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1、Menieres DiseaseChunfu DaiOtolaryngology DepartmentFudan University2021/4/262021/4/261 1Prevalence n nIncidence is 4/100000 in Japan. 15/100000 in US, 46/100000 in Sweden, 100/100000 in UK.n nThe large differences are due to geographic, genetic, ethnic or environmental factors, or different diagnost
2、ic criteria.2021/4/262021/4/262 2Background n nIn 1861, n nMeniere described a syndrome Meniere described a syndrome n nIn 1938, n nHallpike and Yamakawa reported the finding Hallpike and Yamakawa reported the finding of endolymphatic hydrops in temporal bone of endolymphatic hydrops in temporal bon
3、e from patients with MD.from patients with MD.2021/4/262021/4/263 3Background n nIn 1972, n nAAOO report also defined two sub-varieties: AAOO report also defined two sub-varieties: cochlear and vestibular MDcochlear and vestibular MDn nIn 1985, n nAAO-HNS updated the term MD should be AAO-HNS update
4、d the term MD should be “ “restrictive and include only those cases restrictive and include only those cases with complement of classic symptoms and with complement of classic symptoms and findings of the disease presumed to result findings of the disease presumed to result from idiopathic endolymph
5、atic hydropsfrom idiopathic endolymphatic hydrops2021/4/262021/4/264 4Pathogenesis n nRadial circulationRadial circulationn nLongitudinal flowLongitudinal flow2021/4/262021/4/265 5Pathology n nEndolymphatic hydropsEndolymphatic hydropsn nThe hydrops principally involves the cochlear The hydrops prin
6、cipally involves the cochlear duct and saccule but were not obvious in the duct and saccule but were not obvious in the utricle and ampullae of semicirclar canals.utricle and ampullae of semicirclar canals.n nThe walls of the membranous labyrinth may The walls of the membranous labyrinth may show ar
7、eas of thinning, outpouching and show areas of thinning, outpouching and rupturesrupturesn nDecrease in the amount of loose connective Decrease in the amount of loose connective tissue around the endolymphatic sac, hypoplasia tissue around the endolymphatic sac, hypoplasia of vestibular aqueduct, an
8、d decreased of vestibular aqueduct, and decreased vascularization of the sac and perisaccular vascularization of the sac and perisaccular fibrosis were also observe.fibrosis were also observe.2021/4/262021/4/266 62021/4/262021/4/267 7Pathologyn nVestibular fibrosisVestibular fibrosisn nProliferation
9、 of fibrous tissue Proliferation of fibrous tissue within the vestibule is often within the vestibule is often observed which sometimes results observed which sometimes results in the formation of band of fibrous in the formation of band of fibrous tissue between the under-surface tissue between the
10、 under-surface of the footplate and the utriclar of the footplate and the utriclar maculamaculan nThis phenomenon may account for This phenomenon may account for a positive Henneberta positive Hennebert s sign, which s sign, which observed in about 30% of ears observed in about 30% of ears with MD.w
11、ith MD.2021/4/262021/4/268 8Pathologyn nHair cell lossHair cell lossn nIn most of cases with MD, light Microscope has failed to In most of cases with MD, light Microscope has failed to demonstrate loss of HC in cochlear and vestibular organ.demonstrate loss of HC in cochlear and vestibular organ.n n
12、In advanced disease, loss of cochlear HC, atrophy of In advanced disease, loss of cochlear HC, atrophy of support cells, distortion and atrophy of tectorial support cells, distortion and atrophy of tectorial membrane and atrophy of cristae were identified.membrane and atrophy of cristae were identif
13、ied.n nEM could identified fusion of cilia, disruption of cuticular EM could identified fusion of cilia, disruption of cuticular bodies and basal ward displacement of some OHC with bodies and basal ward displacement of some OHC with loss of contact with the cuticular plate. loss of contact with the
14、cuticular plate. 2021/4/262021/4/269 9Pathologyn nNeuronal cellNeuronal celln nSGN and ScarpaSGN and Scarpa s ganglion neuron s ganglion neuron are normal in most patientsare normal in most patientsn n10% of temporal bones showed an 10% of temporal bones showed an isolated loss of cochlear neurons i
15、n isolated loss of cochlear neurons in the apex. Loss of nerve fibers in the the apex. Loss of nerve fibers in the osseous spiral lamina.osseous spiral lamina.n nEM identified striking reduction in EM identified striking reduction in the number of afferent nerve the number of afferent nerve endings
16、and afferent synapes at the endings and afferent synapes at the base of both IHC and OHC.base of both IHC and OHC.2021/4/262021/4/261010nn9 9、 人的价值，在招收诱惑的一瞬间被决定。人的价值，在招收诱惑的一瞬间被决定。2024/7/282024/7/28 2024/7/282024/7/28 Sunday, July 28, 2024Sunday, July 28, 2024nn1010、低头要有勇气，抬头要有低气。、低头要有勇气，抬头要有低气。2024/
17、7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 7/28/2024 7:10:10 AM7/28/2024 7:10:10 AMnn1111、人总是珍惜为得到。、人总是珍惜为得到。2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 Jul-24Jul-2428-Jul-2428-Jul-24nn1212、人乱于心，不宽余请。、人乱于心，不宽余请。2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 Sunday, Ju
18、ly 28, 2024Sunday, July 28, 2024nn1313、生气是拿别人做错的事来惩罚自己。、生气是拿别人做错的事来惩罚自己。2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 7/28/20247/28/2024nn1414、抱最大的希望，作最大的努力。、抱最大的希望，作最大的努力。28 28 七月七月 2024 20242024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28nn1515、一个人炫耀什么，说明他内心缺少
19、什么。、一个人炫耀什么，说明他内心缺少什么。七月七月 24 242024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 7/28/20247/28/2024nn1616、业余生活要有意义，不要越轨。、业余生活要有意义，不要越轨。2024/7/282024/7/28 2024/7/282024/7/28 28 July 202428 July 2024nn1717、一个人即使已登上顶峰，也仍要自强不息。、一个人即使已登上顶峰，也仍要自强不息。2024/7/282024/7/28 2024/7/282024/7/28 2024/7/2820
20、24/7/28 2024/7/282024/7/28Recurring episode of Vertigo n nWhirling vertigo is usually sudden,n nCompanied with nausea and vomitingn nPersist for several hours, attacks last longer than 24 h make the diagnosis of MD doubtful2021/4/262021/4/261212Fluctuating Hearing lossn nEarly fluctuation of low Ear
21、ly fluctuation of low frequencey hearing loss and frequencey hearing loss and later involvement of the high later involvement of the high frequencies.frequencies.n nAn eventual decline over 5-10 An eventual decline over 5-10 years and subsequent years and subsequent stabilization with a flat stabili
22、zation with a flat moderate to severe hearing moderate to severe hearing losslossn nspeech discrimination falling to speech discrimination falling to approximately 50%. Making approximately 50%. Making the use of hearing aid difficult.the use of hearing aid difficult.n nThere is also diplacusis and
23、There is also diplacusis and loudness recruitmentloudness recruitment2021/4/262021/4/261313Hearing lossn nHearing loss may be due to the Hearing loss may be due to the hydrops in membrane of cochlea, hydrops in membrane of cochlea, which lead to restrict movement of which lead to restrict movement o
24、f basal membrane.basal membrane.n nNeural degeneration of unmylinated Neural degeneration of unmylinated afferent processes at the EM may afferent processes at the EM may explain the clinical finding of explain the clinical finding of progressive loss of speech progressive loss of speech discriminat
25、ion despite the presence of discrimination despite the presence of intact HC and SGN.intact HC and SGN.2021/4/262021/4/261414Biochemical and mechanical theoriesn nProposed by Lawrence, McCabe and Schuknecht Proposed by Lawrence, McCabe and Schuknecht that a sudden rupture of the thin distented that
26、a sudden rupture of the thin distented membranous labyrinth results in flooding of the membranous labyrinth results in flooding of the perilymphatic space with potassium-rich perilymphatic space with potassium-rich neurotoxic endolymph, causing paralysis of neurotoxic endolymph, causing paralysis of
27、 sensorineuroal structure which in turn results in sensorineuroal structure which in turn results in a sudden attack of vertigo and hearing loss.a sudden attack of vertigo and hearing loss.2021/4/262021/4/261515Aural pressure and fullnessn nOne possibility is that this One possibility is that this m
28、ight be mediated by might be mediated by sensory nerves supplying sensory nerves supplying the middle ear aspect of the middle ear aspect of the round and oval the round and oval windows.windows.n nAnother possibility is Another possibility is sensory innervation of sensory innervation of dura mater
29、 surrounding dura mater surrounding the endolymphatic sac.the endolymphatic sac.2021/4/262021/4/261616Natural history of MDn nSpontaneous remission of vertigo has been reported in up to 71% of cases with 8 years.n nSpontaneous remission makes assessment of Spontaneous remission makes assessment of e
30、fficacy of therapy quite difficult.efficacy of therapy quite difficult.n nUp to 50% of patients will eventually develop symptoms from the opposite ear. 50% of patients occurred within a period of 2 year2021/4/262021/4/261717Natural history of MDn nLermoyezLermoyez s syndrome: is characterized by s s
31、yndrome: is characterized by hearing improvement that accompanies an acute hearing improvement that accompanies an acute attack of vertigo. The hearing remains good for attack of vertigo. The hearing remains good for a period of days or weeks only to gradually a period of days or weeks only to gradu
32、ally diminish before onset of the next attackdiminish before onset of the next attackn nDrop-attacks associated with MD (Tumarkin): in Drop-attacks associated with MD (Tumarkin): in addition to the typical symptoms, patients addition to the typical symptoms, patients experience abrupt and brief atta
33、cks such that experience abrupt and brief attacks such that they find themselves thrown to the ground with they find themselves thrown to the ground with no warning and with little or no vertigo after the no warning and with little or no vertigo after the initial fallinitial fall2021/4/262021/4/2618
34、18Delayed endolymphatic hydropsn nPatients with pre-existent profound unilateral deafness of long duration.n nSymptoms are relieved by labyrinthectomy in the deaf ear.n nThe original cause of deafness may have led to the hydrops.2021/4/262021/4/261919Glycerol testn nHearing improvement is considered
35、 suggestive Hearing improvement is considered suggestive of MD after oral glycerol administration. Only of MD after oral glycerol administration. Only 60% of MD was positive.60% of MD was positive.n nHowever, negative test result did not exclude a However, negative test result did not exclude a diag
36、nosis, thereby, implying that the test was diagnosis, thereby, implying that the test was specific but not sensitive.specific but not sensitive.n nIn hydropic GP and rabbit ears, CAP thresholds In hydropic GP and rabbit ears, CAP thresholds show further worse rather than an improvement show further
37、worse rather than an improvement after administration of glycerol.after administration of glycerol.2021/4/262021/4/262020Diagnosis n nThe diagnosis is made on the basis of history.The diagnosis is made on the basis of history.n nPhysical examination is usually normalPhysical examination is usually n
38、ormaln nMany tests are interesting for research purpose Many tests are interesting for research purpose but no test proves or disproves the diagnosis.but no test proves or disproves the diagnosis.n nVestibular, audiogram and ENG are performed Vestibular, audiogram and ENG are performed to confirm th
39、e presence of function of the to confirm the presence of function of the other ear. other ear. 2021/4/262021/4/262121Differentiate diagnosisn nBenign paroxysmal positional vertigoBenign paroxysmal positional vertigon nVestibular neuritisVestibular neuritisn nVestibular drug toxicityVestibular drug t
40、oxicityn nLabyrinthitisLabyrinthitisn nHunt syndromeHunt syndromen nCogan syndromeCogan syndromen nDelayed endolymphatic hydropsDelayed endolymphatic hydropsn nPerilymph fistulaPerilymph fistula2021/4/262021/4/262222Benign proxysmal position vertigon nInappropriate excitation of the PSCn nLatency (1
41、-4s), transient (1minute) with position changen nDecreasing with repetitive testingn nMixed vertigo torsional nystagmusn nSpontaneous resolution with 1 year2021/4/262021/4/262323Benign proxysmal position vertigon nCausesn nHead traumaHead trauman nProlonged bedrestProlonged bedrestn nViral or ischem
42、ic labyrinthitisViral or ischemic labyrinthitisn nOlder peopleOlder peoplen nMechanismn ndislodged otoconia trapped in PSC from the dislodged otoconia trapped in PSC from the utricle.utricle.2021/4/262021/4/2624242021/4/262021/4/2625252021/4/262021/4/262626Benign proxysmal position vertigon nInterve
43、ntionsn nSpontaneously resolveSpontaneously resolven nCanalith repositioningCanalith repositioningn nAmpullary nerve section Ampullary nerve section n nBlock posterior semicircular canal (preventing Block posterior semicircular canal (preventing movement of endolymph in the canal)movement of endolym
44、ph in the canal)2021/4/262021/4/2627272021/4/262021/4/2628282021/4/262021/4/262929Perilymph fistula2021/4/262021/4/263030Treatmentn nRecent treatments aim at control of vertigo. Recent treatments aim at control of vertigo. n nMedicine Medicine n nSurgery interventionSurgery interventionn nNo treatme
45、nt has definitively proven to alter the No treatment has definitively proven to alter the natural course of disease in natural course of disease in n nFluctuative, progressive hearing lossFluctuative, progressive hearing lossn nTinnitusTinnitusn nAural fullnessAural fullness2021/4/262021/4/263131Tre
46、atmentn nSalt restrictionn nSedativen nThe key is to use sedative brieflyThe key is to use sedative brieflyn nProlonged use of sedative impair Prolonged use of sedative impair compensation, prolongs symptoms and compensation, prolongs symptoms and produces a suboptimal result.produces a suboptimal r
47、esult.n nDiuretic2021/4/262021/4/263232Treatmentn nShort course of steroid is reasonableShort course of steroid is reasonablen n2 tabs qid x7d 2 tabs qid x7d n n2 tabs tidx2d2 tabs tidx2dn n2 tabs bidx2d2 tabs bidx2dn n1 tab bidx2d1 tab bidx2dn n1 tab dailyx2d1 tab dailyx2dn nIntratympanic gentamici
48、n injectinIntratympanic gentamicin injectinn nMedical therapy failsMedical therapy failsn nIntratympanic injection is recommendedIntratympanic injection is recommendedn nLess than 5% patients progress to the stage where Less than 5% patients progress to the stage where destructive treatment is indic
49、ated.destructive treatment is indicated.2021/4/262021/4/263333Surgical interventions n nEndolymphatic sac Endolymphatic sac shuntshuntn nVestibular neurectomyVestibular neurectomyn nLabyrinthectomyLabyrinthectomy2021/4/262021/4/263434Evaluation of ESSn nPortmann first proposed such procedures 11 yea
50、rs prior to the description of endolymphatic hydrops. n nDefinition of clinically significant hearing change (1995 AAO-HNS committee)n na change of at least 10 dB PTAa change of at least 10 dB PTAn nWord recognition score of at least 15% Word recognition score of at least 15% 2021/4/262021/4/2635352
51、021/4/262021/4/263636Evaluation of ESSn nArguments on hearing outcome (without control Arguments on hearing outcome (without control study)study)n nHearing outcome after ESS is no different than Hearing outcome after ESS is no different than hearing after vestibular nerve section, or attributable he
52、aring after vestibular nerve section, or attributable to natural history alone.to natural history alone.n nSome author indicated postoperative hearing Some author indicated postoperative hearing stabilizes or improves in 55% to 85% of patients after stabilizes or improves in 55% to 85% of patients a
53、fter ESS follow up greater than 2 years.ESS follow up greater than 2 years.n nTinnitus relief after ESS was reported in 21-75% of Tinnitus relief after ESS was reported in 21-75% of patients.patients.2021/4/262021/4/263737Evaluation of ESSn nThomsenThomsen s study indicated that s study indicated th
54、at n nsubjective hearing loss to be slightly significantly better in the subjective hearing loss to be slightly significantly better in the ESS group compared with the placebo group. ESS group compared with the placebo group. n nObjective test showed no significant difference difference Objective te
55、st showed no significant difference difference between the two groups.between the two groups.n nAbove mentioned data reexamed by Welling supported Above mentioned data reexamed by Welling supported n nESS is effective in management of MD and refutes the placebo ESS is effective in management of MD a
56、nd refutes the placebo effect effect n nThe actively shunted group have significant improvement in The actively shunted group have significant improvement in vertigo, tinnitus, and combined overall score when compared vertigo, tinnitus, and combined overall score when compared with the placebo group
57、. with the placebo group. 2021/4/262021/4/263838Evaluation of ESSn nAnimal and human studies showed the shunts Animal and human studies showed the shunts and similar foreign materials become and similar foreign materials become encapsulated by fibrous tissue proliferation encapsulated by fibrous tis
58、sue proliferation which makes it doubtful that will remain patent.which makes it doubtful that will remain patent.n nThe pathway by which endolymph from the The pathway by which endolymph from the cochea might reach the sac is blocked at cochea might reach the sac is blocked at multiple location due
59、 to collapse of the multiple location due to collapse of the endolymphatic lumen.endolymphatic lumen.2021/4/262021/4/2639392021/4/262021/4/264040Evaluation of ESSn nDespite the obvious conflicting beliefs concerning the benefit of endolymphatic sac surgery in MD.n nMost otologist routinely perform t
60、he procedure.n nA success rate approaching 80%, low A success rate approaching 80%, low complications. complications. 2021/4/262021/4/264141Otology group in Nashvillen nLong-term efficacy of ESSLong-term efficacy of ESSn nDo not offer the patients reasonable expectation for Do not offer the patients
61、 reasonable expectation for long-term, complete control of vertigo (7%).long-term, complete control of vertigo (7%).n nThe theoretic benefit of sac surgery in regard to the The theoretic benefit of sac surgery in regard to the control of tinnitus, fullness, and either stabilization or control of tin
62、nitus, fullness, and either stabilization or improvement in hearing were not realized.improvement in hearing were not realized.n nAs a result, ESS is no longer performed. As a result, ESS is no longer performed. Suboccipital vestibular nerve section is primarily Suboccipital vestibular nerve section
63、 is primarily recommendation.recommendation.2021/4/262021/4/264242Evaluation of VNSn nSurgical approaches include the middle fossa, Surgical approaches include the middle fossa, retrolabyrinthine and retrosigmoid /suboccipital retrolabyrinthine and retrosigmoid /suboccipital routes.routes.n nVNS is
64、the gold standard for control of vertigo VNS is the gold standard for control of vertigo spell.spell.n nHighly successful (90%) in eliminating vertigo in Highly successful (90%) in eliminating vertigo in patients with MDpatients with MDn nNo effect on hearing or other MD symptomsNo effect on hearing
65、 or other MD symptomsn nComplications: facial palsy, infection, deafness.Complications: facial palsy, infection, deafness.2021/4/262021/4/2643432021/4/262021/4/264444Evaluation of VNSn nPostoperative caloric test showed a lower percentage of patients actally achieve total ablation of vestibular resp
66、onse.n nThis is due to the difficult in severing all vestibular nerve fiber.n nThe use of intraoperative evoked vestibular potential may overcome this problem.2021/4/262021/4/264545House institution experiencesn nESS is the first line of surgical treatment for MD unresponsive to medical treatment (
67、diuretic and vasodilator therapy)n nIn case with disable vertigo unresponsive to medical treatment or failing ESS, VNS is recommended and often combine with primary or revision ESS 2021/4/262021/4/264646House institution experiencesn nConcurrent ESS and VNS does not improvement hearing or tinnitus o
68、utcome over vestibular nerve section alone2021/4/262021/4/264747Karolinska hospital policyn nPatients with MD still having serviceable hearing Patients with MD still having serviceable hearing were primarily offered ELSwere primarily offered ELSn nIn total loss of cochlear function or persisting In
69、total loss of cochlear function or persisting symptoms after a previous ESS, intratympanic symptoms after a previous ESS, intratympanic gentamicin injection was chosen. gentamicin injection was chosen. n nIn patients with normal cochear function and In patients with normal cochear function and non M
70、enieriform peripheral vestibular non Menieriform peripheral vestibular dysfunction, vestibular neurectomy was dysfunction, vestibular neurectomy was recommended.recommended.2021/4/262021/4/264848Karolinska hospital policyn nAs compared with destructive procedures, such As compared with destructive p
71、rocedures, such as labyrinthectomy and neurectomy that result as labyrinthectomy and neurectomy that result in severe vertigo postoperatively.in severe vertigo postoperatively.n nIntratympanic gentamicin injection seldom force Intratympanic gentamicin injection seldom force the patient to require be
72、d rest and physical the patient to require bed rest and physical inactivity, due to slowly declining vestibular inactivity, due to slowly declining vestibular impairment, patients only feel slightly impairment, patients only feel slightly unsteadness.unsteadness.2021/4/262021/4/264949Labyrinthectomy
73、n nTranscanal labyrinthectomyTranscanal labyrinthectomyn nSemicircular canals remain intact.Semicircular canals remain intact.n nGentamicin us usually placed in the ear as wellGentamicin us usually placed in the ear as welln nTransmastoid labytinthectomyTransmastoid labytinthectomyn nDrilling the se
74、micircular canalsDrilling the semicircular canalsn nOpening the vestibule and destroying the saccule and Opening the vestibule and destroying the saccule and utricle.utricle.n nGentamicin us usually placed in the ear as wellGentamicin us usually placed in the ear as well2021/4/262021/4/2650502021/4/
75、262021/4/265151nn9 9、 人的价值，在招收诱惑的一瞬间被决定。人的价值，在招收诱惑的一瞬间被决定。28-728-7月月-24-2428-728-7月月-24-24Sunday, July 28, 2024Sunday, July 28, 2024nn1010、低头要有勇气，抬头要有低气。、低头要有勇气，抬头要有低气。*7/28/2024 7:10:12 AM7/28/2024 7:10:12 AMnn1111、人总是珍惜为得到。、人总是珍惜为得到。28-728-7月月-24-24*Jul-24Jul-2428-Jul-2428-Jul-24nn1212、人乱于心，不宽余请。、
76、人乱于心，不宽余请。*Sunday, July 28, 2024Sunday, July 28, 2024nn1313、生气是拿别人做错的事来惩罚自己。、生气是拿别人做错的事来惩罚自己。28-728-7月月-24-2428-728-7月月-24-24*28 July 202428 July 2024nn1414、抱最大的希望，作最大的努力。、抱最大的希望，作最大的努力。28 28 七月七月 2024 2024*28-728-7月月-24-24nn1515、一个人炫耀什么，说明他内心缺少什么。、一个人炫耀什么，说明他内心缺少什么。七月七月 24 24* *28-728-7月月-24-24* *2
77、8 July 202428 July 2024nn1616、业余生活要有意义，不要越轨。、业余生活要有意义，不要越轨。*7/28/20247/28/2024nn1717、一个人即使已登上顶峰，也仍要自强不息。、一个人即使已登上顶峰，也仍要自强不息。*28-728-7月月-24-24谢谢大家谢谢大家2021/4/262021/4/265252nn9 9、 人的价值，在招收诱惑的一瞬间被决定。人的价值，在招收诱惑的一瞬间被决定。2024/7/282024/7/28 2024/7/282024/7/28 Sunday, July 28, 2024Sunday, July 28, 2024nn1010
78、、低头要有勇气，抬头要有低气。、低头要有勇气，抬头要有低气。2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 7/28/2024 7:10:12 AM7/28/2024 7:10:12 AMnn1111、人总是珍惜为得到。、人总是珍惜为得到。2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 Jul-24Jul-2428-Jul-2428-Jul-24nn1212、人乱于心，不宽余请。、人乱于心，不宽余请。2024/7/282024/7/28 2024/7/282024
79、/7/28 2024/7/282024/7/28 Sunday, July 28, 2024Sunday, July 28, 2024nn1313、生气是拿别人做错的事来惩罚自己。、生气是拿别人做错的事来惩罚自己。2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 7/28/20247/28/2024nn1414、抱最大的希望，作最大的努力。、抱最大的希望，作最大的努力。28 28 七月七月 2024 20242024/7/282024/7/28 2024/7/282024/7/28 2024/
80、7/282024/7/28nn1515、一个人炫耀什么，说明他内心缺少什么。、一个人炫耀什么，说明他内心缺少什么。七月七月 24 242024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 7/28/20247/28/2024nn1616、业余生活要有意义，不要越轨。、业余生活要有意义，不要越轨。2024/7/282024/7/28 2024/7/282024/7/28 28 July 202428 July 2024nn1717、一个人即使已登上顶峰，也仍要自强不息。、一个人即使已登上顶峰，也仍要自强不息。2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28 2024/7/282024/7/28谢谢大家谢谢大家2021/4/262021/4/265353
