鼻咽癌放疗后分泌性中耳炎的治疗探索

目的探索鼻咽癌（nasopharyngeal carcinoma，NPC）放射治疗后分泌性中耳炎（secretory otitis media，SOM）的治疗方法。方法对63例（72耳）NPC放疗后SOM患者，采用综合治疗措施：全身和局部抗炎，神经营养，扩张血管，激素治疗；加强鼻腔、鼻咽局部清理，治疗鼻腔鼻窦疾病；咽鼓管置管、冲洗并向鼓室注入麻黄碱、氧氟沙星、地塞米松和α-糜蛋白酶混合药液。结果所有患者治疗前均有耳鸣、耳闷塞感、听力下降等症状，鼓室导抗图均为“B”型。经综合治疗后，耳鸣消失45耳（62.50％），好转17耳（23.61％），无效10耳（13.89％），总有效率86.11％；耳闷塞感消失57耳（79.17％），好转11耳（15.28％），无效4耳（5.55％），总有效率94.45％；声阻抗检查鼓室曲线“A”型38耳（52.78％），“As”型25耳（34.72％），“B”型4耳（5.56％），“C”型5耳（6.94％）；0.5、1.0、2.0kHz气导听阈均值从治疗前的（46.0±5.0）dBHL提高到治疗后的（25.8±3.5）dBHL，差异具有显著性（P〈0.001）。结论分析NPC放疗后SOM的发病机理，有针对性地采取对因治疗，是非常有效和切实可行的，对提高NPC患者的生存质量具有重要意义，可以在临床实践中加以应用和推广。

Management of secretory otitis media following radiotherapy in patients with nasopharyngeal carcinoma

Objective To report authors' experiences in treating secretory otitis media(SOM)in patients with nasopharyngeal carcinoma(NPC)after radiotherapy,to improve understanding of its cause and identify effective treatment methods.Methods Sixty three cases(72 ears)of SOM in patients with NPC after radiotherapy were reviewed.Treatments included use of systemic and local antibiotics,neutrophic factors,vasodilators and steroids,supplemented by frequent debridement of the nasal and nasopharyngeal cavities and aggressive treatment of nasal and sinus diseases.Other treatments included endoscope-guided catheterization of the Eustachian tube which also served as a pathway for intratympanic application of theophylline,ofloxacin,dexamethasone and chymolase when indicated.Results Prior to treatments,all patients reposed hearing impairment,tinnitus and fullness or pressure in the ear.Acoustic immittance tests showed type"B"tympanogram in all 72 ears.Following treatment,tinnitus completely resolved or improved in 86.11% of the ears,fullness disappeared or improved in 94.45% of the ears,and tympanograms changed to types"A"or"As"in 87.5% of the ears.The mean pure-tone threshold over 0.5,1 and 2 kHz improved from 46.0±5.0 dB HL before treatment to 25.8±3.5 dB HL after treatment.There was no otorrhea or permanent scarring in the Eustachian tube.Conclusion Targeted treatment of SOM following radiotherapy based upon analysis of individual etiologies in patients with NPC can be quite effective and can significantly improve the life quality in these patients.