综合疗法治疗分泌性中耳炎

分泌性中耳炎为耳科常见病、多发病.笔者自1996年来采用中耳正压治疗仪先行咽鼓管吹张或导管打气,再行鼓膜穿刺抽液,后经鼓膜穿刺孔向中耳加正压并导入药物的方法,治疗顽固性分泌性中耳炎,近期疗效令人满意,现报告如下.     

电子喉镜下咽鼓管吹张治疗分泌性中耳炎

目的观察电子喉镜下咽鼓管吹张治疗分泌性中耳炎的疗效。方法分泌性中耳炎患者69例(77耳)随机分为两组,一组行鼓膜穿刺术(穿刺组,38耳),一组电子喉镜引导下行咽鼓管吹张(吹张组,39耳),分别治疗3次,每次间隔5天,比较两组疗效。结果两组患者治疗后,穿刺组治愈20耳,好转15耳,无效3耳,总有效率92.1%,吹张组治愈22耳,好转16耳,无效1耳,总有效率97.4%,两组比较差异无统计学意义(P>0.05)。结论电子喉镜引导下咽鼓管咽口吹张操作简便、安全、疗效好,可作为分泌性中耳炎的治疗方法之一。     

纤维喉镜下咽鼓管导管治疗分泌性中耳炎36例临床分析

目的：总结并分析在纤维喉镜电视监视下用咽鼓管导管行咽彭管吹张 注药治疗分泌性中耳炎的疗效。方法：在纤维喉镜电视监视下用咽鼓管导管行咽鼓管吹张 注药治疗分泌性中耳炎36例41耳，结果：临床观察4-12个月，显效：18耳，占43.9%；有效；15耳，占36.6%，无效：8耳，占19.5%，总有效率为80.5%，结论：此法操作简单，不破坏鼓膜的生理结构。并发症少，是改善分泌性中耳炎患者咽鼓管功能，提高其听力的一种有效治疗方法。     

纤维喉镜下咽鼓管导管治疗分泌性中耳炎36例临床分析

目的:总结并分析在纤维喉镜电视监视下用咽鼓管导管行咽鼓管吹张＋注药治疗分泌性中耳炎的疗效。方法:在纤维喉镜电视监视下用咽鼓管导管行咽鼓管吹张＋注药治疗分泌性中耳炎３６例４１耳。结果:临床观察４~１２个月,显效:１８耳,占４３．９%;有效:１５耳,占３６．６%;无效:８耳,占１９．５%,总有效率为８０．５%。结论:此法操作简单,不破坏鼓膜的生理结构,并发症少,是改善分泌性中耳炎患者咽鼓管功能,提高其听力的一种有效治疗方法。     

乳突大小与分泌性中耳炎:相互关系问题

以往认为,分泌性中耳炎是由于咽鼓管机能不良（狭窄或阻塞）,不能平衡中耳气压,导致中耳渗出所致。近来报告,中耳气体在中耳腔与粘膜血管之间的弥散在造成中耳负压中所起的作用比咽鼓管机能不良的作用更为突出。乳突腔在中耳有效的气体交换中起压力缓冲腔的作用。当乳突气化不良时,对中耳气体压力变化的缓冲能力减弱,从而导致分泌性中耳炎。为研究乳突气化与分泌性中耳炎的关系,对因耳硬化症进行外半规管开窗术的２８具共３１块颞骨标本进行组织学观察,并与相同数量的耳硬化症或感觉神经性聋但未进行开窗术或耳科手术的颞骨对照。开…     

改良咽鼓管吹张治疗儿童分泌性中耳炎的短期疗效评估

目的评估改良咽鼓管吹张治疗儿童分泌性中耳炎的可行性、安全性、有效性。方法将我科门诊确诊为分泌性中耳炎的患儿随机分为四组,对照组不接受任何处理,观察等待3个月,药物治疗组使用鼻喷剂+口服抗组胺药+口服粘液促排剂治疗1个月后继续观察2个月,咽鼓管吹张组使用改良咽鼓管吹张器治疗1个月后继续观察2个月,药物+咽鼓管吹张组同时使用药物+咽鼓管吹张治疗1个月后继续观察2个月。结果治疗过程中接受咽鼓管吹张的患儿均能配合完成治疗,无严重的不良反应和不适。治疗1个月后四组的疗效差异有统计学意义,吹张组和药物+吹张组有效率高于对照组和药物治疗组,继续观察2个月后这种差异仍然存在。吹张组和药物+吹张组之间疗效无统计学差异。治疗后吹张组和药物+吹张组气骨导差值明显下降,观察组和药物组治疗前后气骨导差值无变化。结论改良咽鼓管吹张治疗儿童分泌性中耳炎是可行的安全的有效的,在观察等待的3个月中可有效清除中耳积液,降低需要手术的机率。     

分泌性中耳炎咽鼓管功能动态观察的临床意义

目的探讨分泌性中耳炎的咽鼓管功能状态和原因及对治疗的意义.方法动态观察分泌性中耳炎51耳的咽鼓管功能.用鼻内窥镜检查咽鼓管咽口,根据咽鼓管功能状态行咽鼓管吹张术或扩张术以及局部用药治疗.结果51耳中咽鼓管功能异常36耳,正常15耳.正常组中咽鼓管咽口充血狭窄或肿胀裂缝状8耳,异常组咽鼓管咽口充血狭窄或肿胀裂缝状32耳,两者差别有显著性(P＜0.05),咽鼓管功能异常与咽鼓管咽口病变有关;咽鼓管吹张术或扩张术和局部用药对分泌性中耳炎有效.结论咽鼓管咽口病变影响咽鼓管的功能,咽鼓管功能检查对治疗分泌性中耳炎有指导作用.     

鼻内窥镜下和传统咽鼓管吹张术治疗分泌性中耳炎的疗效分析

为探讨鼻内窥镜下咽鼓管吹张术治疗分泌性中耳炎的疗效,于１９９６年６月开始在鼻内窥镜下咽鼓管吹张术治疗分泌性中耳炎４８例,并与传统咽鼓管吹张术２５例治疗分泌性中耳炎的疗效进行了对比。 结果。治愈标准：自觉症状消失,鼓膜内陷充血消失,纯音测听气导恢复正常范围,声阻抗显示鼓室任恢复为“Ａ”型。鼻内窥镜组５４耳,１次性治愈２５耳,随访６～１２个月,２例复发。而传统方法组２５例（２８耳）中,１次性治愈６耳,复发６例。鼻内窥镜下和传统咽鼓管吹张术治疗分泌性中耳炎的疗效分析@曹火太$深圳市福田医院耳鼻咽喉科!5180…     

颌下径路阻塞咽鼓管创建大鼠分泌性中耳炎模型

目的 探讨建立大鼠分泌性中耳炎模型的纯物理学方法 ,为建立无化学因素影响的分泌性中耳炎动物模型提供一种造模参考方法 .方法 24只清洁级SD大鼠右侧耳为模型组,左侧为对照组.模型组用木塞经右侧颌下径路阻塞咽鼓管创建分泌性中耳炎大鼠模型,对照组不做任何处理,用ABR和鼓室导抗图检测动物听功能和中耳功能的变化,并用光学显微镜观察中耳黏膜的病理改变.结果模型组24耳中有20耳ABR反应阈从造模前的34.25±5.45 dB升高到57.63±5.46 dB,造模前后ABR反应阈差异有统计学意义(P<0.05).对照组鼓室导抗图为A型或As型,模型组中20耳为B型.光镜下可见模型组病变主要在中耳腔及咽鼓管,有浆细胞大量渗出,咽鼓管腔狭窄,纤维增生,毛细血管扩张.结论 通过颌下径路用木塞阻塞大鼠咽鼓管的方法 可以影响其咽鼓管的功能,成功建立分泌性中耳炎动物模型.     

分泌性中耳炎的无创治疗

分泌性中耳炎（secretory otitis media,SOM）是耳鼻咽喉头颈外科多发病之一,临床上以不伴有急性中耳炎症状和体征的中耳积液及听力减退为主要特征的中耳非化脓性炎症性疾病。对于SOM的治疗多年来一直是临床、基础研究探讨的课题。我科近两年来对确诊为SOM患者,利用纤维鼻咽镜及其图像分析系统,动态观察咽鼓管咽口的开闭情况,并在镜下经纤维镜活检口于咽鼓管咽口处注药、吹张,同时辅以耳正压治疗,外耳道内微波照射等无创治疗,取得较好疗效,报道如下。     

A Model to Explain the Rapid Pressure Decrease After Air–Inflation of Diseased Middle Ears

Objectives: Air-inflation in humans and monkeys with significant negative middle ear pressure or with middle ear inflammation was shown to cause greater than ambient middle ear pressure initially, followed by a rapid rate of pressure decrease to approach the preinflation value. Study Design: A mathematical model of middle ear pressure regulation is presented and used to simulate air-inflation of the normal and diseased middle ear. Materials and Methods: The model represents the total volume of the middle ear as consisting of three subcompartments representing the airspace, effusion, and mucosa/blood. Gas exchange among those compartments was assumed to be diffusion limited, and the gas exchange between the mucosa/blood compartment and systemic blood was assumed to be perfusion limited. Disease was modeled as an increase in mucosal blood flow or, alternatively, as an increase in the volumes of the effusion and mucosa/blood compartments. Results: The predictions of the model agree better with the experimental data when the increased rate of pressure change after middle ear inflation in diseased ears is driven by an increased volume of the effusion compartment as opposed to an increased perfusion rate. The responsible mechanism is a rapid redistribution among subcompartments of the gas volume introduced into the air compartment. Conclusions: These results suggest that middle ear inflation with inert gas can be used to diagnose the presence and relative amount of middle ear effusion, and that current protocols for treating otitis media with effusion using inflation need to be modified to optimize their intended effect.     

Prevention of otitis media with effusion by repeated air inflation in a monkey model

OBJECTIVES: To test the following hypotheses that (1) middle ear (ME) air inflation prevents the development of otitis media with effusion in a monkey model of functional eustachian tube obstruction, and (2) ME inflation treatment of otitis media with effusion can cause artifactual clinical improvements due to fluid displacement from the tympanum to the adjacent airspaces. DESIGN: Randomized controlled trial. SUBJECTS: Twelve cynomolgus monkeys. INTERVENTIONS: Eustachian tube dysfunction was induced by botulinum paralysis of the right tensor veli palatini muscle in all monkeys. Before and on study days 9, 15, and 21 after paralysis, the presence or absence, and distribution of ME effusion were documented using magnetic resonance imaging (MRI). Right and left ears were examined twice daily for 21 days using tympanometry, and right ME air inflation (n = 6 ears) or sham inflation (n = 6 ears) was done immediately after those examinations if the ME pressure was -100 mm H2O or less. On 10 of the scheduled MRI evaluations, the MRI was repeated immediately after an inflation to document the possible redistribution of fluid within the ME caused by the maneuver. RESULTS: Middle ear pressure remained within normal limits for the follow-up period in 11 of the 12 nonparalyzed left ears, in none of the 6 sham-inflated right ears, and in 3 of the 6 air-inflated right ears. Three air-inflated right ears developed flat tympanograms (ie, days 14 through 16). Magnetic resonance imaging documented inflammation and fluid in 1 of the 11 nonparalyzed left ears and in all sham-inflated right ears. Lesser degrees of inflammation and effusion based on MRI evaluations were noted for the 3 air-inflated right ears that retained near-ambient pressures when compared with the right 3 ears that developed a flat tympanogram. The MRI measure of effusion quantity within the tympanum was decreased acutely after inflation, but was simultaneously increased in the adjacent airspaces of the temporal bone. CONCLUSIONS: Repeated air inflation prevented the development of otitis media with effusion in 50% of the ears with functional eustachian tube obstruction. Postinflation MRI documented the displacement of fluid by inflation from the tympanum to the mastoid and petrous air cells. Using standard clinical evaluations such as tympanometry and otoscopy, this fluid redistribution can cause a false diagnosis of improvement.     

声反射在成人分泌性中耳炎中的诊断价值

目的提高耳科门诊成人分泌性中耳炎中耳积液的检出率,探讨声反射在协助诊断分泌性中耳炎是否伴有中耳积液中的临床价值。方法回顾性分析耳鼻咽喉科门诊169例确诊为分泌性中耳炎伴有中耳积液的成年患者的临床资料,并对听力正常与听力下降患者的鼓室图、同侧声反射及纯音测听等资料进行对比。结果169例(237耳)经鼓膜穿刺证实为中耳积液的患者中,223耳(94.1%)未引出声反射,14耳(5.9%)引出声反射;鼓室图异常200耳(84.4%),正常者37耳(15.6%);216耳(91.1%)有传导性听力下降,21耳(8.9%)听力正常。不论听力是否下降,同侧声反射的未引出率均高于异常鼓室图的概率(P<0.05);在不同听力及不同类型鼓室图中,声反射的未引出率没有差异(P>0.05),具有无创、快捷及客观等优点,能更好的帮助临床工作者评估分泌性中耳炎的疗效及预后。结论声反射能协助提高成人分泌性中耳炎伴中耳积液的检出率,具有无创、快速及客观等优点,能更好地帮助临床工作者评估分泌性中耳炎的疗效及预后。     

Accuracy of tympanometric middle ear pressure determination in secretory otitis media: dose-dependent overestimation related to the viscosity and amount of middle ear fluid.

HYPOTHESIS: Tympanometric measurements of middle ear pressure in children with secretory otitis media are overestimated in a dose-response manner because of increased hysteresis explained by the viscosity and amount of middle ear fluid. BACKGROUND: Tympanometric middle ear pressure is important in evaluating children with secretory otitis media. These measurements are influenced by hysteresis appearing as a peak pressure difference in bidirectional tympanometry. This represents an inaccuracy of 0.5 x peak pressure difference, which is only 5 to 25 daPa in normal ears. However, previous experiments found increased hysteresis, suggesting an inaccuracy of 225 daPa in secretory otitis media ears. MATERIALS AND METHODS: In 56 patients with secretory otitis media, bidirectional tympanometry was performed; Type B curves were excluded. The middle ear fluid was semiquantified subsequently at surgery according to viscosity (serous, seromucoid, or mucoid) and amount (small, medium, or large). A control group included 28 normal children. Peak pressure difference was calculated by the difference between middle ear pressure determined by a positive and negative pressure sweep. RESULTS: Mean peak pressure difference was 10 and 69 daPa in the normal and secretory otitis media groups, respectively (p <0.001). However, peak pressure difference ranged to 205 daPa in the secretory otitis media group and showed a significant positive correlation to viscosity and amount of the fluid (both p <0.0001). CONCLUSION: Peak pressure difference is significantly increased in secretory otitis media because of additional damping explained by the viscosity and amount of the fluid. The mean error was 5 daPa in normal ears and 35 daPa in secretory otitis media ears, but ranged to greater than 100 daPa. These results were only a low estimate of the inaccuracy, because patients with Type B tympanograms could not be included, and errors of more than 100 daPa can be anticipated.     

Direct measurement of middle ear pressure through the eustachian tube

We report a method for measuring middle ear pressure through the eustachian tube. We used a 1-mm-diameter micro-tip catheter pressure transducer (Mikro-tip) and inserted this into the tympanic cavity through the eustachian tube. In preliminary studies, we measured four normal ears, two ears with tubal dysfunction, one ear with a dry perforation and 13 ears with otitis media with effusion (OME). Among those ears with OME, three showed negative middle ear pressure, three slight positive pressure and one normal pressure. These findings suggest that our transtubal method is reliable and useful for measuring middle ear pressure.     

Repeated Inflation Does Not Prevent Otitis Media With Effusion in a Monkey Model

Objective: Investigate the efficacy of repeated middle ear inflation with an inert gas (argon) for preventing the development of middle ear effusion in monkeys with functional eustachian tube obstruction. Study Design: Prospective controlled trial of daily middle ear inflation with five monkeys assigned to the inflation group and four to the control group. Methods: The right tensor veli palatini muscle of nine monkeys was paralyzed with botulinum toxin. Tympanometry was done before the procedure and then daily for 21 days. Presence and distribution of effusion were assessed before paralysis and on day 15 using magnetic resonance imaging (MRI). In five right ears inflation was done beginning at the first observation of negative middle ear pressure of ≤?200 mm H₂O and repeated on all days with pressures ≤?100 mm H₂O. Four right ears served as uninflated controls. Results: Right middle ear pressure decreased in all animals over the course of the study. Pressure returned to near-ambient levels immediately following the argon inflation but was decreased to control levels at the subsequent observation on the following day. MRI at day 15 documented effusion in all right ears with no quantifiable differences in amount or distribution between ears that were and were not inflated with argon. Conclusions: Repeated inflation with an inert gas does not prevent middle ear effusion in monkeys with functional eustachian tube obstruction.     

儿童分泌性中耳炎致骨导听力下降的临床特征分析

目的 探讨儿童分泌性中耳炎致骨导听力下降的特点、病因和预后.方法 回顾性分析75例(82耳)分泌性中耳炎患儿骨导听力下降的临床资料,并对其发病年龄、病程、积液性质和积液量与骨导听阈的关系进行观察.结果 75例患儿(82耳)骨导听力下降,平均骨导阈值在2.0 kHz和4.0kHz处增高最明显.骨导听阈与病程和积液性质显著相关(P＜0.01或P＜0.05),与年龄、积液量无关.75例患儿均采取鼓膜切开置管术和(或)腺样体切除术,术后给予药物治疗.随访6月,听力恢复正常者76耳,气导听阈下降但骨导听阈无改善者6耳.结论 分泌性中耳炎可导致儿童骨导阈值增高,是导致儿童耳聋的危险因素之一,及早干预可避免病情发展.     

Comparison of tympanometry and otomicroscopy during healing of otitis media

One hundred ears in 50 children with acute otitis media during healing were examined with tympanometry and the objective measures were compared with the subjective evaluation of otomicroscopy by four otolaryngologists independently. Tympanometric findings could more often correctly suggest reduced tympanic membrane mobility than did otomicroscopy, but both methods gave an equally good indication of middle ear effusion. However, otomicroscopy was necessary when evaluating the colour and the appearance of the tympanic membrane and revealed middle ear effusion in a few cases with 'normal' tympanometry. As a rule: normal tympanometry (Jerger type A) was closely correlated with a normal tympanic membrane and a normal middle ear without effusion; pathological tympanometry (Jerger type B) was accompanied by middle ear effusion and needed follow-up; ears with tympanometric pressure more negative than -150 mmH2O but more positive than a flat curve needed otomicroscopy to identify middle ear effusion.     

Gas exchange function of the middle ear in patients with otitis media with effusion

Gas exchange function through the middle ear mucosa was assessed using nitrous oxide (N₂O) in patients with otitis media with effusion (OME), as well as in normal ears during elective surgery for unrelated disorders. In all normal ears except one (n = 43), an increase in pressure was observed after N₂O inhalation. In 42 of 84 ears with OME, a pressure increase was observed, but not in the remaining 42 ears (50%), indicating that the gas exchange function in these latter ears was impaired. In 21 of the 42 ears showing no middle ear pressure increase following N₂O inhalation, the middle ear pressure was again monitored after myringotomy and aspiration of the effusion A pressure increase was found in 16 ears, indicating that the impairment in gas exchange function in ears with OME may be reversible in most cases. Computed tomography of the mastoid was examined preoperatively in 66 ears, with the presence or absence of a middle ear pressure change well correlated in 57 ears with the presence or absence of mastoid aeration.     

Comparative study on adhesive otitis media and pars tensa cholesteatoma in children

Objective: Recurrent otitis media and persistent otitis media with effusion in early childhood may cause an atelectatic eardrum and adhesive otitis media, which sometimes progress to pars tensa cholesteatoma. When and how children with adhesive otitis media should be operated on remain controversial. Therefore, this study aimed to analyze the clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma, and to determine the risk factors of progression to cholesteatoma.Methods: Seventeen ears of 15 children with adhesive otitis media (adhesive group) and 14 ears of 13 children with pars tensa cholesteatoma (tensa cholesteatoma group) who underwent tympanoplasty were included in this study. We analyzed the following clinical characteristics of children in both groups: medical and life history, associated diseases, sites of the adhesion, and development and aeration of mastoid air cells as shown by temporal bone computed tomography.Results: Most of the children in both groups had a history of recurrent otitis media and/or persistent otitis media with effusion. They showed a male predominance and a frequent association of allergic rhinitis. The number of ears showing undeveloped mastoid air cells in the tensa cholesteatoma group was significantly larger than that in the adhesive otitis media group (P=0.0068). A lack of aeration of the middle ear, including the eustachian tube, was more frequently found in ears with pars tensa cholesteatoma than in ears with adhesive otitis media (P=0.0012). Using multivariate logistic regression, the presence of otorrhea (odds ratio [OR], 14.847; 95% confidence interval [CI], 0.834–264.184), total adhesion (OR, 28.550; 95% CI, 0.962–847.508), and undeveloped mastoid air cells (OR, 19.357; 95% CI, 1.022–366.589) were related to pars tensa cholesteatoma.Conclusion: Children with adhesive otitis media should be carefully followed up in the outpatient setting. Ears with poor mastoid development may develop pars tensa cholesteatoma. Additionally, ears with middle ear effusion, total adhesion, and the presence of otorrhea tend to be at risk of pars tensa cholesteatoma. Tympanoplasty or tympanostomy tube insertion should be considered for children with adhesive otitis media who have these risk factors to prevent progression to pars tensa cholesteatoma.