简介：Otitismediawitheffusionisoneofthemostcommondiseasesinchildren.Itstreatmentremainscontroversial.ClinicalpracticeguidelinesofOMEallowwatchfulwaitingfor3monthsbeforetreatmentifthechildwithOMEisnotatriskforspeech/language/orlearningproblems.Tympanostomytubeinsertionisthepreferredinitialprocedurewhenachildbecomesasurgicalcandidate.ComplementaryoralternativemedicineisnotrecommendedasatreatmentforOME.ThispaperprovidesasystematicreviewofmanagementofOME,whichwehopewillbehelpfulforclinicians.

简介：Tinnitusisasubjectiveperceptionofphantomsoundthatcurrentlycannotbeobjectivelymeasured.However,thereisgrowingevidencesuggestingthatthebiologicalsourceoftinnitusmayexistinoneormorethanoneplaceintheauditorypathway.Recentstudieshavefoundthatneurotransmittersormodulators,suchasglutamate,γ-aminobutyricacid(GABA),serotonin,dynorphin,dopamine,neurosteroid,acetylcholine(ACh)andsubstanceP,areinvolvedintinnitusgeneration.Animalandhumanstudieshaveshownthatsomeoftheseneurotransmittersandtheagonistsorantagonistsoftheirreceptorseitheraffecttinnitusbehaviorsordemonstratesomedegreeoftreatmenteffectsontinnitus.However,duetotheunclearbiologicalmechanismsoftinnitusandsideeffectsofthesedrugs,thevalueofclinicalusageofsuchdrugsintreatingtinnitusisyettobeestablished.Revealingtherelationshipbetweentinnitusandneurotransmitterreceptorfunctionswillhelpidentifymoreeffectivedrugsfortinnitustreatment.Thisarticlereviewstheliteratureofneurophysiologicalstudiesontinnitusinbothanimalandhumansubjectstudiesatvariouslevelsoftheauditorypathway.

简介：ObjectiveTostudyclinicalcharacteristicsofendolymphaticsactumor(ELST)anditsdiagnosisandtreatment.MethodsELSTwasdiagnosedin6casesbasedonsurgicalandhistologicalfindings.Thesecaseswerereviewedfortheirclinicalmanifestations,differentialdiagnosisandsurgicaltreatmenttechniques.ResultsTherewere1maleand5femalesinthisgroup,agedfrom28to59years(meanage=38.7years).Thetumorwasinleftearin4casesandinrightearintheother2cases.Diseasecoursesrangedfrom5to30years(meanduration=12.6years).Clinicalpresentationsincludedsensorineuralhearingloss(n=4),otorrheaandtinnitus(n=2),tinnitusandfacialspasm(n=1),otorrheawithfacialparalysis(n=1),andhearinglosswithtinnitus(n=2).NoneofthecaseswasdiagnosedasELSTpreoperatively.Twocasesweremisdiagnosedasglomusjugularetumor,2aschronicsuppurativeotitismedia,1assweatglandadenomaonbiopsyand1astemporalbonetumor.Tumorsweresurgicallyresectedinall6casesviathemastoidectomy(n=2)orcombinedoto-cervicalorcranio-oto-cervicalapproaches(n=4).Postoperativecerebrospinalfluidotorrheaoccurredin1case.Thetumorswereconfirmedonhistologicalexaminationtobealow-gradeadenocarcinoma.Allpatientshavesurvivedatthetimeofthispaper.ConclusionELSTisrareandcommonlymisdiagnosedandinadequatelytreated.Itsprognosisisrelativelyfavorablebecauseofitsslowgrowthrate.

简介：ObjectivesToreportauthors'experiencesinthediagnosisandtreatmentsofcongenitalfirstbranchialfistula(congenitalauriculocervicalfistula).MaterialsandMethodsTwelvecasesofcongenitalfirstbranchialfistulawerereviewed.Ofthese,8underwentfistulectomywithfacialnervedissectionandpartialparotidectomyand4underwentsimplefistulectomy.ResultsTheinneropenings(upperopening)offistulaelayinthefollowingsites:inferioposteriorwallatthejunctionofcartilaginousandbonysegmentsoftheauricularcanalandinferiorwallofcartilaginousauricularcanal.Theouteropenings(loweropening)layalongtheanteriorborderofuppersternocleidomastoidmuscle,atthemastoidtipandposteriortothemandibularangle.Completefistulaeresectionwasachievedinallbutonecase.Elevencaseswerefollowedfor5yearwithnorecurrence.Recurrenceoccurredin1case6monthsaftertheprimarysurgeryandrevisionsurgerywasperformed.ConclusionsPre-operativeradiographyforthelocationandcourseofthefistulaiscrucialforsuccessfulfistularesection,especiallyincaseswithpastinfections.Facialnervedissectionshouldbedoneroutinelyfordeeplylocatedfistulae.

简介：ObjectiveToevaluateefficacyofsurgicaltreatmentintraumaticfacialparalysis.Methods:Thirty-threecaseswerereviewed,includingtemporalbonefractureandiatrogenicfacialnerveinjury.Allthepatientsweretreatedwithvarioussurgicalmethodsaccordingtotheirpathogeny.ResultsThemeanpercentagefacialfunctionimprovement(House-BrackmannGradeⅠ-Ⅱ)was86%intemporalbonefractureandfunctionwasimprovedafterproperoperationtoiatrogenicfacialnerveinjury.ConclusionsPatientswithtraumaticfacialparalysisreceiveprovedoutcomesitreaedwithpropersurgicalmethodsaccordingtotheirparticularconditionofnerveinjury.

简介：ObjectiveToreportoutcomesofnonsurgicalandsurgicalmanagementofMenière’sdiseaseatBeijingTiantanHospital.MethodsPatientswithMenière’sdiseasewerecategorizedintogroupsbasedonhearingandqualityoflife.Individualizedmanagementwasprovided,includinglifestylemodification,drugtherapies,endolymphaticsacdecompressionandlabyrinthectomy.Treatmentoutcomeswereevaluatedduringupto24monthsfollowup.ResultsEightysevenpatientsunderwentlifestylemodificationanddrugtherapies.ThevertigocontrolrateofGradeAandBwas76.9%and83.8%respectively.Sixpatientsreceivedsurgicalmanagement,includingendolymphaticsacdecompression(n=5)andlabyrinthectomy(n=1).Forthesepatients,thevertigocontrolrateofGradeAandBwas80%and100%,respectively.ConcluIsionsManagementofMenière’sdiseasedependsonseveralfactors,i.e.severitiesofvertigoandhearingloss,qualityoflife,surgicalcontraindicationsandpatientsubjectivedesire.Thetreatmentisdrugtherapiesforthemajorityofpatients,aswellaslifestylemodification.Surgicalindicationsarerareandtheleastinvasiveproceduresshouldbeconsideredfirst.Theresultsofsurgeryaregenerallysatisfying.

简介：ObjectiveToinvestigatetheclinicaloutcomesoffacialneverdecompressionviaacombinedsubtemporal-supralabyrinthineapproachtogeniculateganglionformanagementoffacialparalysisintemporalbonefracture.MethodsEighteenpatientswithunilateralfacialparesisduetotemporalbonefractureweretreatedbetweenMarch2003andMarch2011.FacialfunctionwasHouse-Brackmann(HB)gradeⅢin6patients,HBgradeⅤin9patientsandHBgradeⅥin3patients.Thepreoperativemeanairconductionthresholdwas52dBHLforthe15caseswithlongitudinaltemporalbonefractureandshowedseveresensorineuralhearinglossinthe3caseswithtransversetemporalbonefracture.Fracturelinesweredetectedin15casesontemporalboneaxialCTscansandossiculardisruptionwasdeterminedin11casesbyvirtualCTendoscopy.Thegeniculateganglionorthetympanicmastoidsegmentofthefacialnerveshowedanirregularmorphologyoncurvedplanarreformationimagesofthefacialnervecanal.Afteranintactcanalwallmastoido-epitympanectomy,theossicularchaindamagewasevaluated.Iftheossicularchainwasintact,thesupralabyrinthinerecesswasopenedbydrillingthroughthecellsbetweenthetegmentympaniandossicularchain.Iftheossicularchainwasdisrupted,theincuswasremovedtoaccessthesupralabyrinthinerecess.Thegeniculateganglionandthedistallabyrinthinesegmentofthefacialnervewereexposed.Aftercompletingfacialnervedecompression,thedislocatedincuswasreplaced,orafracturedincuswasreshapedtobridgethespacebetweenthemalleusandthestapes.ResultsPronouncedgangliongeniculatumswellingwasfoundin15casesoflongitudinaltemporalbonefracture,withgreaterpetrosusnervesdamagein3casesandbleedingin5cases.Disruptedossicularchainswereseenin11cases,includingdislocatedincusresultingincrushingofthehorizontalportionofthefacialnervein3casesandfractureoftheincuslongprocessin1case.In3casesoftransversefractures,

简介：Vestibularschwannoma(VS)isaslow-growingbenignneoplasm.TherehasbeenanevolutioninthemanagementofVSfromactivetreatments(microsurgeryandstereotacticradiotherapy)toconservativemanagement(waitandscan).RegularMRIscanningisnecessarytomonitortumorprogression.Conservativemanagementcausessignificantlylesscomplicationsandoffersahigherqualityoflifecomparedwithactivetreatments.ThemeangrowthrateofVSvariesfrom0.4to2.9mm/year,andspontaneousshrinkageisobservedin3.8percentoftumorsduringobservation.Ifsignificantgrowthoccurs,activetreatmentisconsidered.Significantgrowthisdefinedasanincreaseofatleast3mminthelargestextrameataldiameterinanyplanebetweenthefirstandlastavailablescans.Thevestibulocochlearnerveissurroundedbycerebrospinalfluid,whichprovidesnaturalcontrastforMRI;thus,gadoliniummaynotbeneededtodetectVS.Specificsequenceshavehighsensitivity,specificity,andaccuracyfordetectionofprogression.HypointensesignalintheipsilateralinnerearfluidmightbeausefulsigntodistinguishVSfrommeningioma.Inthispaper,wesummarizethecurrentstatusofresearchonconservativemanagementandnon-contrastMRIforthedetectionofVS.