环杓关节脱位属于声带运动障碍性疾病,是指杓状软骨环面在关节囊内失去正常的解剖位置[1],主要表现为声音嘶哑、发音无力、呛咳伴咽喉部异物感等症状.环杓关节脱位的发生原因较多,常由全身麻醉插管、胃肠镜检查等医源性操作所致[2].脱位后24～48 h内复位是治疗的最佳时机[3-4].本例患者在脱位后28 d复位成功.现报道如下.

目的 探讨在招飞医学选拔中对鼻黏膜苍白水肿者进行血清IgE检测,确诊变应性鼻炎,实现精准招飞的可行性.方法 选择2017年1月—2021年3月鲁豫两省和东北三省自愿报考空军飞行学员的12838名高三学生为应招对象,检出有鼻黏膜苍白水肿体征者,并对其行血清IgE检测.并将地域分离的山东、河南两省候检者的检出结果和辽宁、吉林、黑龙江三省进行对比.结果 在12838候选人中共检出鼻黏膜苍白水肿者777人(6.05％),其中鲁豫两省8047人中检出524人(6.51％);东北三省4791人中检出253人(5.28％).两地域检出率差异有统计学意义(χ2=7.79,P<0.01).鼻黏膜苍白水肿者777人中血清IgE阳性517人(66.54％),其中鲁豫两省524人中IgE阳性351人(66.98％);东北三省253人中IgE阳性166人(65.61％).两地域IgE阳性率比较差异无统计学意义.结论 在招飞医学选拔中对可疑AR被检者可通过血清IgE的检测进行确诊,减少AR的漏诊和误淘,为做出体检结论提供精准依据,是安全、方便、可行的.

目的 探讨功能性鼻内镜手术(FESS)九步法标准化治疗慢性鼻窦炎(CRS)的临床效果及其相关影响因素.方法 选取北部战区空军医院耳鼻喉科自2019年1月至2020年12月收治的379例行FESS九步法标准化手术的CRS患者为研究对象.记录并比较患者术前、术后1年的视觉模拟量表(VAS)评分、鼻内镜Lund-Kennedy评分、Lund-Mackay鼻窦CT评分.记录患者术后并发症发生情况及临床效果.采用多因素Logistic回归法分析影响手术疗效的相关因素.结果 所有患者术后1年的VAS评分、鼻内镜Lund-Kennedy评分、Lund-Mackay鼻窦CT评分均较术前均降低,差异均有统计学意义(P<0.05).379例患者中,病情完全控制275例,病情部分控制69例,病情未控制35例,总有效率为90.8％(344/379).根据临床疗效将379例患者分为有效组(n=344)与无效组(n=35).有效组患者的特殊环境接触史、病史时间、合并过敏性鼻炎、合并支气管哮喘、伴发咽食管反流、伴发鼻息肉、既往鼻窦手术次数、VAS评分、鼻内镜Lund-Kennedy评分、Lund-Mackay鼻窦CT评分、筛/上颌窦评分比值、外周血嗜酸性粒细胞比例、组织嗜酸性粒细胞计数均低于无效组,差异均有统计学意义(P<0.05).多因素Logistic回归分析结果显示,合并过敏性鼻炎、伴发咽食管反流、伴发鼻息肉、筛/上颌窦评分比值、外周血嗜酸性粒细胞比例、组织嗜酸性粒细胞计数均为影响行FESS九步法手术的CRS患者手术疗效的相关因素(P<0.05).结论 FESS九步法的手术疗效与多种因素相关,临床诊疗过程中除了要重视提高术者的手术能力,还要对相关影响因素给予足够关注,以取得良好的手术疗效.

目的 探讨α-共核蛋白(α-synuclein)对多巴胺能神经元凋亡、氧化损伤和炎症的调节作用.方法用H2 O2诱导MES23.5细胞的氧化损伤,并在MES23.5细胞中过表达α-synuclein.用谷胱甘肽(GSH)来抵抗MES23.5细胞氧化损伤.采用流式细胞术检测细胞凋亡,分别采用相关试剂盒检测活性氧(ROS)、超氧化物歧化酶(SOD)、白细胞介素(IL)-6、IL-1β和肿瘤坏死因子-α(TNF-α)的水平,以Western blot法检测细胞中B淋巴细胞瘤-2基因蛋白(Bcl-2)和Bcl-2相关x蛋白(Bax)表达.结果过表达α-synuclein可提高MES23.5细胞凋亡率和ROS、IL-6、IL-1β及TNF-α水平,抑制细胞中的SOD活力(F=188.54～315.52,P<0.05).H2 O2可诱导α-synu-clein过表达的MES23.5细胞中α-synuclein的表达、细胞凋亡率和ROS活力增加(F=196.49～251.74,P<0.05).GSH处理α-synuclein过表达的MES23.5细胞后,α-synuclein表达降低,凋亡率和ROS活力降低(F=149.25～258.96,P<0.05).结论氧化损伤能够增强α-synuclein促进的细胞凋亡和炎症反应,从而放大多巴胺能神经元的氧化损伤.

目的 探讨功能性鼻内镜手术(FESS)九步法标准化治疗慢性鼻窦炎的临床疗效.方法 回顾性分析北部战区空军医院耳鼻喉科自2018年1月至2019年12月收治的慢性鼻窦炎并实施FESS九步法手术标准化治疗的93例患者的临床资料.记录并比较患者术前、术后3个月及术后6个月的症状视觉模拟量表(VAS)评分、鼻内镜Lund-Kennedy评分、鼻窦CT Lund-Mackay评分及生活质量鼻腔鼻窦结局测试(SNOT-20)评分.记录患者临床疗效及并发症发生情况.结果 与术前比较,术后3、6个月患者的症状VAS评分、鼻内镜Lund-Kennedy评分、鼻窦CT Lund-Mackay评分、生活质量SNOT-20评分均明显降低,差异均有统计学意义(P<0.05).术后3、6个月治疗的总有效率分别为92.5％(86/93)、95.7％(89/93),差异无统计学意义(P>0.05).结论 FESS九步法手术标准化治疗慢性鼻窦炎患者,具有良好的临床疗效,同时可以降低并发症发生率.

目的:探讨OSAHS患儿经扁桃体腺样体切除术治疗后炎性因子、免疫功能变化情况及临床意义.方法:纳入本院于2018年6月至2019年6月临床确诊的110例阻塞性睡眠呼吸暂停低通气综合症予以扁桃体腺样体切除术治疗患儿,另选取同时间段进行体检的110例健康体检者作为对照组,比较术前与术后半年T细胞亚群、炎性因子及免疫功能变化情况进行对比,分析各细胞因子在睡眠呼吸低通气指数(AHI)中的表达及临床意义.结果:术前,研究组患者CD3+、CD4+、CD8+、CD4+/CD8+水平明显低于对照组,TNF-α、IL-6、hs-CRP、IgG、IgM、IgA水平明显高于对照组(P<0.05);术后半年显示,研究组与对照组患者CD3+、CD4+、CD8+、CD4+/CD8+、TNF-α、IL-6、hs-CRP、IgG、IgM、IgA水平比较未见明显差异(P>0.05);OSAHS患儿经扁桃体腺样体切除术后IgG、IgM、IgA、TNF-α、IL-6、hn-CRP水平随AHI严重程度升高而上升,CD3+、CD4+、CD8+、CD4+/CD8+水平随AHI严重程度升高儿降低(P<0.05);经Spearman相关进行分析,OSAHS患儿经扁桃体腺样体切除术治疗后TNF-α、IL-6、hs-CRP、IgA、IgG、IgM与AHI呈正相关,而CD3+、CD4+、CD8+、CD4+/CD8+与AHI呈负相关(P<0.05).结论:炎性因子及免疫功能的表达与OSAHS患儿睡眠呼吸通气指数具有相关性,可根据其表达水平对患儿病情变化做有效评估.

目的 探讨鼻内镜高选择性鼻部神经阻断术对中重度变应性鼻炎(AR)患者的疗效及血清血管活性肠肽(VIP)表达的影响.方法 选取行鼻内镜高选择性鼻部神经阻断术治疗的中、重度AR患者30例,分别于术前、术后1年用症状VAS评分评估手术疗效,同时检测患者外周血血清中VIP浓度的变化,并分析两者的相关性.结果 与术前比较,鼻内镜高选择性鼻部神经阻断术后1年各症状VAS评分均下降,显效率为53.3％(16/30),有效率为46.7％(14/30);VIP水平明显降低[(18.42±0.64)pg/mL vs(39.89±1.30)pg/mL,P<0.05],且与VAS评分呈直线正相关(r2=0.77).结论 高选择性鼻部神经阻断术可有效改善中重度变应性鼻炎患者的临床症状,其机制可能与降低患者体内VIP的水平有关.

目的 探讨鼻内镜下高选择性鼻部神经(翼管神经鼻后神经丛+咽支+筛前神经分支)阻断术治疗中、重度变应性鼻炎的临床疗效.方法 回顾性分析于北部战区空军医院耳鼻喉科自2017年1月至2019年12月行高选择性鼻部神经阻断术的32例中、重度变应性鼻炎患者的临床资料.记录并比较患者术前、术后主观症状视觉模拟量表(VAS)评分、过敏性鼻炎鼻结膜炎生存质量(RQLQ)评分.结果 所有患者均顺利完成治疗和随访,随访率100.0％(32/32),均无严重并发症发生.与术前比较,术后3个月与术后2年患者的主观症状VAS评分及生活质量RQLQ评分均显著降低,差异均有统计学意义(P<0.05).术后2年的整体有效率为87.5％(28/32),低于术后3个月的100.0％(32/32),但差异无统计学意义(P>0.05).结论 鼻内镜下高选择性鼻部神经阻断术治疗中、重度变应性鼻炎患者临床效果良好,是一种安全、有效的治疗方式.

目的 研究经鼻内镜引导下的微创手术对于慢性鼻-鼻窦炎效果的疗效,分析影响疗效的相关因素.方法 采用随机数字表法选取2017年8月- 2018 年9月共有100 例经鼻内镜引导的手术疗法的慢性鼻 - 鼻窦炎病人,没有合并鼻息肉的病人共有57 例设为单一组,合并鼻息肉的病人共有43 例设为合并组.比较两组病人在半年后的治疗效果,然后搜集病人的临床资料分析影响手术疗效的相关因素.结果 单一组患者的完全控制率比合并组显著增加(P<0. 05),单一组患者的未控制率比合并组显著降低(P<0. 05).经单因素分析可知影响手术疗效的因素包含患者的病型、变应性鼻炎、鼻腔粘连、Lund-Mackay评分、依从性以及复发状况;经多因素分析可知影响手术疗效的高危因素包含患者的病型、变应性鼻炎、Lund-Mackay评分、依从性以及复发状况.结论 慢性鼻-鼻息肉的手术疗效影响因素较多,鼻息肉、变应性鼻炎、Lund-Mackay评分、依从性以及复发状况都能影响疗效,因此在治疗时可针对性地分析,在手术治疗的基础上矫正鼻部的结构,在术后应按时进行鼻腔清洁,避免因复发而降低治疗效果.

肌上皮瘤是由专门特性的肌上皮细胞增殖形成的良性肿瘤,发生在涎腺、乳腺、呼吸道和皮肤等不同系统和部位[1].发生在鼻腔鼻窦的肌上皮瘤较为罕见,大多来源于鼻中隔[2]、鼻窦[3]和鼻甲[4]多见于个案报道.我科收治1例来源于鼻底的鼻腔肌上皮瘤,现报道如下.

变应性鼻炎( allergic rhinitis,AR) 还被称作变应性鼻炎,指的是当致敏原侵入特应性体质的机体后,诱导IgE产生大量的组胺等介质,同时涉及到一系列细胞因子和免疫活性细胞等介导的鼻黏膜发生慢性炎性疾病, AR属于全世界范围内常见的非感染性、慢性疾病.变应性鼻炎严重影响了病人的身心健康,并在一定程度上阻碍了全社会经济的发展.虽然变应性鼻炎对人们的生命不会造成直接威胁,但AR病人的生活质量通常较低,需要全面、正确的认知AR疾病的发生发展机制、临床特点等,有利于临床上更好的预防、诊疗该疾病.

目的 研究分析在咽喉反流性疾病中展开合理诊断及治疗效果.方法 研究对象抽取我院科室在2018年9月～2019年9月就诊的86例咽喉反流性疾病患者,分别应用反流症状指数量表(以下简称RSI)和反流检查积分量表(以下简称RFS)进行诊断,并采取药物治疗,经观测所得结果进行对比分析.结果 相比治疗前,患者的RSI和RFS评分分别为(15.27±5.62)分、(9.64±3.35)分,治疗后的RSI和RFS评分(10.22±3.74)分、(5.24±2.29)分呈下降趋势,且下降明显,P<0.05.经药物治疗,患者治疗后的总有效率为93.02％.结论 RSI与RFS可作为诊断咽喉反流性疾病的重要诊断标准,积极采取药物治疗对患者临床疗效有所提升,诊疗价值高.

目的 研究儿童耳鼻咽喉科疾病与环境气象因素的相关研究.方法 在本文研究中将2018年1月～2019年7月耳鼻咽喉科疾病患者90例作为研究对象,分析每位患者的临床资料,再结合环境气象数据、空气质量指数等,分析环境气象因素和儿童就诊人数之间的相关性.结果 儿童AOM就诊人数和AQI、PM10、PM2.5、CO、SO2浓度之间呈现正相关,和O2浓度、平均风速、平均温度之间呈现负相关,而和平均湿度之间无相关性,儿童AP就诊人数和平均湿度、平均温度之间呈现正相关,和其他因素无显著相关性.儿童AR就诊人数和NO2浓度、SO2、PM10、PM26、AQI、平均风速、平均湿度、平均气压、平均温度之间具有显著相关性,和NO2、CO、PM10、PM2.5、AQI、平均气压之间呈现负相关,和平均风速、平均湿度、平均温度之间呈现正相关,差异有统计学意义(P<0.05),和O2浓度之间无显著相关性.结论 环境气象因素和儿童AR、AP、AOM发病之间具有一定相关性,具有滞后性,儿童AR、AP、AOM发病容易受到季节因素影响.

目的 探讨鼻窦CT测量在呼吸道上皮腺瘤样错构瘤(REAH)术前诊断中的应用价值.方法 选取自2013年1月至2018年9月在北部战区空军医院耳鼻咽喉科进行手术治疗的REAH患者54例为REAH组;选取同期住院经术后病理诊断鼻息肉的70例患者为NPS组;选取门诊以鼻中隔偏曲症状就诊、查鼻窦CT未见异常的70例成年人为Normal组.测量并比较各组患者的鼻窦冠状位CT的嗅裂前区顶部宽度、嗅裂前区宽度、前鼻腔总横径、中鼻甲间距离、嗅裂后区宽度、后鼻腔总横径,计算嗅裂前区宽度/前鼻腔总横径、嗅裂后区宽度/后鼻腔总横径、嗅裂前区顶部宽度/中鼻甲间距离的比值.结果 三组患者的前鼻腔总横径、后鼻腔总横径比较,差异无统计学意义( P＞0.05). NPS组的中鼻甲间距离显著小于REAH组、Normal组,差异有统计学意义(P＜0.05);且REAH组与Normal组比较,差异无统计学意义(P＞0.05). REAH组的嗅裂前区宽度、嗅裂后区宽度、嗅裂前区顶部宽度、嗅裂前区宽度/前鼻腔总横径、嗅裂后区宽度/后鼻腔总横径显著高于NPS组和Normal组,差异有统计学意义(P＜0.05);且NPS组与Normal组比较,差异无统计学意义(P＞0.05). Normal组的嗅裂前区顶部宽度/中鼻甲间距离显著小于REAH组及NPS组,差异有统计学意义( P＜0.05);且REAH组与NPS组比较,差异无统计学意义(P＞0.05).受试者工作特征曲线分析示,嗅裂前区宽度和嗅裂前区宽度/前鼻腔总横径的曲线下面积(AUC)值最大,且这两个指标的AUC比较,差异无统计学意义(P＞0.05).当嗅裂前区宽度取值0.78 cm或嗅裂前区宽度/前鼻腔总横径取值0.30,诊断的灵敏度和特异度均较高.结论 鼻窦CT测量为REAH术前诊断提供帮助,嗅裂前区宽度≥0.78 cm或嗅裂前区宽度/前鼻腔总横径≥0.30是鉴别REAH和鼻息肉的参考依据.

Objective:To discuss multiple-factor analysis of serum allergen distribution of patients with allergic rhinitis and level of main allergen IgE in Shenyang area, and to provide a scientific basis for the prevention of allergic rhinitis in this area.Method:Serum IgE was detected in 749 cases［501 cases of male (66.8%), and 248 cases of female (33.2%)］, with allergic rhinitis.The age range was from 3 to 65 years old, and they were divided into 5 groups based on age. A questionnaire survey was conducted to analyze the distribution of serum allergens and to carry out a multiple-factor analysis of level of the main allergen IgE in patients.Result:The primary allergen was house dust mite/dust mite in each age group, and the differences in the positive rate of elm, mold, cat/dog fur scurf, cockroach and ragweed among different groups were statistically significant（P<0.01 or P<0.05）.The ingested allergen sequencing for all age groups: the distribution of 7-14 years old group and 15-35 years old group were consistent with that of the whole, among the under 6 years old group, mango and pineapple was ranked 1st,beef and mutton was ranked 2nd,the occurrence rate of shrimp and crab rose to the 3rd place, among the 36-60 years old group, mango, pineapple and milk was ranked 1st, egg was ranked 2nd, and beef and mutton ranked 3rd, the differences in positive rate of mango and pineapple, beef and mutton, crab and nut among all groups were statistically significant(P<0.01 or P<0.05).The IgE level of cockroach was impacted by the allergic history, home cultivation of flowers and plants and animal domestication. The IgE level of mold was impacted by sex, allergy history, home rearing of pet and furniture updates. The IgE level of wormwood was impacted by allergy history and asthma history. The IgE level of peanut was impacted by age and allergy history. The IgE level of egg was impacted by history of food and drink allergy, home cultivation of flowers and plants and home rearing of pet. The IgE level of crab was impacted by the allergy history and home rearing of pet.Conclusion: The primary inhaled allergen in all groups is house dust mite/dust mite, and the ingested allergen varies in each group, which has provided a reference basis for prevention of ingested allergy.The varying influence factors for IgE level of primary allergens could be used to prevent the patients from contacting the allergen,and each risk factor has become a focus of prevention and control for patients, offering a major help to the prevention and treatment of allergic rhinitis.

Objective To investigate the quality of life and its influencing factors of 187 patients with chronic suppurative otitis media before and after operation in a hospital.Methods A retrospective analysis was performed on the clinical data of 187 CSOM patients who had undergone surgery in our hospital between March 2012 and February 2016. The quality of life of patients with different clinical data before and after surgery and VAS scores were compared. Multiple linear regression was used to analyze the factors that influenced the quality of life before and after surgery. Results The scores of CSOM patients in each dimension and the total scores of quality of life were higher after surgery(P<0.05). The VAS scores of CSOM patients after operation were sig-nificantly lower (t=22.816,P<0.05). Patients under 40 years old,living in cities,and who had both ears involved or whose oti-tis media was of the non-simple type had lower preoperative quality of life(P<0.05). Patients with otitis media in both ears and of the lipoma type had a higher score of quality of life(P<0.05). Age, residence, involvement of the ear, and types of otitis media were the main factors affecting the quality of life before surgery (P<0.05). Erectile dysfunction and otitis media types were the main factors affecting the quality of life after surgery (P<0.05).Conclusion Surgical treatment can effectively improve the quality of life of CSOM patients,especially among those whose symptoms are complicated and whose lesions involve both ears.

Objective To explore high-resolution computed tomography (HRCT) characteristics of arytenoid cartilage in patients with laryngeal contact granuloma (LCG). Setting Tertiary hospitals. Study Design Individual case-control study. Methods HRCT scans were obtained before treatment from 42 patients with LCG. Similar scans were obtained from 50 patients with glottic laryngeal cancer or vocal cord leukoplakia without vocal process involvement. Results Forty-two male patients with LCG were enrolled in the study. There were 41 patients with unilateral vocal cord lesions, and 1 patient had bilateral lesions. All 50 eligible patients in the laryngeal lesion group were men. There were 39 patients with unilateral lesions, and 11 had bilateral lesions. The rate of arytenoid cartilage sclerosis in the LCG group was 79.07% (34/43) on the lesion side and 7.32% (3/41) on the healthy side. In the laryngeal lesion group, the rate of arytenoid cartilage sclerosis was 13.11% (8/61) on the lesion side and 2.56% (1/39) on the healthy side. The rate of arytenoid cartilage sclerosis on the lesion side of patients with LCG was significantly higher than on the healthy side of patients with LCG and significantly higher than both the healthy and lesion sides of patients with laryngeal lesions ( P < .001). Conclusions Arytenoid cartilage sclerosis was observed on the lesion side in most patients with LCG, and the presence of sclerosis may support the diagnosis of LCG.

We report a rare case of first branchial cleft cyst arising from the nasopharynx.A 47-year old woman with a six-month-history of right ear stuffy and hearing loss was studied.Electronic nasopharyngeal examination revealed a mass in the nasopharynx of this case.The tumor was removed endoscopically with endonasal approach.Postoperative pathological examination indicated that it was branchial cleft cyst.

Obstructive sleep apnea that characterized by chronic intermittent hypoxia (CIH) has been reported to associate with chronic liver injury. Tauroursodeoxycholic acid (TUDCA) exerts liver-protective effects in various liver diseases. The purpose of this study was to test the hypothesis that TUDCA could protect liver against CIH injury. C57BL/6 mice were subjected to intermittent hypoxia for eight weeks and applied with TUDCA by intraperitoneal injection. The effect of TUDCA on liver histological changes, liver function, oxidative stress, inflammatory response, hepatocyte apoptosis and endoplasmic reticulum (ER) stress were investigated. The results showed that administration of TUDCA attenuated liver pathological changes, reduced serum alanine aminotransferase and aspartate aminotransferase level, suppressed reactive oxygen species activity, decreased tumor necrosis factor-α and interleukin-1β level and inhibited hepatocyte apoptosis induced by CIH. TUDCA also inhibited CIH-induced ER stress in liver as evidenced by decreased expression of ER chaperone 78 kDa glucose-related protein, unfolded protein response transducers and ER proapoptotic proteins. Altogether, the present study described a liver-protective effect of TUDCA in CIH mice model, and this effect seems at least partly through the inhibition of ER stress.

Objective To investigate the epidemiology of allergic rhinitis among pilots in Shenyang Military Command and to analyze its epidemiologic features and risk factors. Methods A randomly chosen sample of 485 pilots in Shenyang Military Command was selected, surveyed with a questionnaire, subjected to nasal examination to screen cases of suspicious AR, and was finally diagnosed by allergen serum IgE test. Results A total of 485 questionnaires were valid. The incidence of allergic rhinitis was 13.0%. Cases of intermittent and mild AR accounted for 60.3% and 39.7% of the total respectively. The onset time was mostly in the morning (76.2%) and in August (82.5%). The main symptoms and causes were sneezing (100.0%) and temperature variation (39.7%). Inhaled allergens, including house mites/dust mites (63.5%), were the most common allergens. There was much misunderstanding about the diagnosis and treatment of AR. On the other hand, the daily (46.0%) and flight activities (15.9%) of pilots were affected by AR to different extents. Aasthma, family history and complications with other allergic diseases (such as eczema, allergic conjunctivitis) were the risk factors of allergic rhinitis (P<0.05). Conclusion The prevalence of AR is high among pilots in the original Shenyang Military Command, which can exert some effect on the daily and flight activities of pilots. Effective prevention and control of AR deserves more attention.