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Background: In temporal bone specimens from long-term cochlear implant users, foreign body response within the cochlea has been demonstrated. However, how hearing changes after implantation and fibrosis progresses within the cochlea is unknown., Objectives: To investigate the short-term dynamic changes in hearing and cochlear histopathology in minipigs after electrode array insertion., Material and Methods: Twelve minipigs were selected for electrode array insertion (EAI) and the Control. Hearing tests were performed preoperatively and on 0, 7, 14, and 28 day(s) postoperatively, and cochlear histopathology was performed after the hearing tests on 7, 14, and 28 days after surgery., Results: Electrode array insertion had a significant effect for the frequency range tested (1 kHz-20kHz). Exudation was evident one week after electrode array insertion; at four weeks postoperatively, a fibrous sheath formed around the electrode. At each time point, the endolymphatic hydrops was found; no significant changes in the morphology and packing density of the spiral ganglion neurons were observed., Conclusions and Significance: The effect of electrode array insertion on hearing and intracochlear fibrosis was significant. The process of fibrosis and endolymphatic hydrops seemed to not correlate with the degree of hearing loss, nor did it affect spiral ganglion neuron integrity in the 4-week postoperative period.

Background: Follow-up of cochlear implant effectiveness is mainly focused on 3 years postoperatively, and studies with more than 5 years of observation are rare, especially for local Chinese brands., Objectives: Nurotron (Chinese domestic cochlear implant brand) CI recipients who participated in the clinical trial in 2009 were followed-up for 10 years prospectively, providing data to guide doctors and patients., Material and Methods: From December 2009 to April 2010, 57 subjects underwent Nurotron Venus CI surgery at multiple-centers, and were continued to be followed up and assessed at 1, 2, 3, 4, 5, and 10 years after switch on., Results: All recipients were successfully implanted with CIs with no difficulty in subsequent use with one reported case of re-implantation at 9 years after implantation. The aided hearing thresholds were significantly improved at one month after switch on ( p  < 0.0001) and remained stable afterwards for 10 years. Speech recognition scores were significantly higher than pre-operative results ( p  < 0.05) and continued to improve till 3 years after switch on. At 10 years post-operation, most subjects had improved QOL scores in most sub-items., Conclusions and Significance: Nurotron Venus CI System provides long-term, stable results in hearing speech assistance capabilities and can improve the quality of life of CI recipients.

Background: Over half of patients with enlarged vestibular aqueducts (EVA) will have an air-bonr gap (ABG), however, current research on audiology has focused on the influencing factors of air-conducted., Objective: To retrospectively analyse the influencing factors and clinical manifestations of the bone-conduction threshold and ABG in patients with EVA., Materials and Methods: We included 286 patients with EVA; among them, 126 had full SLC26A4 gene sequence results. We performed a descriptive analysis of the bone-conduction threshold and explored the effect of age. Finally, we analyzed the relationship of ABG and SLC26A4 genes with the degree of vestibular aqueduct (VA) enlargement., Results: Among 555 ears, 312 (57.8%) ears had ABG; approximately 94% of the patients' bone-conduction hearing is almost completely lost at frequencies of 2 and 4 kHz. There was no linear correlation between age and bone-conduction threshold ( p  > 0.05). ABG did not significantly differ according to the degree of VA enlargement and number of SLC26A4 allele mutations ( p  > 0.05)., Conclusions and Significance: Among patients with EVA, ABG is mainly produced at low frequencies and is not significantly correlated with age, size of the VA opening or SLC26A4 genes, which could be attributed to the biomechanical effects.

Background: There are no reports about comprehensive comparative analysis of the effects after various hearing surgery solutions for congenital malformation of the middle and outer ear (CMMOE)., Aims/objectives: To analyze the improvement of Average Air-Conduction Threshold (AACT) of pure tone after various hearing surgery solutions for CMMOE and provide a reference for the selection of accurate hearing solutions., Materials and Methods: A retrospective analysis of 159 cases (170 ears) with CMMOE submitted to various ear surgery solutions, including: (1) Three situations of outer ear canal (OEC): ① atresia 85 ears, ② stenosis 28 ears, and ③ normal 57 ears. (2) Three commonly used hearing solutions: eardrum repair 53 ears, Porp 44 ears and Piston 32 ears implantation. (3) Three OEC situations with different hearing solutions: type I. Reconstruction of OEC (r-OEC), type II. r-OEC and/or different tympanoplasty, including ① eardrum repair, ② release of ossicular chain, ③ Porp implantation, and ④ Torp implantation, type III. Piston implantation with fenestration of the inner ear. Compare AACT of postoperative short term (0.5 years) or long term (0.5-10 years) and preoperative in the speech frequency range of 0.5-4 kHz to assess efficacy. If the sample number ≥10, and not subject to normal distribution, the Kruskal-Wallis multi-sample rank sum test is used for the comparison of multiple groups and Wilcoxon's rank sum test for two groups, with P  < 0.05 being statistically significant. If the sample size <10, the standard of clinical efficacy is one frequency improvement value ≥15 dB HL, or 10 dB HL ≤2 frequency improvements <15 dB HL at 0.125-8 KHz., Results: Intra-group comparison of AACT: (1) three situations of OEC: atresia, stenosis and normal all had P  < 0.05 postoperatively in short term, while in long term only the normal group had P  < 0.05. (2) Three commonly used hearing solutions: eardrum repair, Porp and Piston implantation all had P  < 0.05 in short and long terms, except for eardrum repair P  >0 .05 in long term. (3) Three OEC situations with different hearing solutions: 1) Atresia of OEC: Porp and Piston implantation, r-OEC and release of ossicular chain were effective in short term and were not effective in long term, and the eardrum repair was not effective in both short and long term. 2) Stenosis of OEC: eardrum repair, Porp and Piston implantation were effective in short and long term. r-OEC P  >0 .05 for short and long term, Torp implantation was not effective in long term, 3) Normal of OEC: Porp, Torp and Piston implantation were all P < 0.05 in short and long term except for Torp >0.05 in long term, and release of ossicular chain is both short and long term clinically effective. The AACT values of postoperative in long term for three groups of atresia, stenosis, normal of OEC are over 58.7 dB HL (except Porp implantation 52.5 dB HL), 51.3 dB HL (except Porp implantation 42.5 dB HL), and 37.5 dB HL (except Torp implantation are 32.6 dB HL), respectively., Conclusions and Significance: Intra-group comparison of AACT. (1) Three groups of the atresia, stenosis and normal of OEC are all effective in short term, while in long term only the normal group is effective. (2) The three most commonly used surgical solutions of eardrum repair, Porp and Piston implantation are effective in short and long terms, except for long term eardrum repair. (3) Three OEC situations with different hearing solutions: some of surgical solutions were effective in short term or long term for CMMOE, but based on the AACT values of postoperative in long term for three OEC situations, it is better to choose a hearing device for atresia of OEC, comprehensive review of surgical or hearing device for stenosis of OEC. Surgery can be considered for normal OEC.

Background: No selection criteria for the four bone conduction hearing devices yet. Aims/Objectives: To compare effectiveness of four bone conduction hearing devices in patients with bilateral Congenital Malformation of the Middle and Outer Ear (CMMOE). Material and Methods: 24 Patients (25 ears) were divided into five groups: 1) Bone Anchored Hearing Aid softband (BAHA-s), 2) BAHA implant (BAHA-i nested within group 1), 3) Vibration Sound Bridge implant (VSB-i), 4) Bone Bridge implant (BB-i), and 5) Bone Conduction Hearing Aid softband (BCHA-s). One patient implanted VSB and BB. Auditory parameters were compared: 1. Communication, 2. Average Air Conduction Thresholds (ACT) of pure tone, 3. Sentence Recognition Scores in quiet (SRS-q) and noisy (SRS-n) settings. The one-way analysis of variance (ANOVA) were employed to compare the differences in ACT and SRS-q/n among the groups, a statistical significance level of P < 0.05 was applied. Results: After hearing aid usage, all 24 patients (25 ears) reached or approached the normal in communication (i.e. from difficult to smooth), average ACT and SRS-q/SRS-n (no difference among groups, p  > 0 .05). However, there was the difference in the optimal frequency of ACT and the absolute value of SRS-q/SRS-n for VSB/BAHA implants was higher than that for BB and BAHA softband. Conclusions and Significance: The precise selection of the four hearing devices mainly depends on patient's hearing level, the optimal frequency of ACT and absolute values of SRS-q/SRS-n.

Background: There is no study on the hearing features of congenital malformation of middle and outer ears (CMMOE), including classification, grades, and frequency characteristics, which play a decisive role in the selection of precise hearing solutions for patients. Aims/Objectives: To analyze the hearing features of CMMOE and provide guidance for clinical practice. Material and Methods: 298 cases (351 ears) with CMMOE were retrospectively analyzed for the features of 0.5 ∼ 4KHz pure tone hearing, including the classification, grades and frequency characteristics. Results: We observed conductive deafness in 84.3% (296/351), mixed deafness in 15.7% (55/351), and 0% (0/351) sensorineural deafness. Grades measured by average Air Conduction Thresholds (ACT) of pure tone: Mild deafness (26-40dB HL) 0.6% (2/351), moderate deafness (41-55dB HL) 10.3% (36/351), moderate to severe deafness (56-70dB HL) 46.1%(162/351), severe deafness (71-90dB HL) 39.9%(140/351), extremely severe deafness (> 90 dB HL) 3.1%(11/351). The average ACT of 296 ears conductive deafness was 67 ± 10 dB HL, of which 56-80dB HL accounted for 78.1% (274/351). In 55 ears with mixed deafness, 32 ears (32/55 = 58.2%) increased Bone Conduction Threshold (BCT) at a single frequency, and out of 32 ears, 31ears (31/55 = 56.4%) ≤40dB HL, 25(25/32 = 78.1%) ears at 2KHz. In 55 ears with mixed deafness, 87.3% (48/55) increased BCT at 2KHz, and the average BCT was 35 ± 10dB HL. Conclusions and Significance: CMMOE result mainly in conductive deafness, moderate to severe and severe deafness. In mixed deafness, the BCT increased mainly at a single frequency, 2KHz and ≤40dB HL. These data suggest that bone-conductive hearing devices are a good solution for CMMOE hearing impairment.

Background: Presbycusis with tinnitus has a significant impact on the quality of life of elderly patients, becoming a serious socioeconomic problem., Objectives: We conducted an 11-year cross-sectional analysis of the audiometry results of elderly patients with tinnitus from 2011 to 2021., Methods: 9642 patients aged 60 and over were divided into three groups: young-old (YO) (60-74), old-old (OO) (75-89), and longevous (LON) (90 and over). Pure-tone audiometry results of all patients were analyzed., Results: Among 9642 patients, the cases of female with tinnitus were more than male in all years. The hearing curve showed a typical age-related decline. Hearing level of air conduction in female declined significantly at low frequencies while that of male was worse at high frequencies in YO and OO groups. Compared with right, left hearing level of air conduction was significantly decreased at all frequencies except 0.125 kHz., Conclusions: When the chief complaint was tinnitus, women were likely to experience more distress than men. However, men suffered from more hearing loss than women, at least in high frequencies. The influence weight of presbycusis and tinnitus on the auditory cortices might be a possible reason for the lateral distinction of hearing loss at different ages.

Background: Free fatty acids (FFAs) could induce inflammatory responses via various pathways. Ferroptosis is characterized by the accumulation of lipid peroxidation products and fatal reactive oxygen species derived from iron accumulation, which may be an upstream event in the inflammatory injuries., Objectives: To investigate the involvement of ferroptosis during the FFAs-induced pathological hair cell inflammatory injuries and its underlying mechanisms., Material and Methods: We utilized House Ear Institute-Organ of Corti 1 (HEI-OC1) cell line as an in vitro model. The palmitate acid (PA) was utilized as a substitute for FFA, with cotreatment with ferroptosis inducer RSL3 and ferroptosis inhibitor Fer-1. Cell viability, lactase dehydrogenase (LDH) release, the expressions of ferroptosis-related factors such as glutathione peroxidase-4 (GPX4), solute carrier family 7 member 11 (SLC7A11), as well as toll-like receptor 4 (TLR4), ferric ion and reactive oxygen species (ROS), and partial inflammatory cytokines were measured., Results: PA treatment might induce ferroptosis in HEI-OC1 cells, manifested as decreased cell viability, upregulated LDH release, iron overload, and ROS accumulation. Several inflammatory cytokines including IL-1β, IL-6, IL-1β, IL-6, TNF-α, MCP-1, IL-13, IL-12 p40, CCL5, G-CSF, and GM-CSF were upregulated compared to the Ctr group, while GPX4 and SLC7A11 were downregulated. The expression of TLR4 in the inflammatory pathway was also upregulated. Besides, these changes were further exacerbated by RSL3 cotreatment and abolished by Fer-1 cotreatment., Conclusions and Significance: Ferroptosis inhibition could alleviate the PA-induced inflammatory injuries via inactivation of TLR4 signaling pathway in HEI-OC1 cell line.

Background: Giant cell tumors (GCTs) and giant cell granulomas (GCGs) are giant cell-rich lesions that occur extremely rarely in the temporal bone and have similar clinical presentations., Objectives: We aimed to analyze the clinical features and introduce our staging system and surgical treatment., Methods: Forty-six patients pathologically diagnosed with a giant cell lesion involving the temporal bone between October 2001 and October 2020 were reviewed retrospectively. The clinical characteristics, surgical approaches, and risk factors for recurrence were analyzed., Results: GCTs and GCGs presented as masses centered on the temporomandibular joint with similar imaging features, including a thin, calcified shell and central scattered calcifications on a computed tomography scan. Differences were detected on magnetic resonance imaging in 29.6% (4/14) of GCG and 50% (16/32) of GCT cases; the remaining cases were not distinguishable. Based on our staging system and surgical strategy, 31.8% (7/22) of GCT and 10% (1/10) of GCG cases experienced recurrence, which compares to recurrence rates of 60% in GCT cases and 20% in GCG cases in previous studies., Conclusions: Specific clinical and preoperative imaging features help to make a diagnosis of temporal giant cell-rich lesions. Our staging system and surgical strategy could help surgeons tailor the surgical strategy.

Background: This study was focused on impulse noise induces hidden hearing loss., Objectives: This study was designed to determine the morphology changes of noise-induced hidden hearing loss (NIHHL)., Method: Fifteen guinea pigs were divided into three groups: noise-induced hidden hearing loss (NIHHL) group, noise-induced hearing loss (NIHL) group, and normal control group. For the NIHHL group, guinea pigs were exposed to 15 times of impulse noise with peak intensity of 163 dB SPL at one time. For the NIHL group, animals were exposed to two rounds of 100 times impulse noise, and the time interval is 24 h. Auditory brain response (ABR) was tested before, immediately, 24 h, one week, and one month after noise exposure to evaluate cochlear physiology changes. One month after noise exposure, all guinea pigs in three groups were sacrificed, and basement membranes were carefully dissected immediately after ABR tests. The cochlea samples were observed by transmission electron microscopy (TEM) to find out the morphology changes., Result: The ABR results showed that 15 times of impulse noise exposure could cause NIHHL in guinea pigs and 200 times could cause completely hearing loss. Impulse noise exposure could cause a dramatic increase of mitochondria in the inner hair cell. The structures of ribbon synapse and heminode were also obviously impaired compared to the normal group. The nerve fiber and myelin sheath remained intact after impulse noise exposure., Conclusion: This research revealed that impulse noise could cause hidden hearing loss, and the changes in inner hair cells, ribbon synapse, and heminode all played a vital role in the pathogenesis of hidden hearing loss.

Background: The prevention and treatment of presbycusis becomes a serious health challenge and socio-economic problem., Objectives: We performed a cross-sectional analysis of the audiometry results of all elderly patients who visited our department throughout the year of 2018., Material and Methods: A total of 5520 people aged 60 and over were included and divided into three groups: young-old group (60-74 years old), old-old group (75-89 years old), and longevous group (over 90 years old). Pure-tone audiometry results of all patients were analyzed., Results: Among the 5520 patients, there were 4445 cases in the young-old group, 1029 cases in the old-old group, and 46 cases in the longevous group, accounting for 80.53, 18.64, and 0.83%, respectively. In the young-old group, normal hearing and mild-moderate hearing loss were the most common, while moderate and severe hearing loss were more common among the old-old group and the longevous group. The hearing curve showed typical age-related hearing loss with a drop at high frequencies., Conclusions: With an increase in age, patients tend to suffer from more serious hearing disorders. Presbycusis was associated with specific frequency and age characteristics. Understanding these characteristics is of great significance for the prevention and treatment of age-related hearing loss.

Background: In operations of cochlea implantation (CI), many surgeons choose to drill a window on the bone wall of cochlea basic rotation, when more and more patients receive CI with residual hearing, what damage this step would result in is unclear. Objective: To study the effect to inner ear hair cells which is caused by drilling during CI. Methods: 6 miniature pigs are equally divided into two groups, Round window niche of each pig in the experimental group was milled, while the pigs in control group wasn't. After implanting depth of 6.5, 11.5 and 20 mm, round window electrocochleography was recorded to analyze the change of cochlea microphonic (CM) potentials respectively, histomorphological changes was observed. Results: Thresholds of CM in experimental group were higher than that of control group at different depth, amplitudes were smaller. In further group, cilia of inner hair cells (IHC) at bottom rotation were significantly damaged. After operation, ABR hearing threshold of experimental group was higher, differences at low frequency region were more obvious. Conclusions: Damage caused by mulling round window niche may seriously affect the function of the hair cells. Damage of the IHC is greater than OHC. CI through round window may protect residual hearing.

Background: Tinnitus is common in vestibular schwannoma patients, but the postoperative tinnitus status of these patients and related factors remain unclear., Aims: To identify preoperative and operative factors associated with postoperative tinnitus status., Materials and Methods: Postoperative outcomes were retrospectively assessed in 237 vestibular schwannomas (VS) patients with preoperative tinnitus and 90 VS patients without tinnitus., Results: When evaluating patients with preoperative tinnitus, there were significant differences in rates of improvement, no change, and worsening of tinnitus for the translabyrinthine (TL) and retrosigmoid (RS) approaches. Of patients without preoperative tinnitus, there was a significant difference in rates of not developing tinnitus and new-onset tinnitus. Similar results were observed with respect to preoperative hearing. Least-squares analyses revealed that surgical approach and preoperative hearing were independent predictors of postoperative tinnitus. Preoperative pure tone averages for TL group patients that did not develop postoperative tinnitus were 85.8 dB, whereas in patients that developed new-onset tinnitus they were significantly lower (54.9 dB)., Conclusions and Significance: Tinnitus prognosis in VS patients is better following TL microsurgery relative to RS microsurgery and is also better in patients with worse preoperative hearing. New-onset tinnitus was more likely to occur in patients with better preoperative hearing that underwent tumor removal via a TL approach.

Background: It is difficult to deal with epitympanic cholesteatoma in otologic surgery. The keyhole technique can realize minimally invasive surgery and reconstruct the middle ear canal., Objective: To explore the clinical application of keyhole technique in primary and second-look surgery in middle ear cholesteatoma., Materials and Methods: 34 cases were analyzed retrospectively in terms of residual and recurrence rate, safety (adverse events) and hearing performance at long-term follow-up. The application of the technique in primary or second stage operation was evaluated and the operation was performed by transanal endoscopy or combined approach., Results: The cholesteatoma revealed by CT before operation was limited to the attic in 23 patients, of which 16 had the same imaging range as that of the keyhole technique. The preoperative imaging findings of 11 showed that the attic cholesteatoma may have extended into the mastoid, of which only 6 cases were confirmed by keyhole technique. An endoscopic second-look surgery using the keyhole technique was performed for these patients, 2 were confirmed to have residual lesions in the attic., Conclusions: The keyhole technique under otoendoscopy can be used flexibly and conveniently in the second-look surgery to make up for the shortage of diffusion-weighted magnetic resonance imaging.

Background: Clinical application of vHIT is limited due to a lack of interpretation of vHIT gain and saccades., Objectives: This research focuses on comparing common vertigo diseases on vHIT gain and saccade divergence(PR score)., Material and Methods: We retrospectively reviewed 165 patients who have one definite diagnosis, good data quality, and can be read by MATLAB software. All patients were grouped into unilateral vestibular dysfunction (UVD), Meniere's disease (MD), vestibular migraine (VM), Ramsay Hunt Syndrome (RHS), bilateral vestibular hypofunction (BVH), benign paroxysmal positional vertigo (BPPV), and acoustic neuroma (AN). PR score was calculated by an open-source software HitCal., Results: The saccade detection rate is higher than the abnormal vHIT gain on UVD, MD, VM, RHS, BVH and BPPV. PR score combined with vHIT gain could separate the affected side in UVD and RHS. In the MD group, both vHIT gain and PR score have inconspicuous performance. We also found that different compensation levels and hearing loss status affect results., Conclusions and Significance: vHIT gain combined with PR score enables a proper distinction among common vertigo diseases. PR score is more sensitive than the gain value on evaluating the physiological situation, vestibular compensation and disease progression.

Background: There are few studies focused on vestibular symptoms and function of the children with LVAS., Objectives: This study aimed to find the characteristics of air and bone-conducted VEMPs among children with LVAS, and to investigate the relationship between VEMPs and vestibular symptoms., Material and Methods: A total of 44 children with LVAS and 10 healthy children were recruited as the case group and control group. Air and bone-conducted VEMP were performed to the participants., Results: For air-conducted measurement, there was elevated amplitude of cVEMP in case group than control group. There was no significant difference at oVEMP parameters between the case group and control group. For bone-conducted measurement, significantly longer P1 latency and shorter P1-N1 latency of cVEMP were observed among the case group; there were a series of changes in oVEMP parameters among the case group. Logistic regression model revealed that air-conducted oVEMP asymmetric ratio was valuable to predict vestibular symptoms' development among the kids with LVAS., Conclusion: Asymmetric ratio of oVEMP could be used as one predictor of developing vestibular symptoms of the children with LVAS. Applying bone-conducted VEMP as one alternative parameter of vestibular syndrome is novel and will certainly remain an area of continued investigation.

Background: While stapes surgery has long been employed as a means of improving hearing in patients with otosclerosis, it remains controversial as to whether such surgical intervention is of value in patients with osteogenesis imperfecta (OI)., Aims: This study was therefore designed to determine whether stapes surgery could still be reliably performed in OI patients as it is in otosclerosis patients., Materials and Methods: Seventeen OI patients and 18 matched otosclerosis patients were included. In both of these groups, 22 ears underwent primary stapes surgery. Audiometric follow-up data for patients in these two treatment groups were available for between 2 weeks and 25 years post-surgery., Results: We detected significant improvements in both the short- and long-term mean air conduction threshold and reduced air-bone gap (ABG) in both treatment groups as measured via postoperative follow-up audiometry. There was no difference between the OI and otosclerosis patient groups with respect to short- and long-term postoperative audiometric. Conclusions and significance: The majority of patients with both OI and otosclerosis that underwent stapes surgery achieved beneficial gains in hearing function. We did not observe any differences in short- or long-term post-operative hearing gains or ABG reductions between the two groups.

Background: Endoscopy has been increasingly used in middle ear cholesteatoma surgery. It can increase the proportion of canal wall up (CWU) surgery and effectively control the recurrence and residual rates. However, there is a lack of systematic description on scutum reconstruction technique in endoscopic middle ear cholesteatoma surgery., Objective: The technique and classification of scutum reconstruction in endoscopic cholesteatoma surgery were proposed, and the outcomes were preliminarily evaluated., Methods: According to the development of mastoid and the way of hearing reconstruction, the reconstruction of scutum was classified into three types. The rates of residual and recurrence and hearing outcomes were observed and analyzed., Results: A total of 57 patients underwent endoscopic cholesteatoma surgery, all of which were CWU surgery. The reconstruction of the scutum was performed using tragal cartilage according to three types. The residual of cholesteatoma was observed in three cases. The recurrence of cholesteatoma and retraction pocket was detected in two cases and five cases, respectively. Postoperative hearing results were generally satisfied in all three types of surgeries., Conclusion: The technique of scutum reconstruction in endoscopic cholesteatoma surgery in this work can effectively control the recurrent disease after CWU surgery.

Background: The potential influence of Eustachian tube dysfunction (ETD) on the efficacy of tympanoplasty is controversial. Objective: This study aims to investigate the correlation between Eustachian tube function (ETF) and outcomes of type I tympanoplasty for chronic suppurative otitis media (CSOM). Materials and Methods: 53 patients with CSOM and receiving type I tympanoplasty were divided into a dysfunction group (Eustachian tube score; ETS ≤ 5points) and a normal group (ETS > 5 points) according to their preoperative ETS. During the one-year follow-up, the ETS, hearing results, and eardrum condition of the patients were recorded and analyzed. Results: The ETS improved significantly from 2.57 (±1.73SD) to 4.68 (±2.00SD), while the mean air-bone gap (ABG) decreased significantly from 20.94 (±9.04SD) dB to 16.43 (±9.06SD) dB in the dysfunction group ( p  < .05). The postoperative ABG showed no significant difference in the two groups. The healing rate of the tympanic membrane was 96.43% in the dysfunction group, and 100% in the normal group. Conclusions and significance: The ETF was significantly improved after type I tympanoplasty for CSOM combined with ETD, and the postoperative efficacy was not adversely affected. The ETD may not influence the outcomes of type I tympanoplasty for CSOM.

Background: Tinnitus was a subjective auditory phantom phenomenon which could be highly distressing and had no objective indicators for evaluation. Objectives: The aim of this study was to investigate whether and how did electroencephalography (EEG) microstates of subjective tinnitus patients change in resting state and whether could be an objective indicator for tinnitus. Material and Methods: We enrolled chronic subjective tinnitus patients and matched age and gender with healthy controls. EEG recording, microstate analysis and statistical analysis were performed. Results: We finally had 10 male and 8 female age-matched participants in tinnitus group and healthy control group. Statistical differences were found in the microstate A, C and D durations between the two groups (class A, p = .024; class B, p = .018; class D, p  = .029). Microstate durations of class A and D had linear correlation with VAS scores in tinnitus patients (microstate A [R spare = 0.43, p  = .003*]; microstate D [R spare = 0.46, p  = .002*]). Conclusions: Microstates had changed in chronic tinnitus patients and provided an indicator or perspective to explore the mechanisms of tinnitus. The maintenance of chronic subjective tinnitus may be related to changes in cerebral cortex activity.

Background: A set of Chinese Mandarin monosyllable test lists has been widely used in clinical diagnosis, while the performance of the Mandarin-speaking patients with auditory neuropathy (AN) in the monosyllable tests was still unknown. Objectives: To analyze the characteristics of monosyllable recognition in Mandarin-speaking patients with AN. Materials and methods: Nineteen Mandarin-speaking patients diagnosed with AN were recruited to obtain the performance-intensity (P-I) functions. They were divided into two paired groups according to two conditions: (1) the rising-slope (RS) and the non-rising-slope pattern (NRS) group for the audiogram; or (2) the male and the female group for gender. Results: The performance at 20 and 30 dB SL showed negative correlation with the pure tone-averaged thresholds of 0.5, 1.0, 2.0 and 4.0 kHz (4FA). We found significant differences between the P-I functions of the RS and the NRS group, and surprisingly found that between the male and female as well although there was no difference in 4FA between the paired groups. A notable rollover phenomenon in P-I functions was detected in each group. Conclusions: The monosyllable recognition scores of Mandarin-speaking AN patients showed numerous particular characteristics reflected by P-I functions. Acquiring the complete P-I functions at multiple presentation levels and the rollover index may give us more information about the diagnosis and prognosis.

Background: Tinnitus is a subjective auditory phantom phenomenon which can be highly distressing. About 63%-75% vestibular schwannoma (VS) had a symptom of tinnitus. Objectives: To investigate the tinnitus maintenance mechanism from the view of tinnitus change after surgical treatment in VS patients. Material and methods: We conducted a retrospective study of VS patients with tinnitus from August 2008 to February 2019 and did follow-ups on their changes of tinnitus after surgery. Results: Among 298 VS cases, 201 of them had tinnitus symptom (67.4%). No statistical difference in the surgical approach was found between the tinnitus poor outcome and good outcome groups ( p  = .14), and statistical difference was found in gender ( p  = .04) and tumor size ( p  = .01) between the two groups. Binary logistic regression analysis revealed that gender (odds ratio [OR], 2.12; 95% CI, 1.10-4.08 [ p  = .03]) and tumor size (OR, 2.22; 95% CI, 1.16-4.24 [ p  = .02]) emerged as a significant and independent factor associated with the good outcome of tinnitus. Conclusions and significance: The results of this study confirmed that the cochlear nucleus of the brainstem and above part of the brainstem may play an important role in the maintenance of tinnitus.

Background: Petrosal cholesteatoma is difficult to be diagnosed before operation. MRI-DWI can make the diagnosis more objective and accurate. Objective: Analysis of incidences and clinical characteristics of petrosal cholesteatoma, and the value of MRI-DWI in this disease. Materials and methods: The clinical manifestations, such as gender, hearing loss, vertigo, tinnitus, hemifacial spasm, facial paralysis, diplopia and ear leakage, and some images, such as CT and MRI of 81 patients with petrosal cholesteatoma were collected and analyzed retrospectively. And the Sanna classification of all the cases were also been analyzed. Results: There were 76 cases of hearing loss. There were 16 patients with vertigo; 12 of headache; 23 of tinnitus; 7 of hemifacial spasm; 54 of facial paralysis; 44 of homolateral ear leakage. There were 57 cases of type Supralabyrinthine, 8 of type Infralabyrinthine, 5 of type Apical, 6 of type Infralabytinthine-apical and 5 of type Massive. There were 2 cases of inconsistency between admission diagnosis and discharge diagnosis. Conclusions: The clinical manifestations of petrosal cholesteatoma are various, and sometimes it is difficult to differentiate it from other petrosal lesions. The combining with MRI-DWI and CT examination is necessary and has an advantage.

Background: The SIR scale has been widely used to measure speech improvement in late-implanted prelingually deafened adolescents and adults. However the ceiling effect of the SIR scale may lead to the loss of some information. Aim/objectives: To evaluate the oral ability of late-implanted prelingually deafened adolescents and adults using the MUSS and SIR scale and to analyse the relationship between the SIR score and the MUSS score. Material and methods: Ninety-four prelingually deafened adolescents and adults who had received cochlear implants were investigated. The MUSS and SIR scale were used to evaluate oral ability. Results: The relationship between the duration of implant use and the MUSS score was significantly different. No significant differences were found among the groups for age at implantation, gender and side of cochlear implantation. The total score on the MUSS was positively correlated with the SIR score. Conclusions and significance: The MUSS and the SIR scale could be used to evaluate the oral ability of late implanted patients. The SIR scale could be used to perform a rapid assessment and the MUSS could help provide more information. The combination of the two scales could be used to evaluate vocal ability more accurately and effectively.

Background: Patients may suffer postoperative facial nerve injury, hearing loss, or other postoperative complications after the operation, which seriously affect their postoperative life quality. Aims/objectives: To investigate the differences in QOL (quality of life) of patients with acoustic neuroma resection by the translabyrinthine or retrosigmoid approach. Material and methods: Patients with acoustic neuroma resection in our department were enrolled in this experimental study, among which fifty patients underwent the translabyrinthine approach resection, the other 50 patients underwent the retrosigmoid approach resection. Different scores by the SF-36 scale between these two groups of patients one month after discharge were then analyzed. Results: Scores of patients undergoing the retrosigmoid approach were higher in the three dimensions of Social Functioning, Role-emotional and Mental Health than those of patients undergoing the translabyrinthine approach with statistical significance. However, scores of patients undergoing the translabyrinthine approach were higher in the two dimensions of Body Pain and Vitality than those of the patients undergoing the retrosigmoid approach. Conclusions and significance: The results indicated that individual nursing interventions for different patients are necessary to improve the QOL of patients after hospitalization. Moreover, the operated patients with translabyrinthine approach were more advantage than patients with retrosigmoid approach.

Background: In recent years, the otoendoscopic surgery for epitympanic cholesteatoma has achieved great development, but it still has some disadvantages., Objective: This work aims to improve otoendoscopic surgery for epitympanic cholesteatoma invading the mastoid to retain the normal structure of the middle ear as much as possible., Methods: We classified the patients according to the lesion scope and applied different strategies of using the combination of otoendoscope and microscope. The surgery was improved and the recurrence and residual of middle ear cholesteatoma after operation were observed preliminarily., Results: Forty-six patients with middle ear cholesteatoma accepted surgical treatment, including 10 cases of independent otoendoscopic surgery, 29 cases of otoendoscope-microscope combined surgery, and seven cases of microscopic surgery assisted with an otoendoscope. All cases were treated with canal-up cholesteatoma surgery. The postoperative recurrent rate was 4/46., Conclusion: We improved existing otoendoscopic surgery to reduce or avoid bony defects of the acoustic meatus, and then decreased the proportion of canal-down surgery.

Background: Clinical trials of cell-based therapies using induced pluripotent stem (iPS) cells have already been started for several neurological diseases., Objective: The purpose of the present study was to explore the characteristics and differentiation of somatic cells in vitro undergoing a low pH treatment, so as to provide new therapeutic strategies for treating sensorineural hearing loss., Methods: Somatic cells were treated with low pH solution to alter their characteristics. In addition, a mouse model of the cochlear lesion was constructed using bilirubin. Subsequently, the characteristics and therapeutic effect of somatic cells undergoing low pH treatment were examined by morphology, alkaline phosphatase (AKP) activity, immunofluorescence assay and q-PCR., Results: The cells in the experimental group grew better than those in the control group. The AKP activity in the experimental group was higher than that in the control group. The expression of Nanog and Oct4 was both positive in the two groups. When the cells were changed to neurobasal medium, the marker of nestin was positive., Conclusion: The human somatic cells undergoing a low pH treatment showed the similar characteristics as those of iPS cells, although the functions and therapeutic effect of these altered human somatic cells need to be further studied.

Background: Until now, little is known about the role of miRNAs in the invasion and metastasis of Laryngeal squamous cell carcinoma (LSCC)., Objectives: This study aimed to explore the relationship between microRNA and the invasion and metastasis of LSCC., Material and Methods: The highly metastatic laryngocarcinoma cells were obtained from the established animal model with spontaneous lymph node metastasis of LSCC in our previous study. MicroRNA expression profiling and bioinformatic analysis were performed to analyze the microRNA expression changes in the highly metastatic laryngocarcinoma cells and the parental tumor cells (HEP-2). RT-PCR was performed for further validation of the result of microarray., Results: A total of 40 microRNAs were found to be significantly altered in the highly metastatic laryngocarcinoma cells compared to controls. Bioinformatic analysis identified that 19 key microRNAs might involve in LSCC development. Moreover, RT-PCR confirmed that miR-25, miR-100, miR-125b-5p and let-7g were differentially expressed in different laryngocarcinoma cells and human tumor specimens., Conclusions and Significance: Our findings suggest that microRNA play an important role in the invasion and metastasis of LSCC, and provide the clues for studying the function of microRNA as well as opportunities to analyze the complex molecular abnormalities driving LSCC progression.

Objective: To investigate whether there are more quantitative pre-synaptic ribbons formed in the cochlear region corresponding to middle-frequency in cochlea of mice., Methods: Counts of pre-synaptic ribbons were performed using immunostaining and laser confocal microscopy. Hearing thresholds and function of ribbon synapses were estimated by auditory brain response (ABR) and compound action potential (CAP). Cochlear mapping has been achieved to match the frequencies and corresponding regions along the cochlear spiral., Results: The number of pre-synaptic ribbons in per inner hair cell (IHC) has been found to increase gradually from the base turn, the maximal quantity appeared at the region of 50-70% from the apex. Next, ABR thresholds showed that there was the lowest ABR threshold in the frequency around 8-16 kHz, corresponding to the region of 50-70% from the apex according to the cochlear mapping. Further, CAP amplitudes were estimated, and the maximal value identified at the same frequency (8-16 kHz)., Conclusions: Maximal number of pre-synaptic ribbons is formed in the cochlear region of middle frequency in mice, coupling with the lowest ABR threshold and highest CAP amplitudes. Our study shows that the middle frequency (8-16 kHz) could be the most sensitive region to sound stimuli in mice.

Conclusions: The critical stage for cochlear gene regulation in the embryo is E49-E56. These data provide a valuable resource to help elucidate gene regulation in cochlear development and will benefit ear-related studies, especially those that focus on gene and stem cell therapies in hearing loss., Objectives: To investigate gene regulation in cochlear development and provide reference information for ear-related research., Methods: Total RNA extraction from the Bama miniature pig cochlea was performed at five time points that covered most of the cochlea development process (E42, E49, E56, E91, P13). Transcriptome sequencing was performed by Illumina HiSeq 2500. Transcriptome data were mapped to the genome using TopHat2. Gene expression was quantified using the Cuffquant and Cuffnorm modules. GO and KEGG pathway-enrichment analysis were in progress about the differentially expressed genes (DEGs) by Perl programs., Results: Sequencing of 1778643560000 paired reads revealed 35.9 G of data, and 19,432 expression genes were detected. The ratio of these pairs to the Ensembl genome database was approximately 71% in all samples. The stages E49-E91 and, especially, E49-E56 included the most rapid changes in gene regulation and differentiation for the cochlea. The stem cell characteristics of neural stem cells decreased most rapidly during this period.

Objectives: This study aimed to explore the molecular mechanism of the protective effects of hydrogen-saturated saline on NIHL., Methods: Guinea pigs were divided into three groups: hydrogen-saturated saline; normal saline; and control. For saline administration, the guinea pigs were given daily abdominal injections 3 d before and 1 h before noise exposure. ABR were tested to examine cochlear physiology changes. The changes of 8-hydroxy-desoxyguanosine (8-HOdG), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), intercellular cell adhesion molecule-1 (ICAM-1) and high mobility group box-1 protein (HMGB1) in the cochlea were also examined., Results: The results showed that pre-treatment with hydrogen-saturated saline could significantly attenuate noise-induced hearing loss. The concentration of 8-HOdG was also significantly decreased in the hydrogen-saturated saline group compared with the normal saline group. After noise exposure, the concentrations of IL-1, IL-6, TNF-α, and ICAM-1 in the cochlea of guinea pigs in the hydrogen-saturated saline group were dramatically reduced compared to those in the normal saline group. The concentrations of HMGB-1 and IL-10 in the hydrogen-saturated saline group were significantly higher than in those in the normal saline group immediately and at 7 d after noise exposure., Conclusions: This study revealed for the first time the protective effects of hydrogen-saturated saline on noise-induced hearing loss (NIHL) are related to both the anti-oxidative activity and anti-inflammatory activity.

Object: Acoustic stimulation induced LTP in the human auditory cortex was successfully recorded for the first time by electroencephalography (EEG) using a stimulus of 1 kHz pure-tone in 2005. However, it was barely reproduced, given considerable challenges to reliably elicit and accurately record the enhanced potentials in vivo. The purpose of this paper was to explore whether acoustic stimuli other than 1 kHz pure-tone could generate LTP or not., Measures: To answer this question, we proposed a tetanic-stimulation paradigm of pure-tones, narrow-band noises (NBNs) and white noise (WN) to elicit LTP in human subjects., Results: The results showed that pure-tones with different frequency could elicit LTP in human auditory cortex, and proved for the first time that NBNs and WN could also achieve the same goal. Interestingly, it was also shown that the noises with certain bandwidth induced the greatest LTP and the WN induced LTP had the least variation over time and across subjects in comparison with pure-tones and NBNs., Conclusions: In light of the results, we suggested to use the paradigm for broader studies of human in vivo cortical plasticity.

Objective: To investigate the expression of the miniature pig cochlea after AAV1 transfect into the cochlea via round window membrane (RWM)., Methods: Twenty miniature pigs are equally divided into four experimental groups. Twelve miniature pigs are equally divided into four control groups. Each pig was transfected with the AAV1 in the experimental group via RWM and each pig was transduced with the artificial perilymph in the control group. The expression of green fluorescent protein (GFP) was observed at 2 weeks, 3 weeks and 4 weeks, respectively. Likewise, AAV1 was delivered into the guinea pigs cochleas using the same method, and the results were compared with that of the miniature pigs., Results: The expression was mainly in the inner hair cells of the miniature pig. The expression of GFP began to appear at 2 weeks, reached the peak at 3 weeks. It also expressed in Hensen's cells, inner pillar cells, outer pillar cells, spiral limbus, and spiral ligament. In the meanwhile, AAV1 was delivered into guinea pig cochlea via the same method, and AAV1 was also expressed in the inner hair cells. But the expression peaked at 2 weeks, and the efficiency of the inner hair cell transfection was higher than that of the pig., Conclusion: AAV1 can be transformed into miniature pig cochlea via scala tympani by the RWM method efficiently.

Background: Previous study showed that mild ototoxic exposure could induce a reversible hearing impairment, and the loss and secondary incomplete recovery of cochlear ribbon synapses could be responsible for the hearing loss. However, it remains unclear whether cochlear outer hair cells' (OHCs) functions are affected., Objective: To verify whether the function of OHCs are also affected significantly after the ototoxic exposure., Methods: Mice were injected intraperitoneally with 100 mg/kg concentration of gentamicin daily for 14 days. Distortion Product of Oto-acoustic Emission (DPOAE) was detected at control (pre-treatment), Day 0, day 4, day 7, day 14 and day 28 after the ototoxic exposure, respectively. In addition, the morphology of OHCs was observed by electron microscopy, OHCs has been counted by light microscopy, and the hearing thresholds were detected by auditory brain response (ABR)., Results: No significant changes have been found in OHC and OHC stereocilia among the experimental groups (p > .05). Further, no significant changes or loss was found in the morphology of OHCs either. However, we found ABR threshold elevations occurred after ototoxic exposure., Conclusions: Unitary ototoxic gentamicin exposure may not disrupt the function of cochlear OHCs in mice, regardless of hearing loss identified in this ototoxic exposure.

Conclusion: p53 and Bcl-2 (B-cell lymphoma 2) are involved in the process of sensory cell degeneration in aging cochleae., Objective: To determine molecular players in age-related hair cell degeneration, this study examined the changes in p53 and Bcl-2 expression at different stages of apoptotic and necrotic death of hair cells in aging rat cochleae., Methods: Young (3-4 months) and aging (23-24 months) Fisher 344/NHsd rats were used. The thresholds of the auditory brainstem response (ABR) were measured to determine the auditory function. Immunolabeling was performed to determine the expression of p53 and Bcl-2 proteins in the sensory epithelium. Propidium iodide staining was performed to determine the morphologic changes in hair cell nuclei., Results: Aging rats exhibited a significant elevation in ABR thresholds at all tested frequencies (p < 0.001). The p53 and Bcl-2 immunoreactivity was increased in aging hair cells showing the early signs of apoptotic changes in their nuclei. The Bcl-2 expression increase was also observed in hair cells displaying early signs of necrosis. As the hair cell degenerative process advanced, p53 and Bcl-2 immunoreactivity became reduced or absent. In the areas where no detectable nuclear staining was present, p53 and Bcl-2 immunoreactivity was absent.

Conclusions: In this investigation, a large mammal, Rongchang pigs were used to successfully establish a research platform for cochlear implant study on the routine use of it in clinic., Objective: The aim of this study was to establish a standard method of cochlear implant in a large mammal-pig., Methods: Rongchang pigs were selected, then divided into two groups: normal-hearing group (Mitf +/+) and mutation group with hearing loss (Mitf -/-). Cochlear implants were used and ABR and EABR were recorded. The implanted electrodes were observed by X-ray and HE stains., Results: The success with cochlear implant and the best electrode position could be defined in all animals, the coiling of the cochlea reached 1.5-1.75 turns. Immediately after the operation of cochlear implants, the ABR threshold of the operated ear (right) could not be derived for each frequency at 120 dB SPL. Moreover, 7 days after surgery, the low-frequency ABR threshold of the operated ear (right) could be derived partly at 100 dB SPL, but the high-frequency ABR threshold could not be derived at 120 dB SPL. Immediately or 1 week after cochlear implants, the EABR threshold was 90 CL in the Mitf +/+ group. This was obviously lower than the 190 CL in the Mitf -/- group.

Conclusion: This method might be an effective intra-operative way to access hearing threshold under general anesthesia in the operating room., Objective: To develop an intra-operative hearing monitoring method for surgeons to access hearing threshold under general anesthesia in the operating room., Method: System establishment and calibration was done firstly. Normal hearing (NH) and conductive hearing loss (CHL) participants were recruited. This study applied pure tone audiometry (PTA) to all subjects and tone pip ABR (tp-ABR) via loudspeakers in sound booth and operating room for NH and CHL subjects, respectively. For NH subjects, Bland Altman was conducted to compare 1k Hz PTA and tp-ABR threshold. For CHL participants, Paired t-test, Satterth waite t'-test, and linear correlation analysis were used to compare the two methods. p < .05 was considered statistically different., Results: (1) Bland Altman showed all plots were inside the 95% confidence interval, indicating that there was no difference between the two methods for NH subjects. (2) The two methods had a high correlation (Pearson's coefficient =0.872 > 0.6, p < .05) in assessing hearing threshold in the operating room. (3) Satterth waite t'-test showed the ossicular chain malfunction enlarged the deviation of threshold by the two methods (.01 < p < .025).

Conclusion: The shape from shading and optical flow are implemented to three-dimensional (3D) reconstruction., Objective: Solve the problem of 3D reconstruction in endoscope imaging., Method: One of the fundamental approaches in the domain of computer vision is shape from shading. This algorithm was proposed to obtain the shape of an object from a single intensity image. Because of the severe conditions are required in shape from shading to reconstruct 3D surface. The photometric calibration is proposed from the view of image processing. The calibration is important for illumination-based visualization techniques such as SFS (shape-from-shading). However, the surface reconstruction from SFS is the relative variation in the grey gradient field. So the change from relative variation to absolute variation is necessary when the actual size of surroundings has to be known. Then the optical flow is introduced to solve this change in the paper. The optical tracker is also used in this system to capture the pose of endoscopy., Result: The stability of surface reconstruction is improved when the photometric calibration is used before shape from shading.

Objective: To investigate surgical management of type III EACC with lesions involving the posterior external auditory canal and mastoid., Methods: This retrospective case review was conducted in 12 patients with type III EACC who underwent intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone., Results: During the follow-up, all patients obtained successful results on external auditory canal structures and hearing improvement, except for one patient who needed a revision operation for the fistula between the reconstructed wall and the mastoid., Conclusion: Intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone was proved to be an effective and inexpensive choice for the patients with type III external auditory canal cholesteatoma (EACC) to achieve optimal outcomes.

Conclusion: Noise exposure can cause a decline in cochlear ribbon synapses and result in consequent hearing loss. The reduction of synaptic puncta appears reversible and may contribute to hearing restoration in mice after noise exposure., Objective: To detect whether noise induced reversible changes of cochlear ribbon synapses contribute to temporary hearing loss in C57BL/6J mice., Methods: The mice were assigned randomly to five groups and exposed to white noise at 110 dB SPL for 2 h except the control group. ABR thresholds were acquired before noise exposure (control), immediately following exposure (Day 0), or on Days 4, 7, or 14 after noise exposure. Light microscopy, scanning emission microscopy, and whole mounts examination was utilized to study whether there is morphology change of outer hair cells (OHC), inner hair cells (IHC), or spiral ganglion cells (SGN) due to the 110 dB white noise. Moreover, experimental approaches, including immunostaining and confocal microcopy, were used to detect whether ribbon synapses were the primary targets of noise-induced temporary hearing loss., Result: Exposure to 110 dB white noise for 2 h induced TTS in mice, with the maximal ABR threshold elevations seen on the 4(th) day after noise exposure. There were no significant morphological changes in the cochlea. Paralleled changes of pre-synaptic ribbons in both the number and post-synaptic density (PSDs) during this noise exposure were detected. The number of pre-synaptic ribbon, post-synaptic density (PSDs), and co-localized puncta correlated with the shifts of ABR thresholds. Moreover, a complete recovery of ABR thresholds and synaptic puncta was seen on the 14(th) day after the noise stimulations.

Conclusion: This study suggests that hyperbilirubinemia in the neonatal rat can impair auditory function and induce peripheral nerve pathology by reducing neurofilament-positive cells in spiral ganglion neurons (SGNs). This finding indicates a potential connection between hyperbilirubinemia and auditory impairment., Objective: To establish a neonatal rat hyperbilirubinemia induced by hemolysis and assess the possible link between hyperbilirubinemia and auditory impairment., Methods: Wistar rats were divided into two groups - a bilirubin exposure group injected with phenylhydrazine hydrochloride at 7 and 28 days of age to induce hyperbilirubinemia, and a control group given saline. Auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs) were determined to assess auditory function. Cochlea basilar membrane stretch preparations and cochlear frozen sections were examined for morphological changes in hair cells and SGNs., Results: At day 7, ABR wave I, III, and V latencies, and I-III, I-V interwave intervals (IWIs) in the experimental group were significantly prolonged compared with those in the control group. ABR thresholds were also elevated in the experimental group. We found no significant difference in DPOAEs in the bilirubin exposure group compared to the control group. The ABRs and DPOAEs in the experimental group were restored at age 28 days. Cochlear hair cells showed no signs of loss in either group; however, the total number of neurofilament-positive cells in SGNs was significantly reduced in the phenylhydrazine-treated animals.

Conclusion: SOX2-positive head and neck cancer patients had a worse prognosis, and this was associated with common clinicopathological poor prognostic factors., Objective: To investigate the correlation between SOX2-positive head and neck cancer and clinicopathological features and its impact on survival., Methods: A search in PubMed and Chinese CNKI (up to 1 July 2013) was performed. Only articles in which SOX2 antigen was detected in situ localization by immunohistochemical staining were included. This meta-analysis was done using RevMan 5.2 software. Outcomes included overall survival and various clinicopathological features., Results: A total of 926 gastric cancer patients from 9 studies were included. Meta-analysis showed that patients with SOX2 expression had a significantly worse 5-year overall survival compared with those with low expression (relative risk (RR) = 2.38, 95% confidence interval (CI) = 1.10-5.15, p = 0.03, random-effect). With respect to clinicopathological features, SOX2 overexpression as assessed by the immunohistochemistry method was closely correlated with tumor T stage, lymph node metastasis, and TNM stage.

Objective: The aim of this study was to analyze the safety and effectiveness of a new cochlear implant (CI) system developed in China, the Nurotron Venus device., Material and Methods: Fifteen post-lingually deafened patients received Nurotron Venus CIs in our hospital. The safety and effectiveness of the devices were evaluated within 2 years after implantation. Patients' hearing thresholds were assessed. In addition, the speech perception performance of Nurotron Venus CI recipients was compared with that of 15 Cochlear Nucleus CI24 recipients., Results and Conclusion: During 2 years of observation, all the Nurotron recipients used their devices regularly and effectively. The aided hearing thresholds of all the recipients were within the speech spectrum. The average scores of HOPE sentences and HOPE monosyllable words tests among Nurotron CI recipients were 82.88 ± 21.40% and 56.67 ± 9.77%, respectively. The average scores among Cochlear Nucleus CI24 recipients were 87.33 ± 14.44% and 52.8 ± 12.76%, respectively. There was no statistically significant difference in the speech test scores between these two groups when assessed using the t test. The Nurotron Venus cochlear implant system worked safely and effectively. The speech perception of Nurotron recipients was similar to that of the other CI system recipients.

Conclusion: Ototoxic gentamicin exposure does not disrupt the expression of myosin VIIa in the inner hair cells (IHCs) of mice, whereas gentamicin ototoxicity causes altered expression of otoferlin in IHCs, as well as parallel hearing threshold shifts., Objective: To explore whether myosin VIIa and otoferlin in IHCs have different responses to gentamicin ototoxicity., Methods: Lower dose treatment (100 mg/kg): adult C57 mice were continuously injected intraperitoneally with gentamicin once a day for 14 consecutive days. Dose-dependent gentamicin treatment: mice were injected intraperitoneally with differing doses (100, 200, and 300 mg/kg) once a day for 2 consecutive days. The hearing thresholds were detected by auditory brainstem response (ABR). Immunostaining and Western blotting were utilized to measure the manner of expression of myosin VIIa and otoferlin in IHCs., Results: Lower dose treatment: There were no significant differences among the control (day 0), and 4, 7, and 14 days after the ototoxicity exposure (p > 0.05). Dose-dependent gentamicin treatment: There were no significant differences among the control, 100, 200, and 300 mg/kg groups after the ototoxicity exposure (p > 0.05). In contrast, we found an altered expression of otoferlin in IHCs among the control (day 0), and 4, 7, and 14 days of exposure, when the mice were exposed to gentamicin ototoxicity (p > 0.05).

Conclusions: Subtotal facial nerve decompression seems effective to prevent further episodes of facial palsy and promote facial nerve recovery for recurrent facial palsy in Melkersson Rosenthal syndrome (MRS). The main inflammatory sites of recurrent facial palsy in MRS may be the mastoid segment, tympanic segment, geniculate ganglion, and labyrinthine segment., Objective: To present our surgical experience in preventing further episodes of facial palsy and improving facial nerve recovery of patients with recurrent facial palsy in MRS., Methods: We performed transmastoid subtotal facial nerve decompression on eight patients with recurrent facial palsy in MRS. They were followed up for 3.3 years on average (range 2-5 years)., Results: There were no further attacks of facial palsy in any of the cases. Seven cases (87.5%) recovered to grade I or grade II, and three of eight cases (37.5%) recovered completely. We found obvious edema of the facial nerve at the mastoid segment in all cases, at the tympanic segment and geniculate ganglion in five cases (62.5%), and at the labyrinthine segment in only one case (12.5%).

Conclusion: Dynamic distribution of ototoxic gentamicin entry into inner hair cells (IHCs) may cause an interruption of cochlear ribbon synapse., Objective: To explore the pattern of uptake of gentamicin into IHCs, as well as its possible contribution to hearing loss., Methods: Adult C57 mice were injected intraperitoneally with gentamicin (100 mg/kg, conjugated with Texas Red ester) continuously for 14 days. The hearing thresholds were detected by auditory brainstem response (ABR) examinations. Immunostaining and confocal microscopy were utilized to trace gentamicin distribution, as well as the expression of RIBEYE/CtBP2 in mouse IHCs. Scanning electron microscopy (SEM) observation was used to find possible alterations of stereocilia., Results: The distribution of gentamicin in IHCs was first found on the 4th day and the accumulation of gentamicin was increased significantly on the 7th day after treatment, corresponding to the maximal elevation of the hearing threshold. However, the accumulation of gentamicin on the 14th day did not show significant differences compared with the level found on the 7th day. In addition, the uptake of gentamicin was excessively identified at or near the synaptic ribbons of IHCs throughout the 4th, 7th, and 14th days after the treatment, suggesting that cochlear ribbon synapses could be affected by ototoxic gentamicin exposure.

Conclusions: We consider that the transmastoid-epitympanum approach to decompression of the geniculate ganglion, without a craniotomy, combining the advantages of middle cranial fossa and transmastoid extralabyrinthine approaches, is simple, minimally invasive, safe, and effective, with little postoperative hearing change. It can be employed in some cases of facial palsy due to temporal bone fracture (TBF) and middle ear cholesteatoma (MEC) in accordance with the range of facial paralysis, facial nerve electrophysiology, and imaging guidance., Objective: To evaluate the efficacy of geniculate ganglion decompression of the facial nerve by the transmastoid-epitympanum approach., Methods: Thirty cases of facial palsy were reviewed, including patients with TBF and MEC. All the patients were evaluated by routine preoperative tests including high-resolution computed tomography (HRCT), audiometry, and electroneuronography, and were treated by transmastoid-epitympanum decompression. The negative effects on auditory function were recorded., Results: The mean percentage facial function improvement (House-Brackmann grade I-II) was 88% in TBF and 100% in MEC. The negative effects on auditory function were less than 10 dB in most cases.

Unlabelled: Abstract Conclusions: It is impossible to make a diagnosis of temporal giant cell granuloma (GCG) before operation because of nonspecific clinical and imaging feature. Surgery is the first-line choice of treatment., Objective: To evaluate the diagnosis and treatment of temporal GCG., Methods: Eight patients with GCG receiving treatment in the Chinese PLA General Hospital between 2001 and 2010 were recruited for the study. These patients' clinical features, imaging and histopathological findings, types of surgery, and results of follow-up evaluations were noted., Results: The group was made up of four males and four females, with a median age of 37 years (range 21-50 years). Four patients had a granuloma on the left side and four on the right of the head. The median duration of the disease was 21 months (range 5-60 months). All patients, except one referred to us for recurring disease, were managed in our hospital. The main symptoms were: hearing loss (n = 5), tinnitus (n = 4), otalgia (n = 3), dizziness (n = 2), and local masses (n = 2). Radiological examination of the masses revealed erosion of the temporal bone and base of the skull. There was no definitive diagnosis in any of the patients before surgery. All patients had surgical treatment, six of them by middle cranial fossa approach and two by combined cranio-auricular approach. Surgical complications included partial facial paralysis (three cases) and cerebral edema (one case) but they resolved soon after surgery. One patient was lost to follow-up, but the other seven were followed up over a mean period of 24 months; none has reported a recurrence.

Conclusions: The commonest manifestation of facial nerve tumours was facial paralysis, followed by hearing loss. During tumour resection facial nerve continuity should be maintained and reconstructed in one stage wherever possible. If this is not a viable option, second-stage surgery should be performed as soon as possible after surgery., Objective: To summarize the clinical characteristics of tumours of the facial nerve and discuss their diagnosis and treatment., Patients and Methods: Twenty-two cases of primary facial nerve tumours were reviewed. These cases were confirmed pathologically and treated in the Chinese PLA General Hospital during the period 1986-2003, where the clinical manifestations, diagnosis and treatment of this series were analysed., Results: Among the 22 cases, 14 were facial neurilemmomas, 6 were facial neurofibromas and 2 were facial nerve haemangiomas. The commonest presenting symptom in all cases was facial paralysis (14/22) followed by hearing loss (10/22). Facial paralysis was also the commonest sign of a facial nerve tumour (18/22), followed by a swollen mass in the tympanic cavity (8/22) and a swollen mass in the external auditory canal (5/22). The 22 tumours were totally resected surgically. The function of the facial nerve was normal (grade I) in two cases where the integrity of the nerve was preserved during the operation, grade II in one case and grade III in another case where it was possible to maintain partial continuity of the facial nerve. The facial nerve was reconstructed in one stage when the tumours were resected, with facial-great auricular-facial nerve cable grafting (10 cases) and facial-lateral femoral cutaneous-facial nerve cable grafting (1 case). The facial nerve function consequently recovered to grade II-IV. The second stage facial-hypoglossal nerve anastomosis was carried out in two cases, and facial function consequently recovered to grade II in one case at 3 years and grade III in another with 2 years follow-up. In five cases, the facial nerve remained discontinuous and the facial nerve function showed no recovery (grade VI).