耳内镜下鼓室成形术治疗慢性化脓性中耳炎术后听力恢复不良的相关因素分析

目的 分析耳内镜下鼓室成形术对静止期慢性化脓性中耳炎患者听力恢复不良的相关因素。方法 选择2017年2月-2019年11月在四川省八一康复中心治疗的静止期慢性化脓性中耳炎患者131例，所有患者均在全身麻醉下行耳内镜鼓室成形术。根据手术后6个月行纯音测听检测结果，骨气导间距（ABG）的不同将患者分为两组，ABG ≤ 20 dB为听力良好组，ABG>20 dB为听力不良组。采用单因素分析术后听力改善不良的原因及多因素Logistic回归法分析各因素对患者听力的综合作用。结果 术后ABG ≤ 20 dB患者81例，ABG>20 dB患者50例。两组患者因镫骨、鼓膜张肌腱、鼓室黏膜、咽鼓管、人工听骨类型及人工听骨材料的不同，导致术后听力差异具有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，镫骨完整并活动（OR=0.606，95%CI=0.393~0.919）、镫骨完整活动不佳（OR=0.563，95%CI=0.329~0.844）、存在鼓膜张肌腱（OR=1.913，95%CI=1.508~2.449）、咽鼓管通畅（OR=1.818，95%CI=1.417~2.328）及人工听骨材料为钛合金（OR=2.250，95%CI=1.816~2.755）为慢性化脓性中耳炎患者行耳内镜下鼓室成形术后影响听力恢复的独立危险因素。结论 耳内镜下鼓室成形术可一定程度改善静止期慢性化脓性中耳炎患者听力，其听力恢复效果受镫骨状况、鼓膜张肌腱、咽鼓管功能及人工听骨材料的影响。     

咽鼓管吹张加注药治疗分泌性中耳炎的疗效观察

分泌性中耳炎(oitis media with effusion,OME)是以传导性聋和鼓室积液为主要特征的中耳非化脓性变性疾病,是儿童和成人常见听力下降原因之一.本病病因至今尚不明了,可能与咽鼓管功能障碍、中耳局部感染和变态反应等有关.目前,临床治疗原则为积极治疗原发病,应用抗生素、促纤毛运动及黏液溶解药物、咽鼓管吹张、鼓膜穿刺抽液、鼓膜切开置管等.近年来我们采用He-Ne激光照射后给予咽鼓管吹张加注药治疗OME取得了较好疗效,现报告如下.     

中耳治疗仪自动咽鼓管吹张加高渗盐水鼻腔冲洗联合治疗儿童分泌性中耳炎

目的 探讨中耳治疗仪自动咽鼓管吹张加鼻腔冲洗联合治疗病程较长的儿童分泌性中耳炎(OME)的疗效.方法 选择病程6~10周、年龄3~7岁的28例OME患儿,随机分为治疗组(17例34耳)及对照组(11例22耳),对照组予以糠酸莫米松喷鼻、口服沐舒坦糖浆及开瑞坦糖浆治疗4周,治疗组给予上述相同药物治疗的同时,以中耳治疗仪自动咽鼓管吹张并给予高渗盐水鼻腔冲洗治疗,每天两次,连续四周;两组治疗前后均进行声导抗、纯音测听、耳内镜检查,比较两组疗效.结果 治疗组治愈19耳,好转9耳,总有效率82.35%(28/34);对照组治愈5耳,好转7耳,总有效率54.55%(12/22);前者高于后者,差异有统计学意义(P<0.05).结论 中耳治疗仪自动咽鼓管吹张与高渗盐水鼻腔冲洗联合治疗病程较长的儿童OME患者疗效较好.     

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。     

桉柠蒎肠溶软胶囊联合鼓膜置管治疗慢性分泌性中耳炎

目的 比较桉柠蒎肠溶软胶囊联合鼓膜置管与单纯鼓膜置管治疗慢性分泌性中耳炎的疗效。方法 将60例(72耳)慢性分泌性中耳炎患者随机分成实验组30例(38耳)和对照组30例(34耳)。对照组给予患者耳内镜下鼓膜置管,实验组在对照组的基础上联合应用口服桉柠蒎肠溶软胶囊,随访6个月,比较两组的疗效。结果 实验组治愈21例(26耳),好转6例(8耳),无效3例(4耳),总有效率34/38;对照组治愈16例(16耳),好转7例(8耳),无效7例(10耳),总有效率24/34,实验组疗效优于对照组(P=0.043)。结论 桉柠蒎肠溶软胶囊联合鼓膜置管治疗慢性分泌性中耳炎,疗效明显优于单纯鼓膜置管,患者治愈率提高。     

糖皮质激素治疗分泌性中耳炎的临床疗效观察

目的 观察糖皮质激素治疗分泌性中耳炎(OME)的疗效.方法 将病程在3个月以内的分泌性中耳炎(otitis media with effusion,OME)患者68例(75耳)随机分成治疗组与对照组.对照组38耳鼓膜穿刺抽液后,口服桃金娘油胶囊、抗生素,并行咽鼓管吹张、鼓膜按摩治疗,治疗组37耳在对照组治疗的基础上,静脉加用糖皮质激素.两组均治疗6天,2周后复诊,比较两组疗效.结果 治疗组37耳中23耳治愈,11耳好转,3耳无效,总有效率为92%;对照组38耳中14耳治愈,13耳好转,11耳无效,总有效率为71%,两组疗效差异有统计学意义(P＜0.05).结论 应用糖皮质激素治疗分泌性中耳炎能提高临床疗效.     

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。     

鼓膜置管加中药治疗儿童分泌性中耳炎的远期疗效分析

目的观察鼓膜置管联合中药内服疗法对儿童分泌性中耳炎的远期疗效。方法 60例患儿(73耳),随机分为鼓膜置管联合中药组(治疗组)和单纯鼓膜置管组(对照组),每组各30例。治疗组患儿在行鼓膜切开置管术后,依次服用具有渗湿健脾通窍效用的中药1号方和2号方;对照组患儿仅行鼓膜切开置管术。疗程结束后,所有患者均随访2年,比较二组的远期疗效。结果治疗组总有效率94.3%,2年内复发者6耳,仅3耳遗留轻度后遗症。对照组总有效率73.4%,2年内复发者13耳,11耳遗留后遗症。组间比较,差异具有统计学意义(P0.05)。结论鼓膜置管联合中药疗法治疗儿童分泌性中耳炎的远期疗效明显优于单纯鼓膜置管组,复发率显著降低。     

鼓膜置管治疗腭裂合并分泌性中耳炎疗效观察

目的探讨鼓膜置管术对腭裂合并分泌性中耳炎的疗效. 方法对45例(72耳)患有腭裂合并分泌性中耳炎经鼓膜穿刺抽液无效的患者行鼓膜置管术和随访. 结果随访1～4年,治愈36耳;好转24耳;无效和复发 8耳;并发症 4耳.腭裂修补组有效率93.3%;非腭裂修补组有效率 66.7%,总有效率 83.3%. 结论鼓膜置管治疗腭裂合并分泌性中耳炎有利于改善听力,但不能改善咽鼓管阻塞状况,已行腭裂修补术后置管的疗效明显优于非修补组.早期行腭裂修补术后置管对咽鼓管功能恢复,听力改善,提高生活质量至关重要.     

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。     

Efficacy of Curcumin in the healing of paracentesis in rats

Objectives

The present study was designed to investigate the possible beneficial effect of Curcumin (CMN) in healing of paracentesis in terms of wound thickness, sclerosis and closure by histological evaluation. To evaluate the efficacy of CMN, paracentesis was performed experimentally in the rats; and the results were presented histologically.

Methods

Sixteen, each 270–310 g weighted, healthy Sprague-Dawley female rats were included into the study. In both groups, paracentesis was performed into the eardrum bilaterally. In Group 1 (Paracentesis + Saline Group), saline drop was applied; and in Group 2 (Paracentesis + Curcumin group), Curcumin drop treatment was applied. Paracentesis area did not healed bilaterally in two rats (one in Group 1 and one in Group 2). Therefore, these two rats were excluded from the study. Histological examination performed in 14 rats and 28 temporal bones on the 15th day after the completion of drop treatment and closure of the paracentesis-area and wound healing were evaluated according to the histological examination criteria: Thickening of the tympanic membrane (ThicTM); and sclerosis.

Results

Both tympanic membrane thickening and sclerosis values of Paracentesis + Curcumin Group (Group 2) were significantly lower than those of the Paracentesis + Saline Group's (median: 2.0) (p = 0.001). Histological examination by light microscopy showed that in Paracentesis + Curcumin Group (Group 2), the structure of the tympanic membrane is near to the normal and decreased sclerosis was observed in connective tissue. Whereas in Paracentesis + Saline Group (Group 1), tympanic membrane thickening and connective tissue sclerosis were observed.

Conclusions

Curcumin improves wound healing process in paracentesis of TM. By using Curcumin drops, the closured paracentesis area was observed near to the normal eardrum; and thickness of the TM and sclerosis were less than the control, showing the improved healing at 15th day. The possible mechanisms may be anti-inflammatory effect, improving collagen deposition, and increasing fibroblast and vascular density in wounds thereby enhancing impaired wound healing.     

电子鼻咽喉镜在小儿腺样体肥大诊治中的应用

目的 探讨电子鼻咽喉镜在小儿腺样体肥大诊治中的应用。方法 对578例具有上气道阻塞症状的患儿（病例组）采用电子鼻咽喉镜检查，分析腺样体增大程度与上气道阻塞的关系及其可行性。结果 ①本组病例中，411例能主动配合，119例稍有哭闹，仅48例是在协助固定体位下进行。②14例因鼻中隔偏曲导致一侧后鼻孔和鼻咽部无法检查，5例因双侧鼻腔狭窄无法检查，其余559例均可检查。③559例均有不同程度的腺样体增大。④29例在检查中出现鼻黏膜少量出血，未引发其他并发症。结论 电子鼻咽喉镜检查适合于小儿，该法直观、准确、安全，是判断小儿腺样体肥大最有效、最直观的检查方法。Ⅳ°腺样体是小儿上气道阻塞的主要病因，是手术治疗的适应证。     

我国汉族女性鼻整形手术的研究进展

随着鼻整形手术技术的发展,对填充材料的使用有了更多、更深刻的理解。近年来,我国整形外科的专家们,针对汉族女性鼻部的美学特征,以及不同填充材料的应用特点,设计了一系列更精确的手术方式,使鼻整形手术更趋完善。结合汉族女性的鼻部特点,对鼻背部整形、鼻尖部整形、鼻整形术后并发症及鼻整形材料的使用情况进行总结分析。     

食管异物摘取术的麻醉选择

为探讨食管异物摘取术的麻醉方法，提高手术效果，对７２例食管异物患者采用强化表面麻醉法和气管内插管麻醉法进行了手术和对比观察。７２例异物均取出顺利，无严重并发症发生。资料显示：两种麻醉各具优越性，前者适用于年龄较大的儿童和成人，后者适用于食管异物并呼吸困难的小儿。     

Apoptosis in the pathogenesis of cholesteatoma in adults

The aim of this study was to determine the distribution and apoptotic capacity in the various layers of cholesteatoma epithelium compared to the normal skin. Cholesteatomas were collected during surgical procedures of the ear. Normal skin specimens taken from the retroauricular area served as controls. Apoptosis was detected by using highly specific antibodies against APO2.7 antigen. The Membstain Apoptosis kit Direct based on in situ labeling of nuclear DNA fragmentation (Tolt-mediated dUTP nick and labeling TUNEL staining) was used. The distribution of apoptotic cells in the layer of the cholesteatoma epithelium and the epidermis was determined. The percentage of apoptotic cells was then counted per 100 cells of cholesteatoma epithelium and the normal epidermis in three different areas of each section and expressed in terms of mean ± SD. An automatic analyzing system was used for counting. In normal epidermis, the apoptotic cells were observed in the granular layer of the epidermis. The percentage of these cells was 28.5±8.1%. A significantly greater number of apoptotic cells was observed in the suprabasal layers of the cholesteatoma epithelium (47.39±6.2%). A statistically significant difference was obtained for APO2.7-positive cells in the cholesteatoma epithelium as compared to the skin (P<0.05) as determined by Students t-test and the Mann-Whitney U test. Apoptotic activity is mainly observed in the suprabasal layer of cholesteatoma epithelium. It is not seen in the basal layer. Apoptosis plays an important role in the pathogenesis of cholesteatoma. It seems to be part of the differentiation and accumulation of keratin debris within the middle ear and expansion of cholesteatoma.     

Use of tympanometry in general practice in Denmark

Objectives

Otitis media has been a serious disease and can be that even today. The diagnosis of otitis media is often difficult. Pneumatic otoscopy, otomicroscopy, and tympanometry can improve the diagnostic quality by indication of fluid in the middle ear and thereby improve the quality of treatment. The aim of this ongoing study is to analyze the use of tympanometry in Denmark after reimbursement for doing tympanometry (November 2006) when clinically indicated. Our research questions were: How many clinics were using tympanometry? How frequent was it used? Is the use increasing? Has the number of GPs in the clinic any relation to the use of tympanometry?

Method

We used information in The Danish National Health Service in three Regions to analyze the use of tympanometry in general practice during the years 2007–2009. The coverage of the GPs is 100% in the regions.

Results

The three regions counted about half of Danish population. In 2009 the material was 902 different clinics with more than 1700 GPs. In 2007 55% of the clinics did tympanometry, in 2009 the figure was 60%. In the clinics doing tympanometry the median value was 28 tympanometries per year (inter-quartile range 13–53) per GP. The variation in the use of tympanometry was surprisingly high, from none or a few per GP per year to a maximum of more than 500 tympanometric examinations per GP a year. This huge variation has to be discussed.

Discussion

Many answers can be given. Some of the explanation was problems in doing correct tympanometry, and problems understand the clinical implications of curves and the figures.     

立体放射治疗技术在听神经瘤治疗中的应用进展

听神经瘤(Vestibular Schwannomas,VS)是最常见的桥小脑角肿瘤,目前发病率正逐年提升。立体放射治疗(Stereotactic Radiosurgery,SRS)技术作为手术的替代疗法近年来在VS的治疗中体现出了巨大的潜力和优势。本文将针对近年来SRS技术在VS治疗效果、适应证选择和治疗策略制定方面的进展加以综述。