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。     

鼓膜修补术后中耳炎复发原因分析

目的分析中耳炎患者鼓膜修补术后复发的原因。方法 2007～2010年49例显微镜下鼓膜修补术后中耳炎复发患者,经超过1个月药物治疗无效后,行耳内镜下探查术,总结术后复发原因。结果 49例中,5例咽鼓管鼓口阻塞,24例存在鼓峡部阻塞伴完全性张肌皱襞,14例存在鼓峡部阻塞伴上鼓室垂直粘连带,8例存在上鼓室粘膜上皮化封闭鼓峡,9例鼓窦入口狭窄,12例面神经隐窝及鼓室窦未完全开放,8例乳突气房未完全开放;49例中单一部位阻塞者19例,有2处及以上部位阻塞者30例。耳内镜下确认并解除中耳通气阻塞部位,术后随访1年,干耳率98%。结论中耳炎行鼓膜修补术后复发与中耳腔的气流通道阻塞有关,术中应畅通中耳通气引流,提高手术成功率。     

咽鼓管鼓口通畅度的成形修复术

为恢复咽鼓管通畅度曾采用尼龙线留置、聚乙烯管插置、在管的裸露骨面上移植粘膜瓣等方法,但如咽鼓管内缺乏粘膜时大多不易获得成功。作者为28例18～50岁的伴有咽鼓管不通的慢性全鼓室炎患者做了29次(一例双耳病变)恢复咽鼓管鼓口通畅度的成形修复术。在手术显微镜下证实患者除在鼓室内壁覆盖有鳞状上皮外,鼓口的情况计有四种:10耳有薄的可活动的膜状物,在行鼓气吹张时活动最明显,其手术方法系自鼓口上方开始,与鼓环平行切开鼓岬上皮,并将之剥下,然后由前后分离覆盖于鼓口部的疤痕膜,将游离下的组织覆盖在鼓岬上,所余鼓岬后份的骨壁上植以颊粘膜辦,如此可完全恢复鼓口的通畅度;15耳鼓口被坚固的纤维组织所粘连,     

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。     

慢性化脓性中耳炎咽鼓管鼓口病变与咽鼓管功能的相关性

1999年 8月～ 2 0 0 0年 7月我们用鼓室镜观察 44例慢性化脓性中耳炎术前患者的鼓室及咽鼓管鼓口 ,以了解鼓口的病变情况对咽鼓管功能的影响 ,现将结果报告如下。一、临床资料与检查方法1 临床资料 :慢性化脓性中耳炎术前患者 44例 (4 5耳 ) ,男 2 4例 ,女 2 0例 ,年龄 9～ 5 9岁。经过选择患者均为鼓膜中央性穿孔 ,并接受了手术治疗 ,术中证实为单纯型 2 4耳 ,胆脂瘤型 15耳 ,骨疡型 6耳。术前颞骨ＣＴ检查显示单纯型的鼓室、鼓窦及乳突无软组织影 ,无骨质破坏及听小骨破坏、吸收现象 ;而胆脂瘤型和骨疡型的鼓室、鼓窦及乳突有软组织影 ,有…     

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。     

诊断咽鼓管异常开放症的一种新的鼓室导抗检查法

应用闭口、捏紧双侧前鼻孔后用力呼吸同时记录鼓室导抗图的方法。发现4例咽鼓管异常开放症者鼓室导抗图呈波浪型；而常规鼓室导抗图无异常改变；正常耳无此种波浪型图形。提示此法可作为诊断咽鼓管异常开放症的方法。     

慢性粘连性中耳炎的手术治疗

粘连性中耳炎是一种非化脓性中耳炎,以鼓室粘连和纤维化为其主要特征。由于咽鼓管功能障碍,鼓室腔隙逐渐消失,听力下降;钙化、脂肪变性和瘢痕组织亦妨碍鼓膜及听小骨的活动。作者对接受鼓室成形术治疗的55例粘连性中耳炎患者进行随访,平均随访时间为7.3年。手术过程为:分离鼓室粘连,清除病变后使用硅橡胶覆盖鼓岬,其范围自咽鼓管至卵圆窗。听骨链若有破坏,则用自身听骨或乳突骨修复。有些病例作鼓膜导管引流,还有32耳同时行单纯乳突切除术。术后,鼓膜完整活动者19耳(34%);鼓膜继续粘连30耳(55%);鼓膜穿孔6耳(11%),其中5耳干燥,1耳流脓;全聋1耳;继发胆瘤1耳。骨气导差平均提高3.6 dB;13耳(24%)     

纤维鼻咽喉镜下经咽鼓管咽口鼓室灌注治疗分泌性中耳炎

20 0 0年 10月～ 2 0 0 1年 2月 ,对门诊 98例共 134耳分泌性中耳炎患者在纤维鼻咽喉镜下经咽鼓管咽口吹张、鼓室灌注治疗 ,效果满意 ,报道如下。1　资料与方法1.1　临床资料　经门诊确诊的分泌性中耳炎患者 98例共134耳 ,其中男 5 2例 75耳、女 4 6例 5 9耳。年龄 6～ 77岁 ,平均 4 1.3岁。鼓室积液 4 4耳 (鼓膜见液平线 32耳 ,鼓膜无液平线但在经咽鼓管鼓室灌注时见有黄色粘稠液体从咽鼓管咽口流出 11耳 )。纯音测听示传导性聋 82耳 ,混合性聋5 2耳 ,其气骨导差平均 2 3ｄＢ。声导抗检查鼓室导抗图Ｂ型为 88耳 ,Ｃ型为 4 2耳 ,同侧镫骨肌…     

咽鼓管-鼓室气流动态法对咽鼓管异常开放症的诊断价值

目的 :探讨咽鼓管异常开放症的检测方法。方法 :比较鼓室导抗图法、Morim itsu法和咽鼓管 -鼓室气流动态法 (TTAG法 )检测 2 0耳咽鼓管异常开放症患者的阳性率。结果 :鼓室导抗图法阳性者 5耳 ,阳性率 2 5 % ,Morim itsu法阳性者 12耳 ,阳性率 6 0 % ,TTAG法阳性者 2 0耳 ,阳性率 10 0 %。结论 :TTAG法是诊断和随访咽鼓管异常开放症最有价值的手段。     

慢性化脓性中耳炎的咽鼓管功能对手术疗效的影响

目的探讨慢性化脓性中耳炎咽鼓管功能改变对手术疗效的影响.方法分析40耳行鼓室成形术的慢性化脓性中耳炎的咽鼓管功能与手术疗效的关系.咽鼓管功能检查用正-负压试验、TTAG法及音响法,咽鼓管鼓室口及咽口的观察分别用鼓室镜及鼻窦镜,对比分析咽鼓管功能改变与病变部位的关系,并比较鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况.结果慢性化脓性中耳炎的咽鼓管功能与鼓室口病变程度相关,鼓室口病变轻者,咽鼓管功能良好;而鼓室口病变重者咽鼓管功能不良.40耳鼓室成形术后咽鼓管功能良好耳鼓膜生长良好,咽鼓管功能不良耳鼓膜生长欠佳;两者均有统计学意义.结论慢性化脓性中耳炎咽鼓管功能与鼓室成形术效果关系密切,咽鼓管功能障碍可能是导致手术失败的重要因素之一.     

Myringotomy and tube for relief of patulous eustachian tube symptoms

Reports on the effectiveness of myringotomy and tube for treatment of symptoms of the patulous eustachian tube are discouraging, even though there are no large series substantiating its ineffectiveness. To further investigate this problem, we have reviewed the charts of all patients at the Otologic Medical Group (OMG) from 1974 to 1981 with the diagnosis of patulous eustachian tube who underwent myringotomy and tube for their symptoms. We identified 60 ears of 46 patients with complaints consistent with patulous eustachian tube symptoms. The treatment either eliminated or substantially reduced symptoms in 32 ears (53%). For the other 28 ears, myringotomy and tube were of no benefit. Nine of 13 (70%) ears with a definitive diagnosis based on movement of the tympanic membrane with respiration or tympanometry showed relief of symptoms with myringotomy and tube. Myringotomy and tube will remain part of the treatment regimen because it is relatively simple to perform, reversible, and effective in the majority of patients.     

慢性中耳炎咽鼓管鼓室口病变对咽鼓管功能的影响

目的 :探讨慢性中耳炎咽鼓管鼓室口病变与咽鼓管功能障碍的关系。方法 :用鼓室镜及咽鼓管功能检查仪对 4 4例 (45耳 )慢性中耳炎患者 ,进行术前咽鼓管鼓室口观察和咽鼓管功能检查 ,并对检查结果进行对比分析。结果 :4 5耳慢性中耳炎中 ,咽鼓管鼓室口正常 17耳 ,骨刺增生、黏膜肿胀等轻度病变者 18耳 ,黏膜肿胀或肉芽增生致管腔明显狭窄的重度病变有 10耳 ,其中 9耳咽鼓管功能呈阻塞型改变。结论 :咽鼓管鼓室口及骨部的骨刺增生、黏膜肿胀、肉芽形成是慢性中耳炎的常见病变 ,鼓室口及骨部的阻塞是导致慢性中耳炎咽鼓管阻塞的原因。     

Das Syndrom der klaffenden Tube – neue chirurgische Therapieansätze

A patulous eustachian tube (tuba aperta) may lead to an enormous reduction in quality of life. A patulous eustachian tube can cause symptoms such as autophony, breath synchronous tinnitus, pressure sensation in the ear, and hearing loss. In combination with so-called “sniffing”, it can trigger the development of cholesteatoma. Due to the diffuse symptoms the correct diagnosis of this disease can be challenging. A patulous eustachian tube can be best diagnosed through a well-structured examination including patient history, physical examination with thorough observation of movements of the tympanic membrane, and tympanometry with reflex decay. This publication reviews recent literature on the patulous eustachian tube. We focused on the evaluation of the different surgical strategies such as the patulous eustachian tube reconstruction, the Kobayashi plug or the injection of Vox® implants into the torus tubarius.     

The frequency of patulous Eustachian tubes in pregnancy

Two-hundred and seventy pregnant women (540 ears) were examined for patulous Eustachian tubes. The diagnosis was established by means of a Madsen Zo 70 electroacoustic impedance bridge. Nineteen of the patients were found to have patulous Eustachian tubes in 1 or both ears as evidenced by impedance variations synchronous with the respiration. Only 5 of these women had any subjective symptoms. Nine other women had symptoms, but their Eustachian tubes were closed at the time of examination. The results were related to the duration of the gestation, to oestrogen production and weight gain during pregnancy. A significant correlation was found was found between patulous Eustachian tube and elevated serum oestriol values.     

Langzeitbeobachtungen chronischseröser Otitis media nach experimentellem Tubenverschluß bei Katzen

Summary In order to induce a serous otitis media in cats, the pharyngeal opening of the Eustachian tube was cauterized and obstructed on one side only through transpalatal approach; the other side remaind intact and served as control. On tympanic membrane examination and puncture 11 months later, there was fluid in the middle ear in three ears, no fluid in two ears, a tympanic membrane perforation in one ear and a red tympanic membrane in one ear. The middle ear was then ventilated through a plastic tube in two ears with and without fluid respectively. In all other ears, no tube was inserted. After another 7 months, the animals were intravitally perfused, and the middle ear mucosa biopsyed. The histological results of the light and electron microscopy showed chronic changes of the middle ear mucosa following experimental tubal obstruction.     

Does the silastic eustachian tube prosthesis improve eustachian tube function?

This clinical study attempts to evaluate the effectiveness of Eustachian tube function in 30 ears, 11–29 months after insertion of the Silastic® Eustachian tube prosthesis (SETP). Indications for the SETP were limited to persistent Eustachian tube dysfunction. Preoperatively, 13 patients had intact tympanic membranes with persistent serous otitis media. Seventeen patients underwent tympanoplasty and demonstrated persistent serous otitis media in the opposite ear. Postoperatively, aeration of the middle ear was evaluated by tympanometry, microscopic examination, and myringostomy. Microphotographs demonstrate the state of the middle ear. Histology of the middle ear mucosa was obtained in a few cases. Ninety-six percent of the ears with an SETP demonstrated confirmed persistent Eustachian tube dysfunction beginning an average of six months after insertion. Complications were common.     

Ⅰ型鼓室成形术中咽鼓管功能的评估及其对疗效的影响

目的通过对采用Ⅰ型鼓室成形术治疗慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者的临床资料进行分析,探讨咽鼓管功能及其评估对其疗效的影响。方法分析64例(64耳)采用I型鼓室成形术治疗CSOM的患者资料,根据咽鼓管功能检测(ETS)结果分为咽鼓管功能障碍组及咽鼓管功能正常组。观察声导抗正-负压平衡法与ETS两种检测方法的一致率及两组患者术前及术后的气导听阈值变化、气骨导差值变化、鼓膜愈合、听力改善、干耳时间和并发症等指标情况。结果声导抗正-负平衡法与ETS两种检测方法一致率为76.56%,咽鼓管功能正常组和咽鼓管功能障碍组患者术后的气导听阈值和气骨导差均低于术前(P<0.05),两组在术前及术后(3个月、6个月)的气导听阈值、气骨导差及其差值变化,听力改善率、干耳时间等指标差异有统计学意义(P<0.05);而两组患者在的鼓膜愈合率、术后干耳率及术后并发症发生率差异均无统计学意义(P>0.05)。结论声导抗正负压平衡法结合ETS检测法对鼓膜穿孔患者进行主客观咽鼓管功能检测,可提高咽鼓管功能检测的准确率,可作为咽鼓管功能检测的补充手段。     

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).     

Patulous eustachian tube syndrome: the relationship with sensorineural hearing loss. Treatment by eustachian tube diathermy

The patulous Eustachian tube syndrome has previously been regarded as a troublesome but benign condition. Nine out of 13 patients reported here had evidence of cochlear damage similar to that caused by acoustic trauma. These patients also had vestibular symptoms which improved with treatment of the patulous tube. It is postulated that abnormal patency of the Eustachian tube may allow excessive middle ear pressure changes to occur which may be transmitted by abnormal ossicular movement to the cochlea. Eustachian tube diathermy using a ureteric diathermy probe is a safe and effective method of treating this condition.