咽鼓管-鼓室气流动态图法检测健康人咽鼓管功能的应用探讨

目的：探讨咽鼓管一鼓室气流动态图法（TTAG法）对健康人群咽鼓管功能进行不同亚群分类的临床实用性。方法：对66例（132耳）健康人使用TTAG法采用Valsalva动作检测咽鼓管被动通气功能，并对结果和图形进行分析。结果：TTAG法检测阳性率为93．3％（124／132）。根据曲线特点和吞咽次数将阳性耳分为Ⅰ型77耳，Ⅱ型47耳，两型ET开放时鼻咽腔压力均值比较差异无统计学意义（P〉0．05），外耳道压力均值差异有统计学意义（P〈0．01）。结论：TTAG法对判定健康人群中咽鼓管功能不同亚群状态有一定临床应用价值。     

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.     

咽鼓管异常开放症

咽鼓管是连接鼻咽部和中耳鼓室腔的管道结构,当由于各种原因导致咽鼓管失去静息时关闭功能而处于持续开放状态时,称为咽鼓管异常开放症(PET)。PET是一种常见的耳鼻咽喉科疾病,其典型症状为自听增强、闻及自身呼吸音、主观性耳鸣及耳闷胀感等。PET患者症状由于与咽鼓管开放不良的功能障碍症状相似,常容易被漏诊或误诊,本文围绕PET的诊断和治疗方面,对最新的研究进展进行了综述。诊断上,症状、体征和实验室检查是诊断PET的核心,然而尚没有单一的咽鼓管功能检查可以在没有其他临床观察和检查的情况下准确评估咽鼓管功能。治疗上,常见的治疗方法包括保守治疗及手术治疗,针对PET患者,可进行“阶梯式”治疗策略：即先增重、冲洗鼻腔、滴酸等保守治疗,若保守治疗效果不佳,症状严重且患者有强烈治疗需求者,可采用如鼓膜手术、堵塞咽鼓管、缩窄咽鼓管口创伤性的手术治疗。     

分泌性中耳炎C型鼓室导抗图咽鼓管功能的检测

目的：探讨分泌性中耳炎（ＳＯＭ）、鼓室导抗图为Ｃ型患者的咽鼓管功能。方法：检测捏鼻吞咽法和捏鼻鼓气法后的鼓室导抗图,峰压点的移动进行量化处理,评价３０例ＳＯＭ（４２耳）的咽鼓管功能,并与正常对照组相比较。结果：咽鼓管功能障碍者５２．３８％,与正常对照组相比有显著性差异（Ｐ〈０．０５）。结论：咽鼓管功能障碍是ＳＯＭ的病因之一,但并非唯一因素。     

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。     

Paper patching for patulous eustachian tube

Background: Paper patching, a method that places cigarette paper over the most mobile quadrants of the tympanic membrane, is one of the treatment options for patulous eustachian tube (PET).

Aims/Objectives: The objective of this study was to compare the outcomes of two different treatment strategies for PET.

Material and methods: Twenty-three patients underwent paper patching of the tympanic membrane and 16 patients were treated with nasal saline irrigation with or without ipratropium bromide nasal spray. Medical records were reviewed for resolution of PET symptoms as categorical variables (complete remission, partial remission, or no improvement) with a minimum follow-up of 3 months.

Results: Immediately after undergoing paper patching, 20 of the 23 patients (87.0%) reported complete remission (CR). The percentage of CR after paper patching was 82.6% at 1 month and 65.2% at 3 months. A greater percentage of patients reported CR of aural symptoms in the paper patching group than in the nasal irrigation group at both 1 and 3 months after treatment (p?<?.05).

Conclusions and significance: Repetitive paper patching resolves aural discomfort in most PET patients for at least 3 months and can be considered as a first-line treatment option for PET in the outpatient setting.     

The effects of mastoid aeration on autophony in patients with patulous eustachian tube

The effect of the mastoid pneumatization on sound transmission from the nasopharyngeal cavity to the inner ear, which is one of the important factors to indicate the severity of the patulous eustachian tube (ET), are investigated in patients with patulous ET. Twenty ears of 13 subjects with patulous ET were retrospectively analyzed. Sound transmission from the nasopharyngeal cavity to the inner ear was evaluated by observing the masking effects of noise presented in the nasopharyngeal cavity on the auditory threshold (nasal noise masking audiometry). The relationship between this masking effect and mastoid pneumatization were examined among the patients with similar conditions of ET patency. The masking effect of nasally presented noise was greater with less developed mastoid pneumatization. The present results indicate that the symptoms associated with patulous ET may be more distressful in patients with poorly developed mastoid cavity than in those with well-aerated mastoid under similar conditions of ET patency.     

Use of calcium hydroxylapatite for management of recalcitrant otorrhea due to a patulous eustachian tube

We describe a medically complex 4-year-old child with a history of chronic unilateral myringotomy tube otorrhea and laryngopharyngeal reflux who was diagnosed with a patulous eustachian tube. The diagnosis was confirmed by nasopharyngoscopy, retrieval of food from the affected ear after oral challenges with green dye, and computed tomography. The child was effectively treated with an endoscopic transoral injection of calcium hydroxylapatite (Radiesse Voice) in the lateral pharyngeal wall and torus tubarius. She initially received a test injection with a temporary gel of synthetic polymers (Radiesse Voice Gel) with benefit lasting several months; she subsequently underwent a longer term injection with the hydroxylapatite and tube removal. She had complete resolution of otorrhea for 18 months with no subsequent ear infections or food matter in the ear despite persistent significant gastroesophageal reflux. The patulous eustachian tube is rarely identified in children and, when found, is a challenging condition to manage. Many current surgical treatments involve permanent occlusion of the eustachian tube. Our endoscopic transoral technique is a shorter-term alternative for management of complications related to this anatomic variation, and it allows time for eustachian tube growth.     

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.     

Mucociliary function of the eustachian tube in the eustachian tube dysfunction

Background: Most of the tests to evaluate the eustachian tube (ET) function are focused on the ventilation function of the ET.

Aim: Here we evaluate mucociliary function of the ET in patients with ET dysfunction.

Materials and methods: Ten patients with ET dysfunction were enrolled into the study. Six patients had chronic tympanic membrane retraction and four patients had chronic middle ear effusion (MEE). All patients had intact tympanic membranes. Tympanometry and clinical examinations were done to all patients. Mucociliary function was evaluated with technetium labeled albumin and blue dye. Tympanometry and clinical examinations were done to six patients with chronic tympanic membrane retraction and four patients with chronic middle ear effusion (MEE). Mucociliary function of the ET was evaluated with technetium labeled albumin and blue dye placed into middle ear through an intact tympanic membrane and followed from nasopharynx ET orifice (blue dye) and with gamma camera (technetium).

Results: Blue dye was observed in tubal orifice in six (6 of 10) patients during 30?min observation. Five of those patients (5 of 6) had tympanic membrane retraction and one patient (1 of 6) had MEE. Tracer activity decreased from middle ear in six (6 of 10) patients. Four of those patients had tympanic membrane retraction and two had MEE.

Conclusion: Mucociliary function of the ET seems to be better in patients with tympanic membrane retraction than patients with middle ear effusion.

Significance: Mucociliary function of the ET is an important function for middle ear aeration, blue dye test is easily available to be used also in clinical practice.     

Development of a rat model of patulous eustachian tube by mandibular nerve resection

ObjectivePatulous eustachian tube (PET) is currently treated using a variety of conservative or surgical approaches. To further elucidate the pathology of PET and to establish new therapies, the development of an animal model is necessary. The objective of this study was to develop a highly reproducible and sustainable rat model of PET by mandibular nerve resection.MethodsSixteen rats underwent mandibular nerve resection. Following an external incision, the main trunk of the mandibular nerve at the foramen ovale was identified in the pterygoid fossa, and its branches were resected. This surgery was performed on the right side, with the unoperated left side used as the control. To determine eustachian tube (ET) function, passive opening pressure (POP) was measured using inflation method up to Week 16 post-surgery. Changes in POP were statistically compared to the preoperative level on the operated and control sides. In addition, specimens of the ET and its surrounding tissue at Week 16 post-surgery were prepared for morphological evaluation in eight rats.ResultsOn the control side, POP did not significantly decrease across the 16 weeks post-surgery compared to the preoperative level. In contrast, on the operated side, POP was significantly decreased at Week 2 and continued to be lower than the preoperative level until at least Week 16 post-surgery. POP dropped 10% or more on the operated side examined in thirteen rats. Histologically, the medial pterygoid muscle was atrophied on the operated side mainly.ConclusionMandibular nerve resection in rats may be an effective method for generating an animal model of PET. It was suggested that this rat model may be useful for verifying new treatments for PET.