Benign paroxysmal positional vertigo(BPPV) is the most frequent episodic vestibular disorder. It is due to otolith rests that are free into the canals or attached to the cupulas. Well over 90% of patients can be succe...Benign paroxysmal positional vertigo(BPPV) is the most frequent episodic vestibular disorder. It is due to otolith rests that are free into the canals or attached to the cupulas. Well over 90% of patients can be successfully treated with manoeuvres that move the particles back to the utriculus. Among the great variety of procedures that have been described, the manoeuvres that are supported by evidenced-based studies or extensive series are commented in this review. Some topics regarding BPPV treatment, such as controlling the accuracy of the procedures or the utility of post-manoeuvre restrictions are also discussed.展开更多
Introduction Vestibular migraine (VM), a common disorder with familiar predisposition, is characterized by recurrent episode of dizziness or vertigo and accompanying symptoms of nausea, vomiting, and/or headaches.The ...Introduction Vestibular migraine (VM), a common disorder with familiar predisposition, is characterized by recurrent episode of dizziness or vertigo and accompanying symptoms of nausea, vomiting, and/or headaches.The patients with VM may require neurologic, emergency, or otorhinolaryngologic services, and the disorder is often misdiagnosed with posterior circulation ischemia (PCI) or transient ischemic attack (TIA), peripheral vestibular vertigo, Meniere’s disease (MD), and multiple (lacunar) cerebral infarctions.Report from population-based study showed that the prevalence of VM was up to 1%,^[1] which was one of the common disorders causing dizziness/vertigo, and the rate of misdiagnosis was up to 80%.[2] Thus, a multidisciplinary expert consensus about the definition, characteristics, related work-ups, and diagnostic criteria is needed for the accurate diagnosis and standardized management.展开更多
Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most ...Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation. Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the^electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. Results Total tumor resection was achieved in 140 cases （96.6%） and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% （132/145） of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients （Grade ! and Grade ]I, 79.3%）. No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is展开更多
Whereas much has been learned about age-related auditory changes in the inner ear, relatively little is known about the aging effects on the vestibular part of the inner ear-the peripheral vestibular system. Here we r...Whereas much has been learned about age-related auditory changes in the inner ear, relatively little is known about the aging effects on the vestibular part of the inner ear-the peripheral vestibular system. Here we review relevant literature with regard to the prevalence of vestibular dysfunction, vestibular functional and structural changes in the elderly. The prevalence of vestibular dysfunction increases with age. Functionally, as age increases, VEMP amplitudes decrease, VEMP thresholds increase, VOR gain of HIT decreases. Due to the complexity of the vestibular system, variations in subject age and measurement techniques, findings in VEMP latency and caloric tests are conflicting. To address this, a direct measure of the peripheral vestibular system should be applied. Structurally, age-related loss in vestibular ganglion and otoconia have been noted; hair cell changes are not well defined; while subcellular changes remain to be explored. Defining how the onset of vestibular dysfunction correlates with structural degeneration will offer insights into the mechanisms underlying vestibular aging.展开更多
Objective Patients suffered a lot from decompensated vestibular vertigo.Pharmacotherapy and vestibular rehabilitation training have been proven to be effective in prompting vestibular compensation.Routine rehabilitati...Objective Patients suffered a lot from decompensated vestibular vertigo.Pharmacotherapy and vestibular rehabilitation training have been proven to be effective in prompting vestibular compensation.Routine rehabilitation training is faced with the challenges of patients’compliance,completion,the average recuperation time and so on.This study is aimed to investigate advantages of short-term personalized vestibular rehabihitation at home guided by professional therapist.Methods A short-term personalized vestibular rehabilitation program(ST-PVR)was designed for patients with decompensated vestibular vertigo in this study.Results Patients experiencing the ST-PVR program showed significant improvement of Self-Rating Anxiety Scale(SAS),Dizziness Handicap Inventory(DHI),Activities-Specific Balance Confidence Scale(ABC)scores by the second follow-up(at 2nd week after treatment,P<0.05).However-improvement in the medication group occurred slightly later,DHI for 1 month and SAS for 2 months after treatment(P<0.05).Also,the improvement in the onset time of unilateral weakness(UW)at 2nd week after treatment in the personalized vestibular rehabilitation(PVR)group was faster than that in the medication group.Conclusion In general,the short-term PVR program showed great advantages by prompting vestibular compensation quickly and putting forward future direction for clinical treatment on decompensated vestibular vertigo.展开更多
Backgroud Large vestibular aqueduct syndrome （LVAS） is a major cause of hearing loss in childhood. This study aimed at measuring external aperture of enlargement of the vestibular aqueduct （EVA） and analyzing rela...Backgroud Large vestibular aqueduct syndrome （LVAS） is a major cause of hearing loss in childhood. This study aimed at measuring external aperture of enlargement of the vestibular aqueduct （EVA） and analyzing relationship between the size of external aperture and hearing loss. Methods Diagnostic criteria of LVAS were based on hearing loss and CT images. CT images of temporal bone of 100 LVAS patients were collected and 60 control subjects were reviewed retrospectively in the past 10 years. A battery of audiometric and vestibular function tests were performed. The width of the vestibular aqueduct （VA） was measured on axial CT images of the temporal bone. Results One hundred patients （65 men, 35 women） were diagnosed as having the isolated EVA. Hearing loss mostly occurred in early childhood. The diagnosis age of LVAS was 7.7 years on average. The causes of hearing loss could not be confirmed by initial consult. Typically, audiometric curve is the high-frequency down-sloping configuration. 92% of the cases had severe or profound sonsorineural hearing loss （SNHL）. The mean size of the external aperture was （7.5±1.2） mm in present LVAS. Statistical analysis showed that the degree of hearing loss is unrelated to the width of VA. Conclusions LVAS is a distinct clinical entity characterized by fluctuating, progressive SNHL. The degree of hearing loss is unrelated to the size of external aperture of VA. The protective management and hearing aid have become the main therapies. The cochlear implantation might be performed if the hearing loss affected learning at school.展开更多
The purpose of the study was to observe changes in endolymphatic hydrops by using intratympanic injection of gadolinium and magnetic resonance imaging（MRI） before and after endolymphatic sac surgery in patients with...The purpose of the study was to observe changes in endolymphatic hydrops by using intratympanic injection of gadolinium and magnetic resonance imaging（MRI） before and after endolymphatic sac surgery in patients with unilateral Meniere＇s disease. Thirteen patients with unilateral Meniere＇s disease undergoing endolymphatic sac surgery were retrospectively and prospectively analyzed. Three-dimensional fluid-attenuated inversion recovery or three-dimensional real inversion recovery MRI was performed 24 h after an intratympanic injection of gadolinium to grade the presence of endolymphatic hydrops. Among the 13 patients with hydrops confirmed by preoperative MRI, vestibular hydrops had no significant change in all patients; cochlear hydrops became negative in 2 patients, and remained unchanged in the other 11 patients after surgery. Definite vertigo attacks were substantially controlled in one patient and completely controlled in 12 patients during a follow-up period of 8-34 months after surgery. The hearing levels were improved in 3 patients, remained unchanged in 7 patients, and decreased in 3 patients. In conclusion, endolymphatic sac surgery does not always alleviate endolymphatic hydrops in patients with Meniere＇s disease. Relief from vertigo cannot always be attributed to the remission of hydrops. A change in hearing levels cannot be explained by hydrops status alone.展开更多
Objective:To investigate immune-related genetic background in intractable Meniere’s disease(MD)and the immediate results of a novel therapy by delivering steroids to the surface of the intact endolymphatic sac(ES)and...Objective:To investigate immune-related genetic background in intractable Meniere’s disease(MD)and the immediate results of a novel therapy by delivering steroids to the surface of the intact endolymphatic sac(ES)and incus in a sustainable manner.Case report and methods:Candidate genes involved in immune regulation were sequenced using a nextgeneration sequencing method in a patient with intractable MD.Mutations were confirmed using the Sanger sequencing method.The ES was exposed,and gelatin sponge particles were immersed in highdose methylprednisolone solution and placed onto the surface of ES.“L”-shaped gelatin sponge strips were immersed in dexamethasone solution and served as a guiding device for the steroids by touching the incus and gelatin sponge particles on the surface of the ES.Gelatin sponge particles immersed in dexamethasone solution were placed around the gelatin sponge strips and sealed using fibrin glue.Results:Autoinflammation in the refractory MD case was indicated by genotype,including novel heterozygous mutations of PRF1,UNC13D,SLC29A3,ITCH,and JAK3,as well as phenotype.The vertigo was fully relieved immediately after operation.Tinnitus and aural fullness were resolved 3 weeks after operation,whereas hearing improved in 2 mon postoperation.No recurrence was noted during the 5-monfollow-up,and the final MRI supported the novel therapeutic hypothesis.Conclusion:Autoinflammation was involved in a refractory MD.This novel therapy,which involves the delivery of steroids to the surface of the intact ES and incus,is effective in relieving vertigo and tinnitus and improves hearing function of refractory MD.展开更多
Objective:To investigate the efficacy of quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo (H-BPPV). Methods:Clinical data of 67 patients with H-BPPV who underwent qu...Objective:To investigate the efficacy of quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo (H-BPPV). Methods:Clinical data of 67 patients with H-BPPV who underwent quick repositioning maneuver in our hospital from July 2009 to November 2014 were retrospectively analyzed. The maneuver involved rotating the patient in the axial plane for 180? from the involved side towards contralateral side as quickly as possible. Results:Complete symptom resolution was achieved in 61 patients (91.0%) at one week and in 64 patients (95.5%) at 3 months post-treatment. During the repositioning maneuver process, there were no obvious untoward responses except transient nausea with or without vomiting in a few patients. Conclusion:The results indicate that the quick repositioning maneuver is an easy and effective alternative treatment in the management of H-BPPV. Copyright ? 2015 The Authors. Production & hosting by Elsevier (Singapore) Pte Ltd On behalf of PLA General Hospital Department of Otolaryngology Head and Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌...目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌根治术的120例女性患者的临床资料,分为经口腔前庭入路腔镜甲状腺手术组(腔镜组,n=60)和传统颈部开放手术组(开放组,n=60),对比两组患者术中及术后相关临床资料。结果两组患者年龄、肿瘤直径、中央区淋巴结清扫时间、中央区淋巴结清扫总数、中央区转移淋巴结数量、术后并发症、术后24 h疼痛评分、术后6个月疼痛评分均无统计学差异(P均>0.05)腔镜组手术总时长、术中失血量、术后引流量均大于开放组(P均<0.001),腔镜组术后满意度高。结论ETOVA在治疗甲状腺乳头状癌是安全、有效的,具有更好的美容效果,患者满意度高,可以考虑作为部分患者,尤其是年轻女性甲状腺乳头状癌患者的首选手术方案。展开更多
Objectives: The aim of our study is to examine vestibular-evoked myogenic potentials(VEMPs) elicited by the galvanic vestibular stimulation in the sternocleidomastoid muscle(SCM) in healthy subjects for clinical appli...Objectives: The aim of our study is to examine vestibular-evoked myogenic potentials(VEMPs) elicited by the galvanic vestibular stimulation in the sternocleidomastoid muscle(SCM) in healthy subjects for clinical applications of auditory neuropathy or vestibular neuropathy in the future.Methods: We enrolled sixteen healthy subjects to record the average responses of SCM to galvanic vestibular stimulation(GVS) [current 3 mA;duration 1 ms] by electromyography(EMG). SPSS 18.0 software was used to analyze the obtained data for mean and standard deviation.Results: In all healthy subjects mastoid-forehead galvanic vestibular stimulation produced a positive-negative biphasic EMG responses on SCM ipsilateral to the cathodal electrode. The latency of p13 was 11.7 ± 3.0 ms. The latency of n23 was 17.8 ± 3.4 ms. The amplitude of p13-n23 was147.0 ± 69.0 μV. The interaural asymmetry ratio(AR) of p13, n23 latency and the amplitude was respectively 0.12 ± 0.09, 0.08 ± 0.08 and0.16 ± 0.10.Discussions: Galvanic vestibular stimulation could elicit biphasic EMG responses from SCM via the vestibular nerve but not from the otolith organs. Galvanic stimulation together with air conducted sound(ACS) or bone conducted vibration(BCV) can elicit VEMPs and may enable the differentiation of retrolabyrinthine lesions from labyrinthine lesions in vestibular system.展开更多
Background： Determining the nerve of origin for vestibular schwannoma （VS）, as a method for predicting hearing prognosis, has not been systematically considered. The vestibular test can be used to investigate the f...Background： Determining the nerve of origin for vestibular schwannoma （VS）, as a method for predicting hearing prognosis, has not been systematically considered. The vestibular test can be used to investigate the function of the superior vestibular nerve （SVN） and the inferior vestibular nerve （IVN）. This study aimed to preoperatively distinguish the nerve of origin for VS patients using the vestibular test, and determine if this correlated with hearing preservation. Methods： A total of 106 patients with unilateral VS were enrolled in this study prospectively. Each patient received a caloric test, vestibular-evoked myogenic potential （VEMP） test, and cochlear nerve function test （hearing） before the operation and 1 week, 3, and 6 months, postoperatively. All patients underwent surgical removal of the VS using the suboccipital approach. During the operation, the nerve of tumor origin （SVN or IVN） was identified by the surgeon. Tumor size was measured by preoperative magnetic resonance imaging. Results： The nerve of tumor origin could not be unequivocally identified in 38 patients （38/106, 35.80%）. These patients were not subsequently evaluated. In 26 patients （nine females, seventeen males）, tumors arose from the SVN and in 42 patients （18 females, 24 males）, tumors arose from the IVN. Comparing with tile nerve of origins （SVN and IVN） of tumors, the results of the caloric tests and VEMP tests were significantly different in tumors originating from the SVN and the IVN in our study. Hearing was preserved in 16 of 26 patients （61.54%） with SVN-originating tumors, whereas hearing was preserved in only seven of 42 patients （16.67%） with IVN-originating tumors. Conclusions： Our data suggest that caloric and VEMP tests might help to identify whether VS tumors originate from the SVN or IVN. These tests could also be used to evaluate the residual function of the nerves after surgery. Using this information, we might better predict the preservation of hearing for pati展开更多
文摘Benign paroxysmal positional vertigo(BPPV) is the most frequent episodic vestibular disorder. It is due to otolith rests that are free into the canals or attached to the cupulas. Well over 90% of patients can be successfully treated with manoeuvres that move the particles back to the utriculus. Among the great variety of procedures that have been described, the manoeuvres that are supported by evidenced-based studies or extensive series are commented in this review. Some topics regarding BPPV treatment, such as controlling the accuracy of the procedures or the utility of post-manoeuvre restrictions are also discussed.
文摘Introduction Vestibular migraine (VM), a common disorder with familiar predisposition, is characterized by recurrent episode of dizziness or vertigo and accompanying symptoms of nausea, vomiting, and/or headaches.The patients with VM may require neurologic, emergency, or otorhinolaryngologic services, and the disorder is often misdiagnosed with posterior circulation ischemia (PCI) or transient ischemic attack (TIA), peripheral vestibular vertigo, Meniere’s disease (MD), and multiple (lacunar) cerebral infarctions.Report from population-based study showed that the prevalence of VM was up to 1%,^[1] which was one of the common disorders causing dizziness/vertigo, and the rate of misdiagnosis was up to 80%.[2] Thus, a multidisciplinary expert consensus about the definition, characteristics, related work-ups, and diagnostic criteria is needed for the accurate diagnosis and standardized management.
文摘Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation. Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the^electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. Results Total tumor resection was achieved in 140 cases （96.6%） and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% （132/145） of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients （Grade ! and Grade ]I, 79.3%）. No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is
文摘Whereas much has been learned about age-related auditory changes in the inner ear, relatively little is known about the aging effects on the vestibular part of the inner ear-the peripheral vestibular system. Here we review relevant literature with regard to the prevalence of vestibular dysfunction, vestibular functional and structural changes in the elderly. The prevalence of vestibular dysfunction increases with age. Functionally, as age increases, VEMP amplitudes decrease, VEMP thresholds increase, VOR gain of HIT decreases. Due to the complexity of the vestibular system, variations in subject age and measurement techniques, findings in VEMP latency and caloric tests are conflicting. To address this, a direct measure of the peripheral vestibular system should be applied. Structurally, age-related loss in vestibular ganglion and otoconia have been noted; hair cell changes are not well defined; while subcellular changes remain to be explored. Defining how the onset of vestibular dysfunction correlates with structural degeneration will offer insights into the mechanisms underlying vestibular aging.
基金supported by grants from the General Program of National Natural Science Foundation of China(No.81870724)the Innovation Project of Shanghai Municipal Science and Technology Commission(No.19441900400)the Shanghai Municipal Health Commission(No.201740018).
文摘Objective Patients suffered a lot from decompensated vestibular vertigo.Pharmacotherapy and vestibular rehabilitation training have been proven to be effective in prompting vestibular compensation.Routine rehabilitation training is faced with the challenges of patients’compliance,completion,the average recuperation time and so on.This study is aimed to investigate advantages of short-term personalized vestibular rehabihitation at home guided by professional therapist.Methods A short-term personalized vestibular rehabilitation program(ST-PVR)was designed for patients with decompensated vestibular vertigo in this study.Results Patients experiencing the ST-PVR program showed significant improvement of Self-Rating Anxiety Scale(SAS),Dizziness Handicap Inventory(DHI),Activities-Specific Balance Confidence Scale(ABC)scores by the second follow-up(at 2nd week after treatment,P<0.05).However-improvement in the medication group occurred slightly later,DHI for 1 month and SAS for 2 months after treatment(P<0.05).Also,the improvement in the onset time of unilateral weakness(UW)at 2nd week after treatment in the personalized vestibular rehabilitation(PVR)group was faster than that in the medication group.Conclusion In general,the short-term PVR program showed great advantages by prompting vestibular compensation quickly and putting forward future direction for clinical treatment on decompensated vestibular vertigo.
文摘Backgroud Large vestibular aqueduct syndrome （LVAS） is a major cause of hearing loss in childhood. This study aimed at measuring external aperture of enlargement of the vestibular aqueduct （EVA） and analyzing relationship between the size of external aperture and hearing loss. Methods Diagnostic criteria of LVAS were based on hearing loss and CT images. CT images of temporal bone of 100 LVAS patients were collected and 60 control subjects were reviewed retrospectively in the past 10 years. A battery of audiometric and vestibular function tests were performed. The width of the vestibular aqueduct （VA） was measured on axial CT images of the temporal bone. Results One hundred patients （65 men, 35 women） were diagnosed as having the isolated EVA. Hearing loss mostly occurred in early childhood. The diagnosis age of LVAS was 7.7 years on average. The causes of hearing loss could not be confirmed by initial consult. Typically, audiometric curve is the high-frequency down-sloping configuration. 92% of the cases had severe or profound sonsorineural hearing loss （SNHL）. The mean size of the external aperture was （7.5±1.2） mm in present LVAS. Statistical analysis showed that the degree of hearing loss is unrelated to the width of VA. Conclusions LVAS is a distinct clinical entity characterized by fluctuating, progressive SNHL. The degree of hearing loss is unrelated to the size of external aperture of VA. The protective management and hearing aid have become the main therapies. The cochlear implantation might be performed if the hearing loss affected learning at school.
文摘The purpose of the study was to observe changes in endolymphatic hydrops by using intratympanic injection of gadolinium and magnetic resonance imaging（MRI） before and after endolymphatic sac surgery in patients with unilateral Meniere＇s disease. Thirteen patients with unilateral Meniere＇s disease undergoing endolymphatic sac surgery were retrospectively and prospectively analyzed. Three-dimensional fluid-attenuated inversion recovery or three-dimensional real inversion recovery MRI was performed 24 h after an intratympanic injection of gadolinium to grade the presence of endolymphatic hydrops. Among the 13 patients with hydrops confirmed by preoperative MRI, vestibular hydrops had no significant change in all patients; cochlear hydrops became negative in 2 patients, and remained unchanged in the other 11 patients after surgery. Definite vertigo attacks were substantially controlled in one patient and completely controlled in 12 patients during a follow-up period of 8-34 months after surgery. The hearing levels were improved in 3 patients, remained unchanged in 7 patients, and decreased in 3 patients. In conclusion, endolymphatic sac surgery does not always alleviate endolymphatic hydrops in patients with Meniere＇s disease. Relief from vertigo cannot always be attributed to the remission of hydrops. A change in hearing levels cannot be explained by hydrops status alone.
基金supported by the National Natural Science Foundation of China(contract no.81771006)
文摘Objective:To investigate immune-related genetic background in intractable Meniere’s disease(MD)and the immediate results of a novel therapy by delivering steroids to the surface of the intact endolymphatic sac(ES)and incus in a sustainable manner.Case report and methods:Candidate genes involved in immune regulation were sequenced using a nextgeneration sequencing method in a patient with intractable MD.Mutations were confirmed using the Sanger sequencing method.The ES was exposed,and gelatin sponge particles were immersed in highdose methylprednisolone solution and placed onto the surface of ES.“L”-shaped gelatin sponge strips were immersed in dexamethasone solution and served as a guiding device for the steroids by touching the incus and gelatin sponge particles on the surface of the ES.Gelatin sponge particles immersed in dexamethasone solution were placed around the gelatin sponge strips and sealed using fibrin glue.Results:Autoinflammation in the refractory MD case was indicated by genotype,including novel heterozygous mutations of PRF1,UNC13D,SLC29A3,ITCH,and JAK3,as well as phenotype.The vertigo was fully relieved immediately after operation.Tinnitus and aural fullness were resolved 3 weeks after operation,whereas hearing improved in 2 mon postoperation.No recurrence was noted during the 5-monfollow-up,and the final MRI supported the novel therapeutic hypothesis.Conclusion:Autoinflammation was involved in a refractory MD.This novel therapy,which involves the delivery of steroids to the surface of the intact ES and incus,is effective in relieving vertigo and tinnitus and improves hearing function of refractory MD.
文摘Objective:To investigate the efficacy of quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo (H-BPPV). Methods:Clinical data of 67 patients with H-BPPV who underwent quick repositioning maneuver in our hospital from July 2009 to November 2014 were retrospectively analyzed. The maneuver involved rotating the patient in the axial plane for 180? from the involved side towards contralateral side as quickly as possible. Results:Complete symptom resolution was achieved in 61 patients (91.0%) at one week and in 64 patients (95.5%) at 3 months post-treatment. During the repositioning maneuver process, there were no obvious untoward responses except transient nausea with or without vomiting in a few patients. Conclusion:The results indicate that the quick repositioning maneuver is an easy and effective alternative treatment in the management of H-BPPV. Copyright ? 2015 The Authors. Production & hosting by Elsevier (Singapore) Pte Ltd On behalf of PLA General Hospital Department of Otolaryngology Head and Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
文摘目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌根治术的120例女性患者的临床资料,分为经口腔前庭入路腔镜甲状腺手术组(腔镜组,n=60)和传统颈部开放手术组(开放组,n=60),对比两组患者术中及术后相关临床资料。结果两组患者年龄、肿瘤直径、中央区淋巴结清扫时间、中央区淋巴结清扫总数、中央区转移淋巴结数量、术后并发症、术后24 h疼痛评分、术后6个月疼痛评分均无统计学差异(P均>0.05)腔镜组手术总时长、术中失血量、术后引流量均大于开放组(P均<0.001),腔镜组术后满意度高。结论ETOVA在治疗甲状腺乳头状癌是安全、有效的,具有更好的美容效果,患者满意度高,可以考虑作为部分患者,尤其是年轻女性甲状腺乳头状癌患者的首选手术方案。
基金supported by Japan China Sasakawa Medical Fellowship 2016(YL)
文摘Objectives: The aim of our study is to examine vestibular-evoked myogenic potentials(VEMPs) elicited by the galvanic vestibular stimulation in the sternocleidomastoid muscle(SCM) in healthy subjects for clinical applications of auditory neuropathy or vestibular neuropathy in the future.Methods: We enrolled sixteen healthy subjects to record the average responses of SCM to galvanic vestibular stimulation(GVS) [current 3 mA;duration 1 ms] by electromyography(EMG). SPSS 18.0 software was used to analyze the obtained data for mean and standard deviation.Results: In all healthy subjects mastoid-forehead galvanic vestibular stimulation produced a positive-negative biphasic EMG responses on SCM ipsilateral to the cathodal electrode. The latency of p13 was 11.7 ± 3.0 ms. The latency of n23 was 17.8 ± 3.4 ms. The amplitude of p13-n23 was147.0 ± 69.0 μV. The interaural asymmetry ratio(AR) of p13, n23 latency and the amplitude was respectively 0.12 ± 0.09, 0.08 ± 0.08 and0.16 ± 0.10.Discussions: Galvanic vestibular stimulation could elicit biphasic EMG responses from SCM via the vestibular nerve but not from the otolith organs. Galvanic stimulation together with air conducted sound(ACS) or bone conducted vibration(BCV) can elicit VEMPs and may enable the differentiation of retrolabyrinthine lesions from labyrinthine lesions in vestibular system.
文摘Background： Determining the nerve of origin for vestibular schwannoma （VS）, as a method for predicting hearing prognosis, has not been systematically considered. The vestibular test can be used to investigate the function of the superior vestibular nerve （SVN） and the inferior vestibular nerve （IVN）. This study aimed to preoperatively distinguish the nerve of origin for VS patients using the vestibular test, and determine if this correlated with hearing preservation. Methods： A total of 106 patients with unilateral VS were enrolled in this study prospectively. Each patient received a caloric test, vestibular-evoked myogenic potential （VEMP） test, and cochlear nerve function test （hearing） before the operation and 1 week, 3, and 6 months, postoperatively. All patients underwent surgical removal of the VS using the suboccipital approach. During the operation, the nerve of tumor origin （SVN or IVN） was identified by the surgeon. Tumor size was measured by preoperative magnetic resonance imaging. Results： The nerve of tumor origin could not be unequivocally identified in 38 patients （38/106, 35.80%）. These patients were not subsequently evaluated. In 26 patients （nine females, seventeen males）, tumors arose from the SVN and in 42 patients （18 females, 24 males）, tumors arose from the IVN. Comparing with tile nerve of origins （SVN and IVN） of tumors, the results of the caloric tests and VEMP tests were significantly different in tumors originating from the SVN and the IVN in our study. Hearing was preserved in 16 of 26 patients （61.54%） with SVN-originating tumors, whereas hearing was preserved in only seven of 42 patients （16.67%） with IVN-originating tumors. Conclusions： Our data suggest that caloric and VEMP tests might help to identify whether VS tumors originate from the SVN or IVN. These tests could also be used to evaluate the residual function of the nerves after surgery. Using this information, we might better predict the preservation of hearing for pati
