目的 探讨单侧全聋型突发性耳聋(profound idiopathic sudden sensorineural hearing loss,PISSNHL)患者前庭功能损伤的频率特点和预后.方法 选取2020年10月至2022年3月东南大学附属江阴市人民医院耳鼻咽喉头颈外科PISSNHL患者,按诊疗指南完成治疗,住院10 d后完成温度试验(caloric test,CT)和视频头脉冲试验(ideo head im-pulse test,vHIT),分析患者频率特点和治疗有效率.结果 共纳入单侧PISSNHL患者50例,其中男27例,女23例,年龄18～71岁,平均(48.2±11.2)岁.伴眩晕患者22例(44.0％),CT检查结果异常23例(46.0％).眩晕组CT结果异常率高于非眩晕组(90.9％比10.7％),差异有统计学意义(P＜0.05).vHIT检查结果显示,水平半规管异常13例(26.0％),后半规管异常8例(16.0％),上半规管异常8例(16.0％).治疗后听力疗效等级评估,治愈11例(22.0％)、显效15例(30.0％)、有效10例(20.0％)、无效14例(28.0％).眩晕组、CT异常组治疗有效率分别低于非眩晕组和CT正常组,差异均有统计学意义(P＜0.05).结论 伴有眩晕症状的患者前庭功能和CT异常率更高.与反应高频前庭功能的vHIT检查相比,反应低频前庭功能的CT检查异常率更高,且治疗有效率更低.完善的前庭功能检测能更全面反映PISSNHL患者病变累及范围及治疗效果.

目的:比较鼓室注射甲泼尼龙与地塞米松治疗糖尿病(diabetes mellitus,DM)伴突发性耳聋(sudden hearing loss,SHL)的短期效果.方法:选择2019年1月-2021年10月东南大学医学院附属江阴医院60例DM伴SHL患者.根据随机数字表将其随机均分为D组和M组,各30例.两组均给予基础治疗,D组鼓室注射地塞米松,M组鼓室注射甲泼尼龙.比较两组治疗前后听力、血糖情况,以及临床疗效及不良反应.结果:治疗后,M组纯音听力测试(pure tone audiometry,PTA)低于D组(P<0.05).M组治疗总有效率为86.67％,高于D组的63.33％(P<0.05).治疗后,M组空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h postprandial plasma glucose,2 h PG)均低于D组(P<0.05).两组不良反应发生率比较差异无统计学意义(字2=0.480,P=0.488).结论:鼓室注射甲泼尼龙治疗DM伴SHL的短期效果优于鼓室注射地塞米松.

目的 探讨耳后及鼓室注射地塞米松治疗伴2型糖尿病突发性聋患者的疗效.方法 纳入符合入组标准的伴2型糖尿病突聋患者33例(55～76岁),分为耳后注射组(17例)和鼓室注射组(16例),分别于耳后乳突骨膜下和鼓室注射地塞米松5 mg,隔日一次,注射5次,两组同时应用同样的扩血管、营养神经药物及高压氧治疗,比较两组疗效,治疗后采用视觉模拟量表(VAS)评估耳鸣改善效果和疼痛程度评价.结果 耳后注射组总有效率为76.4％(13/17),鼓室注射组为68.8％(11/16),两组总有效率差异无统计学意义(P>0.05).耳后注射组耳鸣VAS评分下降值(4.17±1.90分)高于鼓室注射组(2.68±1.28分),疼痛程度VAS评分(3.10±2.0分)低于鼓室注射组(5.89±2.34分),差异均有统计学意义(P<0.05).结论 地塞米松耳后注射和鼓室注射两种给药方式治疗突聋的总有效率相似,但耳后注射的疼痛反应小,对耳鸣的改善更好.

目的 观察平阳霉素联合地塞米松注射治疗咽喉部静脉畸形的临床效果.方法 回顾分析2006年5月～2016年9月应用平阳霉素联合地塞米松瘤内注射治疗的咽喉部静脉畸形患者15例临床资料,每次注射平阳霉素8mg+地塞米松注射液5mg.每次注射后三周检查若病变未完全消失则再次注射,每4次为一疗程,平阳霉素注射总量不超过40mg.结果 15例患者中治愈14例,显效1例,没有出现肺纤维化及大出血等严重并发症,治愈率为93.33％,有效率为100％.结论 平阳霉素联合地塞米松注射治疗咽喉部静脉畸形是安全、简便易行、有效的治疗方法.

目的 探讨绝经后女性良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者BPPV的发生和复发与骨密度、血钙及血清维生素D浓度的相关性.方法 选取2014年1月至2016年12月就诊于东南大学附属江阴医院耳鼻喉科门诊且明确诊断为原发性BPPV的78例(78耳)绝经后女性患者为试验组,根据随访结果 分为BPPV未复发组(63例)和BPPV复发组(15例),选取同期来院体检的自然绝经1年的正常女性30例为对照组.采用双能射线吸收法检测所有受试者腰椎骨密度,抽取清晨空腹外周静脉血4 ml,分别运用半自动分析仪和免疫化学发光法检测血钙浓度和血清维生素D水平.比较各组间骨密度、血钙浓度和血清维生素D水平.结果试验组骨密度下降者占82.15％(64/78),高于对照组(23.33％,7/30),差异有统计学意义(P<0.001).BPPV复发组骨密度T值最低(-1.77±0.63),其次为BPPV未复发组(-1.29±0.82),对照组为-0.63±0.92,组间差异有统计学意义(P<0.001).三组间的血钙浓度差异无统计学意义(P=0.71).对照组的血清维生素D水平(23.98±2.12 ng/ml)高于BPPV未复发组(18.45±4.28 ng/ml)和BPPV复发组(17.15±6.04)ng/ml,差异有统计学意义(P<0.001),BPPV未复发组与复发组之间差异无统计学意义(P>0.05).结论 绝经后女性BP-PV患者BPPV的发生可能与骨密度及血清维生素D水平下降有关,而与血钙浓度可能无关;绝经后女性患者BP-PV的复发则仅与骨密度下降有关.

目的 探讨经乳突-上鼓室入路的面神经次全程减压术在颞骨外伤性面瘫中的应用.方法 收集8例9侧颞骨外伤性面瘫患者临床资料,回顾分析术中面神经损伤部位及损伤性质、颞骨骨折类型、术中听骨链探查情况,对比术前术后的听力及术前术后面神经功能,评估手术疗效.结果 8例(9侧)患者横行骨折2侧、纵行骨折7侧,术中探查面神经损伤部位均位于膝状神经结至茎乳孔间.除1例锤砧关节下移外,其他听骨链链接完整;术前3耳出现感音神经性耳聋,2耳混合性耳聋,4耳传导性耳聋.术后随访2～6个月,患者气骨导差均消失,骨导听力未见进一步下降.术前面神经功能HBV 1侧,HBⅥ8侧,术后面神经功能恢复至HBI Ⅱ级8侧,HBⅢ级1侧.结论 经乳突-上鼓室入路可行面神经迷路段远段至茎乳孔处次全程减压,同期可对听骨链进行探查,若听骨链正常,可在保留听骨链完整下行面神经减压术,减少术后听力损失,是治疗颞骨外伤性面瘫的一种行之有效的手术方式.

Objective To evaluate the clinical efficacy of repairing ventral auricular defect with mastoid region pedicle flap. Method 11 cases of postoperative auricular defect had been repaired by mastoid region pedicle flap. Result The stitches were taken out 10 days after the surgery, and the flap were all survival with good color and luster. The auricle showed fine shape. Conclusion The procedure was simple to be mastered and the flap was easy to survival. The donor scar was hidden. It is an ideal choice for reconstructventral auricular defect.

0bjective To evaluate the safety of hemocoagulase agkistrodon(HCA)application after tonsilectomy. Methods According to the self-control method,30 patients were without hemostatic before operation and during operation,administrated haemocoagulase agkistrodon 2 U with 1 to 3 days after surgery ,as the situation.The coagulation function and safety were observed index before operation and after administration in 24h,respectively.Results The body coagulation parameters and safety indexes were similar between two groups(except for WBC).There were no adverse events occurred.Conclusion The application of haemoeoagulase agkistrodon after tonsilectomy is safe.

The patient has complained of twice left nose bleeding. Nasal endoscope examination found bloodstain in recessus sphenoethmoidalis, while nasal sinuses MR examination showed moderate and slightly high signal in left sphenoid sinus on T₁WI and T₂WI. Then, she was underwent nasal endoscopic surgery to stop bleeding. A dark red, pulsating tissue was found above the lateral wall of the sphenoid sinus during the surgery. After the surgery, the patient did a cerebral digital vascular angiography and the diagnosis was internal carotid artery aneurysms rupture.

目的 观察庆大霉素冲洗先天性耳前瘘管脓肿的临床疗效.方法 将我院收治的63例耳前痿管感染并发脓肿患者随机分为对照组31例和试验组32例,对照组行切开排脓,每日常规换药治疗,试验组切开排脓后,每日用庆大霉素冲洗,两组均皮片引流.两组同时抗生素静脉使用3d后改为口服给药至痊愈.比较两组患者的感染愈合时间.结果 试验组脓肿切开后至感染治愈的时间平均为(5.0±-1.6)d,对照组感染治愈时间平均为(17.1±4.7)d,试验组比对照组所用时间短,差异有统计学意义(P＜0.01),治疗期间对照组肉芽形成率为25.8％,试验组未出现肉芽,两组比较,差异有统计学意义(P＜0.05).1年内两组复发率无统计学差异(P＜0.05).结论 庆大霉素冲洗耳前瘘管感染形成的脓肿,效果满意,并发症少,未增加感染复发率,值得临床应用推广.

声带突肉芽肿是发生在杓状软骨声带突的良性增生性病变，目前具体发病机制还不十分明确，但一般认为主要与用声过度、咽喉反流及气管插管损伤有关，且前两者常同时存在，相互影响。对于声带突肉芽肿的治疗，目前主要有嗓音矫正治疗、抑酸药物治疗、手术治疗、肉毒杆菌毒素注射疗法及联合治疗等[1]。近年来随着对声带突肉芽肿病因及发病机制的不断研究，特别是对咽喉反流疾病研究的深入，认为咽喉反流是引起声带突肉芽肿的一个重要原因[2]，故目前普遍认同抑酸疗法是治疗声带突肉芽肿的首选疗法[1，3，4]。

近年来,越来越多的研究聚焦于鼓室内灌注激素治疗突发性聋(sudden deafness,SD).2010年1月～2013年3月我科对99例重度以上SD患者分别给予全身或鼓室内注射激素治疗,现将治疗结果报道如下. 1资料与方法 1.1 一般资料.2010年1月～2013年3月我科收治的SD患者99例;男52例,女47例;年龄32～68岁,平均47岁;均为单耳发病;重度聋73例,极度聋26例;声导抗和头颅CT均显示正常;发病到治疗时间间隔10d以内.用0.5、1.0、2.0 kHz的平均听阈(pure tone average,PTA)评估听力损失程度.

Objective To study the effects of triamcinolone acetonide and ambroxol solutionthe injection at the begin?ning of radiotherapy in slowing down development of secretory otitis media (SOM) in patients with Nasopharyngeal carcinoma (NPC). Methods Forty cases (64 ears exposed to radiation) of Nasopharyngeal carcinoma,but with no signs of secretory otitis media symptoms were divided into experimental and control groups of 32 ears each. Patients in the experimental group re?ceived transtympanic injection of triamcinolone acetonide and ambroxol solutionthe once a week when radiation dose amount?ed to 30 Gy. The treatment was continued until the end of radiotherapy. The two groups were then observed for 6 months after radiotherapy. The rate of SOM,at the end of radiotherapy, and by the end of the third and sixth post-radiation month were compared between the groups. Results At the end of radiotherapy, 1 ear in the experimental group (1/32) and 6 ears (in 4 pa?tients) in the control groups (6/32) showed signs of SOM (X2=18.19, p<0.01). At the end of the third month, 2 ears (in 2 pa?tients) in the experimental group (2/32) and 9 ears (in 6 patients) in the control groups (9/32) developed SOM (X2=20.75, p<0.01). At the end of the sixth month, 6 ears (in 4 patients) in the experimental group (6/32) and 18 ears (in 13 patients) in the control groups (18/32) had SOM (X2=30.47, p<0.01). Conclusions Early intervention with tympanic injection of triamcinolone acetonide and ambroxol may decrease SOM related to radiotherapy for NPC.

Objective The goal of the present study was to determine the effects of different location perfora-tions on the middle ear transfer functions by measuring the velocity and pattern of the tympanic membrane vibration in guinea pigs with intact and perforated TM .Methods A laser Doppler vibrometer was used to measure the sound transmission properties on the movement of the tympanic membrane on 6 fresh temporal bones of guinea pigs in the frequency range of 0 .5~8 kHz at 90 dB SPL .The velocity was measured at three points on the manubrium before and after a different location perforation was made with a 20-gauge needle(1 .1 mm diameter) .The locations of the perforations were in anterior -inferior quadrants of left ears and in posterior -inferior quadrants of right ears .And the velocity was measured from 6 poins with the intact tympanic membrane .Results The highest velocities were re-corded at the site of inferior umbo throughout the frequency range .The manubrium vibration velocity losses were noted in the perforated ears below 1 .5 kHz ,the velocity losses were smaller above 1 .5 kHz ,and the maximum ve-locity loss was about 7 dB at 500 Hz with the posterior -inferior quadrant perforation .Although there was a trend for anterior-inferior perforations to show a slighter loss than posterior -inferior perforations in velocity below 1 .5 kHz ,no statistical differences in velocity loss were found between different perforations .The average ratio of short process velocity to umbo velocity at all frequencies was approximately 0 .5 ,and the ratios were found no systematic differences before and after perforation at almost all frequencies from different perforations .Conclusion The manu-brium vibration velocity losses from TM perforation are frequency -dependent and the largest losses occur at the lowest sound frequencies .Different sites of small perforation have not any important effects on middle ear sound transmission .

变应性鼻炎(AR)作为耳鼻咽喉科常见病，严重影响患者的生活质量，且其发病率有逐年增高的趋势。明确变应原对变应性鼻炎的预防、诊断及治疗有着重要意义。现回顾性分析我科2010年9月～2011年8月中1337例变应性鼻炎患者标准化变应原皮肤点刺试验结果，报告如下。

1 临床资料男,52岁.因声嘶半年加重3周入东南大学医学院附属江阴医院.专科检查:项软,气管居中,于甲状腺右叶中极可及一0.8 cm ×0.8 cm大小肿物,质硬,边界清,随吞咽上下移动,未闻及血管杂音,颈浅淋巴结未及肿大.甲状腺彩超示:甲状腺右叶中极后方近气管处见形态不规则低回声,大小约1.2 cm×0.9cm,局部向下,与喉返神经(recurrent laryngeal nerve,RLN)相邻,考虑右甲状腺癌(图1).电子喉镜示:右侧声带正中位固定. 关键词：甲状腺癌;喉返神经;舌下神经袢

OBJECTIVE:To investigate the therapeutic effect of nasal continuous positive airways pressure (nCPAP) combined with antireflux medicine on obstructive sleep apnea hypopnea syndrome (OSAHS) with gastroesophageal reflux (GER). METHOD:Sixty patients with moderate to severe OSAHS with GER were simultaneously received PSG and esophageal pH monitoring and randomly divided into control group and treatment group with each group 30 patients. The control group were simply received nCPAP for every night. The treatment group were received the same treatment and combined antireflux medicine, with esomeprazole 40 mg/d and mosapride citrate 5 mg, 3 times a day,oral. Both the groups symptomatic status of OSAHS and GER were observed on the third day and the 14th day during therapy, and then the same tests above were repeated on the 14th day. RESULT:Compared with the control group, the symptomatic improvement rate of OSAHS on the third day and 14th day during therapy,the symptomatic improvement rate of GER on the third day during therapy were increased with statistical significance in the treatment group (P<0.05), however, the difference of symptomatic improvement rate of GER between the two groups on the 14th day during therapy did not have statistical significance (P>0.05). Compared with those of the control group on the 14th therapeutic night, AHI, LSaO2, the percentage of time with pH<4, the longest reflux duration,reflux episodes and DeMeester scoring did not have statistical significance in the treatment group (P>0.05). CONCLUSION:nCPAP is the most effective method for patients suffering OSAHS associated with GER, but nCPAP used in conjunction with anti-reflux drugs do not improve efficacy.

1 临床资料 男,52岁.因"声嘶半年加重3周"入东南大学医学院附属江阴医院.专科检查:项软,气管居中,于甲状腺右叶中极可及一0.8 cm ×0.8 cm大小肿物,质硬,边界清,随吞咽上下移动,未闻及血管杂音,颈浅淋巴结未及肿大.甲状腺彩超示:甲状腺右叶中极后方近气管处见形态不规则低回声,大小约1.2 cm×0.9cm,局部向下,与喉返神经(recurrent laryngeal nerve,RLN)相邻,考虑右甲状腺癌(图1).电子喉镜示:右侧声带正中位固定.

<正>慢性上颌窦炎鼻内镜手术关键在于自然开口的处理。自二十世纪八十年代在我国开展鼻内镜技术以来,鼻内镜下各手术技能日趋成熟。然而如何优化手术方式,在彻底清除不可逆性病变的基础上保留关键黏膜,重建鼻窦引流,恢复窦腔生理功能,确保术后的远期疗效,仍需要鼻科医师不断探索。作者采用自制的双刃镰状刀,由后囟入路开放上颌