临床耳鼻咽喉头颈外科杂志
Journal of Clinical Otorhinolaryngology Head and Neck Surgery 림상이비인후두경외과잡지
- 主管单位： 中华人民共和国教育部
- 主办单位： 华中科技大学同济医学院附属协和医院
- 影响因子： 0.83
- 审稿时间： 1-3个月
- 国际刊号： 1001-1781
- 国内刊号： 42-1764/R
- 论文标题 期刊级别 审稿状态
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外耳道粒细胞肉瘤致面瘫1例
A male patients at 11 years of age, was hospitalized for the right ear pain and mouth deviation for five days on August 30, 2016, accompanied by right hypophasis, right ear hearing loss, tinnitus, without otorrhea and vertigo.Patient was diagnosed as acute promyelocytic leukemia in 2008.After standardized chemotherapy, it was completely relieved and the blood and bone marrow images were almost restored to normal.Physical examination:The skin of the right external auditory canal is obviously swollen, without rupture on the surface, and the tympanic membrane cannot be seen.The drooping of the left angle of the mouth, the right eyelid is not closed completely, the right nasolabial groove and forehead line is shallower.House-Brackmann facial nervous systemⅢ.Routine blood:the leucocyte 10.31×109/L, more than in the normal range.Pure tone measurement showed that right ear conductive deafness, air-bone conduction difference of each frequency range 50 to 75 dB.Mastoid CT showed that right mastoid gasification is good, the right external auditory canal, middle ear cavity and mastoid airway are filled with low-density soft tissue shadows, the bone wall of the external auditory canal was not significantly enlarged or damaged.The auditory bone is intact, surrounded by a large number of soft tissue shadows, no obvious abnormalities in the inner ear.Primary diagnosis:Middle ear cholesteatoma (right);External auditory canal tumor (right);Peripheral facial paralysis (right).
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儿童特殊类型的支气管异物1例
A 9 year-old boy suffering from cough for half a month, fever for 4 days was hospitalized.CT three-dimensional reconstruction showed that a metallic needle-like foreign body within the right main bronchial with pneumonia and atelectasis.In the next day, the boy took examination using an open-tube rigid bronchoscope under general anesthesia.For the first time, the foreign body was jammed in glottis with SpO2 and HR declining.For the second time, the operator found the foreign was not a needle but a thumbtack.Finally, the thumbtack was removed from the airway after short-term paralysis using succinylcholine.
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颈咽综合征1例
Cervical pharyngeal syndrome is characterized by the symptom such as sore throat, foreign body sensation or swallowing discomfort which caused by the pathological changes of cervical intervertebral disc and intervertebral structure nonspecific injury.Because of the lack of obvious specificity, it is easy to misdiagnose.Here, we reported a case of cervical pharyngeal syndrome.The symptom were obviously improved after conservative treatment, but the follow-up time is short, and further follow-up is needed.In the process of diagnosis and treatment, in order to reduce misdiagnosis and mistreatment, we should strengthen the understanding of the disease, broaden the clinical thinking, and understand the anatomical relationship between the pharynx and the surrounding organs.
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嗓音疲劳的诊疗研究进展
Vocal fatigue is a common symptom of voice disease, but we prefer to regard vocal fatigue as a separate voice disease.In this paper, the etiology, pathogenesis and clinical diagnosis and treatment of vocal fatigue are reviewed in order to provide reference for the standardized diagnosis and treatment of this disease.
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侵犯前连合早期声门型喉癌的治疗研究进展
Early glottic laryngeal cancer usually refers to the Tis-T2 lesion without cervical lymph node and distant metastases.Radiotherapy of early glottic laryngeal cancer, CO2 laser microsurgery, open surgery, plasma radiofrequency ablation, photodynamic therapy, biological targeting therapy have achieved good therapeutic effect.However, due to the special nature of its anatomy, it is controversial about the treatment of early glottic laryngeal cancer which involves the anterior commissure.In this article, we reviewed the conventional treatment of radiation therapy, CO2 laser microsurgery, open surgery, plasma radiofrequency ablation.
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儿童单侧聋的发现途径及病因分析
目的:探讨儿童单侧聋的发现途径及病因, 为临床诊断、治疗提供依据.方法:回顾性分析36例单侧聋儿童的病史、颞骨薄层CT和内听道MRI检查结果, 分析儿童单侧聋的发现途径及影像学评估结果.结果:儿童单侧聋的平均诊断年龄是6周岁, 经新生儿听力筛查发现的患儿平均诊断年龄是7.7月龄.80.6％的患儿有内耳畸形, 其中96.6％的患儿蜗神经发育不良, 占总研究人数的77.8％.结论:新生儿听力筛查可早期发现儿童单侧聋.蜗神经发育不良是儿童单侧聋的主要病因.内听道MRI应作为儿童单侧聋的首选影像学检查.
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声带白斑形态分型与选择性保守治疗预后相关性分析
目的:探讨声带白斑形态分型与选择性保守治疗预后的相关性.方法:对不同形态分型的声带白斑患者先进行保守治疗, 其中保守治疗未治愈及治愈后复发者采用CO2激光手术切除治疗, 回顾性分析三种形态分型声带白斑患者的疗效.结果:236例声带白斑包括78例平坦光滑型, 146例隆起光滑型和12例粗糙型, 保守治疗的治愈率分别为80.8％、65.1％和0％ (P＜0.01), 其中158例获得治愈的患者1年内复发率为10.1％ (平坦光滑型与隆起光滑型的复发率分别为6.3％和12.6％, P=0.283).
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环甲膜切开术在紧急呼吸道管理中的应用分析
目的:探索环甲膜切开在紧急呼吸道管理中作为首选方法的可行性.方法:分析27例行环甲膜切开术患者的临床资料等相关数据.结果:患者病因学分布主要为头面部或颈部重度外伤、喉狭窄、口底及颌下间隙感染等;首选环甲膜切开术作为气道管理者16例 (A组), 先行常规气管切开术中改行环甲膜切开者11例 (B组), A组、B组平均气道开放时间分别为 (58.12±24.41) s和 (739.09±245.29) s, 两组比较差异有统计学意义 (P＜0.01).同时, 根据患者是否仅行环甲膜切开术, 分为仅行环甲膜切开组 (14例) 和环甲膜切开+气管切开组 (13例), 两组术中出血量差异有统计学意义[分别为 (2.36±1.16) ml和 (14.65±4.31) ml, P＜0.01].除1例术后因原发病死亡, 4例因喉狭窄行喉扩张术带T型扩张管, 2例双侧喉返神经麻痹患者未行进一步治疗而长期带管外, 余20例患者平均带管时间为 (12.35±7.29) d, 未出现喉或气管狭窄等术后并发症, 均顺利拔管.结论:环甲膜切开术快速安全, 且操作简单易行, 临床上发生紧急困难呼吸道管理时可作为快速开通呼吸道的首选方法.
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改良美容切口及皮肤粘合剂在腮腺良性肿瘤功能性外科中的应用
目的:探讨改良美容切口及氰基丙烯酸辛基酯皮肤粘合剂 (Dermabond) 在腮腺良性肿瘤功能性外科中的临床应用价值及相关技术.方法:将42例腮腺良性肿瘤患者随机分为A、B两组, A组应用改良美容切口作为入路, 术后采用6-0可吸收薇乔缝线真皮内缝合外用Dermabond粘合进行切口关闭;B组采用传统S形切口, 术后采用4-0普里灵 (Prolene) 缝线进行皮肤单层连续缝合.比较两组的手术时间、术后引流量、面神经功能、涎瘘、Frey综合征、术区麻木程度、瘢痕和美观满意度等指标.采用SPSS20.0软件包对数据进行统计学分析.结果:手术时间、面神经功能、Frey综合征、涎瘘、面部畸形、耳垂麻木、永久性面瘫及肿瘤复发在两组间的差异无统计学意义 (P＞0.05);而术后引流量、术区麻木程度、面部美观满意度及术后瘢痕, A、B两组差异有统计学意义 (P＜0.05).结论:应用改良美容切口及Dermabond安全可行, 并发症低于传统术式, 瘢痕微小且隐蔽, 患者满意度高, 达到了微创治疗的效果.
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耳内镜下同期双侧鼓室成形术疗效观察
目的:探讨耳内镜下双侧同期鼓室成形术的可行性及疗效.方法:对15例 (30耳) 双侧慢性化脓性中耳炎患者行耳内镜下双侧同期鼓室成形术, 将病变较重侧作为第一手术耳优先手术, 对侧耳为第二手术耳;共完成鼓室成形术Ⅰ型22耳、鼓室成形术Ⅱ型5耳、鼓室成形术Ⅲ型3耳, 其中第二手术耳 (15耳) 均施行鼓室成形术Ⅰ型.术中取用第一手术耳侧的耳屏软骨-软骨膜瓣作为双侧鼓膜修复材料.以术后6个月耳内镜下鼓膜情况及纯音听阈结果评估鼓膜愈合成功率及术后听力改善程度.结果:15例 (30耳) 患者术后鼓膜一期完全愈合29耳 (96.7％), 其中第一手术耳14耳, 愈合率93.3％ (14/15), 第二手术耳15耳, 愈合率100.0％ (15/15).平均气导听阈由术前 (50.9±9.1) dB HL提高到 (32.0±6.0) dB HL, 平均气骨导差由术前 (30.2±7.9) dB HL缩小到 (13.7±6.0) dB HL, 术前术后比较, 差异均有统计学意义 (均P＜0.01).结论:耳内镜下鼓室成形术具有精细、微创的特点, 选择适当病例可以在耳内镜下同期完成双侧鼓室成形术, 疗效满意, 无严重并发症发生, 同时能缩短手术时间, 降低医疗成本, 值得临床推广.
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Van der Hoeve综合征
Van der Hoeve综合征又称Van der Hoeve-de Kleyn综合征、耳聋-蓝巩膜-脆骨综合征, 以传导性听力下降、蓝巩膜及多发性骨折三联征为特点, 群体发病率约为1/15 000, 在中国人群发病率约为0.04％.
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Treacher Collins综合征的精准诊断与治疗(临床篇)
Treacher Collins综合征 (Treacher Collins syndrome, TCS, OMIM 154500), 又称Franceschetti-Klein综合征, 是常见的下颌面骨发育不全综合征 (mandibulofacial dysostosis).Thompson和Toynbee分别于1846、1847年首次报道TCS;Berry于1889年将其描述为一种伴下眼睑缺损的先天性新生儿畸形;1900年英国医生Treacher Collins首次描述本病为颧骨-下眼睑缺损综合征;1949年Franceschetti等系统描述本病特征, 并将其命名为下颌面骨发育不全.近20余年未有大规模TCS流行病学调查, 通常认为其发病率为1/50 000.
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Treacher Collins综合征的精准诊断与治疗(基础篇)
1 概述1.1 简介Treacher Collins综合征 (Treacher Collins syndrome, TCS), 又称Treacher Collins-Franceschetti综合征、Franceschetti-Zwahlen-Klein综合征, 是人类下颌面骨发育不全征 (mandibulofacial dysostosis disorder) 中常见的一种.
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耳聋甲发育不全综合征
遗传性耳聋是常见的人类遗传疾病之一, 平均1 000人中就有1名为出生时即形成听力障碍的先天性耳聋患者.遗传性耳聋具有广泛的遗传异质性, 30％为综合征型耳聋, 70％为非综合征型耳聋.人们对遗传性耳聋的认识是从综合征型耳聋家系的分析开始的, 如Usher综合征、Waardenburg综合征等.综合征型耳聋中有一类常伴有其他外胚层发育畸形, 如皮肤体壁系统紊乱或骨发育畸形等.
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正常豚鼠ACS-VEMPs动物检测方法的建立
目的:建立动物实验VEMPs检测方法, 确定正常豚鼠气导声刺激 (ACS) 的颈肌前庭诱发肌源性电位 (cVEMP) 、眼肌前庭诱发肌源性电位 (oVEMP) 的实验方法和波形引出特点, 从而为cVEMP和oVEMP的后续研究奠定实验基础.方法:选择11只健康豚鼠 (250～350g), 使用特制的动物固定架, 保持动物俯卧抬头位, 在清醒状态下行ACS-cVEMP、ACS-oVEMP, 建立正常豚鼠的VEMPs测试方法并记录分析波形特点和参数结果.结果:11只 (22耳) 健康豚鼠均可引出气导声刺激诱发的ACS-cVEMP和ACS-oVEMP.ACS-cVEMP和ACS-oVEMP的引出率分别为77.27％和59.09％;阈值分别为 (107.1±14.6) dB SPL和 (115.5±15.6) dB SPL;cVEMP的n1、p1潜伏期分别为 (7.4±1.5) ms和 (9.3±1.6) ms, oVEMP的n1、p1潜伏期分别为 (6.4±1.4) ms和 (8.1±1.8) ms;振幅cVEMP和oVEMP分别为 (15.4±8.6) μV和 (11.4±6.0) μV.在阈值、n1潜伏期、p1潜伏期和振幅参数方面, cVEMP和oVEMP无统计学差异 (P＞0.05).结论:通过本实验方法, 成功在动物 (豚鼠) 身上诱发出稳定的气导声刺激诱发的VEMPs波形, 包括cVEMP和oVEMP, 并测得正常豚鼠VEMPs的参数值, 包括引出率、阈值、潜伏期和振幅, 为将来各种内耳疾病评估前庭功能的模型奠定了良好的实验基础.
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重视基因诊断在鳃耳肾综合征中的应用
Branchio-oto-renal syndrome (BOR) is an autosomal dominant genetic disorder characterized by branchial fistulas, hearing impairment, renal malformations and auricular anomalies.Pathogenic mutations have been discovered in several genes such as EYA1, SIX5, and SIX1.However, it has a high penetrance with variable expressivity.The clinical and genetical heterogeneity is widespread amongst and within families.In this review, we describe the clinical manifestations and pathogenic genes with copy number variations in detail, and emphasize the criteria clinically and genetically to provide the basis for clinical diagnosis of BOR and genetic counseling.
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不完全分隔Ⅲ型耳蜗畸形患儿行人工耳蜗植入的临床特点及早期效果分析
目的:分析伴有不完全分隔Ⅲ型 (IP-Ⅲ) 耳蜗畸形的患儿人工耳蜗植入手术的特点及其术后早期效果.方法:回顾性分析10例IP-Ⅲ患儿术前听力学特征及言语水平, 术中手术特点, 术后耳蜗助听听阈, 术后听觉言语康复能力CAP及SIR评分及术后言语识别率结果.另外选取10例耳蜗发育正常的人工耳蜗植入患儿作为对照, 对照组在术前残余听力及言语发育水平、植入年龄、耳蜗使用品牌、耳蜗使用时间等与IP-Ⅲ组相匹配.采用SPSS 20.0软件分析IP-Ⅲ组及对照组人工耳蜗植入的术后效果.结果:所有患儿术前CT显示耳蜗呈特殊IP-Ⅲ型表现, 术中均发生较为严重的脑脊液涌出 ("井喷"), 电极均位于耳蜗内且完全植入.术后无并发症发生.术后3、6、9、12个月, IP-Ⅲ组耳蜗助听听阈分别为 (40.8±8.5) dB HL、 (36.1±9.1) dB HL、 (32.5±6.8) dB HL、 (33.0±7.3) dB HL, 与对照组相比差异无统计学意义 (P＞0.05);术后3、6、9、12个月, IP-Ⅲ组CAP评分低于对照组, 但差异无统计学意义 (P＞0.05);IP-Ⅲ组SIR评分低于对照组, 且在术后6、9、12个月差异有统计学意义 (P＜0.05).结论:人工耳蜗植入是IP-Ⅲ耳蜗畸形患儿重建听力的有效办法.该类畸形患儿行人工耳蜗植入具有一定难度, 但处理得当一般不会引发严重并发症.人工耳蜗对IP-Ⅲ耳蜗畸形患儿有效, 但术后听觉言语能力发展速度较耳蜗发育正常患儿缓慢.
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X连锁Alport综合征女性患者的临床听力学特征及与基因型的关系
目的:分析国人X连锁Alport综合征女性患者的临床听力学特点, 并探讨其听力表型与基因型之间的关系.方法:总结64例X连锁Alport综合征女性患者的临床资料, 对主要临床听力学表现进行回顾性分析, 并采用检测皮肤成纤维细胞mRNA的方法或外周血DNA扩增直接测序的方法对患者进行IV型胶原α5链基因的检测.按照突变类型分为轻型突变和重型突变, 并进行临床表型和基因型关系分析.结果:64例女性患者均有血尿或蛋白尿, 均行纯音测听、声导抗检查, 其中听力正常者51例, 听力下降者13例, 均表现为轻度或中度双侧对称性感音神经性聋, 均以中频听力下降为主, 听力曲线为槽型.64例患者中52例检测出COL4A5基因突变, 共检出42种突变.听力损失患者中, 除1例12岁外, 其余均≥35岁.25例≥35岁患者中, 轻型突变13例 (10例听力正常, 3例听力轻度下降), 重型突变12例 (6例听力正常, 6例听力轻中度下降).随访≥2年者26例, 其中7例听力呈下降趋势, 均为随访2年者, 每年下降约5dB, 余听力无明显变化.结论:国人X连锁Alport综合征女性患者, 早年出现血尿或蛋白尿, 多于中年后开始出现迟发进展性听力损失, 多为轻中度, 曲线为槽型;听力损失发生时间较男性患者晚, 并且听力损失严重程度较男性轻;听力表型与基因型之间未发现明显相关性.
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Goldenhar综合征
Goldenhar syndrome is a condition characterized by alterations involving the development of the structures of the first and second branchial arches.The abnormalities primarily affect the face, the eyes, the spine, and the ears, and the auricular abnormalities are associated with possible hearing loss.Here, we present a review of the literature on Goldenhar syndrome, discussing what is known about the clinical phenotype, the aetiology, audiological findings and treatment, in order to provide certain help for people about disease diagnosis, genetic counseling and hearing intervention.
