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 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 features,diagnosis, treatment, and outcomes of Wegener's granulo-matosis with Otologic Manifestations as first symptoms.Methods We retrospectively reviewed3 cases of Wegener's granulomatosis with Otologic Manifestations as first symptoms,and refer to relevant literatures of 3 cases.We evaluated clinical features, the clinical course ,diagnosis, treatment, and outcomes in all cases. Results In 6 cases, the most first frequently findings were ear fullness ,hearing loss, otalgia,4 cases suffered from facial palsy. All cases were misdiag-nosed as otitis media and given drug and surgical treatment earlily. Diagnosis of Wegener's granulomatosis was made when the patients had clinical findings and positive blood serum markers ANCA or c-ANCA, or when there were typi-cal pathological manifestations. Immunosuppressive therapy and hormone therapy were the main currently treatment op-tions.Conclusions The early otologic manifestations of Wegener's granulomatosis were so atypical that Wegener's granu-lomatosis was misdiagnosed easily ,and the treatment was delayed. ANCA or c-ANCA had high specificity in Wegener's granulomatosis and were helpful to the diagnosis of Wegener's granulomatosis earlily. Early diagnosis and treatment were the key factors of the prognosis of Wegener's granulomatosis, so ENT doctors should strengthen the awareness of Wegener's granulomatosis in the ear performance.

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: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.

<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

目的探讨自制双刃镰状刀片在鼻内镜下经后囟入路开放上颌窦口的可能性。方法用自制双刃镰状刀片剌穿后囟膜部,由背面刀刃向窦口后下方用力,拉锯状锐性切开后囟膜部,再配合电动切割器、反张咬切钳、黏膜咬切钳及吸引器扩大上颌窦口,共30例52侧。结果治愈44侧,好转5侧,无效3侧。治愈好转率为94.2%。结论用双刃镰状刀片在鼻内镜下经后囟入路开放上颌窦口可取的满意疗效。

<正>近年来,国内外已经越来越多地将鼓室注射类固醇激素应用于治疗突发性聋(sudden deafness,SD)。我科对46例重度以上突发性聋患者分别给予全身地塞米松及鼓室内注射甲泼尼龙治疗,现报道如下。

Objective To evaluate the effects of functional endoscopic sinus surgery(FESS) combined with allergen-specific immunologic therapy(ASIT) on chronic rhinosinusitis accompanied by allergic rhinitis by observing the changes in serum eosinophile cationic protein(ECP).Methods Fifty-four patients with chronic rhinosinusitis accompanied by allergic rhinitis were divided into two groups according to dust mite allergens.Dust mite group(n=29) was treated with FESS combined with postoperative ASIT and non-dust mite group(n=25) was treated with FESS associated with postoperative budesonide nasal spray.The changes in serum ECP after treatment were compared between the two groups.Results No siginifant differences in the levels of serumal ECP were observed before treatment between dust mite group and non-dust mite group [(25.7±3.1)μg·L-1vs(24.8±2.7)μg·L-1,P0.05].After treatment,serumal ECP levels in dust mite group were lower than those in non-dust mite group[(18.6±2.8)μg·L-1vs(21.8±1.4)μg·L-1,P0.05].Conclusion ASIT can decrease the levels of serumal ECP through reducing eosnophile granulocyte aggregation and activation.The detection of blood ECP may evaluate the prognosis of chronic rhinosinusitis accompanied by allergic rhinitis and the efficacy of specific immunotherapy.

男,50岁.因右侧鼻塞伴血涕1个月入院.体检:右侧鼻腔充满灰白色新生物.鼻窦CT示:右侧鼻腔、筛窦内见一不规则团片状软组织影,右侧鼻甲、筛骨、上颌窦内侧壁及鼻中隔受压,局部骨质变薄并吸收.

Objective To evaluate the effectiveness and safety of frontal sinus surgery via an approach anterior to ethmoid bulla positioned by the anatomic landmark named tristar of grooves.Methods Frontal sinus surgery was practiced on 225 patients(407 sides) with chronic frontal sinusitis via an approach anterior to ethmoid bulla positioned by tristar of grooves.Preoperative routine sinus CT scan was used to determining the relationship of natural ostium of the frontal sinus with ethmoid bulla and uncinate process.Ethmoid bulla was retained to position natural ostium of the frontal sinus.Results The frontal natural ostium was opened by the surgical procedure in 220 cases.In the other 5 patients(8 sides),the exposure of frontal ostium was difficult and got success in determining the location of the frontal natural ostium by percutaneous injection of frontal sinus.No major complications occurred such as ethmoid artery bleeding,skull fracture.Orbital hematoma occurred in 2 cases due to injury of the medial orbit walll.Followed up for 6 to 12 months,293 sides(72 %) showed good frontal sinus opening and complete epithelialization.Subjective symptoms were relieved in 201 patients(89 %).Conclusion This surgical procedure can locate the frontal sinus natural ostium accurately,therefore,can improve the success rate of frontal sinus surgery and reduce surgical complications.

目的 探讨支撑喉镜下声门暴露困难时的手术方法技巧.方法 对22例术中支撑喉镜暴露困难的声带病变的病例,在麻醉科充分配合下,借助于纤维喉镜、鼻内镜、膀胱镜进行手术.结果 22例手术均顺利完成,术后声嘶改善,随访半年无复发.结论 对支撑喉镜下声门暴露困难的病例,术前应充分评估,在麻醉科的配舍下,可借助于纤维喉镜、鼻内镜、膀胱镜顺利地完成手术.

Objective To evaluate the contribution of plasma matrix metalloproteinases-9(MMP-9)in the invasion and metastasis of laryngeal squamous cell carcinoma(LSCC)and to analyze the correlation of plasma MMP-9 and the MMP-9 immunoreactive staining in the corresponding tumor.Methods(1)The expression of MMP-9 was analyzed semi-quantitatively by immunohistochemical staining in the paraffin-embedded tissue samples.(2)The total MMP-9 in plasma(free and complex form of MMP-9)was measured by enzyme linked immunosorbent assay(ELISA).Results(1)There was a positive correlation between the level of plasma MMP-9 and the corresponding immunohistochemical staining of MMP-9(rs=0.524,P=0.003).The more intensive immunohistochemical staining,the higher the average level of plasma MMP-9.(2)The average level of plasma MMP-9 in LSCC was obviously higher than the controls(P<0.01).(3)The level of plasma MMP-9 was significantly correlated to the node stage(P<0.01).The average level of plasma MMP-9 was(258.71±74.53)μg/L in the group of lymph node metastasis,significantly higher than(129.58±31.44)μg/L in the group without lymph node metastasis.But there were no correlations between plasma MMP-9 and primary location of LSCC,pathological stage,T stage and age respectively.Conclusions The level of plasma MMP-9 upgraded obviously in LSSC,which indicated whether there was lymph node metastasis and might offer information for making a decision for operation of LSCC.The abundance of plasma MMP-9 might originate from the excessive expression of tissue MMP-9.

目的 探讨安全、有效的会厌囊肿切除术的手术技巧.方法 用自制的单极电刀,凝、切、剥交替进行切除会厌囊肿114例,术后随访0.5～1年.结果 在114例手术中,术野清淅,几乎无出血,除8例术中囊壁破裂外其余均完整切除,术后随访除5例失访外,均无囊肿复发,疗效满意.结论 用自制的单极电刀切除会厌囊肿,确保了清淅的术野,以便能完整切除囊肿,降低了术后复发几率,值得临床推广.

Objective To determine the expression of MMP-9 in the plasma of laryngeal cancer recurrence and investigate the usage of the plasma MMP-9 in the postoperative follow-up of laryngeal cancer.Methods Enzyme-linked immunosorbentassay was used to measure the levels of Plasma MMP-9 in 15 samples of patients with postoperative recurrence of laryngeal cancer,in 10 samples of patients who underwent surgery for primary laryngeal cancer without postoperative recurrence,and in 10 samples of normal persons.Results In above three groups,the mean levels of plasma MMP-9 were(135.93±53.32),(82.75±20.63) and(72.66±25.13)ng/mL respectively.The mean level of plasma MMP-9 differ significantly in patients with postoperative recurrence of laryngeal cancer from the levels of the patients who underwent surgery for primary laryngeal cancer without postoperative recurrence,and normal persons(P0.05).Compared with normal persons,the mean level of plasma MMP-9 wasn't significantly elevated in patients who underwent surgery for primary laryngeal cancer without postoperative recurrence(P0.05).Conclusion The mean level of plasma MMP-9 is elevated in the patients with postoperative recurrence of laryngeal cancer.

细胞外基质及基底膜的降解在恶性肿瘤的侵袭与转移中起着关键性的作用。而细胞外基质及基底膜合成与降解的动态平衡的维持主要依赖于基质金属蛋白酶和其组织抑制剂的相互调节,特别是明胶酶和其天然抑制剂。近年来,很多学者对明胶酶及其组织抑制剂与肿瘤的侵袭及转移间的关系进行了大量研究,并得出这些指标与肿瘤的侵袭、转移存在非常密切关系。本文就MMP2,MMP9及其组织抑制剂在喉癌中的表达与喉癌的临床病理特征的关系及对喉癌的预后做一综述。