Active Facial nerve (FN) management, including decompression, end-to-end or rerouting anastomosis, and grafting consistently plays an important role in the surgical management of petrous bone cholesteatoma (PBC), and postoperative FN function is also a major concern for surgeons. The aim of this study is to analyze the long-term FN function outcomes in PBC patients with FN paralysis who have underwent different managements and to explore the prognostic factors. A retrospective analysis of 160 PBC patients with preoperative FN paralysis was conducted, and long-term FN function outcome was evaluated. Multivariate ordinal logistic regression models were used to determine the prognostic factors. 160 patients were collected. 102 males (63.75

This study was to explore the role of ELOVL6 in the development of head and neck squamous cell carcinoma (HNSCC). Considering its previously identified oncogenic role in hepatocellular carcinoma. ELOVL6 gene expression, clinicopathological analysis, enrichment analysis, and immune infiltration analysis were based on the data from Gene Expression Omnibus and The Cancer Genome Atlas, with additional bioinformatics analyses performed. Human HNSCC tissue microarray and cell lines were used. The expression of ELOVL6 in HNSCC was detected by quantitative polymerase chain reaction, immunohistochemistry assay, and western blot analysis. The proliferation ability of HNSCC cells, invasion, and apoptosis were evaluated using cell counting kit-8 method, Transwell assay, and flow cytometry, respectively. Based on the data derived from the cancer databases and our HNSCC cell and tissue studies, we found that ELOVL6 was overexpressed in HNSCC. Moreover, ELOVL6 expression level had a positive correlation with clinicopathology of HNSCC. Gene set enrichment analysis showed that ELOVL6 affected the occurrence of HNSCC through WNT signaling pathway. Functional experiments demonstrated that ELOVL6 knockdown inhibited the proliferation and invasion of HNSCC cells while promoting apoptosis. Additionally, compound 3f, an agonist of WNT/β-catenin signaling pathway, enhances the effect of ELOVL6 on the progression of HNSCC cells. ELOVL6 is upregulated in HNSCC and promotes the development of HNSCC cells by inducing WNT/β-catenin signaling pathway. ELOVL6 stands a potential target for the treatment of HNSCC and a prognosis indicator of human HNSCC.

目的 探讨经颅中窝入路颞骨岩部胆脂瘤切除的手术适应证、手术要点及面、听功能保护.方法 回顾性分析2006年1月至2021年1月我科经颅中窝入路手术治疗的颞骨岩部胆脂瘤病例的临床症状、体征、影像学特点、面神经修复方法、面、听功能保护、手术效果,总结分析颅中窝入路颞骨岩部胆脂瘤切除手术的适应证及手术要点.结果 接受颞骨岩部胆脂瘤外科切除的186例病例中,有56例患者采用颅中窝或颅中窝-乳突联合入路的手术方式.该组患者常见的临床症状分别为:听力下降(54/56,96.4%),面神经麻痹(42/56,75.0%)及耳漏(30/56,53.6%).依据Sanna分型:迷路上型39例(69.6%),广泛型11例(19.6%),岩尖型6例(10.7%).术前47例患者存在骨导听力,其中22例术后保留骨导听力,骨导听力保留率46.8%.手术涉及面神经的有36例(64.3%),其中20例行面神经减压术,1例行面神经端端吻合术,15例行面神经改道吻合术.术前面神经功能按House-Braekmann(H-B)法分级:Ⅰ级14例,Ⅱ级3例,Ⅲ级3例,Ⅳ级4例,Ⅴ级10例,Ⅵ级22例.术后面神经功能H-B分级:Ⅰ级15例,Ⅱ级11例,Ⅲ级11例,Ⅳ级9例,Ⅴ级1例,Ⅵ级9例.术后随访2-16年,1例患者术后5年复发,再次行手术切除.所有患者术后未发生硬膜外出血、颅内感染等并发症.结论 颅中窝入路是彻底切除迷路上、岩尖及部分广泛型岩部胆脂瘤、同时保留功能正常面神经和残留听力的最佳选择.面神经受损的患者可以依据损伤部位和程度的不同,采取减压、改道吻合或神经桥接移植以重建面神经功能.通过颅中窝入路切除岩部胆脂瘤,部分患者的听力有可能保留.

Background Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments. Methods Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed. Results Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery ( P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery ( P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III. Conclusions Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.

Head and neck squamous cell carcinoma (HNSCC) is a high mortality disease. Extension of long-chain fatty acid family member 6 (ELOVL6) is a key enzyme involved in fat formation that catalyzes the elongation of saturated and monounsaturated fatty acids. Overexpression of ELOVL6 has been associated with obesity-related malignancies, including hepatocellular carcinoma, breast, colon, prostate, and pancreatic cancer. The following study investigated the role of ELOVL6 in HNSCC patients. Gene expression and clinicopathological analysis, enrichment analysis, and immune infiltration analysis were based on the Gene Expression Omnibus (GEO) and the Cancer Genome Atlas (TCGA), with additional bioinformatics analyses. The statistical analysis was conducted in R, and TIMER was used to analyze the immune response of ELOVL6 expression in HNSCC. The expression of ELOVL6 was related to tumor grade. Survival analysis showed that patients with high expression of ELOVL6 had a poor prognosis. Moreover, the results of GSEA enrichment analysis showed that ELOVL6 affects the occurrence of HNSCC through fatty acid metabolism, biosynthesis of unsaturated fatty acids, and other pathways. Finally, ELOVL6 verified by the Human Protein Atlas (HPA) database were consistent with the mRNA levels in HNSCC samples. ELOVL6 is a new biomarker for HNSCC that may be used as a potential predictor of the prognosis of human HNSCC.

OBJECTIVE To investigate the effects of Deoxygedunin on Aβ deposition, learning memory, and oxidative stress induced by D-galactose combined with AlCl3 in model rats with Alzheimer's disease and its possible mechanism. METHODS Male SD rats were randomly divided into three groups (n=12):control group, model group (AD) and intervention group (AD+Deo). Morris water maze test was used to detect learning/memory and cognitive function in rats.Glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and malondialdehyde (MDA) contents in homogenate of hippocampus were detected by enzyme-linked immunosorbent assay (ELISA).Tau protein expression in rat cerebral cortex was detected by immunohistochemistry.Western blot was used to detect the expressions of extracellular signal regulated kinase 1(ERK1), protein kinase B (PKB) and tropomyosin-related kinase B (TrkB) on TrkB signaling pathway. RESULTS The results of water maze test showed that D-galactose combined with AlCl3 induced a significant increase in the escape latency compared with the control group (P<0.05).Deoxygedunin could reverse the increase of the escape latency of the model group (P<0.05).On the 7th day after removal of the platform, the model group showed an increase in escape latency compared with the control group and the intervention group (P<0.01), and the number of crossing platforms was declined (P<0.05); The results of immunohistochemistry and ELISA showed that the expressions of Aβ and tau protein in the model group were increased significantly compared with those of the control group (P<0.01).The activities of SOD and GSH-Px were decreased significantly and the content of MDA was increased significantly.Compared with the model group, Deoxygedunin could reverse the increase of the expressions of Aβ and tau protein (P<0.01), the decrease of SOD and GSH-Px activities (P<0.05) and the increase of the MDA content (P<0.05).Western blot results showed that Deoxygedunin treatment reversed the decreased phosphorylation levels of TrkB, AKT and ERK1 in hippocampus of the model group. CONCLUSIONS Supplement of Deoxygedunin can significantly reverse Aβ deposition, oxidative stress and cognitive deficits by activating the TrkB signal transduction pathway, which suggest that Deoxygedunin may serve as a promising therapeutic candidate for attenuating AD-like pathological dysfunction induced by D-galactose combined with AlCl3.

The cochlear blood-labyrinth barrier (BLB), located in the stria vascularis, is critical for the homeostasis of cochlear solutes and ion transport. Significant disruption to the BLB occurs early during noise‑induced hearing loss. Matrix metalloproteinase (MMP)‑2 and ‑9 are important molecules known to be capable of degrading tight junction (TJ) proteins. The TJ proteins are important components of the extracellular matrix (ECM), required to maintain BLB integrity and permeability. Previous studies have demonstrated that MMP‑2 and ‑9, rich in healthy cochlea, serve an essential role in regulating the cochlear response to acoustic trauma. The present study investigated the localization and function of MMP‑2 and ‑9 in the BLB by determining their associated gene expression and activity under normal conditions and after noise exposure. Analysis of gene expression by RNA‑sequencing (RNA‑seq) revealed expression of 15 MMP‑associated genes, including genes for MMP‑2 and ‑9, in healthy stria vascularis. Expression of these MMP genes was dynamically regulated by noise trauma to the cochlea, and accompanied by alterations in tissue inhibitors of metalloproteinases (TIMPs) and the TJ protein zona‑occludens 1 (ZO‑1). These alterations suggested that MMP‑2 and ‑9 serve an important role in maintaining the integrity of BLB and in response to acoustic trauma. MMP‑2, MMP‑9 and ZO‑1 protein expression levels in the stria vascularis by immunofluorescence, and observed that the stable expression of MMP-2 and ‑9 in healthy stria was markedly increased following noise exposure, consistent with the RNA‑seq results. The compact structure of ZO‑1 in the BLB loosened, and strial capillaries exhibited markedly increased leakage of Evans blue dye following acoustic trauma. These data indicated that mediation of MMP‑2 and ‑9 in structural damage to TJ proteins, including ZO‑1, may be an important mechanism in the breakdown of the BLB following acoustic trauma. Additionally, these results indicated that MMPs are involved in regulating the integrity and permeability of the BLB, which may provide a theoretical basis for the prevention of noise‑induced hearing loss.

Objective: To investigate the choice of surgical approach of petrous bone cholesteatoma (PBC)and surgical outcomes. Methods: A retrospective study was performed on 90 patients diagnosed and treated for PBC from January 2000 to December 2014 by the Chinese People's Liberation Army General Hospital otolaryngologists. According to Sanna's classification, 40 out of the 90 cases were supralabyrinthine, five infralabyrinthine, four infralabyrinthine-apical, 25 massive and 16 apical. Five cases underwent transmastoid and retrolabyrinthine approach, translabyrinthine approach was performed on six patients, 19 cases underwent subtotal petrosectomy, seven cases underwent transotic approach, 41 cases underwent middle fossa approach, combined transmastoid/middle fossa approach was performed on 11 cases, translabyrinthine and sphenoid sinus approach were performed on one case. Supralabyrinthine cases mainly applied middle fossa approach (77.5%, 31/40) and combined transmastoid and middle-fossa approach(20.0%, 8/40). Combined transmastoid-retrolabyrinthine approach were applied for all the infralabyrinthine cases (100.0%, 5/5). Infralabyrinthine-apical cases mainly applied subtotal petrosectomy (75.0%, 3/4). Massive cases mainly applied subtotal petrosectomy (60.0%, 15/25), transcochlear approach (20.0%, 5/25), and translabyrinthine approach (16.0%, 4/25). Apical cases mainly applied middle fossa approach (62.5%, 10/16). Results: Ninty percent (18/20) of the patients who had preoperative grade Ⅰ facial nerve function maintained in the postoperative period. Out of 90 cases, only 11 cases received open cavity, and the rest cases received cavityobliteration. There were three cases of recurrence, four cases of cavity infection, three cases of cerebrospinal fluid leakage, and one case of epidural hematoma, who all received surgeries. Conclusions: Sanna's classification should be used to classify different kinds of PBC cases, choose the best surgical approach for different cases, and preserve or repair facial function during removal of PBC, and thus reduce recurrence and complications.

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Objective To analyze the medical and audiological features of trauma induced stapes fracture ,and to summarize the key diagnostic points and to observe the effects of surgical treatment .Methods Five patients with trauma induced stapes fracture confirmed by the surgical exploration from January 1995 to October 2013 were retro_spectively reviewed .Ossicular chain reconstruction was performed on each patient .The preoperative and postopera_tive pure-tone thresholds were compared to judge the effects of surgical treatment .ResuIts The surgical explora_tion revealed 4 cases of stapes feet fracture ,1 case of stapes neck fracture with temporal bone fracture and peripheral paralysis of the facial nerve .Different types of ossicular reconstruction were performed according to the exploration results:2 cases with autogenous stapes remodeling ,1 case with allogenous stapes remodeling ,1 case with bone piece of external acoustic meatus ,and 1 case with artificial auditory ossicle(TORP) implanting .Additionally ,the case of peripheral paralysis of the facial nerve received facial nerve decompression .After the operation ,5 patients felt that their hearing was improved .The mean postoperative pure-tone threshold was 30 .7 dB HL ,and the mean ABG(air-bone-gap) was 18 dB HL while the mean preoperative pure-tone threshold was 61 dB HL(t=6 .725 ,P<0 .05) and the mean ABG was 38 .7 dB HL(t=3 .616 ,P<0 .05) .The facial nerve functions of the case with facial paralysis recovered to House-Brackmann Grade I three months after receiving facial nerve decompression .ConcIu_sion Stapes fractures are rare .Being different from the general conductive hearing loss ,patients with stapes fracture usu_ally have the acoustic stapedius reflex .Through ossicular reconstruction ,we can yield a satisfying hearing recovery .

Objective To discuss on clinical features, radiological characteristics, differential diagnosis and surgical approaches in treating facial nerve tumors and repairing the nerve, as well as treatment outcomes. Methods Cases of facial nerve tumor cases reported after 2002 in Pubmed, Medline, LWW, Elsevier, Springer, CKNI and CQVIP were reviewed in comparison to cases treated by the authors. Results A total of 23 reports were identified covering a total of 354 cases. The average onset age 43.90 years and sex ratio was 1:1.1. Facial palsy, hearing loss and tinnitus were the most common present-ing symptoms. In 271 of the 354 cases, facial nerve function before operation were reported (normal=113, House-Brackman grade II=30, H-B grade III=38, H-B grade IV=29, H-B grade V=29, H-B grade VI=32. The horizontal segment and geniculate ganglion were the most location of involvement. Surgical approach selection depended on tumor location and hear-ing level before operation. Mastoid and labyrinthine approach were commonly used. Facial nerve repairing method was dictat-ed by the length of facial nerve defect and the availability of facial nerve stump . Greater auricular nerve grafts were the most common material used to repair facial nerve in our cases. Of the 208 cases with followed-up data, facial function reached H-B grade I in 34 cases, H-B grade II in 27 cases, H-B grade III in 76 cases, H-B grade IV in 48 case s, H-B grade V in 6 cases and H-B grade VI in 17 cases. Conclusion Facial palsy, hearing loss and tinnitus are the most common symptoms in facial nerve tumors. The seemingly impossible facial nerve tumors must be considered in patients with facial palsy. The hori-zontal segment and geniculate ganglion are most often involved in facial nerve tumors. Selection of operation approach is de-termined by the location and site of the tumor and if residual hearing is to be preserved. Facial nerve repair should be consid-ered unless examination indicates complete loss of facial function and electromyography shows no action potentials before op-eration. Better facial nerve function before operation often suggest better prognosis of facial function recovery.

Petrous bone cholesteatoma is a rare clinical disease. It grows around the labyrinth very slowly. It has the similar clinical symptoms with other temporal bone diseases such as:hearing loss, facial palsy, and vertigo. so itcan be easily misdiagnosed. With the development of imaging technology and microsurgery techniques, significant progress has been made in the diagnosis and treatment of petrous bone cholesteatoma. This research mainly reviews literatures on petrous bone choles-teatoma in recent years, with a summary on the methods of its diagnosis and differential diagnosis, PBC classification, choice of surgical approach, optimal treatment scheme, and selection of suitable operative methods. In the end, we hope to provide an optimized therapeutic approach to improve patient’s quality of life.

Objective The purpose of this rieview is to study management of bilateral facial nerve paralysis in temporal bone fracture. Methods This is a retrospective review of 8 cases of bilateral facial paralysis after bilateral temporal bone frac-ture that were treated with facial nerve decompression on at least one side. High-resolution computed tomography, audiomet-rictests and electromyogram (EMG) were obtained. Evaluation of the facial nerve function according to the House-Brackmann (H-B) grading scale. The decision for surgery was based mainly on the results of afore mentioned evaluations. Timing and the efficacy of surgical intervention were evaluated by pre-vs. post-operative facial nerve function assessments, as well as com-parison between the operation side and the opposite side. Results All the 8 patients were male, aged between 19 and 49 years. Traffic accident was the most commom cause (5/8). Fracture was longitudinal in all 16 temporal bones, with immediate onset of facial paralysis. Preoperative facial nerve function is between gradesⅤ and Ⅵ, in H-B scale, and with l patient showing bilateral conductive hearing loss, 4 Ratients showing bilateral lugh-frequency sensorineural deafness and 3 Ratients showing normal hearing. Among 8 patients, Facial nerve decompression was performed in 11 ears. H-B gradeⅠ-Ⅱfacial nerve function were aclueved in all cases at follow up (more than l year in some). The only patient with bilateral conductive hearing loss also received bilateral ossicular reconstruction, followed by recovery to normal hearing. Conclusions Traffic crash continues to be themain cause of temporal bone fracture and hilaterd faial paralysis and hilaterd faial paralysis. Facial paralysis caused by tempo-ral bone trauma can be satisfactorily treated with decompression.

Objective To discuss issues of facial nerve protection during surgery and recovery of facial nerve function after surgery. Methods This was a retrospective study on 79 cases treated for petrous bone cholesteatoma from 1/1/00 to 31/12/12 by PLA General Hospital otolaryngologists. Facial nerve decompression, primary end-to-end anastomosis, great auricu-lar nerve grafting or facial-hypoglossal anastomosis were adopted for restoration of facial nerve function. Facial nerve func-tion was assessed according to House-Brackmann(H-B) Grade. Results The most common location of facial nerve injury was in the labyrinth segment. Facial nerve re-animation methods included facial nerve decompression (n=48), end-to-end anas-tomosis (n=5), rerouting (n=3), greatre auricular nerve grafting (n=3), facial-hypoglossal nerve anastomosis (n=10), and others (n=10). The facial nerve function was assessed before and after surgery. 48 patients were followed up more than 1 year.Among them,29 patients underwent facial nerve decompression , 22 recovered to H-B I, 2 recovered to H-BⅡ,1 re-covered to H-BⅢ,3 recovered to H-BⅣ, and 1 recovered toⅤ. Of the 4 patients who underwent end-to-end anastomosis, 1 recovered to H-BⅡand 3 recovered to H-BⅢ. Of the 3 patients who underwent facial nerve rerouting, 2 recovered to H-BⅢ,and 1 recovered to H-BⅣ. Of the 2 patients treated with greater auricular nerve grafts, 1 recovered to GradeⅣ, and 1 recovered to Grade Ⅴ. Of the 7 patients receiving facial-hypoglossal nerve anastomosis treatment, 1 recovered to GradeⅢ,4 recovered to GradeⅣ,and 2 recovered to GradeⅤ. Facial function remained unchanged in the 3 cases with no treatment. Conclusions During petrous bone cholesteatoma surgeries, surgeons should protect the facial nerve carefully. When facial nerve injury is noticed, various methods can be used for immediate repair.

Objective To summarize and analyze the pathogenesis,methods of hearing reconstruction and curative effect of mixed hearing loss.Methods Patients with mixed hearing loss who underwent hearing reconstruction from Jan 2009to Dec 2011in the ENT department of PLA General hospital were reviewed retrospectively.After the operation,air conduction(AC),bone conduction(BC),air-bone gap(ABG)at main frequencies and audiometry changes were analyzed.Results Among 32cases,15cases were chronic otitis media,13cases otosclerosis,2cases Van der Hoeve,and 2cases congenital middle ear malformations.There were 26cases with significantly improved hearing after surgery,and the effective rate was 81.25%.AC showed great improvement at 0.25~4kHz(P <0.05)while there was no change at 8kHz(P>0.05).BC showed improvements at 1and 2kHz and improved significantly only at 2kHz.After operation,pure tone audiometry at AC and BC separately improved 24.94±8.15 dB and 5.90±7.96dB;ABG narrowed down to 19.04±11.06dB.Conclusion Mixed hearing losses are mostly seen in chronic otitis media and tympanosclerosis.After auditory rehabilitation,patients can experience improved hearing.

Objective To analyze the pathogenesis,treatment and prognosis of delayed facial palsy after tympanoplasty.Methods The occurrence time,classification,contributory factors,treatment and facial nerve function outcomes in cases with delayed facial palsy after tympanoplasty treated from March 2009 to March 2012 at the Department of Otolaryngology Head and Neck Surgery,PLA General Hospital were reviewed.Result The incidence of delayed facial palsy after tympanoplasty was 1.15%(23/1992).Facial palsy happened between 5 and 14 days(average 7.39±1.95 days) after surgery.Patients with positive syphilis specific antibodies were 32.65 times more likely to have facial palsy than those without.Facial nerve function was House-Brackmann(HB) Grade III in 2 cases,IV in 13 cases and V in 8 cases.In the patients who were treated with glucocorticoid steroids and anti-virus drugs after onset of facial palsy,facial nerve function recovered to Grade HB-I after 3 weeks to 2 months.Conclusion The pathogenesis of delayed facial palsy after tympanoplasty is similar to Bell's palsy.Facial nerve function can restored to normal in the patients treated with corticosteroids and anti-virus drugs when treated early.

目的分析人工耳蜗植入术(CI)后的面瘫并发症病例,探讨并发症的预防和处理方法.方法对1998年3月~2012年1月在解放军总医院耳鼻咽喉-头颈外科接受人工耳蜗植入的1299例患者中发生的面瘫并发症及其处理和预后情况进行回顾性分析.结果1299例患者中,4例患者行人工耳蜗植入术后发生面神经麻痹,其中3例为迟发性面瘫,2例行面神经减压术,预后良好.结论人工耳蜗植入是相对安全的手术,面神经麻痹的发生率较低,为0.31%,经保守治疗或手术干预预后良好.