, （40.92±12.17） dB, and decreased to（30.58±6.40） dB, （23.67±9.74） dB, and（6.92±12.00） dB after surgery. The preoperative air conduction hearing threshold, bone conduction hearing threshold and air bone gap of the control group were（63.55±9.74） dB, （22.64±8.61） dB, （40.91±9.83） dB, and decreased to （41.45±15.50） dB, （25.73±8.52） dB, （15.73±11.20） dB after surgery. The air conduction hearing threshold and air bone gap of the two groups were improved after surgery（P<0.01）, and the postoperative air conduction threshold of the case group was significantly lower than that of the control group（P<0.05）. In the follow-up questionnaire results, the subjective improvement degree of ear fullness, muffled hearing and hearing loss in the case group was higher than that of the control group（P<0.05）. Conclusion:In patients with chronic suppurative otitis media and Eustachian tube dysfunction, simultaneous BET and hearing reconstruction surgery can effectively increase the patients' hearing improvement degree, and can improve the Eustachian tube function and subjective symptoms.

Improvements to the retractor and muscle flap design for minimally invasive cochlear implantation.

OBJECTIVE: The aim of this study was to improve muscle flaps and to evaluate surgical outcomes with the use of a novel specialized retractor, which is a surgical instrument used to locate and shape a bony seat for minimally invasive cochlear implantation. METHODS: 50 patients aged 1-75 years with sensorineural hearing loss who required cochlear implantation were recruited. A small incision (<3 cm) was made, and the novel specialized retractor was used in the study group during cochlear implantation. The incision length, surgical outcomes and operative time were recorded and analyzed. RESULTS: The incision length, total operative time and drilling bony time were shorter in the study group than in the control group (P < 0.05, respectively). All patients recovered well after the surgery without any severe complications. CONCLUSION: The use of a novel specialized retractor standardized the surgical processes of cochlear implantation. The retractor helped locate and control the size of the bony well during bone drilling. The tool reduced the technical difficulty and improved the efficacy of this minimally invasive operation.

The use of the MUSS and the SIR scale in late-implanted prelingually deafened adolescents and adults as a subjective evaluation.

Background: The SIR scale has been widely used to measure speech improvement in late-implanted prelingually deafened adolescents and adults. However the ceiling effect of the SIR scale may lead to the loss of some information.Aim/objectives: To evaluate the oral ability of late-implanted prelingually deafened adolescents and adults using the MUSS and SIR scale and to analyse the relationship between the SIR score and the MUSS score.Material and methods: Ninety-four prelingually deafened adolescents and adults who had received cochlear implants were investigated. The MUSS and SIR scale were used to evaluate oral ability.Results: The relationship between the duration of implant use and the MUSS score was significantly different. No significant differences were found among the groups for age at implantation, gender and side of cochlear implantation. The total score on the MUSS was positively correlated with the SIR score.Conclusions and significance: The MUSS and the SIR scale could be used to evaluate the oral ability of late implanted patients. The SIR scale could be used to perform a rapid assessment and the MUSS could help provide more information. The combination of the two scales could be used to evaluate vocal ability more accurately and effectively.

Preliminary application of intra-operative hearing monitoring by tone pip ABR via loudspeakers.

CONCLUSION: This method might be an effective intra-operative way to access hearing threshold under general anesthesia in the operating room. OBJECTIVE: To develop an intra-operative hearing monitoring method for surgeons to access hearing threshold under general anesthesia in the operating room. METHOD: System establishment and calibration was done firstly. Normal hearing (NH) and conductive hearing loss (CHL) participants were recruited. This study applied pure tone audiometry (PTA) to all subjects and tone pip ABR (tp-ABR) via loudspeakers in sound booth and operating room for NH and CHL subjects, respectively. For NH subjects, Bland Altman was conducted to compare 1k Hz PTA and tp-ABR threshold. For CHL participants, Paired t-test, Satterth waite t'-test, and linear correlation analysis were used to compare the two methods. p < .05 was considered statistically different. RESULTS: (1) Bland Altman showed all plots were inside the 95% confidence interval, indicating that there was no difference between the two methods for NH subjects. (2) The two methods had a high correlation (Pearson's coefficient =0.872 > 0.6, p < .05) in assessing hearing threshold in the operating room. (3) Satterth waite t'-test showed the ossicular chain malfunction enlarged the deviation of threshold by the two methods (.01 < p < .025).

[Analysis on the clinical outcomes of idiopathic sudden sensorineural hearing loss using the EuroQol 5-Dimension 3-Level questionnaire].

OBJECTIVE: To investigate the applicability of EuroQol 5-Dimension 3-Level questionnaire (Chinese Version 1.0) (EQ-5D-3L) in the assessment of life quality of patients with idopathic sudden hearing loss. METHOD: In this retrospect study, the EQ-5D-3L was assigned to 60 patients with idopathic sudden hearing loss before and after drug therapy. Audiometry examinations were undertaken and concomitant symptoms were recorded. A Wilcoxon rank sum test was applicated to the comparisons of results of EQ-5D-3L before and after the treatment, a t-test for results of EQ-VAS and a Kappa measurement for the consistency of certain dimension correlated with the symptoms. RESULT: Sixty patients completed the five questions and visual analog scale of the EQ-5D. A statistically significant changes of pain/discomfort, anxiety/depression before and after the treatment were observed (P < 0.05). The domains of mobility, self-care and usual activities did not show statistically significant different (P > 0.05). The dimension of pain/discomfort was in agreement with the concomitant symptoms. And the result of EQ-VAS was in agreement with the therapeutic outcome. CONCLUSION: It is suitable for the EQ-5D to be a general health measure with sensitivity to clinical change in idiopathic sudden sensorineural hearing loss, which monitors the patients' outcomes.

Clinical analysis on surgical management of type III external auditory canal cholesteatoma: a report of 12 cases.

OBJECTIVE: To investigate surgical management of type III EACC with lesions involving the posterior external auditory canal and mastoid. METHODS: This retrospective case review was conducted in 12 patients with type III EACC who underwent intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone. RESULTS: During the follow-up, all patients obtained successful results on external auditory canal structures and hearing improvement, except for one patient who needed a revision operation for the fistula between the reconstructed wall and the mastoid. CONCLUSION: Intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone was proved to be an effective and inexpensive choice for the patients with type III external auditory canal cholesteatoma (EACC) to achieve optimal outcomes.

Transplantation of human umbilical cord mesenchymal stem cells in cochlea to repair sensorineural hearing.

To examine if transplantation of human umbilical cord mesenchymal stem cells (UMSC) into cochlea can be used to repair sensorineural hearing. Here we transplanted the fifth and sixth generations of UMSCs through the subarachnoid cavity of congenital deaf albino pigs. Auditory brainstem responses (ABR) were measured before and after UMSC transplantation. Cochlear samples were collected at 2 hrs, 3 days, 1, 2, 3, 4 and 8 weeks after transplantation. Immunohistochemistry was used to detect the proliferated cell nuclear antigen (PCNA). The UMSCs were found in different regions of the cochlea, including the stria vascularis, the basal membrane and the spiral ganglions, 3 days to 4 weeks after the transplantation. UMSCs and their DNA were found also in the areas of the brain, the heart, the liver, the kidney and the lung. ABR tests displayed a new waveform in the congenital deaf albino pigs after the UMSCs transplantation. We conclude that human UMSCs injected into the subarachnoid space can migrate into the inner ear, the central nervous system and the periphery organs. The presence of UMSCs in the cochlea maybe associated with changes of ABR waveforms in the congenital deaf albino pigs.

[Study on delivery efficiency and cytotoxicity of Hela cells with mPEG-PLGA-BSA-FITC-NPs nanocarrier].

OBJECTIVE: To construct and obtain ideal protein delivery vectors by researching the delivery efficiency and cytotoxicity to Hela cells using mPEG-PLGA-BSA-FITC-NPs. METHOD: The mPEG-PLGA nanoparticle was obtained through surface modification of PLGA with PEG, and deliver BSA-FITC into Hela cells in vitro. The positive cells were counted by Laser scanning confocal microscopy and the survival rate of Hela cells was calculated by MTT assay at different time points. RESULT: mPEG-PLGA-BSA-FITC-NPs shows the classic nanometer size, and the encapsulation efficiency reached 51. 2%. At the same time, the nanoparticles possess characteristics of slow release. By optimizing the delivery conditions, the highest efficiency of mPEG-PLGA-BSA-FITC-NPs was above 65.2%, and the cellular viability was about 85.7%. CONCLUSION: mPEG-PLGA-BSA-FITC-NPs nanoparticles can successfully carry the target protein into cells as safe and effective as novel delivery materials of protein in vitro, and has shown slow release characteristics. The mPEG-PLGA-BSA-FITC-NPs provide ideal delivery vector for future application in clinical treatment of disease using nano-materials.

One-stage coclear implantation via a facial recess approach in children with otitis media with effusion.

OBJECTIVE: To investigate surgical indications, operative techniques, complications and auditory and speech rehabilitation for cochlear implant (CI) in children with otitis media with effusion (OME). MATERIAL AND METHODS: This is a retrospective review of records of 24children with bilateral profound sensorineural hearing loss and OME who were implanted during January 2011 to November 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery at the PLA Hospital, using one-stage implantation via the facial recess approach and round window insertion. The incus was removed in 8 cases during the implantation procedure. Local infiltration of dexamethasone and adrenaline in the middle ear was also performed. Postoperative complications were examined. Preoperative and postoperative questionnaires including Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and the Meaningful Auditory Integration Scale (MAIS) were collected. RESULTS: All electrodes were implanted successfully without any immediate or delayed complications. Inflammatory changes of middle ear mucosa with effusion were noted in all implanted ears. The scores of post-implant CAP and SIR increased significantly in all 24 cases (t = -25.95 and -14.09, respectively for CAP and SIR, p < 0.05). CONCLUSIONS: One-stage CI via the facial recess approach with round window insertion is safe and effective in cochlear implant candidates with OME, as seen in the 24 children in our study who achieved improved auditory performance and speech intelligibility after CI.

[Clinical analysis of 182 cases esophageal foreign bodies and treatment for special cases].

OBJECTIVE: To provide clinical reference by summarizing and analyzing characteristics, therapeutic principles and methods for special cases of esophageal foreign bodies. METHOD: Statistical analysis 182 cases with esophageal foreign bodies, including 41 special cases. Surgery 165 cases, 17 cases without surgery. RESULT: One hundred and seventy-five cases were cured, 7 cases improved. Hospitalization time 0.5-50 d (average 4.5 d). CONCLUSION: It is important to learn about characteristics of esophageal foreign bodies, therapeutic principles and methods for special cases, and it's a key point to diagnosis early and remove the foreign bodies as soon as possible, and comprehensive treatment measures are really effective to process special cases.

[Comparison of the exposure when using endoscopes of different angles for microlaryngoscopic surgery].

OBJECTIVE: To observe the exposure of the vocal lesions under endoscopes of different angles and to contrast the endoscopes' influence on surgery. METHOD: Fifty patients with benign vocal lesions were selected randomly. During microlaryngoscopic surgery, the laryngoscope was placed softly and the different rigid endoscope (30 degrees, 45 degrees or 70 degrees) was connected to video system to expose the glottis and vocal folds. The operation was taken through looking at the color monitor. RESULT: The vocal fold lesions were completely examined and successfully excised in all patients, only two of them got soft palate mucosal abrasion. No one got complications. CONCLUSION: Rigid endoscopy associated with microlaryngeal surgery brings a better observation to the vocal lesions and a lower incidence rate of complicatons. It's regarded that 45 degrees rigid endoscope is better than the others, for it provides not only a good exposure to the vocal cords, anterior commissure and subglottis, but also convenience to operate. The second one is 30 degrees rigid endoscope, which can save the cost, because of the widely using in many other departments.

[Diagnosis and treatment of esophagus perforation caused by esophageal foreign bodies].

OBJECTIVE: Summarize the treatment skills of esophagus perforation caused by esophageal foreign bodies. METHOD: Retrospectively analyze the seven cases of esophagus foreign body perforation with various complications in our department. RESULT: Six cases recovered in 3 to 18 days after operation, on average 14.2 day, while one case recovered in 49 days by conservative method. CONCLUSION: Foreign bodies removing, fistulae repairing, abscess incising, effusion rinsing, effective antibiotics administrating and support treatment are effective to treat esophagus perforation caused by esophageal foreign bodies. It will take a relative long time to be treated only by conservative way.