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1.
目的 探讨伴咽鼓管功能异常的慢性中耳炎患者术中行咽鼓管冲洗的临床意义。方法 选择2016年8月~2017年12月本院耳鼻咽喉科住院部收治123例伴咽鼓管 功能异常的慢性中耳炎手术患者,随机分为试验组67例(术中行咽鼓管冲洗)及对照组56例(术中不予处理咽鼓管)。所有患者接受鼓室成形术,并根据病情决定是否同期行乳突改良根治术。术后随访1年,分析两组患者术后干耳时间、听力变化、中文版慢性耳病调查量表(Chinese version of the chronic ear survey,CCES)评分变化、鼓膜愈合情况、咽鼓管功能恢复情况。结果 两组患者术后仅干耳时间差异无统计学意义,而术后声导抗结果、鼓膜愈合率、平均听阈改善值、气骨导差改善值、CCES评分改善值等指标,以上指标两组间比较,差异均有统计学意义(P 均<0.05)。结论 伴咽鼓管功能异常的慢性中耳炎患者,术中行咽鼓管冲洗能改善术后咽鼓管功能,进而获得更好生活质量及听力,提高术后疗效。  相似文献   

2.
目的探讨咽鼓管球囊扩张术治疗慢性复发性分泌性中耳炎的临床疗效。方法前瞻性自身病例对照研究,选择从2014年8月至2015年4月住院的11例(13耳)慢性复发性分泌性中耳炎患者,全麻下施行咽鼓管球囊扩张术+鼓膜切开置管术,术后随访12月,以患者的咽鼓管功能评分作为评价指标,分别记录和比较术前、术后1月、6月和12月时的咽鼓管功能评分,并在术后12月复诊时进行满意度问卷调查。结果术后1月时全部患者患耳症状均明显改善,咽鼓管功能评分增加,有效率为100%;术后6月,全部患者症状基本消失,咽鼓管功能评分显著增加,有效率为100%;术后12月,2耳症状复发,其咽鼓管功能评分比术后6月时明显下降,但仍高于术前,其余10耳症状改善明显,咽鼓管功能评分比术前明显提高,有效率为84.6%。术后12月时的满意度问卷调查结果表明84.6%患者对治疗过程满意。结论慢性复发性分泌性中耳炎患者施行咽鼓管球囊扩张术+鼓膜切开置管术,术后大部分患者的症状明显改善,其咽鼓管功能评分显著提高。其近期和中期疗效均显著,总体治疗满意度高。  相似文献   

3.
目的 对鼻中隔偏曲患者进行手术前后的随访评价,了解鼻内镜鼻中隔矫正术的临床疗效及对患者生活质量的影响.方法 对鼻中隔偏曲患者进行鼻内镜手术矫正,对手术前后症状评分进行临床疗效评价,采用SNOT-20量表进行生活质量调查.结果 患者总体症状(术前评分6.06±1.27,术后1.54±0.57),以及鼻塞、头痛或头晕、鼻出血、流涕症状术后较术前缓解,术后生活质量明显提高(术前量表总分及五大问题得分为13.94+5.87、7.39+2.65,术后为11.01+4.06、6.25+1.33),术后生活质量的改善与术前症状的严重程度有相关性联系.结论 鼻内镜鼻中隔矫正术能有效改善患者的临床症状,提高患者的生活质量,SNOT-20量表能反映患者手术前后生活质量变化情况,临床疗效和生活质量的改善程度呈正相关性.  相似文献   

4.
目的探讨慢性化脓性中耳炎患者手术前后生活质量及其影响因素。方法选取2010年5月~2015年5月于我院行手术治疗的慢性化脓性中耳炎患者150例,采用慢性化脓性中耳炎生活质量量表及视觉模拟量表评价其手术前后生活质量及分析其影响因素。结果与手术前相比,患者手术后生活质量总评分、躯体表现、情感异常、医学资源利用、日常活动受限制评分明显较高(P0.001)。患者手术后平均VAS评分显著低于手术前(t=17.620,P0.001)。手术前患者中,年轻、生活在城市、累及双耳、类型为骨疡型、胆脂瘤型的患者生活质量总评分较低(P0.05);手术后患者中,累及双耳、类型为骨疡型、胆脂瘤型的患者生活质量总评分较高(P0.05)。患者手术前年龄、生活环境、累及耳别、中耳炎类型与生活质量有相关性(P0.05);手术后累及耳别、中耳炎类型与生活质量有相关性(P0.05)。结论慢性化脓性中耳炎患者经手术治疗后生活质量明显改善,累及双耳及病情较严重的患者术后生活质量改善更加明显,可根据生活质量评价选取合适的治疗手段。  相似文献   

5.
目的通过咽鼓管球囊扩张术(BET)加鼓膜切开置管术(TBI),治疗难治分泌性中耳炎,分析其疗效。方法 15例(15耳)从2017年1月至2019年1月收治的难治性分泌性中耳炎患者(ROME),术前经硬性耳内镜、电子鼻咽镜、纯音测听、声导抗、咽鼓管压力测定(TMM),以及经过规范药物治疗、鼓膜穿刺以及不少于3次鼓膜置管手术治疗,效果不佳。全麻下施行BET+TBI手术治疗,术后随访12月。用视觉评分量表(VAS)评分对术前及术后1、6和12个月时Valsalva难易程度、耳闷塞感、耳痛进行主观症状评估。对其术前和术后1、3、6、9和12个月的咽鼓管功能问卷(ETDQ-7)调查进行得分均值比较。并在术后12月复诊时进行满意度问卷调查。结果术后1、6、12月Valsalva难易程度、耳闷塞感、耳痛程度较术前显著降低,差异有统计学意义(P0.05);术后ETDQ-7评分较术前显著降低(P0.05);术后12月满意度问卷调查表表明13名患者(86.7%)对治疗过程满意。结论咽鼓管球囊扩张术+鼓膜切开置管术治疗难治性分泌性中耳炎,大部分患者的术后症状明显改善。其近期和中期疗效均显著,总体治疗满意度高。  相似文献   

6.
目的评价慢性化脓性中耳炎患者手术前后的生活质量并探讨其影响因素。方法用慢性化脓性中耳炎生活质量量表对153例患者手术前后的生活质量进行评价,分析其相关影响因素。结果术后患者的生活质量分值显著高于术前(P<0.01),生活质量术前与年龄、居住地、单耳或双耳罹患以及中耳炎型别显著相关,术后则与单耳或双耳罹患以及中耳炎型别显著相关,双耳罹患以及病变程度较重者术后生活质量有望得到更大的改善。结论慢性化脓性中耳炎生活质量评价对治疗策略的选择具有较好的参考意义。  相似文献   

7.
目的 探讨中耳胆脂瘤及手术干预对患者生活质量的影响。方法 使用苏黎世慢性中耳炎量表(the Zurich chronic middle ear inventory, ZCMEI-21))评估53例(53耳)行手术治疗的中耳胆脂瘤患者的生活质量,该量表包括耳部体征和症状、听力水平、心理社会影响和医疗资源的使用情况四个方面;患者术前和术后6~12个月均完成纯音听力检查和ZCMEI-21量表的填写,分析一般情况、听力水平、手术干预对患者生活质量的影响。结果 不同年龄、性别、职业、居住环境患者ZCMEI-21量表评分差异无统计学意义(P>0.05);手术干预前耳部体征和症状、听力水平、社会心理影响和医疗资源使用情况分量表评分及ZCMEI-21量表总分明显高于手术后,差异有统计学意义(均为P<0.05)。患者手术前后ZCMEI-21量表总评分与平均气导听阈差值之间中度相关(r=0.518,P<0.001,与手术前后气骨导差值变化之间无相关性(r=0.062,P=0.658)。结论 手术干预可显著改善中耳胆脂瘤患者的生活质量,术后患者听力恢复情况与生活质量的影响显著相关。  相似文献   

8.
目的探讨儿童慢性化脓性中耳炎(CSOM)的病变特点及手术方式的选择。方法在行手术治疗的儿童CSOM患者82例中,2例双耳病变者先行1耳手术,手术方式选择乳突根治术60例、改良乳突根治术20例、鼓室成形术2例。从术前并发症、病变范围、听骨破坏情况以及术后并发症等方面探讨其临床特征。结果82例手术中胆脂瘤型56例(68.2%),慢性化脓性中耳炎伴肉芽26例(31.7%),病变范围广泛,多累及外耳道鼓室、鼓窦、鼓窦入口,而听小骨破坏程度最重。术后随访0.5~2年,并发症出现有外耳道口狭窄8例,术腔增生挛缩8例;胆脂瘤复发1例,因术前病变严重术后面瘫未恢复1例。结论儿童CSOM其术前并发症中以颅外并发症多见,年龄越小病变程度越重,对其手术彻底清除病灶应放在首位,根据病变的情况选择不同的手术方式和主动定期随访可以有效降低术后复发率,经典的乳突根治术对儿童不宜采用。  相似文献   

9.
目的 探讨慢性鼻-鼻窦炎鼻内镜术后定期随访的临床意义及鼻内镜手术治疗对慢性鼻-鼻窦炎的症状改善情况及生活质量影响.方法 将接受鼻内镜手术治疗的120例慢性鼻-鼻窦炎患者分为慢性鼻-鼻窦炎不伴鼻息肉组和慢性鼻-鼻窦炎伴有鼻息肉组,每组均60例.对两组患者术后进行定期随访1年,分析术后随访疗效.其次评估所有患者术前、术后1、3、6和12个月生活质量状况及主要症状改善情况,比较主要症状和生活质量的变化.结果 不伴鼻息肉组:术后6个月痊愈36例、好转20例、无效4例;12个月痊愈50例、好转7例、无效3例.伴鼻息肉组:术后6个月痊愈30例、好转27例、无效3例;12个月痊愈37例、好转20例、无效3例.两组病情转归差异有统计学意义.120例经鼻内镜手术治疗的慢性鼻-鼻窦炎患者术后第1、3、6、12个月主要症状评分呈下降趋势,与术前相比均明显下降(P<0.01);与术前比较,20个条目和5大条目评分均明显下降(P均<0.01).结论 鼻内镜术后进行定期随访换药及综合治疗是必不可少的重要环节,术后进行定期规律的随访换药及综合治疗可以显著提高手术疗效,鼻内镜手术可以使慢性鼻窦炎患者的症状和生活质量得到明显改善.  相似文献   

10.
目的 比较耳内镜与耳显微镜下鼓膜修补术治疗慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)的临床疗效及安全性。方法 选取2013年1月~2020年8月我院收治的CSOM患者90例,随机分为对照组和观察组,各45例。对照组与观察组分别采用耳显微镜及耳内镜进行鼓膜修补,比较两组手术情况,听力、生活质量、疼痛及不良反应情况。结果 观察组手术时间、出血量、住院时长及视觉模拟量表评分均明显低于对照组(P 均<0.05);两组治疗后气导听阈、骨导听阈及气骨导差均明显低于治疗前(P 均<0.05),组间比较无明显差异(P 均>0.05);观察组治疗后CSOM患者生活质量评分明显高于对照组(87.66±8.32vs 78.64±8.43,t =5.109,P<0.05);两组不良反应发生率比较无明显差异(8.89% vs 13.34%,χ2=0.450,P =0.502)。结论 耳内镜下鼓膜修补术临床疗效显著,且可有效提高CSOM患者生活质量,降低术后疼痛。  相似文献   

11.
The Chronic Ear Survey (CES) is a valid, disease-specific measure for the evaluation of health status and treatment effectiveness for adults with chronic suppurative otitis media (CSOM). This study compares the validation properties of the English and Chinese versions of the CES. The CES was translated into Mandarin Chinese by means of a parallel model. The Chinese version of the CES (CCES) was administered to 103 patients in a prospective manner, then was validated according to established criteria for reliability, validity, and longitudinal sensitivity. The CCES demonstrated good test-retest reliability and internal consistency (Cronbach's a = 0.81). The CCES significantly correlated with the Mandarin Chinese (Taiwan) version of the generic 36-Item Short-Form Health Survey (TSF-36). The standardized response mean for the CCES total score was 2.1, indicating excellent sensitivity to clinical change. This validation study demonstrated that the performance characteristics of the CCES were equivalent to those of the English-version CES. The CCES is a valid tool for evaluation of adults with CSOM among the Chinese-speaking population.  相似文献   

12.
目的:对慢性化脓性中耳炎完壁术式及开放术式的适应证、患者术后生活质量进行研究,为术式的选择提供参考。方法:对慢性化脓性中耳炎行完壁术式或开放术式患者的临床资料进行分析总结。采用纯音测听、声导抗术腔容积测定、耳内镜及慢性耳病调查量表(中文版)对患者进行追踪随访。结果:①术后干耳率完壁术式与开放术式分别为98.7%、98.6%(P>0.05);②干耳时间完壁术式为(40.1±21.2)d,开放术式为(53.5±15.0)d(P<0.05);③患侧耳道容积/对侧正常耳耳道容积完壁术式为1.16±0.10,开放术式为2.05±1.19(P<0.05);④慢性耳病调查量表得分完壁术式为(91.2±6.8)分,开放术式为(72.0±7.7)分(P<0.05);⑤术后认为耳道口扩大、影响外观者的比例,完壁术式为5.7%,开放术式为80.8%(P<0.05);⑥术后主观听力改善者完壁术式占58.9%,开放术式占24.2%(P<0.05);但纯音测听显示听阈及骨气导差2组差异无统计学意义(P>0.05);⑦术后满意度得分完壁术式、开放术式分别为9.55分和8.11分(P<0.05)。结论:①行完壁术式的患者耳道形态接近正常,干耳时间缩短,生活质量较开放术式有明显提高。②对于富有经验的耳科医生,完壁术式的适应证可以扩展至硬化型及板障型乳突、部分伴有解剖变异及有颅内外并发症的患者。  相似文献   

13.
The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold’s abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach.  相似文献   

14.
The objective of this study was to report and discuss the management of chronic suppurative otitis media (CSOM) following cochlear implantation in children. The study was a retrospective review of 650 patients receiving an implant at two paediatric tertiary referral centres for cochlear implantation. Nine patients were identified who developed CSOM following cochlear implantation (incidence 1.38%). The mean time interval between implantation and symptom development was 3.66 years (range 2-8 years) and the mean time interval between implantation and CSOM surgery was 5.02 years (range 2.2-8 years). All patients presented with otorrhoea and/or abscess formation over the implant site. Two patients underwent a modified radical mastoidectomy and seven underwent a combined approach tympanoplasty, three of whom required posterior canal wall reconstruction with cortical bone and one with cartilage. In four cases it was possible to remove the cholesteatoma without removing the implant. All but two patients were fitted with a contralateral implant. In the explanted ears the cochlear implant electrode was cut at the cochleostomy site, which was then covered with muscle. Chronic suppurative otitis media following cochlear implantation may occur either as a result of a posterior canal wall defect related to surgery or possibly de novo. Attempts should be made to save the implant, but explantation with reimplantation of the contralateral ear may be the only option. In these cases the intracochlear part of the electrode array should be left in situ to facilitate possible future reimplantation. Surgical options for management of CSOM should be individualized and may include both canal-wall up and canal-wall down techniques. To reduce the incidence of CSOM following implantation the authors recommend: (1) prompt treatment and careful follow-up of patients with a history of otitis media with effusion, (2) avoidance of excessive thinning of the posterior canal wall during mastoidectomy and (3) reconstruction of any accidental trauma to the annulus or posterior canal wall during posterior tympanotomy.  相似文献   

15.

Objectives

The aim of this study was to compare the hearing outcomes between canal wall up mastoidectmy (CWUM) and canal wall down mastoidectmy (CWDM).

Methods

One hundred seventy one chronic suppurative otitis media (CSOM) patients were enrolled in this retrospective study. The patients who underwent the second staged ossiculoplasty at least 6 months after mastoidectomy and who had an intact, well aerated tympanic cavity as well as intact mobile stapes at the time of operation were selected from the medical record. Based on the type of mastoid surgery, the patients were categorized into two groups: the CWUM (n=38) and CWDM groups (n=133). The hearing results of the CWUM and CWDM groups were compared using the pre- and post-operative air-bone gap (ABG) at 3 months after ossiculoplasty.

Results

The preoperative ABG in both groups (CWUM and CWDM) were 28.4±15.6 dB and 31.8±14.5 dB, respectively (P=0.18). Both groups didn''t show any significant difference (10.9 dB vs. 13.5 dB, respectively) (P=0.21) for the postoperative ABG closure. The proportion of patients with an ABG less than 20 dB was 58.6% of the CWDM patients and 68.4% of the CWUM patients (P=0.25).

Conclusion

The type of mastoid surgery (CWUM and CWDM) did not affect the hearing results of CSOM patients. When choosing the type of mastoidectomy procedure for CSOM surgery, the hearing outcomes are basically the same for both types of procedure.  相似文献   

16.
Abstract

The objective of this study was to report and discuss the management of chronic suppurative otitis media (CSOM) following cochlear implantation in children. The study was a retrospective review of 650 patients receiving an implant at two paediatric tertiary referral centres for cochlear implantation. Nine patients were identified who developed CSOM following cochlear implantation (incidence 1.38%). The mean time interval between implantation and symptom development was 3.66 years (range 2–8 years) and the mean time interval between implantation and CSOM surgery was 5.02 years (range 2.2–8 years). All patients presented with otorrhoea and/or abscess formation over the implant site. Two patients underwent a modified radical mastoidectomy and seven underwent a combined approach tympanoplasty, three of whom required posterior canal wall reconstruction with cortical bone and one with cartilage. In four cases it was possible to remove the cholesteatoma without removing the implant. All but two patients were fitted with a contralateral implant. In the explanted ears the cochlear implant electrode was cut at the cochleostomy site, which was then covered with muscle. Chronic suppurative otitis media following cochlear implantation may occur either as a result of a posterior canal wall defect related to surgery or possibly de novo. Attempts should be made to save the implant, but explantation with reimplantation of the contralateral ear may be the only option. In these cases the intracochlear part of the electrode array should be left in situ to facilitate possible future reimplantation. Surgical options for management of CSOM should be individualized and may include both canal-wall up and canal-wall down techniques. To reduce the incidence of CSOM following implantation the authors recommend: (1) prompt treatment and careful follow-up of patients with a history of otitis media with effusion, (2) avoidance of excessive thinning of the posterior canal wall during mastoidectomy and (3) reconstruction of any accidental trauma to the annulus or posterior canal wall during posterior tympanotomy. Copyright © 2006 John Wiley & Sons, Ltd.  相似文献   

17.
Currently, there is no valid, disease-specific outcomes measure to evaluate health impact and treatment effectiveness for patients with chronic suppurative otitis media (CSOM). The Chronic Ear Survey (CES) is a new, disease-specific outcomes measure for CSOM that was administered in a prospective manner to 91 patients with CSOM. It was then validated according to established criteria for reliability, validity, and sensitivity to clinical change by correlation with objective data and self-assessment questionnaires such as the Hearing Handicap Inventory for Adults (HHIA) and the generic 36-Item Short-Form Health Survey (SF-36). Significant correlations between subscale scores of the CES and audiometric data and between subscale scores of the HHIA and SF-36 were found. The standardized response mean for the CES total score was 0.42, indicating moderate sensitivity to clinical change. Overall, results demonstrated that the CES is a reliable and valid instrument for investigation of health status and health-related quality-of-life outcomes.  相似文献   

18.
《Auris, nasus, larynx》2020,47(2):215-219
ObjectiveTo identify the wideband absorbance (WBA) of reconstructed TM comparing with perforated and normal TM, and to investigate the efficacy of WBA to predict postoperative hearing outcome.MethodsNinety-eight adults (128 ears) with normal TM and 40 patients (40 ears) who were diagnosed with chronic suppurative otitis media (CSOM) and underwent tympanoplasty type 1 were enrolled. Pure tone audiometry and WBA were measured before and 6 and 12 months after surgery. Finally, only 29 patients in CSOM group completed all the tests.ResultsSignificant differences in WBA were observed between normal ears, CSOM, and reconstructed ears at middle to high frequencies. During follow-up, absorbance decreased at low frequencies and increased at middle to high. Significant positive correlation at low to middle frequency was observed between change in air-bone gaps (ABG) and absorbance at corresponding frequencies.ConclusionWBA in patients with CSOM was significantly different from normal TM, and a significant change in WBA was observed after tympanoplasty with improvement of ABG. WBA may be a useful tool for monitoring the postoperative change in absorbance of sound energy in the middle ear.  相似文献   

19.
Tympanomastoid surgery is considered standard management for chronic suppurative otitis media (CSOM) without cholesteatoma, which is unresponsive to ototopical/oral antimicrobial therapy. The following makes this sequence of management less attractive today: 1. potential ototoxicity of ototopical agents; 2. lack of oral antimicrobial agents effective against most common pathogens (e.g., Pseudomonas aeruginosa); 3. frequent occurrence in children who have tympanostomy tubes; and 4. failure of tympanomastoid surgery to eradicate the disease in all cases. We conducted a study in 36 pediatric patients with chronic suppurative otitis media, in which all received parenteral antimicrobial therapy and daily aural toilet (mean duration of treatment = 9.7 days). Thirty-two patients (89%) had resolution of their infection with medical therapy alone; four children required tympanomastoidectomy. Further investigation is needed to understand the etiology, pathogenesis, and most effective methods of management/prevention of CSOM in children.  相似文献   

20.
ObjectiveTo investigate the distribution of pathogenic bacteria in patients with tympanic membrane perforation after chronic suppurative otitis media (CSOM) in dry ear and its influence on the success rate of tympanoplasty and postoperative infection.Methods740 patients with tympanic membrane perforation after CSOM underwent endoscopic tympanoplasty were selected. The mucosal surface secretion of middle-ear was collected for bacterial culture and drug sensitivity test. The patients were followed up several times from 1 week to 3 months after the surgery.Results740 cases of ear secretions samples, raise the pathogens of 208 cases (28.1%), the success rate of surgery with microorganism grown and with no grown was 93.8% and 91.5%. fungus (14.6%) was the most species among the patients with the positive result, followed by methicillin-sensitive Staphylococcus aureus (4.1%), Pseudomonas (2.0%), Staphylococcus epidermidis (1.9%), methicillin-resistant Staphylococcus aureus (1.6%) and so on. There was no statistical difference in the proportion of perforation and infection in each group. There were no statistically significant differences in gender, age and duration of disease among the groups.ConclusionThere were still microbial colonization in patients with tympanic membrane perforation after CSOM in dry ear, include fungus, Staphylococcus aureus and Pseudomonas aeruginosa. Different microbial colonization had no influence on the success rate of tympanoplasty and postoperative infection.  相似文献   

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