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Objective The pandemic of 2019 coronavirus (SARS-CoV-2) disease (COVID-19) has imposed a severe public health burden worldwide. Most patients with COVID-19 were mild. Severe patients progressed rapidly to critical condition including acute respiratory distress syndrome (ARDS), multi-organ failure and even death. This study aims to find early multi-organ injury indicators and blood glucose for predicting mortality of COVID-19. Methods Fasting blood glucose (FBG) ≥7.0 mmol/L for two times during hospitalization and without a history of diabetes were defined as new-onset COVID-19-related diabetes (CRD). Indicators of injuries for multiple organs, including the lung, heart, kidney and liver, and glucose homeostasis were specifically analyzed for predicting death. Results A total of 120 patients with a severity equal to or greater than Moderate were hospitalized. After excluding patients with history of diabetes, chronic heart, kidney, and liver disease, 69 patients were included in the final analysis. Of the 69 patients, 23 were Moderate, 20 were Severe, and 26 were Critical (including 16 deceased patients). Univariable analysis indicated that CRD, lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatine kinase (CK) and creatinine (Cr) were associated with death. Multivariable analysis indicated that CRD was an independent predictor for death (HR = 3.75, 95% CI 1.26–11.15). Abnormal glucose homeostasis or CRD occurred earlier than other indicators for predicting poor outcomes. Indicators of multiple organ injury were in parallel with the expression patterns of ACE2 (the SARS-CoV-2 receptor) in different organs including pancreatic islet. Conclusions New-onset COVID-19-related diabetes is an early indicator of multi-organ injury and predictor for poor outcomes and death in COVID-19 patients. As it is easy to perform for clinical practices and self-monitoring, glucose testing will be helpful for predicting poor outcomes to facilitate appropriate intensive care.

Background: The acceptance of wearable intelligent medical devices (WIMDs) and the factors influencing behavioral intention to use them have been scarcely studied. Methods: Integrating the unified theory of acceptance and use of technology, the theory of perceived risk, and basing on the features of wearable intelligent medical devices, we propose a research model to identify factors influencing the acceptance of WIMDs. Using data collected from 2,192 respondents in China from an online survey, we used structural equation modeling to test the measurement and structural models. Findings: The findings suggest that: (1) facilitating conditions (path coefficient = 0.942, P < 0.001) are critical to the use WIMDs; (2) behavioral intention is a significant mediator of the effects of perceived risk, perceived cost, health expectation, perceived ease of use, and social influence on use behavior (path coefficient = 0.210, P < 0.001); (3) health expectation (path coefficient = 0.860, P < 0.001), perceived ease of use (path coefficient = 0.289, P < 0.001), and social influence (path coefficient = 0.153, P < 0.001) are found to play essential roles in predicting behavioral intention; (4) perceived cost (path coefficient = 0.034, P < 0.05) and perceived risk (path coefficient = -0.031, P < 0.05) have no significant effect on behavioral intention; and (5) people with underlying diseases have lower health expectations and perceived costs. Interpretation: The modified unified theory of acceptance and use of technology model in our research is a reliable model to evaluate the user acceptance of WIMDs. Funding Information: This study was supported by a project grant from National Key Research and Development Program of China: Artificial Intelligence Management and Service Model for Public Health and Medicine (2018YFC0116800). Declaration of Interests: All other authors declare no competing interest. Ethics Approval Statement: This study was approved by the Ethics Committee of Beijing TongRen Hospital, Capital Medical University (TRECKY2019-049) and all respondents provided informed consent online. Personal data were anonymized prior to analysis.

Background: The purpose of the study was to investigate to understand the situation of sleep quality and anxiety among nurses in tertiary hospitals in China, and analyze their influencing factors.Methods: A cross-sectional survey was performed for nurses in Beijing tertiary hospitals including Beijing Tongren hospital, Anzhen Hospital and Beijing Children Hospital. The Pittsburgh Sleep Quality Indes (PSQI) and Zung Self-Rating Anxiety Scale (SAS) were used to measured the sleep quality and anxiety symptoms, respectively. Survey of quality of life in nurses was measured by 36-item Short Form Health Survey (SF-36). Spearman’s correlations analysis and logistic regression analysis was used to understand the influencing factors with sleep disorder, anxiety symptoms and quality of sleep. Quality of life (both PCS and MCS) were affected by influencing factors including marital status, working years, education background, income monthly, working hours, regular diet, physical exercise, sleep disorder, anxiety symptoms, felling of stress, and stress from economic, social, occupational.Results: 643 registered nurses in three tertiary hospitals were surveyed, 517 (80.4%) returned questionnaires were valid for analysis. The average PSQI score was 7.71±3.62, including 372 participants that scores were above 5 (72.0%). The average SAS score was 45.18±9.90,including 157 participants with a SAS score ＞ 50 (30.4%) that had different anxiety symptoms. The nurses’ sleep quality were affected by some factors including income monthly, working hours, regular diet, physical exercise, stress from economic, social, occupational. Education background, income monthly, working hours, regular diet and economic stress, social stress, occupational stress have significantly related to anxiety symptoms. Correlation between sleep disorder and anxiety severity was positive for nurses.Conclusions: The situation of sleep disorder and anxiety symptoms among nurses in tertiary hospitals in China were very serious. The problem has negative effect on physical and mental health in nurses which reminded hospital administrators should take preventive actions. In addition, the results of the study hinted that promotion of health lifestyle, effort-reward balance and providing social support may be significant to decrease the poor sleep quality and anxiety symptoms and increase quality of life in nurses.

ImportanceThe recent outbreak of Novel Coronavirus (SARS-CoV-2) Disease (COVID-19) has put the world on alert, that is reminiscent of the SARS outbreak seventeen years ago.ObjectiveWe aim to compare the severity and mortality between male and female patients with both COVID-19 and SARS, to explore the most useful prognostic factors for individualized assessment.Design, Setting, and ParticipantsWe extracted the data from a case series of 43 hospitalized patients we treated, a public data set of the first 37 cases died of COVID-19 in Wuhan city and 1019 survived patients from six cities in China. We also analyzed the data of 524 patients with SARS, including 139 deaths, from Beijing city in early 2003.Main Outcomes and MeasuresSeverity and mortality.ResultsOlder age and high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. The percentages of older age (≥65 years) were much higher in the deceased group than in the survived group in patients with both COVID-19 (83.8 vs. 13.2, PConclusions and RelevanceOlder age and male gender are risk factors for worse outcome in patients with COVID. While men and women have the same susceptibility to both SARS-CoV-2 and SARS-CoV, men may be more prone to have higher severity and mortality independent of age and susceptibility.Key PointsQuestionAre men more susceptible to getting and dying from COVID-19?FindingsIn the case series, men tend to be more serious than women. In the public data set, the percentage of men were higher in the deceased group than in the survived group, although age was comparable between men and women.MeaningMale gender is a risk factor for worse outcome in patients with COVID independent of age and susceptibility.

Background: Most patients with Coronavirus Disease 2019 (COVID-19) were mild. Severe patients progressed rapidly to critical condition including multi-organ failure and even death. Identification of early predictive factors is urgently necessary to facilitate appropriate intensive care. Methods: We included all patient admitted to Wuhan Union Hospital and treated by the supportive medical team of Beijing Tongren Hospital as of March 20, 2020. Indicators of injuries for multiple organs, including the heart, kidney and liver, and glucose homeostasis were specifically analyzed for predicting primary outcomes (an intensive care unit (ICU) or death). Findings: The data of 120 patients with a severity equal to or greater than Moderate, discharged from the hospital or died were extracted. After excluding patients with chronic heart, kidney, liver disease and diabetes, 69 patients were included in the final analysis. There were 26 cases with primary outcomes including 16 deaths. Univariable analysis indicated that elevations of fasting blood glucose (FBG), lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatine kinase (CK) and creatinine (Cr) were associated with higher odds of primary outcomes and more hazards of death. Cox regression results indicated that FBG≥7mmol/L was the only independent predictor for death (HR = 3.75, 95% CI 1.26-11.15). Cluster analysis found more proximities of FBG (at the time of admission) with LDH, HDDH or Creatinine (at the time after 2-4 days of hospitalization) (r=0.43, 0.43 and 0.50, respectively, P

Concurrent hearing and genetic screening of newborns is expected to play important roles not only in early detection and diagnosis of congenital deafness, which triggers intervention, but also in predicting late-onset and progressive hearing loss and identifying individuals who are at risk of drug-induced HL. Concurrent hearing and genetic screening in the whole newborn population in Beijing was launched in January 2012. This study included 180,469 infants born in Beijing between April 2013 and March 2014, with last follow-up on February 24, 2018. Hearing screening was performed using transiently evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (AABR). For genetic testing, dried blood spots were collected and nine variants in four genes, GJB2, SLC26A4, mtDNA 12S rRNA, and GJB3, were screened using a DNA microarray platform. Of the 180,469 infants, 1,915 (1.061%) were referred bilaterally or unilaterally for hearing screening; 8,136 (4.508%) were positive for genetic screening (heterozygote, homozygote, or compound heterozygote and mtDNA homoplasmy or heteroplasmy), among whom 7,896 (4.375%) passed hearing screening. Forty (0.022%) infants carried two variants in GJB2 or SLC26A4 (homozygote or compound heterozygote) and 10 of those infants passed newborn hearing screening. In total, 409 (0.227%) infants carried the mtDNA 12S rRNA variant (m.1555A>G or m.1494C>T), and 405 of them passed newborn hearing screening. In this cohort study, 25% of infants with pathogenic combinations of GJB2 or SLC26A4 variants and 99% of infants with an m.1555A>G or m.1494C>T variant passed routine newborn hearing screening, indicating that concurrent screening provides a more comprehensive approach for management of congenital deafness and prevention of ototoxicity.

The development and maintenance of spiral ganglion cells (SGCs) appear to be supported by neurotrophins. Removal of this support leads to their gradual degeneration. Intracochlear infusion with neurotrophins can provide trophic support to SGCs in animal deafness models if given shortly after deafening. However, it is not known whether delayed intervention will provide similar protection, which might be clinically relevant. The present research was conducted to determine the effects of brain-derived neurotrophic factor (BDNF) administration on the capacity of the peripheral processes to resprout.The left cochlea of 20 profoundly deafened rats, which were divided into 2 groups equally, was implanted with an electrode and drug-delivery system 30 days after deafening. Either BDNF or artificial perilymph (AP) was delivered continuously for 28 days. Electrically evoked auditory brainstem responses (EABRs) were recorded during the period. SGC body and peripheral process density were measured.The EABR thresholds of AP increase continually. Those of BDNF increase slowly at the beginning then decrease, and were significantly less than those of the AP group from day 14 to 28 (P0.01). In terms of SGC and peripheral process density, the difference between the treated and control ears of BDNF group was clearly significant (P0.01), but not in AP group (P0.05). Analysis of the left cochlea between the two groups demonstrated that SGC/peripheral process density of the BDNF group was significantly greater than that of the AP group. Finally, a functional formula was developed relating the last EABR threshold and SGC density and process density, which was as follows: T = 466.184 - 2.71 (F.B.L).Under the conditions of delayed intervention following 30 days after deafening in rats, it can be concluded that BDNF enhances SGC bodies and peripheral processes survival after differentiation and so improves auditory sensitivity. SGC peripheral processes influence the auditory sensitivity.

To investigate the aerodynamics characteristics of nasal cavity in inspiration phase from 60 healthy Chinese people and provide the reference values for future computational fluid dynamics (CFD) research.CFD was used for numerical simulation. The indices of main airflow passage, total nasal airway resistance, maximal velocity, maximal wall shear stress, nasal mucosa area, nasal volume and surface area-to-volume ratio were extracted from CFD analysis results. SPSS 16.0 software was used to analyze the data.The main airflow passage in nasal cavity was common meatus, the mean total nasal airway resistance was (0.211 ± 0.085) kPa·s·L(-1), the mean maximal velocity was (12.01 ± 2.79) m/s, the mean maximal wall shear stress was (2.50 ± 0.89) Pa, the mean nasal mucosa area was (161.2 ± 34.7) mm(2), the mean nasal volume was (31.7 ± 8.1) ml and the mean surface area-to-volume ratio was (0.58 ± 0.09) mm(-1). No significant difference was detected in aerodynamics indices between male and female people.The main airflow passage is located in common meatus. The nasal valve area is the key constrictive plane in nasal cavity. There are no gender differences of main airflow characteristics in nasal cavity. The normal ranges of aerodynamics indices could be used for reference values for future CFD research.

To discuss the indications, surgery methods and effects of the BAHA implantation by analyzing the patients' medical records of bone-anchored hearing aids(BAHA).Retrospective analyzed the records of 16 patients of BAHA implantation, including nine males and seven females. Their average age was 31 years old (8-53ys). Nine of them were congenital ear malformation, two were chronic suppurative otitis media, two were otosclerosis and three were unilateral severe sensorineural deafness. We evaluated their pure tone audiometry (PTA), speech audiometry and temporal CT before the surgery, and evaluated the aided PTA in soundfield and speech audiometry in sound field.These patients received BAHA implantation and installed the speech processor their months later. The average preoperative PTA measurements (PTA at 0.5, 1, 2, 4 kHz) was (63.2 ± 19.0) dB HL and postoperative aided PTA in sound field was (35.5 ± 10.9)dB HL. The average improvement in Hearing In Noise Test (HINT) was 37.0% ± 31.7%. The average improvement in Mandarin Speech Test was 76.0% ± 19.7%. After 4-16 months' follow-up, no significant complications were recorded.BAHA is a safe and effective bone implantable hearing device.

The aim of this study is to assess of cochlear implantation in children with auditory neuropathy and cochlear nerve aplasia by using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR).Twenty one children with cochlear implants participated in this study. They all received cochlear implant surgery at our hospital from January 2004 to October 2010. All children had hearing aid trial and hearing and speech rehabilitation before surgery at least three months.Nine children (7 male, 2 female) were diagnosed with auditory neuropathy, twelve (7 male, 5 female) with cochlear nerve aplasia. Twenty children (10 male, 10 female) with sensorineural hearing loss served as a control group. All the children received cochlear implant for more than six months. Forty two children with normal hearing served as another control group which were divided into three subgroups according to their age.Group A included 18 children aged under two yrs, group B consisted of 16 children aged from two to four yrs and group C comprised eight children aged above four yrs. CAP and SIR were used to evaluate among all the children and the scores were compared.The CAP scores of children with auditory neuropathy, cochlear nerve aplasia, sensorial neural hearing loss and the three subgroups children with normal hearing were 4.44 ± 1.50, 4.83 ± 1.69, 4.55 ± 1.66, 5.22 ± 1.11, 6.75 ± 0.45 and 7.00 ± 0.00 respectively, and SIR scores were 2.66 ± 1.11, 2.33 ± 1.15, 2.40 ± 0.75, 2.56 ± 1.04, 4.12 ± 0.81 and 5.00 ± 0.00 respectively. There were significant differences among the six groups for CAP scores(χ(2) = 35.481, P0.001) and SIR scores(χ(2) = 40.549, P0.001).No significant differences for CAP and SIR scores were observed between children with auditory neuropathy/cochlear nerve aplasia and sensorial neural hearing loss as well as group A (P0.05 for each), and there were significant differences were shown between children with auditory neuropathy/cochlear nerve aplasia and group B as well as group C (P0.01 for each aplasia).The auditory and speech capabilities of children with auditory neuropathy and cochlear nerve deficiency can can get benefits from cochlear implants as children with sensorineural hearing loss, however not achieve the level of those with normal hearing after cochlear implantation. The long term effects still need follow-up and evaluation.

To investigate the clinical characteristics of arytenoid cartilage dislocation and the outcome of modified closed reduction.Sixty-seven patients with vocal fold immobility underwent modified closed reduction under local anesthesia through indirect laryngoscope. During reduction, a right-angled laryngeal forceps was used to hold the superior surface of the affected arytenoids and rotate in posterolateral or anteromedial direction according different situation of dislocation. Fifty-seven patients had previously undergone endotracheal intubation for surgery and 10 patients had nonintubated injury with blunt laryngeal trauma in 6 cases. Clinical characteristics, voice function, procedural skill and therapy outcome of those cases were evaluated.All patients complained of persistent hoarseness. Stroboscopy revealed vocal fold immobility (50 of 67 cases on the left side, 74.6%) and incomplete glottal closure with anterior arytenoid dislocations in 63 cases and posterior dislocations in 4 cases. The laryngeal electromyography (LEMG) results for 10 of 38 patients (26.3%) of postintubation arytenoids dislocation displayed abnormal patterns with denervated potentials. The voice of all patients for postintubation arytenoids dislocation improved after modified closed reduction with normal in 51 cases and slight hoarseness in 6 cases. The movement of the affected vocal folds recovered to normal in 54 cases and improved in 3 cases. Among the 10 patients with nonintubated vocal fold immobility, the voice and the movement of vocal folds were normal in 7 cases, improved in 1 case and no effective in 2 cases.Some cases of arytenoid dislocation were accompanied by an recurrent laryngeal nerve abnormality (mostly temporary and resolved after a reduction). The modified reduction technique under local anesthesia can restore patients' voice and vocal fold mobility within 6 weeks after dislocation. Nevertheless, the causes of vocal fold immobility following blunt laryngeal trauma were complicated, so the curative effect of arytenoids reduction in those cases may be limited by cicatricial contracture of laryngeal injured tissue.

The inferior turbinate (IT) and nasolacrimal duct (NLD) are often sacrificed while managing the diffuse lesion of maxillary sinus (MS). We report a new approach to MS without ablation of NLD and IT.This retrospective study enrolled 19 hospitalized patients (aged from 42 to 68 years) who underwent endoscopic sinus surgery between 2003 and 2008. Twelve patients had inverted papilloma (IP), two had nasal polyps, two had Kubo's postoperative cyst of MS, one had recurrent bone cyst of maxilla, one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to Caldwell-Luc operation respectively. Two IP patients were excluded from this group since the follow-up time was less than 12 months. The NLD was dissected after removing the anterior bony portion of nasal lateral wall. The prelacrimal recess approach (PLRA) to MS was established when IT-NLD flap was raised medially. The flap was repositioned when MS lesion was removed.All the 17 patients had unilateral lesions. Ten MS IP patients were at the T3 Krouse stage. The follow-up ranged from 7 to 60 months. No recurrence was seen in 16 patients. Only one IP patient had a local recurrence in MS. All of them had no any complications.The diffuse or severe diseases of MS may be the potential indications for PLRA.

It is believed that defects in upper airway neuromuscular control play a role in sleep apnea pathogenesis. Currently, there is no simple and non-invasive method for evaluating neuromuscular activity for the purpose of screening in patients with obstructive sleep apnea. This study was designed to assess the validity of chin surface electromyography of routine polysomnography in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of the condition.The chin surface electromyography of routine polysomnography during normal breathing and obstructive apnea were quantified in 36 male patients with obstructive sleep apnea. The change of chin surface electromyography from normal breathing to obstructive apnea was expressed as the percent compensated electromyography value, where the percent compensated electromyography value = (normal breath surface electromyography - apnea surface electromyography)/normal breath surface electromyography, and the percent compensated electromyography values among subjects were compared. The relationship between sleep apnea related parameters and the percent compensated electromyography value was examined.The percent compensated electromyography value of the subjects varied from 1% to 90% and had a significant positive correlation with apnea hypopnea index (R(2) = 0.382, P0.001).Recording and analyzing chin surface electromyography by routine polysomnography is a valid way of screening the neuromuscular activity in patients with obstructive sleep apnea. The neuromuscular contribution is different among subjects with obstructive sleep apnea.

Juvenile onset recurrent respiratory papillomatosis (JORRP) is a relatively rare disease. It affects the larynx in most cases. Because reports on JORRP to the lower respiratory tract (LRT) are few, we investigated clinical features of patients with a history of JORRP to analyze the risk factors of this disease.Data from 208 JORRP patients admitted to Beijing Tongren Hospital from January 2008 to December 2010 were reviewed. Gender, age at onset of symptoms, age at first surgery, duration of symptoms before the first surgical procedure, the number of surgical procedures, mean interval between surgical interventions, and the number of tracheotomies in patients with and without LRT spread of JORRP were analyzed. The data from patients with and without tracheotomy were recorded and compared. Two cases of primary tracheal papillomatosis were reviewed.Papillomas extension down to the LRT was observed in 46 children (22.1%). Patients with LRT papillomatosis had a shorter time from the onset of the symptoms until the first surgery, required significantly more surgical procedures, and had a shorter mean surgical interval. Tracheotomy was performed in 13/162 (8.0%) children with laryngeal papillomatosis vs. 36/46 (78.3%) children with LRT papillomatosis. After tracheotomy, 36/49 (73.5%) children developed LRT papillomatosis and 10/157 (6.4%) children who did not have a tracheotomy developed LRT papillomatosis. Patients with tracheotomy required a significantly higher number of surgical procedures. The younger the patient had a tracheotomy, the longer the duration of cannulation was.JORRP patients with LRT spread are prone to develop more aggressive disease. Tracheotomy resulted in a significant increase of LRT involvement.

The role of nasal obstruction in the pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) has been debated for decades. In this prospective study, we compared the pharyngeal aerodynamic characteristics of OSAHS patients and normal people, and investigated the contribution of total nasal airway resistance to the pathophysiology of OSAHS.Computational fluid dynamics (CFD) was used to extract the average pressure and average airflow velocity in three transverse cross-sectional planes of the pharynx for statistical analysis, and the correlation between nasal resistance and the average pressure in the pharyngeal cavity was investigated.The negative pressure within the pharyngeal cavity was significantly higher in OSAHS patients than in normal subjects, and total nasal airway resistance correlated well with the average pressure in three consecutive transverse cross-sections of the pharyngeal cavity.Greater negative pressure within the pharyngeal cavity contributed to the increased collapsibility of the pharynx in OSAHS patients, and the strong correlation between nasal resistance and pharyngeal pressure suggests that the nose plays a role in the pathogenesis of OSAHS.

This study aimed to evaluate the role of spectral fine structure and envelope information in Mandarin tone perception for sensorineural hearing-impaired patients.The linear predictive coding technique was applied to synthesize 128 tokens having spectral fine structure from one tone of a monosyllabic word and spectral envelope from other tones with the same syllable. There after, the tone response performance was assessed using these 128 speech materials for 20 normal-hearing and 48 sensorineural hearing-impaired patients, including 20 with moderate, 20 with moderate to severe, and 8 with severe hearing loss.99.7%, 97.7%, 96.3% and 83.0% of the mean tone responses were consistent with spectral fine structure for the normal hearing, moderate, moderate to severe, and severely hearing-impaired groups, respectively. No tone recognition responses were observed in consistent with spectral envelope cues. There was a significant difference in tone recognition among the normal hearing group and three hearing impaired groups (χ(2) = 59.2, P0.001). The negative correlation between the averages for pure-tone hearing thresholds at frequencies of 500, 1000, and 2000 Hz and tone responses that were in consistent with spectral fine structure for the hearing-impaired subjects (r = -0.643, P0.001).For both normal-hearing and hearing-impaired subjects, spectral fine structure plays an important role in tone recognition, and the impact of changing spectral envelope cues on tone recognition is negligible, when spectral fine structure cues are present. Sensorineural hearing impaired patients showed a progressive decrease in the recognition of lexical tones based on spectral fine structure cues, as their hearing loss becomes more severe.

To investigate the effect of Vibrant Soundbridge (VSB) implantation.In accordance with the indications for VSB implantation, surgeries were done for two patients who suffered from either a sensorineural or conductive hearing loss (microtia). Their preoperative auditory thresholds (0.5, 1, 2 and 4 kHz) were 56 dB HL and 61 dB HL. The VSB was turned on and adjusted seven weeks after surgery.Postoperative auditory thresholds of the two patients were improved. Their pure tone thresholds were 32 dB HL and 40 dB HL, and the respective improvement was 24 dB HL and 21 dB HL. There was no facial paralysis, vertigo and tinnitus.Patients with a sensorineural or conductive hearing loss may benefit from VSB implantation.

Fibrovascular polyp of the hypopharynx and esophagus, a rare, benign, intraluminal and submucosal tumor, is most commonly originated from the proximal esophagus. We discussed four cases with regurgitation, respiratory symptom or the feeling of a mass in the throat. All the patients were examined with laryngoscope under general anesthesia. A transverse cervical incision was performed in one patient and the polyps were excised under laryngoscope with CO2 laser in the other three patients. All the lesions were removed successfully. Diagnostic and therapeutic principles involved in these cases are presented and discussed. The recognition of fibrovascular polyp of the hypopharynx and esophagus as a potential cause of regurgitation is paramount. Surgical excision is recommended because of the satisfactory outcome.

Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years, with a mean age of (34 ± 3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation. The patients were satisfied with the cosmetic results of the surgery.The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.

The present study was to evaluate the audiological characteristics of infants with normal auditory brainstem response thresholds in click and abnormal transiently evoked otoacoustic emissions. Relationships between test results of distortion product otoacoustic emissions (DPOAE) and other hearing testing methods were also evaluated.The participants consisted of eighty-nine infants, with a total of 123 ears. All participants' TEOAE screening results were abnormal but diagnostic click ABR results were normal. The participants were classified into the following groups based on the test results from distortion product otoacoustic emissions: group A (normal all-frequency), group B (abnormal low-frequency), group C (abnormal high-frequency), and group D (abnormal all-frequency).Obtained from these groups were compared to results of other hearing tests including the latency of ABR wave I, 40 Hz auditory event related potential (40 Hz AERP), 226 Hz and 1000 Hz tympanometry, and acoustic reflex. Results In six hearing tests in the 123 ears, seven ears (5.7%) were normal, while 116 ears (94.3%) were abnormal. No significantly differences were detected between boys (93.9%) and girls (95.1%), as well as between left (93.1%) and right ears (95.4%). The proportion of abnormal test results ranked as follows: 59 ears in group D (48.0%), 34 ears in group B (27.6%), 20 ears in group A (16.3%), and 10 ears in group C (8.2%). The highest abnormal rates in groups A, B and D were acoustic reflex, which were 40.0% for group A, 55.9% for group B and 66.1% for group D respectively. The highest abnormal rate in group C was the latency of ABR wave I (50.0%). Distribution of low-frequency hearing loss in each group was mainly mild. However, one ear in group B was moderate hearing loss, six ears in group D were moderate hearing loss, and one ear in group D was severe hearing loss.The present study showed that, of which infants with normal thresholds of ABR failed the hearing screening, comprehensively audiology assessment is needed. And of which infants with normal DPOAE in full frequency or abnormal in high frequency region or low frequency region need to be followed up.