Hearing loss is one of the most common human diseases, seriously affecting everyday lives. Mitochondria, as the energy metabolism center in cells, are also involved in regulating active oxygen metabolism and mediating the occurrence of inflammation and apoptosis. Mitochondrial defects are closely related to hearing diseases. Studies have shown that mitochondrial DNA mutations are one of the causes of hereditary hearing loss. In addition, changes in mitochondrial homeostasis are directly related to noise-induced hearing loss and presbycusis. This review mainly summarizes and discusses the effects of mitochondrial dysfunction and mitophagy on hearing loss. Subsequently, we introduce the recent research progress of targeted mitochondria therapy in the hearing system.

Abstract Background It is well known that decision aids can promote patients’ participation in decision-making, increase patients’ decision preparation and reduce decision conflict. The goal of this study is to explore the effects of a “Shared Decision Making Assistant” smartphone application on the decision-making of informed patients with Primary Liver Cancer (PLC) in China. Methods In this quasi-experimental study , 180 PLC patients who knew their real diagnoses in the Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China, from April to December 2020 were randomly assigned to a control group and an intervention group. Patients in the intervention group had an access to the “Shared Decision Making Assistant” application in decision-making, which included primary liver cancer treatment knowledge, decision aids path, continuing nursing care video clips, latest information browsing and interactive platforms. The study used decision conflict scores to evaluate the primary outcome, and the data of decision preparation, decision self-efficacy, decision satisfaction and regret, and knowledge of PLC treatment for secondary outcomes. Then, the data were entered into the SPSS 22.0 software and were analyzed by descriptive statistics, Chi-square, independent t-test, paired t-test, and Mann–Whitney tests. Results Informed PLC patients in the intervention group (“SDM Assistant” group) had significantly lower decision conflict scores than those in the control group. (“SDM Assistant” group: 16.89 ± 8.80 vs. control group: 26.75 ± 9.79, P < 0.05). Meanwhile, the decision preparation score (80.73 ± 8.16), decision self-efficacy score (87.75 ± 6.87), decision satisfaction score (25.68 ± 2.10) and knowledge of PLC treatment score (14.52 ± 1.91) of the intervention group were significantly higher than those of the control group patients (P < 0.05) at the end of the study. However, the scores of “regret of decision making” between the two groups had no statistical significance after 3 months (P > 0.05). Conclusions Access to the “Shared Decision Making Assistant” enhanced the PLC patients’ performance and improved their quality of decision making in the areas of decision conflict, decision preparation, decision self-efficacy, knowledge of PLC treatment and satisfaction. Therefore, we recommend promoting and updating the “Shared Decision Making Assistant” in clinical employment and future studies.

目的:研究白细胞(WBC)和乳酸脱氢酶(LDH)对急性胰腺炎改良的CT严重指数(MCTSI)评分和预后的关系.方法:回顾性分析2015年1月1日-2020年12月31日在哈尔滨医科大学附属第四医院就诊的413例急性胰腺炎患者,依照2004年制定的MCTSI评分标准,将患者分为轻症组(n=335例)和非轻症组(n=78例).采用Spearman分析LDH、WBC与MCTSI评分的相关性;比较2组间患者入院当天的WBC和LDH水平;制作受试者工作特征(ROC)曲线分析WBC和LDH及两指标联合预测MCTSI评分非轻症组的能力;对WBC、LDH、MCTSI评分与住院时间进行相关性分析.结果:①LDH、WBC与MCTSI评分间呈正相关.②非轻症组患者人院当天WBC和LDH水平显著高于轻症组,差异有统计学意义(P＜0.05).③ROC曲线示LDH、WBC以及两者联合预测MCTSI评分非轻症组的AUC值分别为0.705、0.625、0.704,组间比较差异无统计学意义(P＞0.05).④WBC、MCTSI评分与住院时间呈正相关.结论:WBC、LDH、MCTSI评分在一定程度上均可以评估患者病情及预后.WBC、LDH及两者联合均可以良好的预测MCTSI评分非轻症胰腺炎的发生.WBC、MCTSI评分可以作为评估患者住院时长的指标.

The development of medical technology provides medical specialists with a variety of choices for their primary liver cancer patients, including partial liver resection, transcatheter arterial chemoembolization, liver transplantation, and so on. However, in this context, because patients with primary liver cancer frequently do not receive adequate information to help make complicated medical decisions, those patients, who are usually otherwise ignorant about their disease, are facing multiple difficult choices. The problem might be alleviated with a process called "shared decision making." Accordingly, researchers developed a smartphone application named "Shared Decision Making Assistant" for primary liver cancer patients in China, and in this article, we report the process of its development. First, individual interviews were conducted to identify the specific needs and status of primary liver cancer patients participating in shared decision making. Next, expert group discussions were held among primary liver cancer medical experts, nurses, and software engineers, using a decision-making process called the Delphi method, which was used to arrive at a group opinion or decision by surveying a panel of experts, to draft the framework and decide on the contents of the mobile health-based decision aids program. Feedbacks and suggestions were collected to optimize the workflow of "Shared Decision Making Assistant." The resulting application consisted of seven modules: personal information, primary liver cancer treatment knowledge center, decision aids path, continuing care, interactive platform, health education, and backstage management.

Background Human-derived acellular dermal matrix (ADM) has been widely used as an effective alternative to autologous grafts in tympanoplasty. However, evidence of ADM as an alternative to autologous grafts in the repair of tympanic membrane (TM) perforation still lacks adequate empirical evidence. Objectives To determine the clinical safety and efficacy of human-derived ADM as TM graft material for tympanoplasty. Data sources The PubMed, EMBASE, Cochrane Library, EBSCO, Ovid, Scopus, and Web of Science databases and reference lists of the retrieved articles were searched, with no language restriction. Selection criteria All randomized controlled trials and retrospective cohort studies that compared the use of human-derived ADM and autologous grafts in tympanoplasty for TM perforation were included. Data collection and analysis Two review authors independently assessed risk of bias in the included studies and extracted data. The pooled results for continuous data were reported as a mean difference (MD) and 95% confidence intervals (CI). For dichotomous data, odds risk (OR) with 95% CI was used. ChI2 statistic and Galbraith plots were used to assess the heterogeneity. Publication bias was assessed with a funnel plot and Egger's test. Main results Five retrospective cohort studies and four randomized controlled studies with a total of 610 participants were included in the meta-analysis. No significant differences in graft success (OR: 0.71 [0.39, 1.29], p = 0.26), air-bone gap (ABG) reduction (MD: − 0.59 [− 3.81, 1.19], p = 0.51), or complications (OR: 1.23 [0.07, 20.64], p = 0.89) were found between the ADM group and autologous graft group. The use of ADM significantly shortened tympanoplasty surgery time (MD: − 16.14 [− 21.22, − 11.07], p < 0.00001) and reduced postoperative pain (MD: − 2.57 [− 3.57, − 1.58], p < 0.00001) compared with the autologous graft group. Conclusion Human-derived ADM might be an effective alternative to autologous grafts for tympanoplasty. However, some of the studies that were included in the present meta-analysis had rather low methodological quality, and more adequately designed clinical trials should be performed in the future. Graphical abstract

目的 探讨儿童耳后骨膜下脓肿的临床特点及治疗方案.方法 回顾性分析2013年9月～2018年2月行手术治疗的14例儿童耳后骨膜下脓肿患者的临床资料.结果 学龄前儿童9例,学龄期儿童5例,均继发于急性中耳炎.与学龄期儿童相比,学龄前儿童病程短、炎症重、进展快.所有患者均行完壁式乳突开放术+上鼓室开放术±鼓膜切开术/鼓膜置管术.随访期间均未复发.结论 儿童耳后骨膜下脓肿常继发于急性中耳炎,好发于学龄前儿童.完壁式乳突开放术+上鼓室开放术+鼓膜切开术/鼓膜置管术是有效的治疗方式.

目的 原创性研发基于移动技术的原发性肝癌患者治疗决策辅助平台,辅助患者了解肝癌疾病治疗信息,提高医患沟通效率,提升共享决策质量.方法 基于加拿大渥太华决策支持框架,利用微信小程序构建"平台",包含肝癌不同治疗方案知识库、肝癌患者决策辅助路径、延续护理以及医患沟通功能四个核心模块.结果 实现决策辅助工具实时指导、决策路径实时评估、健康科普、咨询等功能.结论 建立以原发性肝癌患者为中心的治疗决策辅助平台,在不增加医务人员工作负担的同时,方便患者随时获取决策知识,并通过医护患之间的良好互动提升决策质量;也为我国决策辅助的发展提供新路径.

目的 分析血尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)、C-反应蛋白质(C-reactive protein,CRP)单独或联合应用,在急性胰腺炎的早期严重程度预测及预后评估中的临床价值.方法 回顾性分析了2015—2020年于哈尔滨医科大学附属第四医院住院的221例急性胰腺炎患者,依据《中国急性胰腺炎诊治指南》(2019,沈阳)将患者分为轻症组178例和非轻症组43例,评估两组患者入院BUN、SCr、CRP水平差异,分析各指标与改良CT严重指数评分(modified CT severity index,MCTSI)的相关性,应用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析各指标对非轻症急性胰腺炎的诊断价值.结果 非轻症组入院SCr、BUN、CRP水平显著升高(P<0.05);入院SCr及CRP水平与MCTSI评分呈正相关(P<0.05);ROC曲线显示各指标单独或联合应用AUC值均>0.5,各AUC值间差异无显著性(P>0.05).结论 SCr、BUN、CRP均可作为急性胰腺炎严重程度的预测指标,联合应用未见更好的预测价值,其中SCr及CRP可以早期预判急性胰腺炎炎症坏死进展.

BACKGROUND:Lymph node (LN) involvement is a critical prognostic factor in patients with gallbladder carcinoma (GBC). Controversy exists regarding optimal categorization of nodal metastasis status, including anatomical location of positive nodes (AJCC 7th N staging), number of metastatic lymph nodes (NMLN), log odds of metastatic LNs (LODDS), and lymph node ratio (LNR).METHODS:Patients who underwent curative-intent resection for GBC from six Chinese tertiary hospitals between 2008 and 2013 were analyzed retrospectively. The relative discriminative abilities of the different LN staging systems were assessed by different models including the tree-augmented naïve Bayesian (TAN) model, Cox proportional hazards regression model, and binary logistic regression model.RESULTS:A total of 226 patients were involved in this cohort. Based on the TAN model and composite importance measures, the most important factor affecting the prognosis in the different LN staging systems was NMLN. Among the four TAN models which were built with 4 metastatic LN markers and baseline variables, the accuracy of the NMLN-based prognostic model was 88.15%, higher than 7th N staging (86.44%), LNR (87.34%), and LODDS (85.19%). The Cox model based on NMLN (C-index: 0.763, AIC: 1371.62) had a higher fitness than the others (7th N staging C-index: 0.756, AIC: 1375.51; LNR C-index: 0.759, AIC: 1378.82; LODDS C-index 0.748, AIC: 1390.99). The AUCs of different staging binary logistic regression models were NMLN (0.872), LNR (0.872), 7th N staging (0.869) and LODDS (0.856), respectively.CONCLUSIONS:NMLN was the optimal LN staging system in evaluating prognosis of GBC.

目的 探讨近中阻生下颌第三磨牙(MTM)和第二磨牙远中牙槽骨丧失(MSMDBL)的相关关系.方法选取274例近中阻生MTM的CBCT资料,测量MTM与MSM牙长轴夹角、MTM近中釉牙骨质界至MSM远中釉牙骨质界距离(MTMMCEJ-MSMDCEJ)和MSMDBL,并统计年龄、性别,分析各因素对MSMDBL的影响及相关关系.结果 MTM与MSM牙长轴夹角与MSMDBL呈正相关关系,当角度大于22.5?时,MSMDBL明显加重;当MTMMCEJ-MSMDCEJ距离大于6mm,MSMDBL明显加重,在9～12mm时最严重.结论 可将近中阻生的MTM与MSM牙长轴夹角超过22.5.或者MTMMCEJ-MSMDCEJ超过6mm视为预防性拔除MTM的指导原则.

Objective: To examine the role of the number of lymph nodes examined(NLNE) on the prognosis of patients with curatively resected gallbladder carcinoma(GBC). Methods: The clinicopathological data and prognosis of 401 patients with GBC who underwent radical surgery from six institutions of China from January 2013 to December 2017 were analyzed retrospectively. There were 153 males(38.2%) and 248 females(61.8%), with age of (62.0±10.5) years (range: 30-88 years). Fifty-three patients(22.2%) were accompanied by jaundice. All patients underwent radical resection+regional lymphadenectomy.R0 or R1 resection was confirmed by postoperative pathological examination.The different cut-off values of NLNE were determined by the X-tile software, the optimal cut-off values were identified by analyzing the relationship between different cut-off values of NLNE with survival rate. Kaplan-Meier method was used for survival analysis. Univariate and multivariate analysis were implemented respectively using the Log-rank test and Cox proportional hazard model. Results: Among the 401 patients enrolled, 135 cases (33.6%) had lymphatic metastasis, of which 98 cases were in N1 stage(24.4%) and 37 cases were in N2 stage(9.2%).A total of 2 794 NLNE were retrieved, with a median count of 6 (5).The median positive lymph nodes count was 0 (1), and the median positive lymph nodes ratio was 0 (IQR, 0-0.2). Since the 12 and 15 were determined as the cut-off values by X-tile, all patients were divided into three groups of 1-11, 12-15 and ≥16.The 3-year survival rate of the three groups was 45.2%, 74.5%, 12.0% respectively, with statistically significant difference between three groups (χ(2)=10.94, P<0.01). The results of multivariate analysis showed that NLNE was an independent prognostic factor for overall survival (P<0.05). Further analysis was performed specifically for subgroup of T stages. For T1b patients, the prognosis of the NLNE with 1-7 group was significantly better than that of the ≥8 group(χ(2)=4.610, P<0.05). For T2 patients, the prognosis of the TLNE ≥7 group was significantly better than that of 1 -6 group (χ(2)=4.287, P<0.05). For T3 and T4 patients, the prognosis of the TLNE with 12 - 15 group was significantly better than that of 1 -11 group (χ(2)=5.007, P<0.01) and ≥16 group (χ(2)=10.158, P<0.01). Conclusions: The NLNE is an independent factor affecting the prognosis of patients with GBC.For patients with stage T1b,8 lymph nodes should be retrieved; for patients with stage T2,extensive dissection of more than 6 lymph nodes can significantly improve the prognosis.For advanced patients (stages T3 and T4), extensive dissection with 12-15 lymph nodes is recommended. However, it fails to get more survival benefits by dissecting more than 16 lymph nodes.

Background: In this study, we developed a nomogram and a Bayesian network (BN) model for prediction of survival in gallbladder carcinoma (GBC) patients following surgery and compared the performance of the two models. Methods: Survival prediction models were established and validated using data from 698 patients with GBC who underwent curative-intent resection between 2008 and 2017 at one of six Chinese tertiary hospitals. Model construction and internal validation were performed using data from 381 patients at one hepatobiliary center, and external validation was then performed using data from 317 patients at the other five centers. A BN model and a nomogram model were constructed based on the independent prognostic variables. Performance of the BN and nomogram models was compared based on area under receiver operating characteristic curves (AUC), model accuracy, and a confusion matrix. Results: Independent prognostic variables included age, pathological grade, liver infiltration, T stage, N stage, and margin. In internal validation, AUC was 84.14% and 78.22% for the BN and nomogram, respectively, and model accuracy was 75.65% and 72.17%, respectively. In external validation, AUC was 76.46% and 70.19% for the BN and nomogram, respectively, with model accuracy of 66.88% and 60.25%, respectively. Based on the confusion matrix, the nomogram had a higher true positive rate but a substantially lower true negative rate compared to the BN. Conclusion: A BN model was more accurate than a Cox regression-based nomogram for prediction of survival in GBC patients undergoing curative-intent resection. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

目的 探讨耳源性脑脓肿的临床特点及治疗.方法 回顾性分析2011年8月～2017年9月于中国医科大学附属第一医院收治的耳源性脑脓肿患者的临床病例资料,总结其临床特点及治疗.结果 所有患者中3例脑脓肿经抗炎治疗治愈,8例行开颅脑脓肿切除术,3例行钻孔引流术.13例行耳部手术.14例患者中13例患者治愈,治愈率92.9％,随访10个月～3年,未出现脑脓肿及耳部疾病复发.1例患者脑脓肿术后病情加重转回当地治疗失访.结论 耳源性脑脓肿好发于颞骨胆脂瘤.对于有中耳炎急性发作病史,持续头痛,影像学提示骨质破坏的病例应高度怀疑脑脓肿等颅内并发症的可能.尽早发现脑脓肿并针对性的治疗是治愈的关键.

Hypopharyngeal carcinoma (HPC) is an aggressive malignancy with the worst prognosis among all head and neck cancers. MicroRNAs (miRNAs) are involved in the development of many human cancers, and may function as oncogenes or tumor suppressors. The present study aimed to evaluate the effects of miRNA (miR)-194-5p on the proliferation and invasion of HPC cells and to identify the potential regulatory mechanism. First, miR-194-5p and Smad ubiquitin regulatory factor 1 (SMURF1) expression levels were examined in HPC tissues. Subsequently, to explore the effects of miR-194-5p on SMURF1, a dual-luciferase reporter gene assay was performed to verify the target relationship. To define the role of miR-194-5p in HPC progression, miR-194-5p upregulation and depletion were used to evaluate its effects on cell viability, invasion and migration. SMURF1 silencing and rapamycin [an inhibitor of the mammalian target of rapamycin (mTOR) signaling pathway] treatment were also used to analyze the regulatory mechanism in HPC. Finally, tumor growth was assessed in xenografted tumors in nude mice. SMURF1 was demonstrated to be highly expressed, whereas miR-194-5p was poorly expressed in HPC tissues; SMURF1 was identified as a target gene of miR-194-5p. FaDu hypopharyngeal squamous cell carcinoma cells treated with miR-194-5p mimics exhibited decreased viability, invasion and migration. The results indicated that miR-194-5p may inactivate the mTOR signaling pathway by targeting SMURF1. In addition, the in vivo experiments further verified these regulatory effects. These data suggested that miR-194-5p-targeted SMURF1 inhibition may be involved in the disruption of HPC progression through the repression of the mTOR signaling pathway.

Objectives: To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer. Methods: The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ(2) test, survival analysis was carried by Kaplan-Meier and Log-rank test. Results: Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ(2)=288.60,P<0.01),N stage(χ(2)=68.10, P<0.01), vascular invasion(χ(2)=128.70, P<0.01)and neural invasion(χ(2)=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ(2)=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05). Conclusion: With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

Cochlear otosclerosis is defined as otosclerosis located in the otic capsule involving the cochlear endosteum and causing sensorineural hearing loss or mixed type hearing loss.There was characteristic representation in imaging findings,which can be useful for diagnosis.The treatment includes drug therapy,stapedectomy or stapedotomy,hearing aid and cochlear implant,each case should be thoroughly analyzed and pay attention to the complication of cochlear implant.

目的 探讨自发性脑脊液耳漏的临床特点及治疗.方法 回顾性分析2015年7月-2016年12月手术治疗的4例自发性脑脊液耳漏患者的临床病例资料,4例患者均有细菌性脑膜炎病史,2例为内耳畸形(内耳不完全分隔Ⅰ型),漏点均位于镫骨足板;行耳后切口鼓室探查术,术中见镫骨足板缺损有清亮液体涌出,去除镫骨及砧骨,以颞肌筋膜、耳廓软骨及纤维蛋白胶封堵前庭窗.另2例漏点位于后颅窝硬脑膜,其中1例位于弓状隆起至总角水平,1例位于圆窗至外耳道下壁水平;此2例患者均行完壁式乳突开放术,显露后颅窝骨质缺损处,可见脑脊液流出,以颞肌筋膜、耳廓软骨、乳突皮质骨骨粉及纤维蛋白胶封堵缺损.结果 4例患者术后随访23 ～39个月,脑脊液耳漏及脑膜炎均无复发.结论 自发性脑脊液耳漏发病率低,容易漏诊、误诊,以致脑膜炎反复发作.听力下降伴脑膜炎的患者应高度怀疑自发性脑脊液耳漏的可能.

The aim of this study was to evaluate the feasibility of hepatectomy in elderly patients with hepatocellular carcinoma (HCC). A total of 1,142 patients, undergoing hepatectomy for HCC from January 2010 to December 2013, were recruited into this retrospective study. Samples were classified into three groups according to age: young group (< 65 years), young-old group (65-79 years), and old-old group (>= 80 years). Compared to the young group, lower BMI, lower hepatitis B virus infection rate, higher ASA grade, and Child-Pugh grade A were more frequent both in young-old and old-old groups. Rate of overall complications was elevated along with increasing age. Rate of severe complications, similar in the young (5.1%) and young-old (5.8%) groups, sharply surged in the old-old group (18.8%). Multivariate analysis displayed that risk of overall complications was strongly associated with age, Child-Pugh grade, ASA grade, and multiple comorbidities. Rates of overall survival (OS) were 31.9%, 57.1% and 63.0% in young, young-old, and old-old groups, respectively. These suggest that OS rates reduce with age. Multivariate analysis also showed that OS rate was negatively related to the number of tumors, satellite nodule, vascular invasion, portal vein thrombosis, TNM stage, and BCLC stage. When adjusted for confounding factors, young-old age was not a risk factor for poor outcomes but old-old age was. Thus, hepatectomy is relatively safe and beneficial for the young-old, while the decision to conduct hepatectomy for the old-old should be made carefully.

OBJECTIVETo investigate the efficacy of operations of acquired middle ear cholesteatoma.METHODSRetrospectively analyzed clinical data of 102 patients whom received tympanoplasty with CWU or CWD with mastoid obliteration in our hospital between January 2014 and December 2014. Patients were divided into different groups according to types of the cholesteatoma as well as the different surgical procedures. Patients were followed up for 12-24 months, the pre and post-operative PTA was performed and evaluated. The post-operative hearing was assessed in terms of average ABG.RESULTSThe average dry ear time was (5.4±1.7)weeks. The dry ear time of patients of attic cholesteatoma was shorter than those of tensa cholesteatoma[(4.9±1.7)weeks vs(6.1±1.5)weeks, t=-3.52, P=0.001]; the dry ear time of patients underwent CWU was shorter than those underwent CWD with mastoid obliteration[(2.3±0.5)weeks vs(5.8±1.4)weeks, t=-8.43, P=0.000]. Mean pre and post-operative air bone gaps in 93 ears underwent ossiculoplasty were (34.2±11.8)dB and (19.0±5.5)dB respectively and these differences were statistically significant. Both the pre and post-operative air bone gaps of ears of attic cholesteatoma were smaller than those ears of tensa cholesteatoma(P<0.05). In the patients who underwent ossiculoplasty with CWD with mastoid obliteration, the post-operative air bone gaps of attic cholesteatoma were smaller than those of tensa cholesteatoma(P<0.05). Both the pre and post-operative air bone gaps of ears underwent CWU were smaller than those underwent CWD with mastoid obliteration(P<0.05). The post-operative air bone gaps of ears underwent PORP with CWD with mastoid obliteration were smaller than those underwent TORP with CWD with mastoid obliteration(P<0.05).CONCLUSIONSBoth the hearing loss and the outcome of tensa cholesteatoma are worser than attic cholesteatoma. The outcome of PORP is better than TORP. The patients who will accept CWU should be selected more carefully and be followed up regularly.