局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎

目的：探讨局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎的临床疗效。方法收集顽固性分泌性中耳炎患者20例（24耳）,于门诊局麻下,结合鼻内镜经鼻腔径路行咽鼓管咽口球囊扩张,并行鼓膜置管。所有患者均于术后3个月拔出T型管。结果术后随访6个月,18例患者耳闷塞感、听物朦胧感症状明显减轻,未再出现鼓室内积液。2例术后仍有耳内闷胀及听力下降,耳内镜检查示鼓室积液未吸收,再次置入T型通气管后症状改善。结论局麻下行咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎疗效显著,对于改善咽鼓管功能方法安全可行,并发症极小,是一种微创的新方法。     

咽鼓管功能障碍的慢性化脓性中耳炎治疗分析

目的 探讨合并咽鼓管功能障碍的慢性化脓性中耳炎病例的适宜手术方案。 方法 收集咽鼓管功能障碍的慢性化脓性中耳炎病例68耳,分为观察组(28耳),同期行中耳乳突手术及咽鼓管球囊扩张术,对照组(40耳),仅行中耳乳突手术。术前,术后3个月、6个月、12个月分别以ETDQ-7评分、听阈、气骨导差进行对比。 结果 观察组术后6~12个月随访气导平均听力改善率为89%(25/28),干耳率93%(26/28)。对照组听力改善率为75%(30/40),干耳率95%(38/40)。观察组术后3~6个月EDDQ-7评分及听阈达到较明显缓解,但术后6~12个月上述指标有加重趋势。观察组及对照组术后听力均比术前听力提高,有统计学差异,两组的术后听力相对比,观察组优于对照组,有统计学意义。 结论 在咽鼓管功能障碍的慢性化脓性中耳炎患者中,中耳手术同期咽鼓管球囊扩张术较单纯中耳手术的听力改善率高,改善程度高,重新内陷率低,重新粘连率低,干耳率无明显差别。术后3~6个月患者咽鼓管相应症状达到较明显缓解,6~12个月症状有反复。     

Chronisch obstruktive Tubenfunktionsstörung des Erwachsenen

Background

Sufficient diagnostic tools and effective therapies for chronic obstructive eustachian tube dysfunction are lacking.

Patients and methods

A total of 120 patients (209 ears) with chronic obstructive eustachian tube dysfunction were treated over a 2-year period using transnasal endoscopic balloon dilatation of the cartilaginous part of the eustachian tube (balloon eustachian tuboplasty, BET). A balloon catheter is inserted into the eustachian tube via the pharyngeal opening and dilated with a pressure of 10 bar for 2 min.

Results

The first 12 patients (20 dilatations) had a pretreatment average tube score of 1.25 (±?1.83 SD), and1 year after treatment, the score improved to 6.2 (±?2.61 SD). Furthermore, the pretreatment and 2-month posttreatment data of 66 additional patients (115 dilatations) were analyzed. In these patients, the tube score improved significantly from 2.21 (±?2.02 SD) to 5.4 (±?2.53 SD).

Conclusion

The initial long-term results suggest that BET is feasible and safe for the treatment of chronic obstructive eustachian tube dysfunction.     

咽鼓管冠脉球囊扩张联合鼓膜置管治疗复发性分泌性中耳炎

目的观察咽鼓管冠脉球囊扩张联合鼓膜置管治疗复发性分泌性中耳炎的疗效。方法将49例（65耳）复发性分泌性中耳炎患者随机分为A、B、C组,A组为试验组,接受咽鼓管球囊扩张联合鼓膜置管治疗,共16例（22耳）,B和C组是对照组,B组单纯接受咽鼓管球囊扩张治疗,共16例（21耳）,C组单纯接受鼓膜置管治疗,共17例（22耳）。所有球囊扩张器械使用冠状动脉球囊。患者术后1、3、6个月定期随访。术后通过咽鼓管功能障碍7项问卷评分（the seven item eustachian tube dysfunction questionair,ETDQ 7）、咽鼓管评分量表（eustachian tube score,ETS）及声导抗进行疗效评价。结果3组患者术后1、3、6个月咽鼓管功能均有提高。鼓膜愈合后复查,A型鼓室图逐渐增多。A组术后3、6个月ETDQ 7评分均较B组和C组低,对照组C组较B组低。术后3、6个月ETS得分A组均高于B、C组,对照组之间C组较B组高。 结论对于复发性分泌性中耳炎的患者咽鼓管球囊扩张联合鼓膜置管能显著改善患者咽鼓管功能,提高分泌性中耳炎的治疗效果。冠状动脉球囊价格较常规咽鼓管球囊便宜,用于治疗分泌性中耳炎取得了同样好的疗效。     

咽鼓管功能障碍的慢性化脓性中耳炎治疗分析

目的探究咽鼓管功能障碍的慢性化脓性中耳炎治疗效果。方法2016年12月~2020年2月,从本院收治的咽鼓管功能障碍的慢性化脓性中耳炎患者中选择50例进行研究,回顾患者病例,以不同的治疗方案作为分组标准,将50例患者分为对照组、实验组,各25例。对照组只开展中耳乳突手术,实验组同期开展中耳乳突手术与咽鼓管球囊扩张术,对比两组听力改善效果、治疗效果、并发症发生率。结果实验组听力改善效果明显高于对照组,P<0.05;术后3个月、6个月实验组患者的EDTQ-7评分、听阈值均低于对照组,P<0.05;实验组并发症发生率低于对照组,P<0.05。结论在咽鼓管功能障碍的慢性化脓性中耳炎患者行中耳乳突手术时,同期开展咽鼓管球囊扩张术,既能改善患者的听力状态,又能提升治疗效果,减少并发症,值得推荐。     

咽鼓管球囊扩张术治疗慢性分泌性中耳炎的短期疗效观察

目的 观察咽鼓管球囊扩张术联合鼓膜切开置管治疗慢性分泌性中耳炎的短期疗效。 方法 对2014年8月至2016年12月诊断为慢性分泌性中耳炎并入院接受咽鼓管球囊扩张术联合鼓膜切开置管术治疗的19例21耳行短期疗效观察分析。评价的指标如下:纯音电测听气导均值(PTA)、气-骨导差(ABG)、声阻抗、耳内镜检查、颞骨CT扫描和主观满意度(VAS视觉模拟评分)。 结果 19例均于全麻下顺利完成手术,术后6个月鼓膜置管未脱落者予以取管。术后随访6~10个月,纯音电测听测试耳气导结果术后较术前有所提高。PTA从术前(59.5±21.5)dBHL降低到术后(52.0±31.0)dBHL(t=3.409, P=0.005), ABG从术前(35.5±17.5)dBHL降低到术后(21±16)dBHL(t=2.957,P=0.011), 76.19%的患者声阻抗鼓室图术后转为A型;3例5耳自觉听力和症状无明显改善,其中2例4耳鼓室积液持续存在,1例1耳取管后3周再次复发,予以持续置管。术后疗效满意度平均为(6.17±1.16)分。 结论 咽鼓管球囊扩张术联合鼓膜切开置管治疗慢性分泌性中耳炎短期疗效好。     

Nasal surgery and eustachian tube function: effects on middle ear ventilation

Objectives: To investigate the effect of nasal obstruction surgery on eustachian tube function and middle ear ventilation. Design: Prospective study. Setting: University Campus Bio‐Medico of Rome. Participants: Forty consecutive patients who underwent nasal surgery were evaluated for middle ear ventilation and tubal function. Main outcome measures: Pre‐ and postoperative Valsalva and Toynbee tubal function tests, tympanometry and ear fullness sensation were evaluated for both ears of each patient. Results: Results of postoperative tubal function tests were significantly better than preoperative ones (90% versus 46%; P < 0.001). No significant difference in tympanometric values was found. The majority (95%) of the patients reported a postoperative improvement of ear fullness sensation compared with preoperative (25%; P < 0.001). Conclusions: Surgery for chronic nasal obstruction significantly improves clinical tubal function but 1‐month postoperative tympanometric findings remain almost the same.     

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.     

The tympano-frontal shunt: A procedure for the treatment of chronic eustachian tube insufficiency.

Eight ears with complications due to chronic eustachian tube insufficiency had insertion of a silicone rubber tympano-frontal shunt tube between the mastoid antrum and the ipsilateral frontal sinus. A one-way valve designed to open at-10 mm H₂O was placed on the tympanic end of the tube to minimize tube obstruction by ear secretions. Follow-up an average of 20 months post insertion showed six of the eight ears to have an aerated middle ear without fluid or tympanic membrane retraction or perforation.     

颞骨CT和咽鼓管功能检查对胆脂瘤型中耳炎咽鼓管鼓室口病变的诊断意义

目的：探讨颞骨高分辨率CT（HRCT）和咽鼓管功能检查对胆脂瘤型中耳炎患者术前咽鼓管鼓室口病变的诊断价值。方法：回顾性分析38例（41耳）胆脂瘤型中耳炎患者术前颞骨HRCT扫描和咽鼓管功能综合测试仪检查结果，并与术中显微镜下探查咽鼓管鼓室口处病变情况进行对比分析。结果：颞骨HRCT发现咽鼓管鼓室口软组织占位影34耳；术中发现鼓室口病变32耳，其中为肉芽组织22耳和胆脂瘤4耳，脓团堵塞3耳，鼓室口周围黏膜肥厚肿胀2耳，黏膜粘连闭锁1耳。咽鼓管功能障碍37耳，其中为阻塞型32耳，闭锁不全型5耳。结论：对胆脂瘤型中耳炎患者术前进行颞骨HRCT扫描和咽鼓管功能检查，对术中有目的地处理咽鼓管鼓室口的病变，制定手术方案和预估治疗效果具有重要意义。     

Ligation of eustachian tube for intractable patulous eustachian tube: a preliminary report

Pharyngeal orifice of the eustachian tube was ligated on ten patients, 15 ears with intractable patulous eustachian tube. While the eustachian tube orifice was observed by an endoscope inserted through the contralateral nostril, the orifice was ligated transnasally and/or transorally using instruments usually used in the endoscopic nasal surgery. Now 13–27 months after the surgery, the outcome was excellent (both symptoms and sonotubometry were normalized) in two ears, good (either symptoms or sonotubometry was improved) in seven ears, and unchanged in the remaining six ears. In one of the ears with an outcome of unchanged, the ligation was found to be spontaneously released soon after surgery, but the symptom was improved after the second operation 2.5 months after the first operation. Temporary otitis media with effusion was seen in one ear, mild inflammation around the ligated site also in one ear, but no other serious complication has been observed. Although further improvement in the surgical procedure and further discussion about its long-term outcome should be required, this procedure appeared to be one of the therapeutic options for intractable patulous eustachian tube.     

Therapie chronisch obstruktiver Funktionsstörungen der Tuba Eustachii

This paper reviews the past and present developments in the treatment of chronic obstructive eustachian tube dysfunction. Alongside tube catheterization and bougie insertion, modern approaches such as laser eustachian tuboplasty and balloon eustachian tuboplasty (BET) are described. In BET, transnasal endoscopic insertion via the pharyngeal ostium places a balloon catheter in the cartilaginous portion of the eustachian tube. This is then dilated to a pressure of 10 bar for 2 min. Up until January 2013, 351 chronic obstructive eustachian tube dysfunction patients had been treated in our department using BET. The average preoperative eustachian tube score was 2.1 (±?1.8 standard deviation, SD); 12 months postoperatively it was 6.1 (±?2.6 SD). Of these patients, 87% expressed satisfaction with the improvement in chronic obstructive dysfunction. These results demonstrate that BET is a safe and effective treatment for improving eustachian tube function and ear ventilation.     

儿童鼻窦炎对咽鼓管与中耳传音功能的影响

目的：探讨儿童鼻窦炎对咽鼓管与中耳传音功能的影响及程度,观察治疗鼻窦炎后,中耳传音功能障碍的恢复情况。方法：对儿童鼻窦炎100例和正常儿童50例行耳科检查、咽鼓管咽口观察、声阻抗检查、纯音测听,对比结果;对鼻窦炎合并耳病变的68例患者（128耳）行有针对性的治疗。结果：鼻窦炎患者中鼓膜异常率为64%、咽鼓管咽口异常率为62%、咽鼓管功能异常率为63.5%、鼓室导抗图异常率为62.5%,听力减退47.5%,与正常儿童组相比,差异有统计学意义（P＜0.01）。急性鼻窦炎、亚急性鼻窦炎与慢性鼻窦炎中耳病变的发生率和程度相比,差异有统计学意义（P＜0.05）。治疗鼻窦炎后,中耳传音功能障碍有明显改善。结论：儿童鼻窦炎引起咽鼓管功能的改变,中耳病变发生率较正常儿童显著增高;随病程的延长,发病率增高且程度加重。     

表面活性物质在分泌性中耳炎咽鼓管开放功能中的作用

目的　探讨外源性的表面活性物质在分泌性中耳炎咽鼓管开放功能中的作用。方法　通过鼓室内注入灭活的肺炎链球菌悬液 ,建立分泌性中耳炎动物模型 ,测试咽鼓管的被动开放压。结果　测试了中耳有渗液者 2 7耳和正常者 2 1耳的咽鼓管被动开放压 ,有渗液耳的被动开放压高于正常耳的被动开放压 ,分别注入外源性的表面活性剂后 ,被动开放压均降低 (P <0 .0 1)。结论　外源性的表面活性剂可以降低咽鼓管的表面张力 ,有利于咽鼓管的开放     

Tubal compliance--changes with age and in tubal malfunction

OBJECTIVE: It is known that eustachian tubal compliance has influence on the tubal function. We applied the direct measurement method to ascertain whether or not aging and tubal diseases are related to the compliance of the cartilaginous part of the eustachian tube. METHODS: We developed a method for directly measuring tubal compliance by inserting a balloon catheter, which is inflated with water, into the eustachian tube and comparing the change in balloon pressure with the balloon volume. This method is advantageous in that one can directly measure tubal compliance in the cartilaginous part of the eustachian tube. Using this method we examined tubal compliance in 16 normal young volunteer ears, 21 normal elderly volunteer ears, 11 elderly ears with patulous tube and 12 elderly ears with stenotic tube including otitis media with effusion. RESULTS: In adults the tubal compliance increases in value with age. Tubal compliance of the elderly patulous tube was significantly higher than that of the normal elderly one, on the other hand the compliance of the elderly stenotic tube was significantly lower than that of the normal one. CONCLUSION: Tubal compliance was considered to be changed with aging and influence of the patulous and stenotic tubes.     

鼓膜置管治疗鼻咽癌放疗后分泌性中耳炎疗效观察

目的:探讨鼓膜置管对鼻咽癌(NPC)放疗后的分泌性中耳炎(SOM)的疗效。方法:对32例(51耳) NPC放疗后经鼓膜切开抽液冲洗治疗无效的SOM患者进行鼓膜置管和随访,对治疗耳的咽鼓管功能、听力及其 他症状的改变进行评估。结果:随访6个月～5年,治愈8耳,治愈率为15.7%,有效41耳,总有效率为96.1%。 7耳(13.7%)咽鼓管功能好转,所有重复置管耳的耳功能均得到不同程度的改善。置管后耳漏发生率为25.5%, 鼓膜穿孔发生率为9.8%。结论:鼓膜置管治疗SOM有利于咽鼓管功能的恢复,对于咽鼓管功能已经严重损害 的患耳,重复鼓膜置管是维持耳功能的可靠手段;鼓膜置管的并发症利大于弊。     

Effect of nasal packing on eustachian tube function

Sixty-three patients undergoing surgery to the nasal septum followed by bilateral packing had pre- and post-operative tympanometry in order to determine the effect on eustachian tube function. Fifty-five of the 126 ears tested (46 per cent) developed a reduction in middle ear pressure of at least 50 daPa; 76 per cent became normal within 24 hours of removing the nasal packs. All ears were asymptomatic and no patient had evidence of middle ear effusion. Nasal packing following septal surgery is a frequent cause of short-lasting eustachian tube dysfunction but rarely severe enough to cause symptoms or middle ear effusion. Tubal dysfunction is most likely due to a combination of surgical oedema and a direct effect of the nasal packing.     

The Silverstein permanent aeration tube in tympanoplasty

Hearing improvement for cases of chronic ear disease has become one of the goals of tympanoplasty. Although great strides continue to be made toward this goal, one enigma which frustrates even the most carefully performed tympanoplasty is the blocked or non-functioning eustachian tube. Early attempts to overcome this problem consisted of passing polyethylene tubing through the eustachian tube and out the nose, Zoller, or drilling out the tubal orifice, Wullstein. Other articles recommended rerouting the eustachian tube through the maxillary sinus or reconstructing its normal course by a middle fossa approach. Herbert Silverstein first introduced the idea of a permanent indwelling silastic aeration tube for treatment of chronic serous otitis media in 1970; he also described its use in ears with ossicular problems and poor eustachian tube function. He places this tube by drilling a hole through the posterior inferior bony annulus of the middle ear or directly into the mastoid antrum. The Silverstein permanent silastic aeration tube has been found to be a valuable adjunct in tympanoplasty. This tube may be utilized at the time of the initial surgery or as a secondary procedure. It may be placed through the bony annulus of the middle ear or into a hole drilled to the mastoid antrum as described by Silverstein; however, in ears where the incus must be removed, the fossa incudis becomes the preferred location. Sixteen cases are reported in which the Silverstein permanent aeration tube was utilized in conjunction with tympanoplasty. The concept for use of this permanent silastic tube arose out of the frustrating experience of producing recurrent perforations in grafted tympanic membranes by the use of conventional aeration tubes; therefore, the following technique was adopted: a diagnostic myringotomy was performed and a polyethylene tube placed temporarily through the grafted tympanic membrane. If the hearing improved following the procedure the patient was scheduled for insertion of a permanent aeration tube. In selected cases the aerating device was used in conjunction with the original tympanoplasty. Postoperative care is simple and consists of cleaning crusts from within and around the tube. Although infections through the tube are infrequent, if they occur the tube may be removed as an office procedure. Overall hearing results have been gratifying. Six months following surgery 81 percent of the patients had closed the air bone gap to within 10 decibels or less and another 12 percent to within 20 decibels of the preoperative bone conduction. There was more loss of hearing in two of the 16 ears following this procedure, but in none was there a significant change in the discrimination score or the development of an unserviceable ear. Truly this is a detour and bypass procedure, and it would be much more physiologic and desirable to restore middle ear aeration through the normal eustachian tube; however, until a reliable, simple and consistent procedure can be devised, the Silverstein permanent aeration tube appears to fulfill the requirements of maintaining middle ear aeration with good hearing and function.     

Eustachian tube endoscopy in patients with chronic ear disease

OBJECTIVES/HYPOTHESIS: A paucity of research exists on trans-eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in chronic ear disease is needed, particularly because the eustachian tube has been implicated in the chronicity and pathogenesis of chronic ear disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans-eustachian tube endoscopy. STUDY DESIGN: Twenty-two adult patients with chronic ear disease gave informed consent to participate in a prospective, trans-eustachian tube endoscopic investigation. METHODS: Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for chronic ear disease. The endoscope was passed from the middle ear (transtympanic approach) to the nasopharynx. RESULTS: The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing disease (> or = 20 y) than for persons without long-standing disease (<20 y). The mean therapeutic efficiency of ossicular reconstruction was higher for the subgroup with normal than for the subgroup with abnormal eustachian tube mucosa. CONCLUSIONS: The findings of trans-eustachian tube endoscopy provide objective evidence concerning eustachian tube status in persons with chronic ear disease and have implications for the timing of surgical intervention (ossicular reconstruction).     

Implications of laser assisted tympanostomy in adults.

OBJECTIVES: To assess outcome in adult individuals undergoing laser-assisted tympanostomy without ventilation tube placement. STUDY DESIGN: Case series with 2-month follow-up. SETTING: Faculty practice, research protocol, tertiary care academic medical center. PATIENTS AND METHOD: Laser-assisted tympanostomy was performed on a total of 142 ears (108 individuals). Indications included serous otitis media with effusion (66 ears/47 patients), functional eustachian tube dysfunction (48 ears/36 patients), acute otitis media (19 ears/16 patients), and endoscopic visualization of the middle ear (9 ears/9 patients). INTERVENTION: The laser-assisted tympanostomy procedure is performed with a CO2 laser under local anesthesia on an outpatient basis. MAIN OUTCOME MEASURES: Patency time of the tympanostomy, presence of fluid after the closure of the tympanostomy, tympanometry and tone audiometry findings, relief of symptoms. RESULTS: Middle ear disease was resolved after the closure of tympanostomy in 47.9% of patients with serous otitis media with effusion. In 79.1% of patients with functional eustachian tube dysfunction, symptoms were diminished. All patients with acute otitis media had a satisfactory outcome. Laser-assisted tympanostomy was found to be quite helpful in patients undergoing middle ear endoscopy. CONCLUSIONS: Laser-assisted tympanostomy without ventilation tubes provides a safe alternative surgical option in adult patients in certain cases. The selection criteria for this procedure are addressed in detail.