目的:探讨腺样体切除术治疗儿童分泌性中耳炎及鼾症的临床疗效。方法:对住院行腺样体切除术的120例分泌性中耳炎及鼾症患儿的临床表现、治疗方法和预后进行回顾性分析。结果:120例患儿经切除肥大的腺样体，辅以相应的药物治疗，临床症状均明显好转。结论:腺样体肥大较易成为儿童分泌性中耳炎及鼾症发病的基础因素。切除肥大的腺样体是治疗儿童分泌性中耳炎及鼾症有效、安全的方法。
Objective To assess the frequency and the proportion of correct use of statistical analytic methods in five Chinese otorhinolaryngological journals from 2000 to 2002. Methods The statistical methods used in all original articles (n=1 331) published in these journals in three years were evaluated. Results Only 52.0 % of the articles were used statistical analytic methods. And the frequency was higher in basic research (63.5%) than that in clinical research (48.7%) (P＜0.01). The proportions of correct use of statistical analytic methods in the five journals varied from 48.7% to 72.7%, with an average rate of 56.5%. The most frequently used statistical methods were t tests (37.9%), contingency tables (chi-square test) (28.2%) and ANOVAs (14.3%). The most common errors were on the presentation of P values without specifying the test used, using t tests instead of ANOVAs in the comparison among three and more groups, and using unpaired t tests when paired tests were required. Conclusions The rate of application statistical analytic methods is rather high, but incorrect or inappropriate use remain a serious problem.
Objective To evaluate the quality of randomized controlled trials in otorhinolaryngology in China and provide to comprehend the possibility of its contribution in providing reliable, evidence in clinical practice; thus providing evidence to elevate the clinical treatment level. Methods Five Chinese clinical otorhinolaryngology journals were searched and randomized controlled trials were identified and analyzed according to the standards of evidence-based medicine. Results Two hundred and eighty seven issues were referred to and eighty-one randomized controlled trials were identified and analyzed. Of these randomized controlled trials, 34.57% (28/81) had definite diagnostic standards, 38.27% (31/81) had inclusion standards and 33.33% (27/81) had exclusion standards; only 1.23% (1/81) got the approval of the participants; 40.74% (33/81) had moderate sample size; 3.70% (3/81) had large sample size and no one mentioned sample size estimation; 81.48% (66/81) didn’t report the method of randomization and 38.27% (31/81) had baseline comparison; 18.52% (15/81) didn’t define the control interventions and 8.64% (7/81) even didn’t explicate the experimental interventions; 32.10% (26/81) used blank comparison; 86.42% (70/81) didn’t use blindness; 37.04% (30/81) didn’t mention the adverse effects; 23.46% (19/81) used accredited standards to evaluate the outcomes; l l.11% (9/81) mentioned the loss of participants and only 1.23% (1/81) treated the loss with statistics methods. Conclusions The quantity and quality of the otorbinolaryngologic randomized controlled trials in present review can not meet the clinical need. Higher quality of randomized controlled trials are required to improve the level of prevention and the treatment of otorhinolaryngologic diseases.
Objective To assess the clinical effectiveness and safety of uvulopalatopharyngoplasty （UPPP） in the treatment of snoring and obstructive sleep aponea syndrome （OSAS ）. Methods MEDLINE （1966 -2005 ）, EMBASE （1984 - 2005 ）, The Cochrane Library （Issue 1, 2005 ）, CBM （1979 - 2005 ）, CNKI （1994 - 2005 ）, VIP （ 1989 - 2005 ）, CMCC （1994-2005） ,Wanfang Database and Internet were searched in English and Chinese versions. Randomized controlled trials（ RC,Ts）, quasi-randomized controlled trials and prospective cohort studies were included. Study quality was evaluated by two researchers independently. RevMan4.2.7 was used for meta-analysis.Results Twelve studies were included, of which 5 were RCTs, 7 were prospective cohort studies. Compared with dental appliance（DA）, PSG （polysomnography） changes of DA group were larger than UPPP group, but patients of UPPP group had better quality of life and compliance. Comparing UPPP with LAUP （laser-assisted uvulopalatpharyngoplasty ） and RFTVR （radiofrequency tissue volume reduction）, the postoperative pain of the latter two was less than UPPP. About complications, UPPP and LAUP had no difference except for nasal reflux at 1 week after operation, there was no statistical difference between UPPP and RFTVR. There was no study to compare the PSG change among the three groups. Comparing UPPP with CPAP （continuous positive airway pressure）, PSG changes were larger in CPAP. Conclusions At present, there is no evidence to assure that UPPP is better than other treatments for snoring and OSAS or to suggest which type of surgery is most effective.The literature search is restricted to the publications of English and Chinese language, which may have resulted in missing some studies; the evidence is still weak due to the poor quality and a small number of included studies. There is an urgent need for high quality RCTs to be carried out.
Objective To investigate the feasibility of repairing thyroid cartilage defects by implantation of chondrocyte-allogenous acellular cartilaginousmatrix(chondrocyte-ACM) composite in rabbits. Methods The thyroid chondrocyteswere isolated and co-cultured in vitro with allogenous acellular cartilaginousmatrix(ACM) to form the chondrocyte-ACM composite. The composite was analyzed histologically and was used to repair defects of thyroid cartilage. Eighteen New Zealand adult rabbits were made the defect models of thyroid cartilage at the two sides and divided into three groups. The defects were repaired with chondrocyte-ACM composite in the experimental group(n=6), with simple ACM in the ACM group (n=6)and without any material in the control group(n=6). The animals were sacrificed at 8 weeks after operation. The specimens were evaluated histologically. Results In vitro, the growth of chondrocytes was observed on the surface of allogenous acellular cartilaginous matrix and no chondrocytes grew inside the matrix. The defect filled with muscle and connective tissues in control group; the lymphocyte infiltration was observed in the matrix and no new cartilage formationoccurred at 8 weeks after operation in simple ACM group and experimental group.So the defect repair of rabbits thyroid cartilage failed. Conclusion The allogenous acellular cartilaginous matrixfailed to serve as a scaffold for chondrocytes both in vitro and in vivo. The allogenous acellular cartilaginous matrixshould be improved.
Objective To evaluate the effectiveness ofradiofrequency volumetric tissue reduction （RFVTR） in the treatment of sleep disordered breathing （SDB ）. Methods We searched The Cochrane Central Register of Controlled Trials （Issue 1, 2005）, MEDLINE （1966 to Apr. 2005）, EMBASE （1989 to Apr. 2005）, CINAHL （1982 to Dec. 2000）, VIP （1989 to Dec. 2004） , CJFD （1979 to 2005）, WANFANG DATA （1977 to 2004） , and CBMdisc （1978 to 2005）. The bibliographies of all papers retrieved in full text form and relevant narrative reviews were searched for additional publications. All randomized controlled clinical trials （RCT） or quasi-randomized controlled trials （quasi-RCT） or prospective cohort studies of RFVTR alone or in combination with other treatments compared with placebo or other treatments were included. Data were extracted independently from the trial reports by the two authors. Meta-analysis was performed using RevMan software. Results There were 11 studies including 540 patients met the inclusion criteria for this review, among which five were RCTs, six were prospective cohort studies, and all trials were of lower methodological quality. RFVTR showed benefit over placebo in apnea index （AI）, but this benefit was not seen in other polysorrmography （PSG） parameters, symptom and quality of life, psychomotor vigilance pain, swallowing difficulty and adverse events. Compared with continuous positive airway pressure （CPAP）, uvulopalatopharyngoplasty （UPPP） and laser assisted uvulopalatoplasty （LAUP） , RFVTR was more effective in psychomotor vigilance pain and swallowing difficulty, but this effect was not seen in PSG parameters, symptom and quality of life. Conclusions RFVTR is more effective than placebo in AI improvement and other treatments in decreasing postoperative pain and other adverse events ; but this benefit was not seen in improving quality of sleeping and life. More well-designed randomized trials need to be conducted to identify the effectiveness and the influence on effectiveness of severity and frequency of treatment.
Objective To investigate the relationship of resonant frequency and low frequency conductive hearing loss. Methods Eighty- four participants were included, and tested by gold standard and resonant frequency respectively. Receiver operator characteristic (ROC) curve was used to explore the most appropriate cutoff point for diagnosing low frequency conductive hearing loss and Levene’s test was used to test the difference of the low frequency conductive hearing loss and normal hearing groups. Results The resonant frequencies of low conductive frequency hearing loss and normal hearing groups were different. The optimum cutoff points of resonant frequency were 850Hz and 1 050Hz. The resonant frequency range from 850Hz to 1 050Hz was considered normal. The test was powerful when the resonant frequency was lower than 850Hz. The test was powerless when the resonant frequency was higher than 1 050Hz. Conclusions Conductive hearing loss could be predicted from resonant frequency when it is lower than 850Hz. The test is powerless when the resonant frequency is higher than 1 050Hz. The resonant frequency could be affected by many factors, so ENT (ear, nose and throat) doctors and audiologists have to be careful about how to explain the results when the resonant frequency is higher than 1 050Hz.
Objective To evaluate the safety of intranasal use of beclomethasone dipropionate, budesonide, fluticasone propionate and mometasone for adults and children with chronic sinusitis/nasal polyps and allergic rhinitis. Methods Randomized controlled trials were located. Study quality was evaluated by two researchers independently. RevMan 4.2 was used for meta-analysis. Results Seven RCTs involving 826 patients were included. Compared with placebo, local use of fluticasone proprionate in adults showed no statistically significant trend to increase incidence of acute sinusitis (OR 16.87, 95% CI 0.87 to 301.62), but no significant difference was seen for epistaxis (OR 7.76, 95% CI 0.38 to 157.14): 1 trial, 60 patients. In another trial, no cases of nasal atrophy were reported in either fluticasone or placebo groups. No significant differences were seen between local use ofbudesonide and placebo in adults for dryness of nasal mucosa (OR 3.38, 95%CI 0.66 to 17.18) and epistaxis (OR 2.20, 95%CI 0.39 to 12.32): 1 trial, 193 participantions. No significant difference was seen between budesonide and pollinex for headache (OR 1.71, 95%CI 0.52 to 5.62). No differences were seen between placebo and fluticasone propionate in children for epistaxis (OR 0.85, 95%CI 0.20 to 3.66), headache (OR 0.25, 95%CI 0.02 to 2.83), plasma cortisol concentration (OR 1.56, 95%CI 0.06 to 38.69) and dryness of nasal mucosa (OR 4.76, 95%CI 0.25 to 89.54). Beclomethasone dipropionate in children showed no statistical differences for dryness of nasal mucosa (OR 0.51, 95%CI 0.14 to 1.87), epistaxis (OR 0.68, 95%CI 0.26 to 1.73) and rhinitis (OR 0.47, 95%CI 0.04 to 5.36). No decrease of plasma cortisol concentration was detected in either group. Mometasone and placebo showed no significant differences in children for epistaxis (OR 1.57, 95%CI 0.41 to 5.95), rhinitis (OR 0.33, 95%CI 0.01 to 8.22) or headache (OR 0.33, 95%CI 0.01 to 8.22). Decrease of plasma cortisol concentration was not detected. Conclusions According to this systematic review, long term intranasal use of steroid for adults and children may be safe based on the two high quality, four moderate quality trials and one with b bias. High quality studies with larger sample sizes and in other languages are needed to provide ber evidence.