目的 研究组蛋白去乙酰化酶 2(HDAC2)基因多态性与噪声性听力损失(Noise-in-duced hearing loss,NIHL)易感性的关联.方法 以噪声作业工人为研究对象,选取 2019 年 6 月-2022 年 6 月北京市东城区第一人民医院耳鼻喉科确诊的 246 例NIHL患者为观察组,选择同期246 例听力未损伤者为对照组,均接受纯音听力检测,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)检测外周血 HDAC2 基因多态性(SNP)位点,采用Logistic 回归分析法明确 HDAC2基因SNP位点与NIHL易感性的关系.结果 与对照组比较,观察组高频听阈升高,差异有统计学意义(P＜0.05).观察组与对照组 HDAC2 基因rs10499080 和rs6568819 位点基因型分布比较,差异有统计学意义(P＜0.05).与对照组比较,观察组rs10499080 和rs6568819 位点T等位基因频率升高,差异有统计学意义(P＜0.05).Logistic 分析表明 rs12208304、rs1320445 和rs3757016 位点各基因型患者NIHL的发生风险无明显增加(P＞0.05);rs10499080 位点TT基因型[OR(95%CI)=1.659(1.120～2.694)]及隐性模型 CT+TT 基因型[OR(95%CI)= 1.944(1.120～3.217)]NIHL风险增加(P＜0.05),显性模型CC+CT基因型[OR(95%CI)= 0.731(0.535～0.917)]NIHL 风险降低(P＜0.05);rs6568819 位点患者 TT 基因型[OR(95%CI)=3.108(1.531～8.731)]及隐性模型 CT+TT基因型[OR(95%CI)=1.510(1.031～2.536)]NIHL风险增加(P＜0.05),显性模型CC+CT基因型[OR(95%CI)=0.892(0.420～0.954)]NIHL风险降低(P＜0.05).结论 HDAC2 基因rs10499080 和rs6568819 位点碱基C突变为T的噪声作业工人发生NIHL的风险较高.

Background: The pathophysiology and etiology of vestibular paroxysmia (VP) remains unclear, moreover, due to the lack of reliable diagnostic features for VP, the clinical diagnosis will be made mainly by exclusion. Aims/objectives: To evaluate the diagnostic value and curative effect of keyhole microvascular decompression with local anesthesia for VP. Material and methods: 54 patients with trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia underwent keyhole microvascular decompression with local anesthesia, twelve of whom were coexistent with VP. The evaluation of the vertigo after operation was performed with symptom report card for 12 patients with VP and the mean follow-up period was 116 months (range 114–118 months). Results: The cochleovestibular neurovascular compression at the root zone of vestibular nerve was found in 12 patients with VP, of whom 11 patients had the neurovascular compressive vertigo induced intra-operatively and the vertigo disappeared postoperatively, moreover, one patient had no neurovascular compressive vertigo induced intra-operatively and the vertigo was not improved significantly after operation. Of 12 patients with VP during the mean 116-month follow-up, 11 patients had no recurrence of neurovascular compressive vertigo and the effective control rate of vertigo was 91.7%. Conclusions and significance: Keyhole microvascular decompression with local anesthesia is not only an effective method for treating VP and controlling neurovascular compressive vertigo, but also has definite clinical significance in the diagnosis of VP.

Background: Meniere's disease appears to be a complex inner ear disorder and also remains a controversial and often difficult disease as regards determination of diagnosis, pathogenesis and especially optimal treatment.Aims/objectives: To investigate the long-term effects of progressive surgical treatment in the management of the vertigo attacks of intractable Meniere's disease.Material and methods: Eighteen patients with medically intractable and active Meniere's disease were opted to try Meniett pulse generator (Meniett), endolymphatic sac decompression (ESD) and triple semicircular canal occlusion (TSCO) in order to control the attacks of vertigo. Patients were indicated on the symptom report card the maximum level of vertigo, activity and stress.Results: Of 18 patients with medically intractable and active Meniere's disease during mean 165-month follow-up, the attacks of vertigo were effectively controlled in 14 patients by Meniett (77.78%), 2 patients by Meniett and ESD (11.11%), 2 patients by Meniett, ESD and TSCO (11.11%).Conclusions and significance: It is of great importance for intractable Meniere's disease to select surgically combined treatment process including Meniett, ESD and TSCO to effectively control the attacks of vertigo and a long-term follow-up.

目的 分析药物诱导睡眠内镜下不同严重程度的睡眠呼吸障碍患者鼾声来源的特点及分类.方法 选择74例(19～55岁,平均37.9±8.70岁)AHI<50的单纯打鼾(simple snoring,SS)和不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者为研究对象,分为SS及轻度OS-AHS组(39例)和中、重度OSAHS组(35例);各组分别用右美托咪定复合异丙酚进行诱导睡眠后,通过纤维鼻咽喉镜观察两组对象仰卧位打鼾时咽部组织振动及塌陷的情况,并进行分类比较.结果 74例患者中,鼾声来源及振动形式不同,分为软腭振动为主型(I型,前后型),咽侧壁振动为主型(II型,左右型),软腭+咽侧壁共同振动型(III型,向心型)三种类型;软腭振动为主型在SS及轻度OSAHS组和中、重度OSAHS组中的例数分别为24例(61.54％)和10例(28.57％);咽侧壁振动为主型在两组中的例数分别为9例(23.08％)和16例(45.71％);软腭+咽侧壁共同振动型在两组中的例数分别为6例(15.38％)和9例(25.71％),两组间鼾声来源类型及分布差异有统计学意义(P=0.016).结论 不同程度睡眠呼吸障碍的患者睡眠中鼾声来源部位及咽部组织振动形式不同;咽侧壁振动为鼾声的主要来源(Ⅱ型及Ⅲ型),且随打鼾者阻塞程度加重而占比增加;以鼾声主要来源为依据的分类法可为该类患者治疗方案的制定提供依据.

Objective:To analyze the effect and safety of treatment in patients with airway stenosis caused by tracheotomy for mechanical ventilation. Method: We treated the patients with airway stenosis caused by granulation tissue. The patients with grade Ⅰ,Ⅱ airway stenosis were treated with adjustable flange tracheostomy tube, and the holmium laser under a fibro-laryngoscope were applied for the patients with grade Ⅲ airway stenosis.Two hundred and sixteen patients were enrolled in this study. Forty-four patients had been found tracheal stenosis caused by granulomatous hyperplasia, accounting for 20.4% of all patients, including 12 cases of gradeⅠ, 18 cases of grade Ⅱ, and 14 cases of grade Ⅲ.Result:Thirty patients with grade Ⅰ and Ⅱ were replaced with adjustable flange tracheostomy cannula. Fourteen cases of grade Ⅲ airway stenosis were treated with Ho:YAG laser under a fibro laryngoscope. All cases were completed operation successfully. None of cases bleeding, perforated and asphyxia during operation. The clinical symptoms disappeared after operation, and endoscopy showed that airways of patients were smooth. No recurrence were found after operation.Conclusion: Replacement of adjustable flange tracheostomy tube and Ho:YAG laser can safely and effectively treat airway obstruction caused by tracheal granulation tissue hyperplasia after tracheotomy.

Objective:To ascertain the effects of a new method of photochemical reaction in vestibular function in guinea pigs.Method:Local photochemical reaction was initiated by systemic injection of rose bengal(20mg), photoillumination of the vestibule through medial wall of epitympanum for 30 minutes was started immediately after the injection of rose bengal, with a optic fiber connected to a xenon light (wavelength, 540nm; photointense, 500-600 mW/cm ²). There were 20 guinea pigs divided random equally into 2 groups. Group 1 was injected with rose bengal. Group 2 was control, injected with physiological saline solution. The ice caloric tests were performed on the second day.Result:The test group (7 ears) and the control group (6 ears) with test nystagmus showed mean frequencies were（2.0±0.33）times/s and（3.7±0.33）times/s,the mean amplitude were (3.1±0.39)mm and (3.5±0.54)mm,and the mean duration were (44.7±17.22)s and (62.0±7.22)s respectively.The nystagmus frequency difference was statistically significant, but the amplitude and the duration of the nystagmus were not significantly different. There was no obvious spontaneous nystagmus in the two groups, and there were negative results of ice water test (3 ears in the test group and 4 ears in the control group).Conclusion:Photochemical reaction can induce the ischemic state of the vestibule system in guinea pig, and produce an acute vestibular dysfunction, and ice water test shows that the frequency of nystagmus is reduced.

Objective To retrospectively analyze the tracheotomy in elderly patients aged 75years and over,and to explore the surgical strategy for ensuring the safety of surgery and reducing the complications. Method The clinical data of the patients who underwent tracheotomy at our institute from January 2011 to December 2015 were reviewed. The data include general condition, accompany disease, the neck, the use of anticoagulant, treatment and operation were recorded and analyzed. Result In this study, we analyzed the data from 74 patients. All cases were intubated endotracheal before operation, and tracheotomy was performed successfully. the thyroid isthmus were cutted and ligated in 3 cases for completing the operation. Postoperative bleeding occurred in 2 cases, 1 case stopped the bleeding with vaseline gauze plugging, the surgical field was reexposed for hemostasis in another case. Without heparin hemodialysis were selected for 4 cases in 24 hours before and after surgery. No other complications occurred. Conclusion Patients with aged 75years and over have high risks of tracheotomy. But after correct and appropriate preoperative assessment and taking actions accordingly, it can ensure safety of surgery and reduce the complications.

目的 探讨光化学法诱导豚鼠膜外半规管微循环缺血的可行性及其对前庭功能的影响.方法 将24只豚鼠分为实验组和对照组,每组12只,均以左耳为实验耳,取耳后径路,暴露上鼓室;实验组颈静脉注射2％四碘四氯荧光素二钠20 mg/kg、对照组注射0.5 ml生理盐水后,立即用波长为540±40 nm、光强为500 mW/cm2的冷光光纤持续照射左侧上鼓室内侧壁30分钟,术后两组立即各取4耳作内耳膜外半规管分离铺片,余8耳5天后作颞骨石蜡切片观察.结果 术后实验组豚鼠均出现向左侧的晃头动作及转圈、肌肉震颤、步调协调性差等表现;对照组仅2只出现静止时轻度晃头和肌肉震颤.膜外半规管分离铺片显示实验组4耳膜外半规管均有不同程度的微循环闭塞,血流中断,对照组毛细血管网无明显改变.颞骨石蜡切片可见实验组8耳壶腹嵴下毛细血管网均有不同程度的萎缩、闭塞,部分毛细胞变性、坏死、缺失;膜外半规管形态异常,扭曲变形,网状纤维萎缩,毛细血管闭缩,仅见少量红血球;对照组8耳壶腹嵴细胞界限清晰,纤毛清晰可见;壶腹嵴和半规管血流丰富,半规管管腔基本呈圆形,网状纤维无萎缩.两组均未见椭圆囊、球囊毛细胞明显异常.结论 光化学法可以诱导豚鼠膜半规管、壶腹嵴微循环局部缺血,壶腹嵴毛细胞损伤严重,可以为进一步研究急性血管性眩晕发病机理提供参考.

Objective:The research aimed to study the relationship between endolymphatic imaging and clinical manifestations(duration of last attack period to MRI scan) of Meniere's patients.Method:Twenty-six Meniere's patients and 29 affected ears were enrolled in this research. According to clinical manifestations, when performing MRI scan, patients who were not in attack period and the duration of last attach period to MRI scan was longer than 14 days were divided to Group A; and patients who were in attack period or the duration of last attach period to MRI scan was shorter than or equal to 14 days were divided to Group B. Administrate gadolinium to mid-ear affected by MD via non-invasive method through Eustachian tube, and then perform 3D-FLAIR MRI scan the next day. After measurement and calculation, compare RV and RC (area of endolymphatic space divided by total lymphatic space in vestibule and cochlea, respectively) of the two groups. Result:Twenty-nine affected ears of 26 patients were administrated successfully.The endolymphatic spaces were distinct from perilymphatic spaces in vestibule and cochlea in 26 ears. In the images of B6, B12, B14, the cochlea and semicircular canals were enhanced, but the vestibules were not enhanced. For Group A ,the average of RV was 0.37±0.06; the average of RC was 0.15±0.04. As to Group B ,the average of RV was 0.52±0.26; the average of RC was 0.18±0.06. According to ANOVA test,RV of the two groups had significant difference（P<0.05）, RC had no significant difference（P>0.05）. The positive RC and RV in Group A were 7.1% and 42.9% respectively. The positive RC and RV in Group B were 13.3% and 66.7%, respectively. As to 4 patients who were during attack period in Group B, the positive RC and RV were 50% and 100%, respectively. The positive RV of Group B was higher than that of Group A. Conclusion:The clinical manifestations(duration of last attack period to MRI scan) of Meniere's patients had relationship with positive rate of MRI scan. The possibility of positive RV was higher when the duration of attack period to MRI scan was shorter.

Abstract Objective: To discuss the possibility of fundamental frequency (F0) and formant frequency (FF) to generally differentiate the sources of snoring sounds determined by drug-induced sleep endoscopy (DISE). Methods: A total of 74 snoring subjects underwent DISE and snoring sounds were recorded simultaneously. The noise-suppressed snoring sounds were analyzed and classified into different groups based on the sources of vibration identified by DISE. F0 and FFs were calculated. Results: Totally, 516 snoring sounds from three vibrating sources (the palate, combined the palate and the lateral wall, the lateral wall) of 47 patients were divided into three groups then analyzed. The levels of F0 and FFs for each group follow the order: Group 1 < Group 2 < Group 3. There was statistical difference between Group 1 and other groups in F0 and F2 (p < .05). The area under the receiver–operator curves (AUC) was F0, at 0.727, and the cut-off value was 134.2 Hz; and F2, at 0.654, and the cut-off value was 2028.0 Hz. Conclusions: F0 and the second formant frequency (F2) are found to be significantly lower in palatal snoring sound. F0 might be a significant in distinguishing palatal snoring sound from non-palatal snoring sound. F2 is more significant than F1 and F3 in identifying the sources of the snoring sounds but is less sensitive than F0.

Objective The research aimed at evaluating whether non-invasive endolymphatic MR imaging could be used in aged patients(≥60 years)suffering from Meniere's disease.Methods Under guidance of nasal endoscopy,a diluted gadopentetate dimeglumine injection was administrated through eustachian tube into mid-ear cavity in four patients (≥60 years old) suffered from Meniere's disease.3D-FLAIR MRI scan was performed one day after the administration.Results The administration succeeded through eustachian tube into mid-ear cavity in those four patients.A rise of fluid level on tympanic membrane while administrating a diluted gadopentetated meglumine injection was observed.Imaging of inner ear endolymphatic spaces were visible in vestibule and cochlea in imaging of patient 1.As to patient 2,in cochlea the scala tympani of the first and second turns were enhanced while scala vestibule weren't;Vestibules couldn't be recognized.In images of patient 3,the scala tympani of the three turns in cochlea were enhanced while scala vestibule weren't;Vestibules couldn't be recognized.For Patient 4,in cochlea the scala tympani of the first turn were enhanced while scala vestibule weren't,and the second turn was partially enhanced;and endolymphatic space of vestibule could be distinguished from perilymphatic space.Conclusions This technique could be adopted in investigation of Meniere's disease in elderly patients.MR imaging of endolymphatic spaces in vestibule and cochlea can be visualized,which may partially provide data for diagnosis of Meniere's disease.

Objective To compare the endolymphatic spaces between Meniere's disease (MD) group and normal volunteer group.Methods Patients were performed administration of gadolinium to mid-ear affected by MD via non-invasive method through eustachian tube,and then performed 3D-FLAIR MRI scanning afer one day.After measurement and calculation,the RV and RC (area of endolymphatic space divided by total lymphatic space in vestibule and cochlea,respectively) between the MD group and the normal group were compared.Results The endolymphatic spaces were distinct from perilymphatic spaces in vestibule and cochlea,the average of RV was 0.39,and the standard deviation of RV was 0.07;the average of RC was 0.16,and the standard deviation of RC was 0.05.RV of the MD group had significant difference compared to that of the normal group(t =-6.07,P ＜0.05);RC of the MD group had no significant difference compared to that of the normal group (t =0.783,P ＞ 0.05).According to diagnosis standard raised by Liu F in previous research,the positive ratio of RV was 42.9％,while the positive RC was 9.52％.The two patients during attack period both had positive RVs.Conclusion RV of the MD group had significant difference compared to that of the normal group;RC of the MD group had no significant difference compared to that of the normal group.

Objective: The purpose of this study was to observe the clinical characteristics of two types of geotropic direction-changing positional nystagmus, the transient(nystagmus time <1 min) and the persistent(nystagmus time > 1 min), and to evaluate the efficacy of the barbecue roll maneuver. Methods: A total of 105 cases diagnosed by supine roll test were studied, which including 35 males and 70 females and the average age was (56.9±14.6)years. There were 70 transient geotropic DCPN and 35 persistent geotropic DCPN. The clinical characteristics and the immediate and one-week efficacy of the barbecue roll maneuver were discussed. Results: The nystagmus disappeared at the null-point position and the nystagmus in supine position were opposite to the bowing (90° nose-down) position in persistent geotropic DCPN cases. While to the transient geotropic DCPN cases, there were no NP and no nystagmus in prone position. The ratio of the first onset of the two groups was 28.6% (persistent) and 72.9% (transient) respectively, and the difference was statistically significant (P<0.05). The immediate and one-week efficacy after barbecue roll maneuver were 91.4% and 80.0% in transient geotropic DCPN cases, and 0% and 42.9% in persistent geotropic DCPN cases, which were statistically significant different(P<0.05). Conclusions: The light cupula hypothesis can mainly explain the clinical features of persistent geotropic DCPN cases; the barbecue roll maneuver is invalid to persistent geotropic DCPN cases which can be self-healing.

Objective To investigate the consistency of the sources of snoring sound induced by simulated snoring and drug-induced sleep endoscopy in simple snores (SS) and mild obstructive sleep apnea/hypopnea syndrome (OSAHS).Methods A total of 40 cases diagnosed as either SS or mild OSAHS by polysomnography (PSG) underwent simulated snoring and drug-induced sleep endoscopy successively.The vibration of soft tissue of upper airway was observed with fiberoptic laryngoscope.Results Under simulated snoring condition and drug-induced sleep endoscopy,there were different vibrations in the pharynx.The McNemar statistical results showed that there was no significant difference between simulated snoring and drug-induced sleep endoscopy in determining the vibration of soft palate and epiglottis/tongue base (P =0.774,0.077),while there was very significant difference between the two methods in determining the vibration of the lateral phaynged wall (P =0.002).Under these two conditions,there was no significant difference in the incidence rates of vibration of both soft palate and epiglottis/tongue base (P =0.770,0.110),while the incidence rate of vibration of lateral pharyngeal wall was much higer under drug-induced sleep endoscopy than that under simulated snoring (P =0.005).Conclusion Compared with drug-induced sleep endoscopy,simulated snoring is relatively reliable in determination of soft palate vibration,slightly inferior for epiglottis/tongue base,but is unreliable in the determination of lateral pharyngeal wall vibration.

Objective To study the effectiveness of intravenous Lidocaine on subjective tinnitus in the elderly, and analyze its correlation with the effectiveness of subsequently oral Carbamazepine.Methods A prospective case-control study was conducted in 120 elderly patients with subjective tinnitus, who were divided into two groups.The control group (n=60) was treated with oral Carbamazepine 0.1 g Bid for one month, and the treatment group (n=60) was treated with 2％ lidocaine by intravenous injection.Patients in the treatment group were observed on responses in tinnitus during the period with Lidocaine injections.The treatment group was further divided into the improvement subgroup and the no-improvement subgroup, according to responses to intravenous lidocaine.All the patients in the treatment group received oral carbamazepine 0.1 g Bid for one month following the intravenous lidocaine injection phase.Results In the control group, 5 patients showed marked improvement, 20 patients showed partial improvement, 33 patients showed no improvement, and 2 patients showed symptom deterioration, with an effectiveness rate of 41.7％ (25/60).In the treatment group, 6 patients showed marked improvement, 26 patients showed partial improvement, 24 patients showed no improvement, and 4 patients showed symptom deterioration, with an effectiveness rate of 53.3％ (32/60).Of the 32 patients in the improvement subgroup, 6 cases showed marked improvement, 16 cases showed partial improvement, 8 cases showed no improvement, and 2 cases showed symptom deterioration after subsequent oral Carbamazepine treatment, and the effectiveness rate was 68.8％ (22/32).Of the 28 patients in the no-improvement subgroup, 1 case showed marked improvement, 9 cases showed partial improvement, 16 cases showed no improvement, and 2 cases showed symptom deterioration, and the effectiveness rate was 35.7％ (10/28).The effectiveness rate in the improvement subgroup was higher than in the no-improvement subgroup (68.8％ vs.35.7％, x2 =6.55, P＜0.05).The effectiveness of lidocaine followed by carbamazepine was better than that of carbamazepine alone (68.8％ vs.53.3％, x2 =6.13, P＜0.05).Conclusions Oral Carbamazepine treatment following intravenous Lidocaine injection in elderly patients with subjective tinnitus has better therapeutic outcomes than treatment with oral Carbamazepine alone, but is not as effective in patients with negative responses to Lidocaine as in patients with positive responses.

Objective To investigate the relationship between sound pressure level parameters of snoring sound and obstructive sites in patients with media or severe obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Forty-six patients with media or severe OSAHS were included in this study.All underwent continuous upper airway pressure measurements and snoring sound pressure level recording simultaneously.The correlations between obstructive site,AHI,BMI and sound pressure level parameterssuch as equivalent continuous sound level (LAeq )and maximum sound pressure level (L10 )were analyzed.Results Both LAeq and L10 were affected only by AHI,whereas unrelated to obstructive site and BMI.Conclusion There is no definite relationship between the site of obstruction and sound pressure level parameters of snoring sound.It appears that LAeqand L10may be helpful to e-valuate the severity of OSAHS,but may have no clinical value on distinguishing obstructive sites.

Objective:This study was designed to observe the dizziness handicap inventory (DHI) scores in patients with BPPV (benign paroxysmal positional vertigo) before and after maneuver repositioning and aimed to discuss the values of DHI scores in the diagnosing and treatment of BPPV. Method:Charts of 72 patients with BPPV diagnosed by positioning test were reviewed. Four DHI scores were used including the total score (DHIT), the functional score (DHIF), the emotional score (DHIE), and the physical score (DHIP). We compared the pre-repositioning DHI scores and post-repositioning scores of patients, and also compared the DHI scores of patients with and without residual dizziness. Result:All of the 72 patients were underwent maneuver repositioning and recorded the DHI scores. The mean post-repositioning scores were dramatically decreased compared with pre-repositioning scores, and the difference was significant (P<0.01). The differences of the DHIP scores between the residual dizziness group and the non-residual dizziness group was not significant, while the DHIF scores, the DHIE scores and the DHIT scores between the two groups were statistically different. Conclusion:After maneuver repositioning the dizziness handicap of BPPV patients could be significantly improved. The next treatment program for residual dizziness patients after successful repositioning could be aimed at the functional and emotional dizziness.

Abstract Conclusions: Noninvasive standard evaluation of normal endolymphatic space and endolymphatic hydrops using magnetic resonance imaging (MRI) in various age groups is reported for the first time. Objective: To compare the standard evaluation of endolymphatic space in healthy volunteers in the cochlea and the vestibule among different age groups by applying noninvasive intratympanic gadolinium (Gd) perfusion through the eustachian tube and three-dimensional fluid-attenuated inversion recovery MRI (3D-FLAIR MRI). Methods: This was a prospective study. 3D-FLAIR MRI was performed with a 3 T unit 24 h after intratympanic administration of Gd through the eustachian tube in 60 healthy volunteers aged 20–55 years. Pure-tone test and tympanometry were performed 24 h before and 1 week after Gd administration. Results: There was no significant difference in the ratios of the area of the endolymphatic space to that of the fluid space in the cochlea and the vestibule between males and females, or among 20–30-, 31–44-, and 45–55-year-old healthy volunteers. In 20–55-year-old healthy volunteers, the normal value of the endolymphatic space in the cochlea ranged between 7% and 27%, and that in the vestibule was between 17% and 39%. No significant changes in pure-tone test or tympanometry were noted.

Objective To investigate the sources of snoring sound in simple snores and in patients with different degrees of obstructive sleep apnea/hypopnea syndrome (OSAHS).Methods A total of 15 subjects with simple snores and 37 patients with mild to severe OSAHS were involved.Sites of vibration from nasopharynx to laryngeal pharynx while sno-ring in each patient were observed with fiberoptic laryngoscope during drug-induced sleep.Results Vibration of soft palate,lateral wall,epiglottis and tongue base could be observed during snoring,and the distribution of lateral wall vibration had statistical significance among different groups.52 snores showed two types of source of snoring in general:palatal fluttering only(type Ⅰ)and multisite vibration (type Ⅱ).The latter could be divided into 3 subtypes further:palatal fluttering with vibration of epiglottis (type Ⅱa),palatal fluttering with vibration of Lateral wall(type Ⅱb),and palatal fluttering with vibration of lateral wall,epiglottis and tongue base together(type Ⅱc).Percentage of type Ⅰdecreased as the severity of OSAHS increased.Type IIb was more common in patients with media and heavy OSAHS, and type IIc were most common in patients with heavy OSAHS.Conclusion Source of snoring is of diversity,snorers with different severity of sleep breath disorder shows different patterns of that.The main source of snoring should be identified when we choose treatment method for snorers.

Objective To compare the advantages and disadvantages of two different surgical methods for broad-based type of vocal cord polyps. Method 60 patients with vocal polyps were randomly divided into two groups. In Group A, 30 patients were treated by the ENT precision cutter combined with the application of laryngeal endoscopy. In Group B, 30 patients were treated by CO2 laser combined with the application of microscope. The 60 patients were followed up for 6 months. Result Group B showed significantly less blood loss and shorter operation time than that group A(P<0. 05). No complication was found in the 60 patients. The total effective rate of the two groups was not significantly difference. Conclusion Satisfactory results were achieved with all the two surgical methods for the broad-based type of vocal cord polyp with different advantages and disadvantages. CO2 laser and microscope shorten the operation time and decrease intraoperative blood loss comparing the ENT precision cutter, but the selection of patients have limitations. The ENT precision cutter and endoscopy provide a wider visual field and more extensive application, but it has a long learning curve and needs more practice.