| Meniere's disease(MD)is a clinically common idiopathic vertigo disease of the inner ear.The etiology and pathogenesis are currently unknown.About15% of patients with Meniere's disease,even through lifestyle changes,medical treatment or endolymphatic decompression and other treatments,vertigo can not be controlled.In this study,we retrospectively analyzed the clinical efficacy of Triple semicircular canal occlusion in patients with Intractable Meniere's disease and examined the differential expression of nuclear factor NF-?B in patients with Meniere's disease to explore Intractable Meniere's disease Therapeutic methods and mechanisms of action in the pathogenesis of Meniere's disease.Part 1: Analysis of clinical efficacy after Triple semicircular canal occlusion in patients with Intractable Meniere's diseaseObjective: To explore the clinical efficacy of triple semicircular canal occlusion in patients with Intractable Meniere's disease.Methods: We retrospectively analyzed the data of 66 patients with intractable Meniere's disease from November 2014 to October 2019,including 46 patients who underwent Triple semicircular canal occlusion on the affected side and endolymphatic decompression The 20 patients treated were followed up regularly after operation to observe and analyze the clinical symptoms of dizziness,hearing loss,tinnitus,and changes in vestibular function before and after the operation.We evaluate the clinical efficacy of triple semicircular canal occlusion in patients with Intractable Meniere's disease by comparing the efficacy of the two groups of patients.Results: 66 patients with refractory Meniere's disease were divided into two groups,Triple semicircular canal occlusion group and endolymphatic sac decompression group.The two groups of patients were statistically analyzed in terms of age,gender,ear profile,preoperative staging,preoperative hearing.The two groups of patients were comparable.The 46 patients in the Triple semicircular canal occlusion group had a vertigo control rate of 100%,including 35 cases(76.09%)with complete control(grade A)and 11 cases(23.91%)with basic control(grade B).In 20 patients in the endolymphatic decompression group,the vertigo control rate reached65.00%,including 7 cases(35.00%)with complete control(Grade A),6 cases(30.00%)with basic control(Grade B),and partial control(Grade C))3 cases(15.00%),uncontrolled(Grade D)4 cases(20.00%).The postoperative vertigo control rate was significantly higher in patients with triple semicircular canal occlusion group than in lymphatic decompression group(P<0.001).Of the 46 patients with Meniere's disease in the Triple semicircular canal occlusion group,5(10.87%)patients had no significant change in postoperative hearing,37(80.43%)patients had postoperative hearing loss,and 4(8.70%)patients had postoperative hearing loss.Hearing improved.In 4 patients with improved hearing,the improvement in hearing was less than 15 d BHL,and the hearing assessment was grade C(ineffective).Among the 20 patients with Meniere's disease in the endolymphatic decompression group,10(50.00%)patients had no significant change in postoperative hearing,6(30.00%)patients had postoperative hearing loss,and 4(20.00%)patients had postoperative hearing loss.After hearing improved.In 6 patients with improved hearing,the improvement in hearing was less than 15 d BHL,and the hearing assessment was grade C(ineffective).Patients in the triple semicircular canal occlusion group had worse postoperative hearing than the endolymphatic decompression group(P<0.001).Among the 46 patients in the t Triple semicircular canal occlusion group,19cases(41.30%)had no change in postoperative tinnitus classification,2 cases(4.35%)had increased tinnitus,and 25 cases(54.35%)had improved tinnitus.Among them,17 had tinnitus improvement of grade 1,Six patients had tinnitus improvement of grade 2,one patient had tinnitus improvement of grade 3,and one patient had tinnitus improvement of grade 4.In 20 patients in the endolymphatic decompression group,9 patients(45.00%)had no change in tinnitus grade,2 patients(10.00%)had increased tinnitus,9 patients(45.00%)had improved tinnitus;all 9 patients had 1 improvement in tinnitus level.There was no difference in postoperative tinnitus improvement rate between the two groups(P <0.284).Of 66 patients with Meniere's disease,Before operation,72.72%(48/66)patients' vestibular double temperature test suggested that the affected side of the semicircular canal dysfunction.After three semicircular canal occlusions,all patients had lower outer semicircular canal function,and hemiplegia index was82% to 94%;after endolymphatic decompression,70% of patients had lower outer semicircular canal function,and postoperative hemiplegia index was 15%to 49%.There was no difference between the two groups before operation(P=0.279).Postoperative comparison between the two groups of patients,the external semicircular canal function of the triple semicircular canal obstruction group was significantly lower than that of the endolymphatic decompression group,P<0.001,which was statistically significant.Among the 46 patients in the Triple semicircular canal occlusion group,33patients(71.74%)had complete improvement in postoperative mobility(Grade A)and 13 patients(28.26%)had basic improvement(Grade B).Endolymphatic sac decompression group: Of the 20 patients,postoperative mobility was completely improved(Grade A)in 6 cases(30.00%),basic improvement(Grade B)in 6 cases(30.00%),and partial improvement(Grade C)3 Cases(15.00%),no improvement(grade D)in 5 cases(25%).The improvement rate of postoperative tinnitus in patients with triple semicircular canal obstruction group was significantly higher than that in lymphatic sac decompression group(P<0.001).Ten patients in the triple semicircular canal occlusion group underwent gadolinium-enhanced magnetic resonance imaging of the inner ear before and 6months after operation: compared with the lymph volume in the vestibule of the affected ear and the healthy ear before operation,t value 5.823,P=0.01,difference It is statistically significant,suggesting that there is lymphatic hydrops in the vestibule of the affected ear.Compared with the lymph volume in the vestibule of the affected ear before and 6 months after operation,the t value was 0.733,P=0.517,and the difference was not statistically significant,suggesting that the affected ear still had endolymphatic hydrops.Conclusions: 1.Triple semicircular canal occlusion have a significant effect on vertigo control in patients with intractable Meniere's disease;2.Triple semicircular canal occlusion have significant effects on cochlear function in patients with intractable Meniere's disease;3.The vertigo control rate of the Triple semicircular canal occlusion group was significantly higher than that of endolymphatic decompression,and the postoperative hearing preservation rate was significantly lower than that of the endolymphatic decompression group;4.Triple semicircular canal occlusion failed to reduce endolymphatic hydrops After the patient's vertigo is controlled,it may have nothing to do with the improvement of hydrocephalus.The mechanism of controlling dizziness needs further study.Part 2: The differential expression of nuclear factor NF-?B in Meniere's diseaseObjective: To explore the differential expression of nuclear factor NF-?B in patients with Meniere's disease,and to clarify its mechanism of action in the pathogenesis of Meniere's disease.Methods: Two groups:research group and control group.The research group included 70 patients with Meniere's disease,the control group included 70 healthy people.To detected the expression level of NF-?B in peripheral blood by RT-PCR and ELISA.to determine the correlation between the expression level of nuclear factor NF-?B in peripheral serum and hearing grading and single-sided analysis of Meniere's disease patients,to determine the relationship between NF-?B and Meniere The correlation between diseases.Results: There was no difference in general information between the two groups.(P>0.05).60% of patients with Meniere's disease have a disease course of less than 5 years;the hearing grades of patients with Meniere's disease are mostly concentrated in grades 3 and 4,and the patients themselves do not have immune diseases;unilateral Meniere's disease The proportion of patients is mostly.RT-PCR detection: the expression of nuclear factor NF-?B and its subunit p65 and p50 m RNA in Meniere's disease group was higher than that in the control group(P<0.05).ELISA test: the expression levels of nuclear factor NF-?B and its subunits p65 and p50 in Meniere's disease group were higher than those in the control group(P<0.05).NF-?B was correlated with the hearing level of Meniere's disease patients.There is a correlation between NF-?B and unilateral Meniere's disease,unilateral<Two-sided,P value is 0.039.In 46 patients with intractable Meniere's disease,the expression concentration of NF-?B at 6 months after triple semicircular canal occlusion was lower than before operation(P <0.05).Conclusions: 1.The pathogenesis of Meniere's disease may be regulated by the nuclear factor NF-?B,which may be a potential target for the treatment of Meniere's disease;2.After intractable Meniere's disease with triple semicircular canal occlusion,the expression of NF-?B was significantly lower than that before surgery,and its mechanism needs further study. |
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