经耳内窥镜鼓室置管治疗鼻咽癌放疗后渗出性中耳炎疗效观察

目的:评价经耳内窥镜鼓室置管治疗鼻咽癌放疗后渗出性中耳炎的疗效.方法:对我院24例(36耳)鼻咽癌放疗后渗出性中耳炎行经耳内窥镜鼓膜置管术,并观察听力、中耳功能的变化.结果:治愈12耳,占33.33%.有效14耳,占38.89%.总有效率72.22%.无效6 耳,占13.89 %.出现并发症 4 耳,占11.11%,患耳长期流脓.结论:经耳内窥镜鼓膜置管术是一种有效的治疗鼻咽癌放疗后渗出性中耳炎的方法.     

鼻咽癌放疗后分泌性中耳炎的临床观察和防治探讨

目的：探讨鼻咽癌患者放疗后分泌性中耳炎发生的原因和防治对策。方法：观察176例鼻咽癌患者放疗前后分泌性中耳炎的发生情况,对中耳积液耳聋者行鼓室穿刺抽液处理。采用χ^2检验比较患者年龄、性别、鼻咽原发病灶大小、部位以及放疗前后有否分泌性中耳炎等因素与放疗后产生分泌性中耳炎的关系。结果：鼻咽癌患者放疗后分泌性中耳炎的发生率为48.9%,而放疗后6个月内的发生率为51.2%。患者年龄（P=0.367）、性别（P=0.126）及鼻咽原发灶大小（P=0.147）等因素对放疗后分泌性中耳炎的发生无显著影响,而放疗前有分泌性中耳炎和鼻咽肿瘤侵及侧壁与放疗后分泌性中耳炎的长期存在显著相关,P值均为0.000。结论：放疗前有分泌性中耳炎、鼻咽肿瘤侵犯侧壁是鼻咽癌放疗后分泌性中耳炎长期存在的危险因素。对放疗后分泌性中耳炎患者的耳聋实行多次鼓室穿刺抽液和适当选择助听器是目前可行的处理方法。     

鼻咽癌放射治疗后分泌性中耳炎的临床观察

目的 探讨鼻咽癌患者放射治疗后分泌性中耳炎的发生，寻找有效的防治措施。方法 观察104例（208只耳）鼻咽癌患者放疗前后分泌性中耳炎的发生。结果 鼻咽癌患者放疗后分泌性中耳炎的发生率为44.1%(64/145只耳），放冶后6个月，分泌性中耳炎的发生率达高峰，为50.1%(33/64只耳）。放疗所致分泌性中耳炎与电离辐射对中耳的直接损伤和放疗前中耳负压升高有密切关系。结论 改进放射治疗设野技术，使用有效药物，采取鼓膜置管和鼓膜切开等方法对防治分泌性中耳炎的发生有一定用处，但其耳瘘发生率很高。     

咽鼓管球囊扩张术治疗鼻咽癌放疗后咽鼓管功能障碍的效果观察

目的 探讨咽鼓管球囊扩张术(BDET)治疗鼻咽癌放疗后咽鼓管功能障碍(ETD)的临床效果。方法 选取2017年1月至2019年6月间黄梅县人民医院收治的62例手术治疗的鼻咽癌放疗后ETD患者,按照随机数字表法分为观察组和对照组,每组31例。对照组患者采用鼓膜置管术治疗,观察组患者采用BDET治疗,比较两组患者的临床效果、视觉模拟评分及咽鼓管功能障碍评分。结果 术后12个月,两组患者气导听阈、平均气骨导差和鼓室压图比较,差异均有统计学意义(均P<0.05)。观察组患者手术治疗总有效率为83.9%,高于对照组的51.6%,差异有统计学意义(P<0.05)。术后12个月时,两组患者耳闷、听觉模糊、耳痛及耳鸣评分均降低,且观察组均低于对照组,差异均有统计学意义(均P<0.05)。术后12个月时,两组患者咽鼓管功能障碍评分均降低,且观察组低于对照组,差异均有统计学意义(均P<0.05)。结论 BDET治疗鼻咽癌放疗后ETD,可有效改善患者的气导听阈、平均气骨导差、鼓室压图及咽鼓管测压,提高术后VAS和咽鼓管功能障碍评分,治疗总有效率优于鼓膜置管术。     

鼓膜部分切除术治疗鼻咽癌放疗后分泌性中耳炎的临床价值

背景与目的:对于放疗后咽鼓管功能已经严重受损的分泌性中耳炎,目前的治疗方法疗效有限。鼓膜穿孔可以避免分泌性中耳炎的复发,本研究旨在探讨鼓膜部分切除术治疗鼻咽癌放疗后分泌性中耳炎的临床价值。方法:经过综合的耳功能检测,确认鼻咽癌放疗后分泌性中耳炎患耳的咽鼓管功能已经严重受损后,对16例(18耳)符合条件的患者施行鼓膜部分切除术,对术后患者的听力及其它症状进行超过6个月的随访观察。结果:鼓膜部分切除术后61%(11/18)残留鼓膜穿孔,患者听力普遍提高,平均气骨导差由术前的30.1dB减至16.0dB,耳闷、耳鸣和头痛等症状基本消失。鼓膜部分切除术后鼓膜再愈合7耳(39%),术前和术后平均气骨导差分别是33.0dB和32.1dB。结论:鼓膜部分切除术治疗分泌性中耳炎疗效确切而持久,对鼓膜再愈合耳的听功能无损害。     

鼻咽癌患者放疗后耳聋的危险因素和临床处理

目的:了解鼻咽癌患者放疗后耳聋的影响因素探索耳聋的处理方法.方法:观察220例鼻咽癌患者放疗后耳聋的发生情况,对耳聋者鼓室行穿刺抽液.分析患者性别、年龄、鼻咽肿瘤T分期、侧壁侵犯、放疗前分泌性中耳炎等因素与放疗后出现耳聋的关系.结果:鼻咽癌患者放疗后耳聋的发生率为46.82%,放疗后6个月内发生率为52.42%.患者性别、年龄、鼻咽肿瘤T分期等因素对放疗后耳聋的发生无显著性影响(P>0.05),肿瘤侵犯鼻咽侧壁和放疗前有分泌性中耳炎与放疗后耳聋的发生显著相关(P<0.01).结论:肿瘤侵犯鼻咽侧壁和放疗前有分泌性中耳炎是放疗后耳聋的危险因素.鼻咽癌患者放疗后耳聋的处理目前比较好的是重复鼓室穿刺抽液配合适时倒佩戴助听器.     

头颈部恶性肿瘤放疗后分泌性中耳炎鼓膜置管疗效观察

观察头颈部恶性肿瘤放疗后分泌性中耳炎(secretoryotitismedia,SOM)鼓膜置管的疗效。采用陶瓷通气管对30例(49耳)头颈部恶性肿瘤放疗后经治疗无效的SOM患者进行鼓膜置管和随访,对治疗耳的听力,伴随症状的改变和咽鼓管功能进行对比。随访3个月~6年,治愈7耳,治愈率为14%,有效40耳,总有效率为96%,6耳(12%)咽鼓管功能好转,所有重复置管的耳功能均得到不同程度的改善。置管后耳漏发生率为29%,鼓膜穿孔发生率为12%。鼓膜置管对该类患者咽鼓管功能恢复和耳功能改善均有帮助。     

头颈部肿瘤放射治疗后分泌性中耳炎的研究进展

头颈部肿瘤尤其是鼻咽癌放疗后分泌性中耳炎发病率高达16%-26%。放射治疗引起局部组织水肿、血管扩张、粘膜损害，引起中耳包括咽鼓管相关肌肉组织的纤维化，从而导致咽鼓管通气功能障碍。在放疗后6个月，咽鼓管功能损害达高峰。放射治疗后肿瘤消失，但炎症及放射后水肿仍可导致咽鼓管功能障碍及分泌性中耳炎。放疗后5年随访发现，放射剂量在80Gy以下者，咽鼓管功能均有改善，放疗后咽鼓管功能正常及开放状态者比较，放射剂量差别无统计学意义。放疗后2年随访，鼓膜切开或置管术后耳漏发生率很高；5年和10年随访分泌性中耳炎有自愈倾向，并渐成咽鼓管开放状态。     

射频技术配合治疗巨块型子宫颈癌的临床研究

目的 探讨射频治疗技术在巨块型子宫颈癌治疗中的价值.方法 160例巨块型(肿瘤直径≥4 cm)子宫颈癌患者随机分为两组,每组各80例,射频治疗配合手术或(和)放疗(试验组)的患者,在放疗前1 d(或手术前后装治疗的前1 d),在超声监控下,用射频技术将子宫颈癌块快速除去,次日行放疗.单纯手术或(和)放疗(对照组)患者,按传统方法行手术或(和)放疗.结果 两组3年生存率:试验组97.5%,对照组95%,差异无统计学意义(χ2=0.35、P>0.05).放射性直肠炎的发生率:实验组7.5%(6/80),对照组22.5%(18/80),两组比较差异有统计学意义(χ2=12.15,P<0.01).放射性膀胱炎的发生率:实验组5%(4/80),对照组20%(16/80),两组差异有统计学意义(χ2=12.52,P<0.01).一次止血成功率:试验组96%(29/30),对照组66%(22/33),两组差异有统计学意义(χ2=9.17,P<0.01).止血时间:试验组(30.5±6.4)min,对照组(210±45)min,两组差异有统计学意义(t=35.32,P<0.01).住院时间:试验组平均(7.5±1.5)周,对照组平均(9.5±2.1)周,两组差异有统计学意义(t=6.93,P<0.01);住院费用:试验组每例平均(8500±170)元,对照每例平均(10 000±202)元,两组差异有统计学意义(t=50.82,P<0.01).结论 射频技术配合手术或(和)放疗治疗巨块型子宫颈癌,能降低放疗并发症;止血效果好,速度快;缩短住院时间;节省医疗费用.     

同步调强放化疗联合生脉注射液治疗鼻咽癌的疗效观察

目的 研究同步调强放化疗联合生脉注射液治疗鼻咽癌的近期疗效、不良反应和生活质量.方法 51例初治鼻咽癌患者随机分为治疗组和对照组,治疗组患者给予同步调强放化疗联合生脉注射液治疗,对照组患者给予同步调强放化疗治疗.观察患者的近期疗效和不良反应,应用SF-36量表评估患者生活质量.结果 放疗至50 Gy时和放疗结束时,治疗组鼻咽部肿瘤CR率(%)与对照组比较差异无统计学意义(P>0.05).两组恶心/呕吐、口干、黏膜炎、皮肤炎不良反应发生率无显著性差异(P>0.05).治疗组血红蛋白减少、白细胞减少、血小板下降Ⅰ/Ⅱ级发生率显著低于对照组(χ2=4.777,P=0.029;χ2=5.436,P=0.020;χ2=5.436,P=0.020).两组SF-36量表各项评分差异有统计学意义(P<0.05).结论 同步调强放化疗联合生脉注射液能够提高鼻咽癌患者近期疗效,减少不良反应,提高患者生活质量.     

Cavernous haemangioma of the tympanic annulus

A rare case of Cavernous haemangioma of tympanic annulus in 60 years old female is reported.     

Metastatic hepatocellular carcinoma in the tympanic membrane

Primary tympanic membrane cancer is very rare; metastatic cancer to the tympanic membrane is extremely rare and presents diagnostic challenges. We report a case of metastatic hepatocellular carcinoma in the tympanic membrane. The presenting symptom was hearing loss. Physical examination revealed a friable granulomatous mass over the left anterior tympanic membrane extended from the external auditory canal. Computed tomography scan of the temporal bone revealed one soft tissue mass involving the left external auditory canal and tympanic membrane. A left middle ear mass biopsy was performed. The tumor cells were uniformly positive for cytokeratin and hepatocyte paraffin-1, confirming a diagnosis of metastatic tympanic membrane. A tympanic membrane mass might easily be misdiagnosed and improperly treated. This case serves as a reminder that the differential diagnosis of acute hearing loss in cancer patients should include the metastasis occurring in the auditory canal or tympanic membrane, and that tissue biopsies are necessary to establish the definitive diagnosis for such lesions.     

Homologus dural graft as neo tympanic membrane

50 cases of chronic suppurative otitis media wth dry ear were taken up for myringoplasty operation by underlay technique through permeatal route in most of the cases. The dura mater was taken at autopsy from dead bodies within 6–8 hours of death, which was then stored in 70% Alcohol. The graft was washed with normal saline half an hour before the use. Homologus duramater graft was fully taken up in 68 percent cases and partially taken up in 12% cases, failure rate of the graft was 20% in a follow up of 6–12 months.     

Silent perforation of tympanic membrane and otomycosis

Otomycosis causing the silent perforation of tympanic membrane in denovo has been studied extensively for the last three years. The study also enlightens the peculiar reaction of tympanomeatal epithelium for fungal invasion without any hyperkeratotic reaction. It has been found in fairly good number of cases (90%) only local causes (trauma) have perpetuated the infection in otherwise healthy individuals.     

Solitary ivory osteoma of the tympanic ring

Multiple ivory osteomas of the external auditory canal are known. But a solitary one arising from the tympanic ring has not yet been reported. In cases of exostosis or multiple osteomas the middle ear is usually normal. In this case the osteoma was associated with an attic cholesteatoma.     

Successful treatment of parotid fistula with tympanic neurectomy

Background

Parotid fistula is a cause of great distress and embarrassment to the patient. A host of treatment modalities have been described in past but no unanimity exists regarding the most satisfactory of all. Tympanic neurectomy is an effective procedure for persistent parotid fistula with no significant side effects.

Objective

To describe our experience with tympanic neurectomy for the treatment of persistent parotid fistula and discuss the other treatment modalities described.

Setting

Tertiary care referral centre.

Methods

Two cases with post traumatic parotid fistula recalcitrant to conservative therapy were treated with tympanic neurectomy between 2004–2005. The cases were followed up regularly for any recurrence of fistula.

Results

Successful and immediate cessation of flow from parotid fistula with no recurrence in subsequent followup.

Conclusion

Tympanic neurectomy is a safe and effective procedure for the successful treatment of persistent parotid fistula.     

Closure of tympanic membrane perforations by chemical cautery

Fifty cases of dry, central, tympanic membrane perforation were studied for closure by application of saturated solution of trichloracetic acid. Aetiologically 17 cases belonged to traumatic and 33 to the inflammatory group. Eustachian tube patency and good air-bone gap on audiometry were the pre-requisites. Study concluded with 78% success with average of 2.8 applications. The patients had definite improvement in the hearing acuity and relief from other symptoms. The study highlights the achievements by using this old method.     

Haemangioma of the tympanic membrane and external auditory canal

An unusual case of haemangioma of external auditory canal in a 16 yrs. old male is documented for its rarity.