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Journal of Otology 2017年第4期12卷 174-184页

作者： Jing Zou Timo Hirvonen Department of Otolaryngology-Head and Neck Surgery Center for Otolaryngology-Head & Neck Surgery of Chinese PLA Changhai Hospital Second Military Medical University Department of Otorhinolaryngology-Head and Neck Surgery University of Helsinki and Helsinki University Hospital

Vestibular schwannoma(VS) is a slow-growing benign neoplasm. There has been an evolution in the management of VS from active treatments(microsurgery and stereotactic radiotherapy) to conservative management(wait and scan). Regular MRI scanning is necessary to monitor tumor progression. Conservative management causes significantly less complications and offers a higher quality of life compared with active treatments. The mean growth rate of VS varies from 0.4 to 2.9 mm/year, and spontaneous shrinkage is observed in 3.8 percent of tumors during observation. If significant growth occurs, active treatment is considered. Significant growth is defined as an increase of at least 3 mm in the largest extrameatal diameter in any plane between the first and last available scans. The vestibulocochlear nerve is surrounded by cerebrospinal fluid, which provides natural contrast for MRI; thus, gadolinium may not be needed to detect VS. Specific sequences have high sensitivity, specificity, and accuracy for detection of progression. Hypointense signal in the ipsilateral inner ear fluid might be a useful sign to distinguish VS from meningioma. In this paper, we summarize the current status of research on conservative management and non-contrast MRI for the detection of VS.

关键词： Vestibular schwannomas Treatment Magnetic resonance imaging Contrast Quality of life

Label-free visualization of cholesteatoma in the mastoid and tympanic membrane using CARS microscopy

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Journal of Otology 2016年第3期11卷 127-133页

作者： Jing Zou Antti Isomaki Timo Hirvonen Antti Aarnisalo Jussi Jero Ilmari Pyykko Department of Otolaryngology-Head and Neck Surgery Center for Otolaryngology-Head&Neck Surgery of Chinese PLAChanghai HospitalSecond Military Medical University Hearing and Balance Research Unit Field of Oto-laryngologySchool of MedicineUniversity of Tampere Biomedicum Imaging Unit Faculty of MedicineUniversity of Helsinki Department of Otorhinolaryngology-Head and Neck Surgery Helsinki University Central Hospital

Objective:The present study aimed to evaluate the possibility of using coherent anti-Stokes Raman spectroscopy（CARS） microscopy to determine the specific molecular morphology of cholesteatoma by detecting the natural vibrational contrast of the chemical bonds without any staining.Materials and methods:Specimens from the mastoid and tympanic membrane with and without cholesteatoma were analyzed using CARS microscopy,two-photon excited fluorescence（TPEF） microscopy,and the second harmonic generation（SHG） microscopy.Results:In cholesteatoma tissues from the mastoid,a strong resonant signal at 2845 cm;was observed by CARS,which indicated the detection of the CH;hydro-carbon lipid bonds that do not generate visible signals at 2940 cm;suggestive of CH;bonds in amino acids.A strong resonant signal at 2940 cm;appeared in an area of the same specimen,which also generated abundant signals by TPEF and SHG microscopy at 817 nm,which was suggestive of collagen.In the tympanic membrane specimen with cholesteatoma,a strong resonant signal with corrugated morphology was detected,which indicated the presence of lipids.A strong signal was detected in the tympanic membrane with chronic otitis media using TPEF/SHG at 817 nm,which indicated collagen enrichment.The CARS and TPEF/SHG images were in accordance with the histology results.Conclusion:These results suggest the need to develop a novel CARS microendoscope that can be used in combination with TPEF/SHG to distinguish cholesteatoma from inflammatory tissues.

关键词： Cholesteatoma Imaging Label-free Raman spectroscopy High resolution

Development of otology specific outcome measure:Ear Outcome Survey-16 (EOS-16)

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Journal of Otology 2021年第3期16卷 150-157页

作者： Juha T.Laakso Juha Silvola Timo Hirvonen Samuli Suutarla Ilkka Kivekas Riitta Saarinen Lotta Haavisto Jaakko Laitakari Antti A.Aarnisalo Aarno Dietz Jussi Jero Maija Hytonen Saku T.Sink Department of Otorhinolaryngology-Head and Neck Surgery Head and Neck CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland Department of Ear Noseand Throat-Division of SurgeryAkershus University HospitalLørenskogNorway Department of Otorhinolaryngology Kymenlaakso Central HospitalKotkaFinland Department of Otorhinolaryngology-Head and Neck Surgery Tampere University Hospital and Tampere UniversityTampereFinland Department of Otorhinolaryngology-Head and Neck Surgery Turku University Hospital and University of TurkuTurkuFinland Department of Otorhinolaryngology-Head and Neck Surgery Oulu University Hospital and PEDEGO Research UnitUniversity of Oulu and Medical Research Center OuluFinland Department of Otorhinolaryngology-Head and Neck Surgery Kuopio University Hospital and University of KuopioKuopioFinland

Purpose An important outcome measure of patient care is the impact on the patient’s health-related quality of life(HRQoL).Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms,hearing problems,psychosocial impact,and the need for care.The optimal length of the recall period has not been studied.For these reasons,a new survey is needed that would cover most chronic ear diseases.Methods A preliminary 24-item survey(EOS-24)was created.Untreated adult patients(included n=186)with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument.The recruiting otologists evaluated the severity of the disease and the disability caused by it.A control group was recruited.Based on the patients’responses in different diagnosis groups,the items were reduced according to pre-defined criteria.The resulting survey was validated using a thorough statistical analysis.Results The relevance and necessity of the original 24 items were thoroughly investigated,leading to the exclusion of 8 items and the modification of 1.The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups,thus constituting the final instrument,EOS-16.The most suitable recall period was three months.Conclusions EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population.The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.

关键词： Otology Chronic ear diseases HRQoL Health-related quality of life PROM

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芬兰人工耳蜗植入术加强无菌措施的方法

中华耳科学杂志 2018年第1期16卷 118-121页

作者：邹静秦晶姜晓瑜李勇周蓉珏徐菲 Timo Hirvonen Antti Aarnisalo Jussi Jero 郑宏良中国人民解放军第二军医大学长海医院耳鼻咽喉头颈外科全军耳鼻咽喉头颈外科中心上海中国人民解放军第二军医大学长海医院麻醉学部手术室上海 Department of Otorhinolaryngology-Head and Neck Surgery University of Helsinkiand Helsinki University HospitalHelsinkiFinland

人工耳蜗植入已经在全球广泛开展并帮助广大聋病患者重新返回正常生活,且并发症的发生率也越来越少;然而,围手术期和术后晚期感染性并发症仍然时有发生。在某些特殊病例中,当抗生素无效时,植入体也将会被废弃,重新植入将会显著增加患者... 详细信息

人工耳蜗植入已经在全球广泛开展并帮助广大聋病患者重新返回正常生活,且并发症的发生率也越来越少;然而,围手术期和术后晚期感染性并发症仍然时有发生。在某些特殊病例中,当抗生素无效时,植入体也将会被废弃,重新植入将会显著增加患者经济负担。芬兰的所有人工耳蜗植入中心都采用一种术中加强无菌措施以便预防或者减少感染性并发症的发生。其关键点是,从手术室的术前准备到完成植入手术,全程严格实施无菌操作,在完成颞骨钻磨工作以后,清理术野,医生和护士重新进行手部消毒,更新术区的无菌巾和医护人员的手套,打开人工耳蜗植入体的包装,固定植入体并安装耳蜗电极,完成后续程序。在仅预防性使用抗生素的情况下,610次人工耳蜗植入未发生植入体的原发性感染并发症。邹静于2016年在赫尔辛基大学中心医院耳鼻咽喉头颈外科学习人工耳蜗植入的临床相关技术,将这一加强无菌措施在长海医院推广应用。除了因为医院的实际情况而存在一些较小的差异外,关键步骤完全可以在长海医院实施。本文将对该技术进行详细报道,期望今后在中国全国推广这一效价比很高的技术。

关键词：人工耳蜗植入无菌措施感染并发症手术

前庭功能损失后电动头脉冲试验中水平前庭眼反射的恢复普遍存在

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临床耳鼻咽喉头颈外科杂志 2014年第8期28卷 557-561页

作者： TOPI JUTILA HEIKKI AALTO timo P.hirvonen 张甦琳孔维佳 Department of Otorhinolaryngology Helsinki University Central Hospital 华中科技大学同济医学院附属协和医院耳鼻咽喉科武汉430022

目的:对急性单侧外周前庭功能损失的患者使用机动化的头脉冲试验量化前庭功能的恢复,并把这些结果与其他体征和症状相比较。方法:使用机动化头脉冲旋转仪记录30例突发单侧前庭功能障碍的患者平均在发生后3d(前期)的潜在的水平前庭眼反射... 详细信息

目的:对急性单侧外周前庭功能损失的患者使用机动化的头脉冲试验量化前庭功能的恢复,并把这些结果与其他体征和症状相比较。方法:使用机动化头脉冲旋转仪记录30例突发单侧前庭功能障碍的患者平均在发生后3d(前期)的潜在的水平前庭眼反射(VOR),20例患者平均3个月后(后期)继续测量。计算VOR增益和不对称(珚x±s)。结果:从前期的患侧增益0.49±0.21到后期的0.79±0.23(P=0.0000)有高度显著改善。各自的不对称从(32±18)%到(12±14)%(P=0.0002)也有高度显著改善。至少80%的患者增益或不对称恢复。后期的高症状评分与低增益(P=0.043)和高不对称(P=0.018)有相关性。结论:用机动化的头脉冲旋转仪来测量减少的水平VOR增益,突发单侧前庭功能损失后至少部分恢复。除了眼震的传统评价,头脉冲试验的反应为前庭损失的严重程度和恢复提供了有价值的信息。

关键词：头晕眩晕跟震前庭神经炎