The diagnosis of tuberculosis otitis media (TBOM) remains a great challenge. This study aims to suggest potential diagnostic clues and proper management of TBOM. The study is a retrospective review of TBOM cases that were treated at our department, between January 2015 and June 2023. Summarizing their clinical characteristics, diagnosis, and treatment. Additionally, a literature review is conducted. Eight cases of TBOM, 6 female and 2 male patients, median age was 32 years old, were included in the study. TBOM mainly presents with symptoms of otorrhea, hearing loss, and occasional early-onset facial palsy. One case had a positive Purified Protein Derivative (PPD) before the operation. Middle ear tissue was pathologically biopsied in 7 cases, with 3 cases testing positive for Acid Fast Bacillus and 6 cases testing positive for Mycobacterium tuberculosis PCR. Middle ear surgery and Anti-tubercular treatment (ATT) were completed in all cases. The median follow-up was 11 months. No cases of TB relapse were observed. Proper suspicion and confirmation of TBOM is the primary clinical orientation. Middle ear surgery combination with ATT results in satisfactory outcomes. Hearing reconstruction should be performed after ATT is completed.

目的 研究使用生物信息学的方法来获得腺样囊性癌(adenoid cystic carcinoma,ACC)相关的关键基因,探寻其病因和发病机制.方法 通过GEO数据库中GSE36820和GSE88804数据集获取腺样囊性癌的基因表达谱,筛选出腺样囊性癌组织与正常涎膜组织共同差异表达基因(DEGs),对DEGs进行基因本体论(GO)分析、京都基因与基因组百科全书(KEGG)信号通路分析,并通过String在线软件和Cytoscape软件构建DEGs蛋白互作网络,经cytoHubba获得关键基因,在GSE59702数据集对关键基因表达进行验证.结果 GO分析在生物过程中包括多细胞生物的体内平衡、抗菌体液反应、视网膜内稳态;KEGG通路富集于唾液分泌、PPAR信号通路和酪氨酸代谢;GSEA分析基因在细胞循环有丝分裂、TP53介导的转录调节、Rho家族的鸟苷三磷酸酶介导的信号、肿瘤通路和M期富集.在PPI网络筛选出前10个关键基因,对关键基因表达验证显示,DTL、CENPU、BUB1B、ANLN、CENPF、TOP2A 的 mRNA 表达水平在肿瘤组织中显著升高,而 CDK1、NUSAP1、CCNB2 和 KIF11的mRNA表达无统计学意义.结论 本研究中发现的关键基因可能参与ACC的发病机制,为获得新的诊断方法和治疗手段提供研究方向.

INTRODUCTION Ear surgeons are increasingly concerned about protecting the chorda tympani nerve while avoiding injury to the facial nerve during cochlear implant surgery. The chorda tympani nerve is the sensory branch of the facial nerve and carries taste information and general sensation (e.g., pain and temperature) from the anterior two-thirds of the tongue. It supplies efferent vasodilator fibers to the tongue and secretomotor fibers to the salivary glands in the floor of the mouth and parotid gland. The chorda tympani nerve is the largest branch of the facial nerve in the intrapetrous compartment; it splits from the facial nerve just before it exits via the stylomastoid foramen. It arises below the nerve to the stapedius and traverses anterosuperiorly via the posterior canaliculus, usually accompanied by the posterior tympanic branch of the stylomastoid artery. This canaliculus opens into the middle ear cavity through an aperture situated at the junction of the posterior and lateral walls of the tympanic cavity. This opening lies just medial to the fibrocartilaginous annulus, and the posterior canaliculus is roughly 0.5 mm in diameter. The chorda tympani nerve courses through the middle ear and is thus susceptible to damage during ear surgeries, such as stapedectomy[1] and cochlear implantation.[2] Following chorda tympani nerve damage, taste buds disappear from the denervated side of the tongue[3] and taste loss or distortion can occur. Although the peripherally injured chorda tympani nerve usually regenerates to successfully reinnervate taste buds within several weeks,[4] persistent dysgeusia (i.e., taste alteration) can last for months or years[5] and may indicate alterations in central nervous system (CNS) function. Loundon et al.[6] reported that facial and chorda tympani nerve injury occurred in 1 of 434 (0.23%) cochlear implantation surgeries. Of the 1402 cases from Department of Otorhinolaryngology Head and Neck Surgery of Beijing Friendship Hospital, temporary facial nerve injury was noted in 4 (0.28%) cases, and injury to the posterior wall of the external auditory canal was reported in 14 (0.99%) cases.[7] Here, we described our experience regarding performing cochlear implantation surgery in 180 patients with a profound sensorineural hearing loss by affixing the facial and chorda tympani nerves to the bony wall to maintain their integrity. METHODS Subjects From February 2013 to April 2014, 180 patients (180 ears, 116 males and 64 females) with profound sensorineural hearing loss underwent successful cochlear implantation with no damage to the chorda tympani nerve in Department of Otorhinolaryngology Head and Neck Surgery of Beijing Friendship Hospital. All the patients in this study provided the written informed consent. The study has been approved by the Research Ethics Committee of Beijing Friendship Hospital (BJFH-EC/2013-075). The age range was from 3 to 21 years, and the average age was 13.8 years. All patients presented with hearing loss, including five patients who previously suffered from common cold and high fever, and three patients with a history of umbilical cord around the neck in the 35th week of gestation who were delivered via cesarean due to placenta previa. None of the patients had residual hearing with type A tympanogram, a stapedius muscle reflex in tympanometry, or otoacoustic emissions. All patients had worn hearing aids for at least 6 months but did not obtain any benefit. Twenty-six patients were implanted with Cochlear CI24R CA implants (COCHLEAR, Australia), and the other 154 patients receiving MED-EL Pulsar implants (MED-EL, Austria). All patients underwent temporal bone computed tomography (CT) and magnetic resonance imaging (MRI)scans before surgery. Surgery Routine mastoidectomy was performed to expose the eminence of the horizontal semicircular canal and the short crus of the incus. As a marker of the short crus tip of incus, the beginning of the chorda tympani was identified 1 mm behind the tympanomastoid fissure, which was 8 mm away from the short crus sharp of incus. Then, the full length of the chorda tympani was revealed with approximately 1 mm of bony wall below the short crus tip. The vertical part of the facial nerve was revealed in the same step [Figure 1]. If the facial recess width was <1 mm at the plane of the round window, the chorda tympani nerve was separated with a 1-mm diameter diamond burr and then suspended [Figure 2a]. Next, the chorda tympani nerve was anteplaced and adhered to the posterior wall of the external auditory canal with medical glue [Figure 2b]. The width of the facial recess was enlarged at the level of the round window [Figure 2c]. Then the facial recess was opened, and the round window niche was exposed. The niche was removed, and the round window membrane was observed. The cochleostomy was drilled in the promontory, anteroinferiorly to the membrane of round window to enter the scala tympani where the electrode was inserted. Small pieces of temporalis muscle were used to seal the cochleostomy port. Finally, neural response telemetry and electrode impedance were assessed.Figure 1: The short crus tip of the incus is a useful marker indicating the chorda tympani nerve and remaining bony wall (approximately 1-mm thick).Figure 2: (a) The width of the facial recess is <1 mm at the plane of the round window. The chorda tympani nerve is separated with a 1-mm diameter diamond burr. (b) The chorda tympani nerve is anteplaced and adhered to the posterior wall of the external auditory canal with medical glue. (c) The width of the facial recess is enlarged at the level of the round window.Taste sensation test The taste sensation scores were divided into five grades, from 0 to 4, for evaluating the change of four taste sensations (sweet, sour, salty and bitter): 0 means no taste sensation; 1 means only 30% of the taste sensations; 2 means 60% of the taste sensations; 3 means 90% of the taste sensations; and 4 means all four taste sensations are normal. All patients completed taste tests (sweet, sour, salty, and bitter) before surgery, 1 day, and 4 weeks to 1 year after cochlear implantation. The scores of the taste sensation were compared pre- and post-operatively. Statistical analysis The scores of the taste sensation were shown as mean ± standard deviation (SD). The paired rank sum test was used to compare the average pre- and post-operative taste sensation scores in 180 cases. A P < 0.05 was considered as statistically significant. Statistical analysis was carried out with SPSS 15.0 (SPSS Inc., Chicago, IL, USA). RESULTS In the 32 patients with narrow facial recesses, the average width at the level of the round window was 0.85 mm. The main reason for the narrow facial recess was chorda tympani nerve retropositioning. The chorda tympani nerve was separated, anteplaced, and adhered to the posterior wall of the external auditory canal with medical glue to maintain its integrity. The facial and chorda tympani nerves were revealed with approximately 1 mm of bony wall below the short crus tip, which allowed the chorda tympani nerve to be kept intact in 148 patients with normal-width facial recesses. None of the 180 patients experienced postoperative complications including injury of the facial or chorda tympani nerve or damage to the posterior wall of the external auditory canal during the 1-year follow-up period. The average pre- and post-operative taste sensation scores in 180 cases was 3.98 ± 0.15 and 3.96 ± 0.19, respectively, without significant difference (P = 0.083). DISCUSSION Hamamoto et al.[8] suggested that the line connecting the CT nerve with the round window passed through the posterior wall of the external auditory canal in 92.3% of individuals, and this characteristic could be useful for preventing CT nerve injury during surgery. But there are a large number of CT nerve variations. In some patients, it may arise from more proximal portion of facial nerve, even close to the geniculate ganglion. The length of the posterior canaliculus is also highly variable, ranging from 3 to 14 mm. In 10% of individuals, there may not be a posterior canaliculus at all in approximately 10% of individuals; rather, it could be replaced by a groove.[9] In our study, the facial recesses narrowed for chorda tympani nerve retropositioning in 32 patients. Taste is mediated by three cranial nerves: The sensory component of the facial nerve, glossopharyngeal nerve, and vagus nerve. The chorda tympani nerve is one of the three cranial nerves involved in transmitting taste fibers from the anterior two-thirds of the tongue. The mechanism of taste sensation is rather unique in that it involves a complicated feedback loop, with each nerve acting to inhibit signals from other nerves. The chorda tympani nerve exerts a strong inhibitory influence on other taste and pain fibers from the tongue. When the chorda tympani nerve is damaged, its inhibitory function is disrupted, disinhibiting the other taste fibers.[10] chorda tympani nerve injury may induce glial responses at primary nerve terminals in the CNS.[11] Usually, microglial cells respond first, which in turn induce astrocytic responses.[12] As the resident immune cells of the CNS, microglia continually surveys the environment with highly mobile processes and quickly detects and responds to disturbances.[131415] Damage to the chorda tympani nerve results in central glial responses, which may influence long-lasting taste alterations following chorda tympani nerve lesion.[16] This glial activity might also affect nearby trigeminal fibers, which could explain the tingling or burning sensations reported following chorda tympani nerve damage.[17] Michael and Raut[18] reported that taste disturbance is more likely when the chorda tympani nerve is stretched rather than divided. Division of the chorda tympani nerve seems to have minimal effect on taste perception. Taste sensation from the taste buds is also supplied by the greater petrosal, vagus, and glossopharyngeal nerves, and it has been reported that cutting the chorda tympani nerve may abolish some inhibition of the glossopharyngeal nerve.[1920] Taste disorders after middle ear surgery are mostly transient, even when the chorda tympani nerves are bilaterally sectioned. In contrast, bilateral chorda tympani nerve lesions may lead to severe, persistent, and distressing xerostomia. Based on this neglected aspect of chorda tympani nerve function, Guinand et al.[21] emphasized the importance of preserving the chorda tympani nerve whenever possible. In our study, the CT nerve was suspended, anteplaced, and adhered to the posterior wall of the auditory canal to enlarge the facial recess in 32 patients with narrow recesses. The full length of the chorda tympani nerve was revealed with approximately 1 mm of bony wall below the short crus tip, which allowed us to keep the chorda tympani nerve intact in 148 patients with normal-width facial recesses. No change in taste sensation was identified compared with preoperative evaluation results. In conclusion, our identification method successfully preserved chorda tympani nerve structure and function and did not lead to taste loss during cochlear implantation surgery. The chorda tympani nerve may be a useful marker for positioning the facial nerve and keeping the posterior wall of the external auditory canal intact.

The goal of cochlear implantation (CI) surgery is to make all patients with profound sensorineural hearing loss achieve satisfied postoperative performance. It will contribute to the excellent postoperative performance to insert the full length of the electrode array into the scala tympani with little trauma to the structure. The totally ossified cochlea has been considered as a contraindication to CI for some questions: the ability to insert the electrode, resistance to the spread of electrical stimuli, and survival of stimulable neural elements. The imaging evidence confirming cochlear ossification was a contraindication to CI.1 Prevalence of cochlear ossification, in all patients in whom CI surgery is to be performed, is 10%-20%, and 80% in patients with a profound sensorineural hearing loss due to meningitis.2 It was reported that in some cases of partial cochlear ossification, CI surgery through scala vestibule could be performed.3 However, reports of CI surgery in cases of complete ossification of the cochlea are rare. Two methods are currently used for electrode insertion in total ossification: the short insertion tunnel technique reported by Cohen and Waltzman4 and the total drill-out technique. Up to now, we have performed successful CI surgery in four Chinese children with totally ossified cochlea and reported relevant data, including operation technique and follow-up postoperative hearing outcomes. METHODS Clinical information From January 1998 to March 2013, three girls and one boy showing evidence of totally ossification of the cochlea, determined by computer tomography (CT), were implanted with a cochlear implant at the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital. The age of the children ranged from 1 year old to 6 years old (mean: (2.5±2.06) years). The three girls were implanted with a MED-EL C40+, MED-EL PULSAR, and MED-EL SONATA, respectively. The boy was implanted with a Clarion 90k. All children had a prelingual hearing loss. One patient had previously suffered a cold and high fever, one patient had a history of otitis media, one patient had a large vestibular aqueduct, and one patient did not have obvious medical history. All the children without residual hearing had worn hearing aids for at least 6 months and did not experience either significant benefit or any benefit from hearing aids amplification. Each subject underwent extensive testing and parental counseling prior to implantation. The children had no residual hearing, a type A curve, no stapedius muscle reflex in tympanometry, and no otoacoustic emission. Before surgery, temporal bone CT and cranium magnetic resonance imaging (MRI) scans showed totally ossified cochlea in four patients (Figure 1A and 1B). The children were followed up for 1 to 20 months after CI surgery. Neural response telemetry (NRT) and auditory and speech perception evaluation were performed.Figure 1. A:: Preoperative temporal bone CT showing total cochlear ossification of the right ear (arrows). B: Preoperative MRI (T2W) scans showing the absence of a normal cochlea.CI surgery steps CI surgery involved the following steps: (1) the patients were placed in supine position; (2) a retroauricular skin flap was raised after making an S-shaped skin incision; (3) the temporal occipital bone was exposed, after a Y-shaped subperiosteal flap was elevated, and an anchoring well for the receiver body was drilled in this location; (4) routine mastoidectomy was performed to expose the eminence of the horizontal semicircular canal and short crus of incus; (5) the vertical part of the facial nerve and the chorda tympani were revealed for about 1 mm in thickness of bony tubal wall, and below the short crus tip of incus about 1 mm in thickness of bony tubal wall remained; (6) the incus was removed (Figure 2A); (7) the chorda tympani was dissociated, moved anterolaterally, and fixed to the posterior wall of the auditory canal with medical adhesive (Figure 2B). The width of the facial recess was enlarged at the level of the round window. The facial recess was then opened. The round window niche was not exposed; (8) an anterior-inferior cochleostomy was performed through the facial recess, with a 1.5 mm diamond drill, using the stapes as a marker. The abnormal bone was identified. The drill was moved forward for a distance of approximately 8 mm. Along the apical margin of the basal turn, an anteriorsuperior cochleostomy was performed, with a 1.5 mm diamond drill, using the cochleariform process as a marker. The abnormal bone was identified. The drill was moved forward for a distance of approximately 6 mm. The bony junction between the two tunnels was removed with a hooked needle to form a passage. The abnormal bone in the second turn of the cochlea was removed to create a tunnel when approaching the superior segment of the basal turn (Figure 2C). An absorbable string was inserted (Figure 2D). Care was taken to avoid damaging the labyrinthine segment of the facial nerve, or the contents of the internal auditory canal, while attempting to access the deepest parts of the basal turn. Along the string, the electrode was inserted into the tunnel drilled around the modiolus. The top of the electrode was inserted into the tunnel of the second turn (Figure 2E). The top of the electrode and the entrance were covered with a piece of fascia and fixed with bioprotein gel (Figure 2F); (9) the subperiosteal flap was used to cover the receiver body, and the retroauricular skin incision was sutured.Figure 2. A:: The incus was removed. B: The chorda tympani was dissociated and fixed to the posterior wall of the auditory canal to enlarge the facial recess. C: The basal turn and partial second turn were drilled into a tunnel around the modiolus. D: After the bony junction between the two tunnels was removed, an absorbable clue was imported. E: The electrode was implanted into the tunnel and the top of the electrode was implanted into the tunnel of the second turn. F: The top of the electrode and the entrance were covered with a piece of fascia and fixed with bioprotein gel.Test materials The test materials we used included simple finals a, e, i and simple sounds g, k, h, j, q, x. The simple finals recognition rate and simple sound recognition rate of the patients were tested to evaluate the auditory and speech outcomes. RESULTS Surgery was performed on the four patients using a transmastoid facial recess approach. The electrode was implanted into the tunnel of the basal turn and the second turn around the modiolus. A radical mastoidectomy was performed on one patient for her otitis media with mucus secretion. NRT was performed immediately in the operative suite. Electrode impedance was normal in all four patients and auditory response telemetry curve was shown in two electrodes of one patient. Postoperative cranial X-ray did not show electrode retortion. There were no postoperative complications (facial nerve palsy, vertigo, and leakage of cerebrospinal fluid). Meningitis occurred in one patient at 1 month after surgery. The patient took antibiotics and was discharged without complications. The postoperative mapping at 2 months showed normal electrode resistance in four patients. The postoperative hearing thresholds were 70 dBHL (decibels hearing level) for the four patients. Auditory and speech perception evaluation was performed at 6 months and 1 year after surgery in three patients without ossified modiolus. The simple finals recognition rate was 70% in three patients and the simple sound recognition rate was 30% in two patients and 10% in one patient. In one patient with ossified modiolus, the simple finals recognition rate was 50% and the simple sound recognition rate was 0. DISCUSSION Meningitis is a common cause of acquired profound sensorineural hearing loss in up to 10% of children and is associated with a high incidence (15%-20%) of cochlear ossification. In the present study the children did not exhibit any obvious etiologies of hearing loss. Ossification in labyrinthitis ossificans occurs initially in the basal turn of the cochlea. Histopathologic studies have demonstrated that the most common region of cochlear ossification, regardless of the etiology, is the basal turn of the scala tympani. This is because the routes by which the inflammatory process reaches the labyrinth are in close proximity to the scala tympani. Scala vestibuli ossification is less common, and it may appear in a delayed phase of the ossification process. Fortunately, complete ossification of the cochlea is very rare.3 In this study, the four patients had totally ossified cochlea. It was reported that 10 formalin-preserved human temporal bones were prepared for promontory dissection, by removing the skin of the external auditory canal (EAC) along with the tympanic membrane and incus.1 A facial recess mastoidectomy was performed and the round window membrane was identified. Working through the EAC, labyrinthine bone, anterior and inferior to the round window membrane, was removed until the endosteum was identified. The endosteum was followed apically, tracing the entire basal turn. Then CI surgery was performed. Four patients with CT evidence of totally ossification underwent implantation. The first two patients were implanted with the canal wall down (CWU), using a mastoid obliteration technique. The last two were implanted with the canal wall up, without mastoid obliteration. The four patients with totally ossified cochlea were implanted with a mean of 20 electrodes. All electrodes remained stable for 1–3 years after surgery.1 Four patients in our study underwent successful CI surgery, which involved removing the incus, enlarging the facial recess through suspending the chorda tympani nerve, and creating a channel for the electrode to wrap around the modiolus (Figure 2). Our technique has some advantages: (1) the implanted electrodes may stimulate more extensive residuary spiral ganglion cells; (2) the canal wall up surgery can avoid the ear canal closure and mastoid obliteration; (3) for this technique double electrodes need not be used (special electrode); and (4) the implanted electrodes are easy to fix. Our technique also has some disadvantages: (1) the difficulties of the surgery are increased because the modiolus, internal carotid artery, facial nerve, and bottom of the inner auditory meatus are easily injured; and (2) the operation needs longer time. One patient in our study underwent successful CI surgery and a radical mastoidectomy for her otitis media with mucus secretion. The CWU surgery may be chosen if the patient has otitis media with mucus secretion, since this surgery may easily prevent infection into the inner ear and avoid mastoid obliteration. Balkany et al5 reported poor open-set word recognition in patients with totally ossified cochlea in whom short insertions were performed during CI surgery. In our study, the simple finals recognition rate and simple sound recognition rate of the patients were tested to evaluate the auditory and speech outcomes. We thought this test is simple and more accurate on Chinese speech sound characteristic, because it includes more part speech sound of Chinese word. In three patients without ossified modiolus, auditory and speech perception evaluation was performed at 6 months after surgery. The simple finals recognition rate was 70% in three patients and the simple sound recognition rate was 30% in two patients and 10% in one patient. Also in the one patient with an ossified modiolus, auditory and speech perception evaluation was performed. The simple finals recognition rate was 50% and the simple sound recognition rate was 0. Further follow-up should be conducted to evaluate postoperative performance. In conclusion, this study showed that the totally ossified cochlea should not be considered as a contraindication to CI. The feasibility of successful CI surgery in cases of total cochlear ossification was confirmed. Due to the complicated anatomy, in cases of cochlear ossification, attention should be paid during surgery to the protection of the modiolus, internal carotid artery, facial nerve, and bottom of the inner auditory meatus. Further follow-up should be conducted to evaluate postoperative performance. (Received July 15, 2014) Edited by Chen Xin

Objective To observe the Gerbil electrically audiotory brainstem responses change after Ouabain was applied to the round window of the gerbil.Methods A piece of gelfoam immerged with Ouabain solution(50 μl 1 mM) was used to cover on the round window membrane of the cochlea.After applying ouabain in the cochlea for 24 h and 96 h,the threshold changes of audiotory brainstem responses(ABR),Cochlear microphonics(CM),electrically audiotory brainstem responses(EABR) were observed.Results Ouabain application for 24 h and 96 h induced the threshold of ABR and EABR to increase obviously.The difference had statistical significance(P 0.05).But the threshold of CM remained no obvious change,the difference had no statistical difference(P 0.05).Conclusion Ouabain application on the round window membrane of the gerbil cochlea for 24 h and 96h may make the threshold of ABR and EABR increase,but the threshold for CM had no obvious change.

Objective To analyze the causes and imaging features of cases with cerebrospinal fluid (CSF) gusher during cochlear implant surgery. Methods The preoperative imaging examination results of 134 cases with CSF gusher during cochlear implantation were retrospectively analyzed. Results According to the CT and MRI findings, there were 11 cases with bony defects in the fundus of the internal acoustic meatus plus large vestibular aqueduct, 28 cases with bony defects in the fundus of the internal acoustic meatus plus large vestibular aqueduct and Mondini malformation, 88 cases with bony defects in the fundus of the internal acoustic meatus plus Mondini malformation only and 7 cases with common cavity between cochlea and internal acoustic meatus in all the 134 cases. Conclusion CSF gusher occurred in all inner ear malformation cases with bony defects of internal acoustic meatus fundus communicating with inner ear during cochlear implant surgery.

OBJECTIVE:To report the way for searching the chorda tympani nerve and the significance for preserving the chorda tympani nerve during canal-wall-down mastoidectomy and tympanoplasty surgery.METHOD:Sixty-six cases with chronic suppurative otitis media underwent canal-wall-down mastoidectomy and tympanoplasty surgery. According to the marker of the short crus of incus, the posterior wall of auditory canal was lowered and crista of the chorda tympani nerve was found through tracing the facial nerve contour. The chorda tympani nerve was preserved after clearing the surrounding tissue.RESULT:Among the 66 cases, 24 cases had middle ear cholesteatoma, 42 cases had granulation in middle ear. The cholesteatoma and granulation on the surface of the chorda tympani nerve were cleared thoroughly. No neurotmesis or obvious change of taste occurred after operation.CONCLUSION:Canal-wall-down mastoidectomy and tympanoplasty surgery preserving chorda tympani nerve integrality may preserve the structure and function of the chorda tympani nerve, reduce the risk of ossicle extrusion above the head of stapes and serve as a frame for transplanting fascia.

Objective To evaluate the therapeutic effects and inflammatory mediator levels in induced sputum of H1 blocker nazal spray in combination with inhaled corticosteroid on allergic asthma.Methods Sixty-one patients with moderate to severe allergic asthma were received either azelastine nazal spray(group A) or beclomethasone nazal spray(group B) or combination with azelastine nazal spray and beclomethasone nazal spray(group C) on the basis of inhaled samelterol/fluticasone for 3 months.Symptom scores of asthma and eosinophils in induced sputum were recorded,eosinophilic cationic protein(ECP),ICAM-1and interleukin 13(IL-13) in induced sputum supernatants were measured before and after the treatment.Results After treatment,there was significant improvement in symptom score,eosinophils in induced sputum and induced sputum ECP,ICAM-1 level in all three groups as compared with before the treatment(P 0.05);there was no significant difference in symptom score,induced sputum eosinophils and induced sputum ECP,ICAM-1 level between group A and group B(P 0.05);there was much better improvement in symptom score and induced sputum ECP in group C as compared with group A(P 0.05).However,there was no significant change in induced sputum IL-13 levels after treatment in all groups(P 0.05).Conclusion On the basis of inhaled corticosteroid,azelastine nazal spray significantly improves asthma symptom and reduces induced sputum ECP,ICAM-1 level and eosinophils in patients with asthma and allergic rhinitis.

目的探讨双侧小耳畸形合并耳道骨性闭锁患者,面神经垂直段后进路振动声桥植入的可行性和术后效果.方法1例双耳先天小耳畸形合并耳道骨性闭锁患者,左耳传导性耳聋,右耳混合性聋,语频区平均骨气导差为55 dB.Jahrsdoerfer评分患者左侧为5分,右侧为4分.双侧面神经后进路开放骨性隧道,一期双耳振动声桥圆窗植入.结果双耳面神经后进路振动声桥圆窗植入,术后2.5个月开机使用,声场测听语频区左耳听阈平均40 dB HL,右耳平均听阈39 dB HL,双耳气导听阈降低15~16 dB HL.开放式汉语单声母、韵母言语识别率为98%.结论面神经后进路开放骨性隧道暴露圆窗行振动声桥圆窗植入术治疗小耳畸形,听力改善较为理想.

BACKGROUND:Most patients with auditory neuropathy (AN) could receive good even the best effects after cochlear implantation. How to diagnose AN objectively and accurately is very important. In this study, we screened the patients with AN according to the presence or absence of compound action potential (CAP) of intraoperative round window electrocochleography (RW ECochG).METHODS:Intraoperative RW ECochG was performed on 32 patients with profound sensorineural deafness, who had normal cochlea during cochlear implantation surgery under general anesthesia in the standard operating room. The cochlear microphonic (CM) and CAP of RW ECochG was observed and recorded.RESULTS:The presence of CM but the absence of CAP of RW ECochG occurred in 12 among the 32 patients. They were suspected to suffer from AN. The rest patients who had CM and CAP of RW ECochG were thought not to suffer from AN.CONCLUSION:Application of intraoperative RW ECochG during the cochlear implantation surgery may objectively and accurately screen the patients with AN, and can give a meaningful clue for implanted device working.

OBJECTIVE To investigate the imaging and clinical feature of leukoencephalopathy with hearing loss first complaint. METHOD The head MRI and clinical feature of 7 cases leukoencephalopathy with hearing loss first complaint were retrospectively analysed, including their place, shape, range and blood plasma very-long-chain fatty acid (VLCFA). RESULT The head MRI of 2 cases shows symmetry distributed long T, and T2 signal like butterfly aliform in white matter beside both cornu posterior ventriculi lateralis. The head MRI of 5 cases shows abnormal long T1 and T2 signal in different part in Alba. The pathological changes often located in white matter of frontal lobe and secondly beside both cornu posterior ventriculi lateralis. The shape shows little patching in 7 cases. The range only shows beside cornu posterior ventriculi lateralis in 2 cases. The range only shows in frontal lobe in 1 cases. Two or more than two parts shows in the rest 5 cases. The result of VLCFA is normal in 3 cases. The rest 4 cases refused to have examination of VLCFA. CONCLUSION The patient who firstly complained of hearing loss should be routinely done head MRI. The head MRI imaging could clearly show abnormal white matter in order to avoid omitting existent pathological changes.

肺栓塞是外科手术后致命的并发症之一,因其临床表无特征性,易被手术本身掩盖,故误诊、漏诊率高,死亡率高本文回顾分析1例重症0SAHS患者悬雍垂腭咽成形术后肺栓塞的有关资料.

OBJECTIVE:To investigate the methods of preoperative diagnosis and differentiation of different pathological tissue in middle ear and mastoid.METHODS:The temporal bone lamellar CT findings in 106 patients with chronic suppurative otitis media (including cholesteatoma) were retrospectively analyzed. The CT value of pathological tissue were measured for 183 times and were compared with the surgical findings and postoperative pathological findings to definitude the CT value range of different pathological tissue. Sixty patients taken from 106 patients at random were analyzed and made the diagnosis again by the same doctor team according to the CT value of the different pathological tissue and surrounding histoclasia resulted by pathological tissue. The diagnose accordance rate was compared with the routine diagnose report from radiology department. The predetective diagnosis was made in 10 patients with chronic suppurative otitis media according to clinical manifestation (pathological changes of tympanic membrane, nature of otorrhea, character of hearing), temporal bone lamellar CT finding (CT value of pathological tissue, surrounding histoclasia) to validate the value of this study for preoperative diagnosis and differentiation of different pathological tissue in middle ear and mastoid.RESULTS:The CT value of cholesteatoma, granulation tissue, cholesteatoma combined with granulation tissue, effusion, calcified tissue, thickened and polypoid membrane was respectively (46.6 +/- 10.3) Hu, (26.6 +/-7.4) Hu, (42.1 +/- 11.4) Hu, (- 24.6 +/- 9.2) Hu, (223.6 +/- 63.7) Hu, (23.8 +/- 8.5) Hu. The diagnose accordance rate in 60 patients who were analyzed and made diagnosis again according to the CT value of the different pathological tissue and surrounding histoclasia resulted by pathological tissue raised from 68. 3% to 81.7% ( P < 0.05) . The predetective diagnose accordance rate reached at 90% according to clinical manifestation, temporal bone lamellar CT.CONCLUSIONS:It was not reliable to diagnose and differentially diagnose different pathological tissue in middle ear and mastoid only by the CT value, however, the CT value could still be considered to be a very significant information. The accurate rates of diagnosis and differentiation of different pathological tissue in middle ear and mastoid obviously raised by synthetically analyzing various kinds of pathological tissues in middle ear and mastoid according to clinical manifestation, temporal bone lamellar CT finding.

Objective To summarize the experience on the diagnosis and treatment of the petrous bone cholesteatoma. Methods Based on the relative literatures, the findings during the operation and postoperation of two cases with petrous bone cholesteatoma were analyzed. Results One case was treated with a supralabyrinthine approach accompaning with facial nerve decompression,and left the petrous cavity exposed,the function of facial nerve was recovered from Ⅵ to Ⅴ of House-Brackmann grading and the hearing result had not been improved; Another case was treated with a translabyrinthine approach accompaining with facial nerve anastomosis,closed the petrous cavity,the function of the facial nerve had not been improved and the hearing had been lost.There had been no evidence of recurrence in two cases up to now. Conclusion The surgical approach must be chosen according to the place of the lesions,exposing and closing of the petrous cavity can be used in proper patients because of their own advantages.

OBJECTIVE:To objectively evaluate whether cochlear implantation surgery made damage to cochlear basal membrane or not through analyzing the change of the threshold of cochlear microphonic (CM) of round window electrocochleography before and after inserting electrode during cochlear implantation surgery.METHOD:Round window electrocochleography was performed on 40 cases with profound sensorineural deafness under general anesthesia in the standard operating room in order to analyze the change of the threshold of cochlear microphonic (CM) of round window electrocochleography before and after inserting electrode during cochlear implantation surgery.RESULT:Among the 40 cases, thresholds of cochlear microphonic (CM) before and after inserting electrode during cochlear implantation surgery were similar in 39 cases. The thresholds of cochlear microphonic (CM) after inserting electrode decreased about 5 dB at certain frequency. The thresholds of cochlear microphonic (CM) after inserting electrode increased 20-50 dB in only one case. There was a sense of resistance in implanting the electrodes in this patient.CONCLUSION:Use of round window electrocochleography may objectively evaluate whether cochlear implantation surgery make damage to cochlear basal membrane or not.

Cochlear implant is a biomedical device, which can directly stimulate the auditory nerve pass-by the damaged hair cell to recover and rebuild the hearing of deaf people. The implant can also stimulate the auditory brainstem and cortex in patients whose auditory nerve is not accessible because of acoustic tumors. Cochlear implantation can make the patients generate electrical hearing (artificial hearing).The artificial hearing can recover, improve or rebuild the hearing of deaf people through electrical stimulus. Current status of cochlear implantation Cochlear implantation has been used successfully in more than 80 000 hearing-impaired people including 40 000 children worldwide.1 The number of people who received cochlear implantation has reached more than 3000 in China in early 2006. The Australian multi-channel cochlear implant was firstly recommended to be used at Peking Union Medical College Hospital in May 1995. Since then, the Austria and American cochlear implant devices have also been introduced into China. More than 30 hospitals can perform multi-channel cochlear implantation in this country. According to the survey of Han DM,2 more than 1600 patients received multi-channel cochlear implantation from 1995 to December 2003, with a male to female ratio of 31:19. In these patients, the children below 12 years of age accounted for 76.5%. Auditory brainstem implantation for patients with auditory nerve absence or damage has not yet been carried out in China. For the expensive cochlear implants imported, most of patients could not afford them. In order to meet the need of numerous people suffering from hearing loss, cochlear implants are being made in Beijing, Shanghai and other cities in China. The number of cochlear implant users has been growing rapidly in recent years with improved function of the implant. The cochlear implant has evolved from a single-electrode device as an aid for lip-reading and sound awareness to a modern multi-electrode device allowing an average user to talk on the telephone. Cochlear implant research has also matured as a scientific field. The annual number of publications on cochlear implantation shows a growth in skip pattern, mirroring the increased number of cochlear implant users. The growth and maturity of the field of cochlear implantation are also reflected by the number and density of papers published in broad interest-based journals like Science and Nature. From the 1960s to the 1980s, two case reports on cochlear implantation were published in Science.3,4 In the 1990s, three papers on cochlear implants appeared in Science and Nature.5-7 In 2000 an article and a review concerning the implantation were published again in Nature.2,8 Related issues on cochlear implantation Cochlear implantation program As a cooperative field involving clinical medicine, biomedical engineering, education, psychology, and social and economical aspects, cochlear implantation is considered a systematic engineering with striving specialties and high responsibility. A good team of cochlear implantation should be composed of clinician, audiologist, speech pathologist, rehabilitation teacher, psychologist and parents. This team will offer the patients a systematic service including consultation, pre-surgical evaluation, surgery, post-surgery fitting procedure and auditory verbal rehabilitation. The patients will have the same education as normal people and take part in social activities. Although most of hospitals can not accomplish this at present, it is the goal we ought to pursue. Issues on surgeon and surgery There is a big challenge for the surgeon who performs cochlear implant surgery for the first time. A few risks should be considered. First, the complexity of the surgery is demonstrated by the anatomy of the facial nerve, round window and cochlea, the insertion depth of electrodes, reserve of the residual hearing by avoiding damage to the cochlea, especially in young children. Second, since the device is expensive, patients have an over expectation on the operative results. Third, more than 10% of patients have to some extent middle and inner ear malformation, cochlear ossification, and otitis media. Facial nerve preceding or abnormal position makes the surgeon difficult to find the cochlea and implant the electrode properly. CSF gusher during cochleotomy makes the operation even more difficult. If the surgeon can't handle these problems, he/she will face surgical failure or severe complication. Before cochlear implantation, surgeons should be skillful in ear surgery and have a systematic training in cochlear implantation. Preoperative audiological evaluation Preoperative audiological evaluation is very important for the patient who is subject to cochlear implantation. Despite numerous attempts, we are still far from predicting preoperatively with reasonable confidence and accuracy the level of postoperative hearing. This has become increasingly important for people with residual hearing and various etiology become candidates for cochlear implant.9 If we cannot predict the outcome, how can we advise a hearing-impaired person with an intelligibility of 50% or more to get a cochlear implant or not. The solution to this problem may require a combination of old-fashioned promontory stimulation and newly developed brain imaging and cognitive measures. Postoperative fitting procedure Successful cochlear implantation is not meant that the patient may have good results. The quality of fitting procedure usually decides implant users' actual hearing. The fitting procedure is meant by adjusting the threshold and maximal comfortable loudness of every electrode implanted in order to make them work in the best condition. Each electrode can transfer the specific frequencies of sound information. If an electrode does not work in order, a specific frequency of sound information will lose. In addition, loudness balance should be kept between every electrode. Fitting procedure is easily done in post-lingual adults, but very hard to complete in pre-lingual children. Because this procedure is a psychophysic testing completed by subjective expression, the cochlea stimulated by electricity cannot produce a sense of sound, but sometimes non-hearing stimulus. It is common that electrical stimulus can lead to facial muscle twitching and a sense of pain. So fitting procedure has more requests for an audiologist to deal with some complicated conditions. The audiologist should have more professional knowledge and more practice experience in addition to techniques of behavior hearing test for infants. Auditory-verbal rehabilitation Postoperative auditory verbal rehabilitation is an important step in cochlear implantation. Pre-lingual deafness children who have received cochlear implantation can acquire hearing, but they cannot understand languages or communicate effectively. Strict rehabilitation training should be given to them to communicate with normal people and participate in social activities. Cochlear implantation surgeons have to explain the importance of rehabilitation training and guide the parents of patients to make plans for training and rehabilitation. Postoperative rehabilitation presents an equally challenging problem in explaining the large individual variability and improving the performance in poor users. At present, there are essentially no postoperative rehabilitation protocols, but limited data have shown improvement in auditory training.10 Formal, structured, and systematic learning protocols ought to be developed to help cochlear implant users adept to the new modality with electric hearing. The work on cochlear implant has been improved significantly in China, but there are still problems needed to be solved. We hope we will see a new situation for the development of cochlear implantation through our hard work.

BACKGROUND Ouabain, a cardiac glycoside that specifically binds to Na/K-ATPase and inhibits its activity, was applied to gerbils to develop a method for studying auditory neuropathy. METHODS Ouabain was applied to the round window of the cochlea in each gerbil by using a piece of gelfoam with 3 microl or 24 microl (1 mmol/L) ouabain solution. The changes of the threshold of auditory brainstem response, cochlear function round window electrocochleography, as well as the morphological changes of the spiral ganglion cells of the cochlea were observed after application of ouabain for 24 hours or 96 hours. RESULTS In ouabain treated gerbils, auditory brainstem response and compound action potential thresholds showed either elevation or no response at all. However, the thresholds of cochlear microphonic and distortion product otoacoustic emissions were not affected. Degeneration and necrosis of some spiral ganglion cells in ears with applications of ouabain (24 hours, 3 microl, 1 mmol/L; 96 hours, 24 microl, 1 mmol/L ouabain). The number of spiral ganglion cells was decreased (24 hours, 3 microl, 1 mmol/L ouabain) or near to a total loss (96 hours, 24 microl, 1 mmol/L ouabain). CONCLUSIONS These results indicate a high degree of independence between the spiral ganglion cells and the outer hair cell systems in the cochlear transduction mechanism. The method used in this study would provide a valuable tool for studying auditory neuropathy.

OBJECTIVE:To report the surgery and the postoperative outcomes with Nucleus 24 Contour electrode array in patients suffered from profound sensorineural hearing loss.METHOD:The surgery and postoperative current level making electrical hearing are compared between the group with Nucleus 24 contour and the group with Nucleus 24 M.RESULT:Among the 82 cases,32 electrodes were inserted in 81 cases, 28 electrodes in 1 case. The intraoperative small CSF flowing occurred in 31 cases and no CSF flowing occurred in 2 cases. The slight postoperative complications of the surgeries occurred in seven patients. The postoperative NRT threshold of the group with Nucleus 24 Contour was lower than the group with Nucleus 24M. There was a statistically significant difference in the 1th channel about the NRT threshold (P < 0.05).CONCLUSION:Using Nucleus 24 Contour makes the surgery esaier than using Nucleus 24 M, minimizes the introcochlear trauma during insertion and reduces the current level producing electrical hearing. The Nucleus 24 Contour is a new, safe and effective implantation to the patients with profound sensorineural hearing loss.

人工耳蜗植入术(Cochlear implantation,Cl)的并发症分为两类:一类属于严重并发症,病人需要手术治疗;一类属于轻度并发症,病人不需要治疗.人工耳蜗植入术后可能发生的并发症主要有:切口感染、中耳炎、面神经麻痹、外淋巴漏、脑膜炎、电极脱出和装置故障等.人工耳蜗植入最常见的并发症为组织瓣坏死,电极压迫或错位及面神经损伤、麻痹或刺激[1].面神经麻痹即使不需要进一步的手术或住院治疗,也属于严重的并发症.