咽鼓管异常开放症28例报告

咽鼓管异常开放症容易漏诊和误诊。１９８６年６月～１９９７年１２月共诊治２８例,报告如下。１临床资料２８例中,男１８例,女１０例;年龄１４～６４（平均４０）岁。双耳２０例,单耳８例,其中左耳５例,右耳３例。病程２个月～３２年。全部病例有低调吹风样耳鸣,...     

鼻内窥镜下微波热凝咽鼓管口治疗咽鼓管异常开放症

咽鼓管异常开放症临床上并不罕见。传统的治疗方法因咽鼓管解剖位置深在,其效果不甚理想。1995年以来我科运用鼻内窥镜下微波热凝咽鼓管咽口治疗咽鼓管异常开放症38例(51耳),效果满意,现报告如下。     

咽鼓管异常开放症研究进展

咽鼓管静息状态时正常是关闭的,通常在吞咽、打呵欠或活动下颌时开放.如在静息状态时仍保持开放,鼻咽和中耳之间发生空气和声音自由通过;或者虽然管腔闭合,但关闭力不足,不能抵抗生理的鼻咽正压或负压的影响,称为咽鼓管异常开放(patuloils eustaclalan tube,PET),或咽鼓管关闭功能障碍,迄今尚无满意的治疗方法.问题的解决有赖于对咽鼓管的解剖、生理及病理生理深入的了解.     

手术治疗咽鼓管异常开放症八例

手术治疗咽鼓管异常开放症八例陈著声，陈钊，吴健，陈郁敏我科于１９８４年６月～１９９４年１１月对咽鼓管异常开放症８例（１２侧）行腭帆张肌松解术及（或）咽鼓管鼓口半堵管术。术后经０．５～９年观察，效果良好。现报告如下。１临床资料本组８例（１２侧）中，男７...     

咽鼓管鼓口黏膜下半堵塞术治疗咽鼓管异常开放症

咽鼓管异常开放症曾被认为是一种罕见疾病,国内外报道较少,但近年来随着对本病认识的提高,其发病率正逐渐上升。我们自2000年以来在咽鼓管鼓口半堵塞术的基础上,尝试采用改良的鼓口黏膜下半堵塞术治疗该病,效果良好,现报道如下。     

自体血咽鼓管咽口黏膜下注射治疗咽鼓管异常开放症

目的　探讨自体血咽鼓管咽口黏膜下注射治疗咽鼓管异常开放症的治疗效果。方法　收集2002年1月～2013年12月我科门诊经保守治疗无效的咽鼓管异常开放 症患者14例,共20耳,采用患耳咽鼓管咽口黏膜下自体静脉血注射进行治疗,记录治疗前后患耳鼓膜及咽鼓管咽口情况,并进行咽鼓管-鼓室气流动态（tubo-tympanic airflow dynamics,TTAG）法测定判定疗效。结果　诊断为咽鼓管异常开放症患者,均见病变侧咽鼓管咽口闭合不全,呈裂隙状,坐位观察明显,TTAG法显示患耳外耳道压力随鼻咽腔压力变化而波动;病变侧咽鼓管咽口外侧壁注射自体血1～4次后,13耳症状完全消失,同侧咽鼓管咽口平静状态下能够闭合;7耳症状减轻,咽鼓管咽口未能完全闭合。所有治疗耳均无分泌性中耳炎等并发症发生。结论　自体血咽鼓管咽口注射是一种安全、有效的治疗方法,由于简便易 行,值得在治疗咽鼓管异常开放症中推荐使用。     

咽鼓管异常开放症非声刺激的声顺曲线变化

文中对9例（11耳）咽鼓管异常开放症患者在平静呼吸状态下作“临床声反射”检查时，记录到非声刺激的波状曲线，波幅在0.05-0.60mmho之间，其波动频率与呼吸次数一致，屏气时波动消失，深呼吸时波幅增大，此种表现在正常人及患者健耳均不能见到；经治疗后该波动可减弱或消失，提示该曲线为咽鼓管异常开放症的特征性表现，与其它检查比较更为敏感。     

耳内镜下手术治疗咽鼓管异常开放症

目的探讨耳内镜下以骨蜡为材料行咽鼓管鼓口粘膜下半堵塞术治疗咽鼓管异常开放症的疗效、复发率及其优点。方法回顾性分析我科2002年1月～2011年6月收治的45例(56侧)经保守治疗无效后采用耳内镜下手术治疗的咽鼓管异常开放症患者资料。所有患者均在局部麻醉后,在耳内镜下分离外耳道皮瓣至鼓环,将鼓环连同鼓室粘膜一起分离开,暴露咽鼓管的鼓室口。取骨蜡少许,适形后置入分离开的鼓口粘膜下,至患者耳鸣消失。治愈标准:患者自觉症状消失,耳内镜检查鼓膜随呼吸扇动消失,鼓室压力曲线恢复正常;好转标准:患者自觉症状大部分消失或减轻,耳内镜检查呼吸时鼓膜偶有扇动,鼓室压力曲线基本正常;无效:自觉症状无改善,呼吸时鼓膜扇动仍明显,鼓室压力曲线异常。术后门诊随访半年～9年。结果治愈40例48侧,治愈率85.7%;好转5例8侧(2例单侧,3例双侧),好转率14.3%;无效率0%。同时,未观察到任何不良反应。结论耳内镜下以骨蜡为材料行咽鼓管鼓口粘膜下半堵塞术治疗咽鼓管异常开放症疗效好且微创,值得临床推广。     

升清阳补肝肾治疗咽鼓管异常开放症

咽鼓管异常开放症，笔者遇10例，报道如下。一、一般资料男6例，女4例；最大年龄52岁，最小32岁；平均年龄41岁。耳鼻喉科检查，10例均可见耳鼓膜随呼吸节律而内外扇动，吸气时向内，呼气时向外，耳道听诊能清晰听到患者呼吸声和说话声或空气进人鼓室冲击声，压迫颈部或端坐低头能使症状暂时缓解。鼻咽镜检查，全部病例均可见咽鼓管隆突变薄或咽口扩大，呈三角形或卵圆形，其中咽隐窝有瘢痕粘连者2人，鼻咽部粘膜干燥暗红者3人，鼻粘膜肿胀者2入。明显消瘦者4人。全部病例均有不同程度头晕、失眠、多梦症状。最长病程为1年，最短病程为2个月…     

Objective assessment of autophony in patients with patulous Eustachian tube

The objective of the present study is to evaluate the Eustachian tube (ET) acoustic patency during phonation. The sound level in the EAC during phonation of the “A” and ”N” sounds was measured by microphones in the bilateral EACs of nine normal subjects and 31 patients with patulous ET. The measured sound pressure differences between the right and left ears were correlated with the differences in severity of autophony between the bilateral ears assessed by a visual analogue scale (VAS). The patulous condition was often remarkable when the “N” sound was phonated. In some patients with patulous ET, the patulous condition was indicated only by the present method, and not by conventional ET function tests such as tubo-tympano-aerodynamic-graphy or sonotubometry.     

The efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube patient

Objective: To assess the efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube (PET) patients.

Methods: A prospective survey of medical records identified 36 patients and 47 ears with PET, and 15 patients and 15 ears as control. The ETDQ-7, patulous Eustachian tube handicap inventory-10 (PHI-10) and Likert scale were evaluated. PET patients were divided into two groups based on severity of symptoms using the PHI score.

Results: The Cronbach α value of the PET group was 0.765. The average total score of the ETDQ-7 in the control group was 7.6?±?1.1 and 22.5?±?10.0 in the PET group (p?r?=?0.248, p?=?.09). The average total score of the ETDQ-7 in the mild or moderate PET group was 19.9?±?9.0 and 25.3?±?11.1 in the severe PET group and this was not statistically different (p?=?.08).

Conclusion: The highest ETDQ-7 score was also observed in PET patients and in ET dysfunction patients. These findings necessitate careful discrimination between ET dysfunction and PET in balloon dilation Eustachian tuboplasty (BET) based on ETDQ-7.     

Trans-tympanic silicone plug insertion for chronic patulous Eustachian tube

Conclusion. Trans-tympanic insertion of a new silicone plug seems to be useful for controlling the distressing symptoms of patients with a chronic patulous Eustachian tube (PET). Objective. To evaluate the effectiveness of a new silicone plug for blocking the isthmus of a PET in patients whose symptoms were resistant to other therapies for?>?6 months. Material and methods. The silicone plug (total length 23–25 mm; tip diameter 1.0–2.0 mm) was inserted in 44 ears of 37 patients with chronic PET. It was inserted through the tympanic orifice of the ET to obstruct the isthmus of the tube via an incision in the anterosuperior portion of the tympanic membrane. Results. Insertion of the plug was possible in all except two ears, in which it failed because of a narrow tympanic orifice of the ET. In 11 ears of 10 patients, the plug was replaced by a larger one using the same approach to improve efficacy. Of the 42 ears in which the silicone plug was successfully inserted, 30 (71.4%) achieved relief from symptoms of PET without additional treatment. In?>?60% of these cases, the symptoms of PET were well controlled with an aerated middle ear. The follow-up period ranged from 6 to 68 months (mean 38.9 months).     

Plug size selection protocol for the treatment of intractable patulous Eustachian tube with Kobayashi Plug

Abstract

Background: There have been no useful criteria for initial plug size selection protocol for the treatment of intractable patulous Eustachian tube (PET).

Aims/objectives: To establish a method for appropriate plug size selection using tubal function test and subjective symptom severity in PET patients who were treated by Kobayashi Plug insertion.

Material and methods: A retrospective survey of medical records identified 39 ears of 35 patients with PET who received insertion of the Kobayashi Plug and whose PET symptoms were thereafter controlled for at least 6 months after surgery.

Method: The evaluation scale of PET handicap inventory-10 (PHI-10) was used to indicate PET subjective symptom severity. Tubal function tests (sonotubometry and tubo-tympano-aerodynamic-graphy: TTAG) were performed.

Results: There was no correlation between the preoperative PHI 10 score and plug size (p?=?.157). There was a significant correlation between the preoperative sound attenuation from nostril to EAC measured by sonotubometry and plug size (p?<?.001). There was no correlation between the preoperative pressure transmission ratio estimated by TTAG and plug size (p?=?.271).

Conclusions and Significance: Sonotubometry which evaluates sound attenuation from nostril to EAC can be a useful tool for selecting plug size.     

咽鼓管功能障碍及咽鼓管球囊扩张

在正常情况下咽鼓管为连接鼓室和咽部的唯一通道,由骨部与软骨部两部分组成。一旦咽鼓管出现功能障碍,无法正常开放,会引起中耳负压。主要表现为耳闷胀感,并伴有不同程度的传导性聋或耳鸣。治疗包括非手术治疗和手术治疗,最常用的手术治疗为鼓膜穿刺及鼓膜置管。咽鼓管球囊扩张是一种新兴的治疗方法,具有简便、安全、微创、有效等优点。     

Effectiveness of Kobayashi plug for 252 ears with chronic patulous Eustachian tube

Conclusions: Trans-tympanic plugging of the Eustachian tube (ET) with the silicone plug (Kobayashi Plug) induced long-term effectiveness for over 80% of chronic and severe patulous ET (PET) patients. The New Kobayashi Plug was more effective with fewer complication of plug descent to the pharyngeal orifice.

Objective: To investigate the effectiveness and complications of trans-tympanic plugging of the ET using a Kobayashi Plug for chronic PET.

Method: Trans-tympanic plugging of the ET using the Kobayashi Plug was performed for 252 ears of 191 patients. The Prototype Plug (115 ears of 82 patients in 2001–2007) and the New Plug (137 ears of 109 patients in 2008–2013) were inserted for chronic PET patients.

Results: The success rate of the Kobayashi Plug for PET was 83.0% of a total (Prototype Plug 80.0%, New Plug 85.4%). In 26 ears, the Prototype Plugs were found to have descended toward the nasopharynx. Conversely, this did not happen with the New Plug. The rate of TM perforation (Prototype 22.6%, New 17.5%), middle ear effusion (Prototype 20.2%, New 10.2%) and ventilation tube placement (Prototype 14.8%, New 4.4%) decreased after transition to the New Plug.     

Prevalence and incidence of clinically significant patulous Eustachian tube: A population-based study using the Korean National Health Insurance Claims Database

Objectives

The aim of this study is to estimate the entire population-based prevalence and incidence of Patulous Eustachian tube (PET) using the Korean National Health Insurance (NHI) claims database. The annual trends of prevalence and incidence of PET were also investigated.