Meta-Analysis of the Effect of the Clinical Pathway Applied to Patients with Endoscopic Sinus Surgery in China.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common diseases in China. The incidence of CRS in the Chinese urban population is between 5 and 15%. It is difficult to cure with traditional surgery. Endoscopic sinus surgery is the first choice for the treatment of CRS. Compared with developed countries, the development of the clinical pathway of endoscopic sinus surgery in China is still unclear. OBJECTIVES: The aim is to explore whether the clinical pathway of endonasal sinus surgery is better than the traditional one in the Chinese population. METHODS: We searched PubMed, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov, SinoMed, China National Knowledge Internet, Wanfang database of Chinese Journals, and VIP database of Chinese Journals. The last retrieval date was August 24, 2018. Review Manager 5.3 software was used for comprehensive quantification data analysis. RESULTS: Fourteen papers involving 1,882 patients were included in this study. The results showed that compared with the traditional pathway, the clinical pathway can effectively shorten the average number of hospitalization days (mean difference, MD = -2.00, 95% CI: -2.50, -1.49). In total, 10 of the 14 papers, with a total of 1,500 patients, proved that the clinical pathway can effectively reduce the hospitalization costs of patients (standard mean difference, SMD = -3.15, 95% CI: -4.20, -2.10); 11 of the 14 papers, with a total of 1,488 patients, proved that the clinical pathway can effectively improve patients' knowledge of health (95% CI:1.03, 1.09); and 7 of the 14 papers, with a total of 810 patients, proved that the clinical pathway can effectively improve patient satisfaction (95% CI:1.10, 1.20). CONCLUSIONS: Our systematic review and meta-analysis support the use of the clinical pathway in patients with endoscopic sinus surgery in China.

The accuracy and influencing factors of sleep staging based on single-channel EEG via a deep neural network / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate theaccuracy of artificial intelligence sleep staging model in patients with habitual snoring and obstructive sleep apnea hypopnea syndrome (OSAHS) based on single-channel EEG collected from different locations of the head. Methods: The clinical data of 114 adults with habitual snoring and OSAHS who visited to the Sleep Medicine Center of Beijing Tongren Hospital from September 2020 to March of 2021 were analyzed retrospectively, including 93 males and 21 females, aging from 20 to 64 years old. Eighty-five adults with OSAHS and 29 subjects with habitual snoring were included. Sleep staging analysis was performed on the single lead EEG signals of different locations (FP2-M1, C4-M1, F3-M2, ROG-M1, O1-M2) using the deep learning segmentation model trained by previous data. Manual scoring results were used as the gold standard to analyze the consistency rate of results and the influence of different categories of disease. Results: EEG data in 124 747 30-second epochs were taken as the testing dataset. The model accuracy of distinguishing wake/sleep was 92.3%,92.6%,93.5%,89.2% and 83.0% respectively,based on EEG channel Fp2-M1, C4-M1, F3-M2, REOG-M1 or O1-M2. The mode accuracy of distinguishing wake/REM/NREM and wake/REM/N1-2/SWS , was 84.7% and 80.1% respectively based on channel Fp2-M1, which located in forehead skin. The AHI calculated based on total sleep time derived from the model and gold standard were 13.6[4.30,42.5] and 14.2[4.8,42.7], respectively (Z=-2.477, P=0.013), and the kappa coefficient was 0.977. Conclusions: The autonomic sleep staging via a deep neural network model based on forehead single-channel EEG (Fp2-M1) has a good consistency in the identification sleep stage in a population with habitual snoring and OSAHS with different categories. The AHI calculated based on this model has high consistency with manual scoring.

Analysis of Medical Service Capacity of Otorhinolaryngology in County-level Hospitals in Ningxia / 中国医院管理

Objective To investigate the status quo of Otolaryngology services in county-level hospitals in Ningxia,to know its developmentbottlenecks and shortcomings,and to provide suggestions for promotion of Otolaryngotogy medical service ability in county-level hospitals in Ningxia.Methods By cluster sampling method,and through questionaire survey,investigating and analyzing the actuality of Otorhinolaryngology in county-level hospitals in Ningxia.Results The current status of Otorhinolaryngology in county-level hospitals in Ningxia was lower than the standard of county-level hospitals.The number of personnel and equipment is seriously insufficient.Few medical technology can be carried out.The number of outpatients and discharged patients increases.The number of outgoing patients increases.Conclusion The medical service ability of Otorhinolaryngology in county-level hospitals in Ningxia is low.It is suggested to formulate development plans and to innovate development way;to develop human resources,and to upgrade technical level;to use information platform,and to joint construction of academic alliances.

Retinal Vascular Morphological Changes in Patients with Extremely Severe Obstructive Sleep Apnea Syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea syndrome (OSAS) has been shown to generate hypertension and endothelial dysfunction. Retinal vessel is the only vessel that can be observed directly and noninvasively; retinal vascular abnormalities can serve as a predictive marker for the occurrence, clinical course, and prognosis of cardiovascular and cerebrovascular diseases. The objective of this study was to identify the effect of OSAS severity on the morphological changes of retinal vessels.</p><p><b>METHODS</b>Adult patients complained of snoring were included in this study. The patients' general information, polysomnography, and fundus photography parameters including central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole-to-venule ratio (AVR) were collected. Patients were divided into four groups according to their apnea-hypopnea index (AHI) results: Group I, AHI ≤5/h; Group II, 5/h < AHI ≤30/h; Group III, 30/h < AHI ≤60/h; and Group IV, AHI> 60/h.</p><p><b>RESULTS</b>A total of 133 patients were included in this study with 111 males (83.5%) and 22 females (16.5%). Mean age was 41.6 ± 9.9 years, and the mean body mass index was 28.1 ± 4.0 kg/m2. AHI ranged between 0 and 130.8/h with a mean of 39.1 ± 30.7/h. There were 24, 34, 35, and 40 patients in Group I, Group II, Group III, and Group IV, respectively. Significant differences were found for AHI (F = 388.368, P< 0.001), minimal pulse oxygen saturation (F = 91.902, P< 0.001), and arousal index (F = 31.014, P< 0.001) among four groups; no significant differences were found for CRAE (F = 0.460, P = 0.599) and CRVE (F = 0.404, P = 0.586) among groups; there were significant differences for AVR between Group I and Group IV (63.6 ± 5.1% vs. 67.2 ± 5.5%, P = 0.010) Group II and Group IV (64.5 ± 6.0% vs. 67.2 ± 5.5%, P = 0.030), and Group III and Group IV (64.7 ± 4.1% vs. 67.2 ± 5.5%, P = 0.043). A main group-by-AHI effect was found on the AVR: patients with higher AHI showed higher AVR results (r = 0.225, P = 0.009). Multivariate logistic regression analysis was used for multi-variable factors. A group-by-age effect was found on the AVR: younger patients showed higher AVR results (β = -0.001, P = 0.020).</p><p><b>CONCLUSIONS</b>This study indicated that increased AVR of retinal vessel can be observed in extremely severe OSAS patients. For patients with OSAS, retinal vascular abnormalities may become an early indication for further cardiovascular abnormalities.</p>

Three-dimensional Evaluation of Nasal Surgery in Patients with Obstructive Sleep Apnea / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea (OSA) is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway. The effectiveness of nasal surgery has been discussed in several studies and shows a promising growing interest. In this study, we intended to evaluate the effects of nasal surgery on the upper airway dimensions in patients with OSA using three-dimensional (3D) reconstruction of cone-beam computed tomography (CT).</p><p><b>METHODS</b>Twelve patients with moderate to severe OSA who underwent nasal surgery were included in this study. All patients were diagnosed with OSA using polysomnography (PSG) in multi sleep health centers associated with Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary and the Partners Health Care from May 31, 2011 to December 14, 2013. The effect of nasal surgery was evaluated by the examination of PSG, subjective complains, and 3D reconstructed CT scan. Cross-sectional area was measured in eleven coronal levels, and nasal cavity volume was evaluated from anterior nasal spine to posterior nasal spine. The thickness of soft tissue in oral pharynx region was also measured.</p><p><b>RESULTS</b>Five out of the 12 patients were successfully treated by nasal surgery, with more than 50% drop of apnea-hypopnea index. All the 12 patients showed significant increase of cross-sectional area and volume postoperatively. The thickness of soft tissue in oral pharynx region revealed significant decrease postoperatively, which decreased from 19.14 ± 2.40 cm 2 and 6.11 ± 1.76 cm 2 to 17.13 ± 1.91 cm 2 and 5.22 ± 1.20 cm 2 .</p><p><b>CONCLUSIONS</b>Nasal surgery improved OSA severity as measured by PSG, subjective complaints, and 3D reconstructed CT scan. 3D assessment of upper airway can play an important role in the evaluation of treatment outcome.</p>

Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea/hypopnea syndrome (OSAHS) and laryngopharyngeal reflux (LPR) disease have a high comorbidity rate, but the potential causal relation between the two diseases remains unclear. Our objectives were to investigate the esophageal functional changes in OSAHS patients and determine whether OSAHS affects LPR by affecting esophageal functions.</p><p><b>METHODS</b>Thirty-six OSAHS patients and 10 healthy controls underwent 24-h double-probed combined esophageal multichannel intraluminal impedance and pH monitoring simultaneously with polysomnography. High-resolution impedance manometry was applied to obtain a detailed evaluation of pharyngeal and esophageal motility.</p><p><b>RESULTS</b>There were 13 OSAHS patients (36.1%) without LPR (OSAHS group) and 23 (63.9%) with both OSAHS and LPR (OSAHS and LPR group). Significant differences were found in the onset velocity of liquid swallows (OVL, P = 0.029) and the percent relaxation of the lower esophageal sphincter (LES) during viscous swallows (P = 0.049) between the OSAHS and control groups. The percent relaxation of LES during viscous swallows was found to be negatively correlated with upright distal acid percent time (P = 0.016, R = -0.507), and OVL was found to be negatively correlated with recumbent distal acid percent time (P = 0.006, R = -0.557) in the OSAHS and LPR group.</p><p><b>CONCLUSIONS</b>OSAHS patients experience esophageal functional changes, and linear correlations were found between the changed esophageal functional parameters and reflux indicators, which might be the reason that LPR showed a high comorbidity with OSAHS and why the severity of the two diseases is correlated.</p>

Modified closed reduction for the arytenoid cartilage dislocation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of arytenoid cartilage dislocation and the outcome of modified closed reduction.</p><p><b>METHODS</b>Sixty-seven patients with vocal fold immobility underwent modified closed reduction under local anesthesia through indirect laryngoscope. During reduction, a right-angled laryngeal forceps was used to hold the superior surface of the affected arytenoids and rotate in posterolateral or anteromedial direction according different situation of dislocation. Fifty-seven patients had previously undergone endotracheal intubation for surgery and 10 patients had nonintubated injury with blunt laryngeal trauma in 6 cases. Clinical characteristics, voice function, procedural skill and therapy outcome of those cases were evaluated.</p><p><b>RESULTS</b>All patients complained of persistent hoarseness. Stroboscopy revealed vocal fold immobility (50 of 67 cases on the left side, 74.6%) and incomplete glottal closure with anterior arytenoid dislocations in 63 cases and posterior dislocations in 4 cases. The laryngeal electromyography (LEMG) results for 10 of 38 patients (26.3%) of postintubation arytenoids dislocation displayed abnormal patterns with denervated potentials. The voice of all patients for postintubation arytenoids dislocation improved after modified closed reduction with normal in 51 cases and slight hoarseness in 6 cases. The movement of the affected vocal folds recovered to normal in 54 cases and improved in 3 cases. Among the 10 patients with nonintubated vocal fold immobility, the voice and the movement of vocal folds were normal in 7 cases, improved in 1 case and no effective in 2 cases.</p><p><b>CONCLUSIONS</b>Some cases of arytenoid dislocation were accompanied by an recurrent laryngeal nerve abnormality (mostly temporary and resolved after a reduction). The modified reduction technique under local anesthesia can restore patients' voice and vocal fold mobility within 6 weeks after dislocation. Nevertheless, the causes of vocal fold immobility following blunt laryngeal trauma were complicated, so the curative effect of arytenoids reduction in those cases may be limited by cicatricial contracture of laryngeal injured tissue.</p>

Nasal cavity computer fluid dynamics analysis on 60 healthy Chinese adults / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVES</b>To investigate the aerodynamics characteristics of nasal cavity in inspiration phase from 60 healthy Chinese people and provide the reference values for future computational fluid dynamics (CFD) research.</p><p><b>METHODS</b>CFD was used for numerical simulation. The indices of main airflow passage, total nasal airway resistance, maximal velocity, maximal wall shear stress, nasal mucosa area, nasal volume and surface area-to-volume ratio were extracted from CFD analysis results. SPSS 16.0 software was used to analyze the data.</p><p><b>RESULTS</b>The main airflow passage in nasal cavity was common meatus, the mean total nasal airway resistance was (0.211 ± 0.085) kPa·s·L(-1), the mean maximal velocity was (12.01 ± 2.79) m/s, the mean maximal wall shear stress was (2.50 ± 0.89) Pa, the mean nasal mucosa area was (161.2 ± 34.7) mm(2), the mean nasal volume was (31.7 ± 8.1) ml and the mean surface area-to-volume ratio was (0.58 ± 0.09) mm(-1). No significant difference was detected in aerodynamics indices between male and female people.</p><p><b>CONCLUSIONS</b>The main airflow passage is located in common meatus. The nasal valve area is the key constrictive plane in nasal cavity. There are no gender differences of main airflow characteristics in nasal cavity. The normal ranges of aerodynamics indices could be used for reference values for future CFD research.</p>

Intranasal endoscopic prelacrimal recess approach to maxillary sinus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The inferior turbinate (IT) and nasolacrimal duct (NLD) are often sacrificed while managing the diffuse lesion of maxillary sinus (MS). We report a new approach to MS without ablation of NLD and IT.</p><p><b>METHODS</b>This retrospective study enrolled 19 hospitalized patients (aged from 42 to 68 years) who underwent endoscopic sinus surgery between 2003 and 2008. Twelve patients had inverted papilloma (IP), two had nasal polyps, two had Kubo's postoperative cyst of MS, one had recurrent bone cyst of maxilla, one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to Caldwell-Luc operation respectively. Two IP patients were excluded from this group since the follow-up time was less than 12 months. The NLD was dissected after removing the anterior bony portion of nasal lateral wall. The prelacrimal recess approach (PLRA) to MS was established when IT-NLD flap was raised medially. The flap was repositioned when MS lesion was removed.</p><p><b>RESULTS</b>All the 17 patients had unilateral lesions. Ten MS IP patients were at the T3 Krouse stage. The follow-up ranged from 7 to 60 months. No recurrence was seen in 16 patients. Only one IP patient had a local recurrence in MS. All of them had no any complications.</p><p><b>CONCLUSION</b>The diffuse or severe diseases of MS may be the potential indications for PLRA.</p>

Evaluation of neuromuscular activity in patients with obstructive sleep apnea using chin surface electromyography of polysomnography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is believed that defects in upper airway neuromuscular control play a role in sleep apnea pathogenesis. Currently, there is no simple and non-invasive method for evaluating neuromuscular activity for the purpose of screening in patients with obstructive sleep apnea. This study was designed to assess the validity of chin surface electromyography of routine polysomnography in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of the condition.</p><p><b>METHODS</b>The chin surface electromyography of routine polysomnography during normal breathing and obstructive apnea were quantified in 36 male patients with obstructive sleep apnea. The change of chin surface electromyography from normal breathing to obstructive apnea was expressed as the percent compensated electromyography value, where the percent compensated electromyography value = (normal breath surface electromyography - apnea surface electromyography)/normal breath surface electromyography, and the percent compensated electromyography values among subjects were compared. The relationship between sleep apnea related parameters and the percent compensated electromyography value was examined.</p><p><b>RESULTS</b>The percent compensated electromyography value of the subjects varied from 1% to 90% and had a significant positive correlation with apnea hypopnea index (R(2) = 0.382, P < 0.001).</p><p><b>CONCLUSIONS</b>Recording and analyzing chin surface electromyography by routine polysomnography is a valid way of screening the neuromuscular activity in patients with obstructive sleep apnea. The neuromuscular contribution is different among subjects with obstructive sleep apnea.</p>

Clinical application of bone-anchored hearing aid implantation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the indications, surgery methods and effects of the BAHA implantation by analyzing the patients' medical records of bone-anchored hearing aids(BAHA).</p><p><b>METHODS</b>Retrospective analyzed the records of 16 patients of BAHA implantation, including nine males and seven females. Their average age was 31 years old (8-53ys). Nine of them were congenital ear malformation, two were chronic suppurative otitis media, two were otosclerosis and three were unilateral severe sensorineural deafness. We evaluated their pure tone audiometry (PTA), speech audiometry and temporal CT before the surgery, and evaluated the aided PTA in soundfield and speech audiometry in sound field.</p><p><b>RESULTS</b>These patients received BAHA implantation and installed the speech processor their months later. The average preoperative PTA measurements (PTA at 0.5, 1, 2, 4 kHz) was (63.2 ± 19.0) dB HL and postoperative aided PTA in sound field was (35.5 ± 10.9)dB HL. The average improvement in Hearing In Noise Test (HINT) was 37.0% ± 31.7%. The average improvement in Mandarin Speech Test was 76.0% ± 19.7%. After 4-16 months' follow-up, no significant complications were recorded.</p><p><b>CONCLUSION</b>BAHA is a safe and effective bone implantable hearing device.</p>

Effectiveness of cochlear implantation in children with auditory neuropathy and cochlear nerve aplasia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The aim of this study is to assess of cochlear implantation in children with auditory neuropathy and cochlear nerve aplasia by using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR).</p><p><b>METHODS</b>Twenty one children with cochlear implants participated in this study. They all received cochlear implant surgery at our hospital from January 2004 to October 2010. All children had hearing aid trial and hearing and speech rehabilitation before surgery at least three months.Nine children (7 male, 2 female) were diagnosed with auditory neuropathy, twelve (7 male, 5 female) with cochlear nerve aplasia. Twenty children (10 male, 10 female) with sensorineural hearing loss served as a control group. All the children received cochlear implant for more than six months. Forty two children with normal hearing served as another control group which were divided into three subgroups according to their age.Group A included 18 children aged under two yrs, group B consisted of 16 children aged from two to four yrs and group C comprised eight children aged above four yrs. CAP and SIR were used to evaluate among all the children and the scores were compared.</p><p><b>RESULTS</b>The CAP scores of children with auditory neuropathy, cochlear nerve aplasia, sensorial neural hearing loss and the three subgroups children with normal hearing were 4.44 ± 1.50, 4.83 ± 1.69, 4.55 ± 1.66, 5.22 ± 1.11, 6.75 ± 0.45 and 7.00 ± 0.00 respectively, and SIR scores were 2.66 ± 1.11, 2.33 ± 1.15, 2.40 ± 0.75, 2.56 ± 1.04, 4.12 ± 0.81 and 5.00 ± 0.00 respectively. There were significant differences among the six groups for CAP scores(χ(2) = 35.481, P < 0.001) and SIR scores(χ(2) = 40.549, P < 0.001).No significant differences for CAP and SIR scores were observed between children with auditory neuropathy/cochlear nerve aplasia and sensorial neural hearing loss as well as group A (P > 0.05 for each), and there were significant differences were shown between children with auditory neuropathy/cochlear nerve aplasia and group B as well as group C (P < 0.01 for each aplasia).</p><p><b>CONCLUSIONS</b>The auditory and speech capabilities of children with auditory neuropathy and cochlear nerve deficiency can can get benefits from cochlear implants as children with sensorineural hearing loss, however not achieve the level of those with normal hearing after cochlear implantation. The long term effects still need follow-up and evaluation.</p>

Pharyngeal aerodynamic characteristics of obstructive sleep apnea/hypopnea syndrome patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The role of nasal obstruction in the pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) has been debated for decades. In this prospective study, we compared the pharyngeal aerodynamic characteristics of OSAHS patients and normal people, and investigated the contribution of total nasal airway resistance to the pathophysiology of OSAHS.</p><p><b>METHODS</b>Computational fluid dynamics (CFD) was used to extract the average pressure and average airflow velocity in three transverse cross-sectional planes of the pharynx for statistical analysis, and the correlation between nasal resistance and the average pressure in the pharyngeal cavity was investigated.</p><p><b>RESULTS</b>The negative pressure within the pharyngeal cavity was significantly higher in OSAHS patients than in normal subjects, and total nasal airway resistance correlated well with the average pressure in three consecutive transverse cross-sections of the pharyngeal cavity.</p><p><b>CONCLUSIONS</b>Greater negative pressure within the pharyngeal cavity contributed to the increased collapsibility of the pharynx in OSAHS patients, and the strong correlation between nasal resistance and pharyngeal pressure suggests that the nose plays a role in the pathogenesis of OSAHS.</p>

Roles of spectral cues in Mandarin tone perception for sensorineural hearing-impaired patients / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>This study aimed to evaluate the role of spectral fine structure and envelope information in Mandarin tone perception for sensorineural hearing-impaired patients.</p><p><b>METHODS</b>The linear predictive coding technique was applied to synthesize 128 tokens having spectral fine structure from one tone of a monosyllabic word and spectral envelope from other tones with the same syllable. There after, the tone response performance was assessed using these 128 speech materials for 20 normal-hearing and 48 sensorineural hearing-impaired patients, including 20 with moderate, 20 with moderate to severe, and 8 with severe hearing loss.</p><p><b>RESULTS</b>99.7%, 97.7%, 96.3% and 83.0% of the mean tone responses were consistent with spectral fine structure for the normal hearing, moderate, moderate to severe, and severely hearing-impaired groups, respectively. No tone recognition responses were observed in consistent with spectral envelope cues. There was a significant difference in tone recognition among the normal hearing group and three hearing impaired groups (χ(2) = 59.2, P < 0.001). The negative correlation between the averages for pure-tone hearing thresholds at frequencies of 500, 1000, and 2000 Hz and tone responses that were in consistent with spectral fine structure for the hearing-impaired subjects (r = -0.643, P < 0.001).</p><p><b>CONCLUSIONS</b>For both normal-hearing and hearing-impaired subjects, spectral fine structure plays an important role in tone recognition, and the impact of changing spectral envelope cues on tone recognition is negligible, when spectral fine structure cues are present. Sensorineural hearing impaired patients showed a progressive decrease in the recognition of lexical tones based on spectral fine structure cues, as their hearing loss becomes more severe.</p>

Risk factors of juvenile onset recurrent respiratory papillomatosis in the lower respiratory tract / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Juvenile onset recurrent respiratory papillomatosis (JORRP) is a relatively rare disease. It affects the larynx in most cases. Because reports on JORRP to the lower respiratory tract (LRT) are few, we investigated clinical features of patients with a history of JORRP to analyze the risk factors of this disease.</p><p><b>METHODS</b>Data from 208 JORRP patients admitted to Beijing Tongren Hospital from January 2008 to December 2010 were reviewed. Gender, age at onset of symptoms, age at first surgery, duration of symptoms before the first surgical procedure, the number of surgical procedures, mean interval between surgical interventions, and the number of tracheotomies in patients with and without LRT spread of JORRP were analyzed. The data from patients with and without tracheotomy were recorded and compared. Two cases of primary tracheal papillomatosis were reviewed.</p><p><b>RESULTS</b>Papillomas extension down to the LRT was observed in 46 children (22.1%). Patients with LRT papillomatosis had a shorter time from the onset of the symptoms until the first surgery, required significantly more surgical procedures, and had a shorter mean surgical interval. Tracheotomy was performed in 13/162 (8.0%) children with laryngeal papillomatosis vs. 36/46 (78.3%) children with LRT papillomatosis. After tracheotomy, 36/49 (73.5%) children developed LRT papillomatosis and 10/157 (6.4%) children who did not have a tracheotomy developed LRT papillomatosis. Patients with tracheotomy required a significantly higher number of surgical procedures. The younger the patient had a tracheotomy, the longer the duration of cannulation was.</p><p><b>CONCLUSIONS</b>JORRP patients with LRT spread are prone to develop more aggressive disease. Tracheotomy resulted in a significant increase of LRT involvement.</p>

Fibrovascular polyp of the hypopharynx and esophagus / 中华医学杂志(英文版)

Fibrovascular polyp of the hypopharynx and esophagus, a rare, benign, intraluminal and submucosal tumor, is most commonly originated from the proximal esophagus. We discussed four cases with regurgitation, respiratory symptom or the feeling of a mass in the throat. All the patients were examined with laryngoscope under general anesthesia. A transverse cervical incision was performed in one patient and the polyps were excised under laryngoscope with CO2 laser in the other three patients. All the lesions were removed successfully. Diagnostic and therapeutic principles involved in these cases are presented and discussed. The recognition of fibrovascular polyp of the hypopharynx and esophagus as a potential cause of regurgitation is paramount. Surgical excision is recommended because of the satisfactory outcome.

Gasless endoscopic surgery through the upper chest in treatment of thyroid tumor / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.</p><p><b>METHODS</b>A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years, with a mean age of (34 ± 3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.</p><p><b>RESULTS</b>All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation. The patients were satisfied with the cosmetic results of the surgery.</p><p><b>CONCLUSION</b>The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.</p>

Audiology characteristics in newborns and infants who failed in the hearing screening by transiently evoked otoacoustic emissions: 89 cases study / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The present study was to evaluate the audiological characteristics of infants with normal auditory brainstem response thresholds in click and abnormal transiently evoked otoacoustic emissions. Relationships between test results of distortion product otoacoustic emissions (DPOAE) and other hearing testing methods were also evaluated.</p><p><b>METHODS</b>The participants consisted of eighty-nine infants, with a total of 123 ears. All participants' TEOAE screening results were abnormal but diagnostic click ABR results were normal. The participants were classified into the following groups based on the test results from distortion product otoacoustic emissions: group A (normal all-frequency), group B (abnormal low-frequency), group C (abnormal high-frequency), and group D (abnormal all-frequency).</p><p><b>RESULTS</b>Obtained from these groups were compared to results of other hearing tests including the latency of ABR wave I, 40 Hz auditory event related potential (40 Hz AERP), 226 Hz and 1000 Hz tympanometry, and acoustic reflex. Results In six hearing tests in the 123 ears, seven ears (5.7%) were normal, while 116 ears (94.3%) were abnormal. No significantly differences were detected between boys (93.9%) and girls (95.1%), as well as between left (93.1%) and right ears (95.4%). The proportion of abnormal test results ranked as follows: 59 ears in group D (48.0%), 34 ears in group B (27.6%), 20 ears in group A (16.3%), and 10 ears in group C (8.2%). The highest abnormal rates in groups A, B and D were acoustic reflex, which were 40.0% for group A, 55.9% for group B and 66.1% for group D respectively. The highest abnormal rate in group C was the latency of ABR wave I (50.0%). Distribution of low-frequency hearing loss in each group was mainly mild. However, one ear in group B was moderate hearing loss, six ears in group D were moderate hearing loss, and one ear in group D was severe hearing loss.</p><p><b>CONCLUSIONS</b>The present study showed that, of which infants with normal thresholds of ABR failed the hearing screening, comprehensively audiology assessment is needed. And of which infants with normal DPOAE in full frequency or abnormal in high frequency region or low frequency region need to be followed up.</p>

Vibrant soundbridge implantation (two cases report) / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Vibrant Soundbridge (VSB) implantation.</p><p><b>METHODS</b>In accordance with the indications for VSB implantation, surgeries were done for two patients who suffered from either a sensorineural or conductive hearing loss (microtia). Their preoperative auditory thresholds (0.5, 1, 2 and 4 kHz) were 56 dB HL and 61 dB HL. The VSB was turned on and adjusted seven weeks after surgery.</p><p><b>RESULTS</b>Postoperative auditory thresholds of the two patients were improved. Their pure tone thresholds were 32 dB HL and 40 dB HL, and the respective improvement was 24 dB HL and 21 dB HL. There was no facial paralysis, vertigo and tinnitus.</p><p><b>CONCLUSION</b>Patients with a sensorineural or conductive hearing loss may benefit from VSB implantation.</p>

Current state of diagnosis and treatment of allergic rhinitis in China / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the understanding among otolaryngologists and perspectives on the diagnosis and management of allergic rhinitis in major cities in China.</p><p><b>METHODS</b>A survey among otolaryngologists in mainland China was carried out through questionnaire, including the medical history, diagnosis and pharmacotherapy.</p><p><b>RESULTS</b>The survey was conducted in 508 otolaryngologists. In general otolaryngology head and neck surgery clinic, the patients with allergic rhinitis was about 19% +/- 14%, which was of 35% +/- 17% in rhinological clinic. Most of the otolaryngologists (61% +/- 29%) diagnosed AR based on medical history and nasal examination. Only 35% +/- 28% of the otolaryngologists used skin prick test or specific IgE serum test. 70% +/- 27% of the patients with AR were offered nasal steroids, 49% +/- 32% and 36% +/- 28% of the patients were offered oral or nasal antihistamines respectively. Only 24% +/- 17% of patients realized the importance of follow-up.</p><p><b>CONCLUSIONS</b>Allergic rhinitis is a core component in the specialty of otolaryngology head and neck surgery. The diagnosis and management of allergic rhinitis is sub-optimal. Chinese otolaryngologists need continuous education in aspects of diagnosis and management of allergic rhinitis.</p>