鼻咽癌放疗后分泌性中耳炎的治疗

目的探讨治疗鼻咽癌放疗后分泌性中耳炎的治疗方法。方法将60例鼻咽癌放疗后并发分泌性中耳炎患者随机分为A、B两组,每组30例。A组鼓室置管;B组在鼻内镜下行鼻腔鼻咽部清理加鼓膜穿刺抽液加鼓室给药沐舒坦。比较分析两组治疗效果及并发症。结果随访10个月,60例中存活49例。存活患者中,分泌性中耳炎治疗有效率A组为52.6%,B组为81.6%,差异有统计学意义（P〈0.05）;并发症发生率A组为23.7%,B组为7.9%,差异有统计学意义（P〈0.05）。结论对鼻咽癌放疗后伴发的分泌性中耳炎治疗,鼻腔鼻咽部清理加鼓膜穿刺抽液加鼓室给药沐舒坦优于单纯鼓室置管引流。     

鼻咽癌并发的分泌性中耳炎治疗方法的研究

目的:探讨鼻咽癌并发的分泌性中耳炎的治疗方法。方法:将58例鼻咽癌放疗前并发分泌性中耳炎患者随机分为两组。A组:鼻腔鼻咽部清理及冲洗加鼓膜穿刺抽液;B组:鼓膜切开或鼓室置管引流。随访半年,对治疗分泌性中耳炎的有效率和并发症发生率进行比较。结果:随访半年后,58例中存活51例。存活患者中,治疗分泌性中耳炎的有效率A组为82.1％,B组为57.1％,差异有显著性意义(P<0.05);治疗分泌性中耳炎并发症发生率A组为3.6％,B组为28.6％,差异有显著性意义(P<0.05)。结论:鼻咽癌患者分泌性中耳炎的治疗,鼻腔鼻咽部清理及冲洗加鼓膜穿刺抽液优于鼓膜切开或鼓室置管引流。     

鼻咽癌二例误诊回顾

例1，男，41岁。因左耳鸣、闭气、听力下降1月余于1992年5月就诊。检查：左耳鼓膜呈淡黄色，鼓室内粮液，鼻咽部检查见鼻咽左侧壁粘膜不光滑，未见明显新生物，电测听检查示左耳传导性聋，声阻抗测试技室声顺图呈B型，诊断为左耳渗出性中耳炎。予鼓膜穿刺抽波及对症处理，症状缓解，3月后患者症状复发，鼻咽部检查发现鼻咽左侧壁隆起，局部活检阴性，二周后再次活检为低分化鳞癌。例2，男，45岁。患者系进行性耳塞、多脓涕一年余，开涕带血，回吸痰中带血月余干1995年9月就诊，鼻腔检查见双鼻腔多发性息肉，予单纯鼻腔息肉摘除术，术后鼻腔…     

鼻咽癌放疗后分泌性中耳炎的疗效评价

目的 寻找鼻咽癌放疗后分泌性中耳炎的有效治疗方法，以提高鼻咽癌患者放疗后的生存质量。方法 对鼻咽癌放疗后并发分泌性中耳炎的患者行鼓膜穿刺抽液、鼻腔鼻咽部清理及冲洗，随访半年后评价疗效。结果 在治疗鼻咽癌放疗后分泌性中耳炎的患者时，行鼓膜穿刺加鼻腔鼻咽部清洗疗效较佳。结论 对鼻咽癌放疗后分泌性中耳炎的治疗需要综合疗法。     

蛔虫引起耳痛1例

患儿 ,男 ,1 0岁。因阵发性左耳疼痛 4d于1 999年 4月 6日就诊。 4d前无明显诱因突发左耳剧痛 ,伴左耳鸣和鼻咽部异物感 ,耳痛持续约 1 0min后自行消失。此后左耳剧痛每 1～ 2 h发作 1次 ,发病以来无发热、流涕及耳流脓。曾在当地医院拟“左耳急性化脓性中耳炎”用“青霉素”抗炎 ,“颅痛定”止痛治疗 3d,无效。检查 :双耳廓外形正常 ,无牵拉痛。双外耳道清洁。左耳鼓膜完整呈反应性充血 ,右耳鼓膜紧张部干性小穿孔 ,无充血。间接鼻咽镜检见鼻咽部左侧壁有一灰白色蜷曲状条形虫体 ,鼻腔、口咽及喉咽部正常。用 1 %地卡因行鼻咽部表麻后 ,在…     

分泌性中耳炎置管后的鼓膜硬化

鼓膜硬化意味着鼓膜固有层的胶原纤维和弹力纤维发生了透明变性,这在慢性中耳炎及其后遗症和患分泌性中耳炎之后极为常见。多篇报道显示在对儿童各种分泌性中耳炎施用置管引流后,鼓膜硬化的发生率达25～35%。作者于1977、1978两年对224名双侧性分泌性中耳炎患儿进行了连续随访观察。最初的治疗方法包括腺样体刮除、鼓膜穿刺排液。右耳放置扣眼式通气管,左耳穿刺排液而不置管。对发生再积液、B型鼓室曲线图和听力下降3个月以上的患儿右耳再置管,左耳行二期置管。通过有对照的统计学处理研究,结果表明鼓膜硬化多由置管所致。鼓膜硬化可以发生在鼓膜的一处或多     

鼻腔冲洗治疗儿童分泌性中耳炎疗效分析

目的探讨鼻腔冲洗对腺样体切除术后儿童分泌性中耳炎的疗效。方法对2005年6月至2009年8月期间30例(42耳)已行腺样体切除术、经药物治疗疗效不满意且仍反复发作的分泌性中耳炎患儿,应用生理盐水500ml加地塞米松5mg鼻腔冲洗,每日2次,连续2周,同时辅以桉柠派口服及呋嘛滴鼻液滴鼻,观察疗效。结果除3例未能坚持治疗失访者及2例治疗后3月鼓室导抗图仍为B型、行鼓膜切开置管术治愈者外,其余25例均取得较好疗效,纯音听阈及鼓室导抗图均恢复正常。结论鼻腔冲洗能改善鼻咽部局部环境,促进咽鼓管功能恢复,可有效治疗儿童分泌性中耳炎。     

鼻咽癌患者放疗后并发分泌性中耳炎的综合治疗

目的：探讨鼻咽癌患者放射治疗后并发分泌性中耳炎的综合治疗疗效。方法回顾性分析78例（88耳）因鼻咽癌行放射治疗后并发分泌性中耳炎的患者进行全身治疗（包括激素、神经营养和血管扩张剂,并适当应用广谱抗生素）、鼻腔及鼻咽局部定期清理、盐酸氨溴索与曲安奈德鼓室注射、鼓膜置管等综合治疗后的疗效。结果78例（88耳）鼻咽癌放疗后并分泌性中耳炎患者中71耳治愈,6耳好转,总有效率87．5％（77／88）,无效11耳（12．5％,11／88）。结论对鼻咽癌放射治疗导致的分泌性中耳炎患者进行全身及局部综合治疗,尤其是鼓室注射类固醇激素或鼓膜置管,可改善患者听力,提高其生存质量。     

鼻咽癌中耳转移1例

患者 ,女 ,47岁。因鼻咽癌放疗后 2年 ,左耳后疼痛 4个月 ,左面歪斜 3d,于 1 999年 1月 1 1日入院。患者于 1 996年底因鼻咽低分化鳞癌接受全程根治性放疗。 1年后因双耳听力下降以分泌性中耳炎行双侧鼓膜切开置管术 ,术后 2周左耳听力再度下降 ,被认为自行脱管而未作任何处理。 4个月前出现左耳后疼痛 ,呈持续性胀痛 ,3d前左侧口角歪斜、流泪、流涎。体检 :鼻咽部光滑 ,左鼓膜混浊呈淡红色 ,膨胀、增厚且不活动 ;左乳突区饱满 ,皮肤潮红 ,压痛不明显 ,左侧周围性面瘫征。纯音测听示左侧混合性聋 ,鼓室导抗图 B型 ,未引出镫骨肌反射 ;肌电…     

分泌性中耳炎(OME)治疗方法的选择依据

由于发病率增高、诊治困难、难估预后，长期ＯＭＥ可促成鼓室硬化和听力下降，故近１０年来受广泛重视。该作者探讨鼻腔非炎性改变在ＯＭＥ发生上的作用，评估内科疗法效果和早期手术的适应证。诊断靠显微耳镜、硬管内窥镜（直径２．７ｍｍ、４ｍｍ、３０°、９０°）、动态鼓室压图、声反射、鼻压力计。共观察无鼻、鼻咽部感染的ＯＭＥ患者１３２例，病程２～５周，７９例接受传统内科治疗（鼓膜按摩，咽鼓管通气，经鼓膜向鼓室注入强的松龙０．５ｍｌ，内窥镜下矫正可能影响咽鼓管功能的鼻部结构异常），５３例接受手术（鼓室探查，咽鼓管…     

Effects of nasal obstruction on Eustachian tube function and middle ear pressure.

To evaluate the relationship between nasal obstruction and otitis media, 10 ferrets were studied before and after either unilateral (E = 5) or bilateral (n = 5) nasal obstruction. Observations included otomicroscopic assessments of middle ear status, tympanometric recordings of middle ear pressure and forced-response, inflation-deflation and continuous monitoring tests of Eustachian tube function. During the 6 8 week post-obstruction follow-up period no animal developed evidence of otitis media. Abnormal positive middle ear pressures lasting for the period of follow-up occurred only in the animals with bilateral nasal obstruction. Eustachian tube function test results showed these pressures to be generated during swallowing. No changes in the passive function of the tube were documented in either group, but changes in active function consistent with alterations in the pressure gradient between the middle ear and the nasopharynx were observed in both groups.     

Influence of nasal allergic reactions on the clearance of middle ear effusion

In order to investigate the influence of nasal allergic reactions on the clearance of middle ear effusion, an animal model of nasal allergy and otitis media with effusion was produced in the same guinea pigs simultaneously by passive sensitization with serum of homologous animals containing IgE antibodies (for nasal allergy) and by inoculation of immunocomplex into the tympanic cavity (for otitis media with effusion). Usually, middle ear effusion appeared within 2 to 3 days and disappeared within 7 to 9 days after the inoculation of immunocomplex. Three days after the inoculation of immunocomplex, intranasal antigen challenge was performed three times daily and continued until the animals were killed. Disappearance of middle ear effusion appeared to be delayed in animals in which nasal allergic reactions were induced. Middle ear effusion was not found in those ears that were not inoculated with immunocomplex. Findings of the present study indicate that IgE-mediated allergic reactions of the mucous membrane lining the nose, nasopharynx, and eustachian tube constitute a factor indicative of a chronic state of disease, rather than a cause of otitis media with effusion.     

内窥镜下鼻腔鼻窦手术对咽鼓管功能的影响

目的 :观察内窥镜下鼻腔鼻窦手术对咽鼓管功能的影响。方法 :运用MedsenZO 174声导抗仪对 10例鼻窦鼻甲手术患者 (鼻窦鼻甲组 )及 10例鼻中隔矫正术患者 (鼻中隔组 ) ,手术前及术后 1、3、5、10d的鼓室压、声顺、坡度等进行自动检测 ,观察其变化。结果 :术后 1、3d ,鼻窦鼻甲组鼓室压由术前 - 85 .5daPa分别降至- 14 8.0daPa及 - 139.0daPa ,分别与术前比较 ,其差异均有极显著性意义 (P <0 .0 1) ;鼻中隔组鼓室压由术前- 5 1.0daPa分别降至 - 111.5daPa及 - 96 .0daPa ,分别与术前比较 ,其差异亦有极显著性意义 (P <0 .0 1)。术后 5、10d两组鼓室压逐渐恢复至术前水平。手术前、后两组声顺、坡度无明显变化 (P >0 .0 5 )。术后 1、3d两组鼓室峰压点明显左移 ,术后 5、10d逐渐恢复至术前水平。结论 :鼻窦鼻甲手术和鼻中隔矫正术的术后早期均能引起咽鼓管阻塞 ,术后积极抗感染 ,正确、及时、定期清理术侧鼻腔 ,及早解除鼻腔压力 ,可减轻手术对咽鼓管功能的影响     

鼻咽癌放疗后分泌性中耳炎的循证治疗

目的:分析鼻咽癌(NPC)放疗后分泌性中耳炎(SOM)的发生机制,依据循证医学(EBM)的原则,探索一种有效的、针对其发病机制各个环节的治疗方法。方法:对106例(112耳)NPC放疗后SOM患者,采用全身和局部抗炎、神经营养、扩张血管及激素治疗;加强鼻腔、鼻咽局部清理,治疗鼻腔鼻窦疾病;采用咽鼓管置管、冲洗及注药等综合治疗措施。结果:所有患者治疗前均有耳鸣、耳闷塞感及听力下降等症状,鼓室导抗图均为B型。经综合治疗后,耳鸣:消失81耳(72.32%),好转25耳(22.32%),无效6耳(5.36%),总有效率为94.64%耳闷塞感:消失92耳(82.14%),好转18耳(16.07%),无效2耳(1.79%),总有效率为98.21%。声阻抗检查:鼓室曲线A型56耳(50.00%),As型42耳(37.50%),B型2耳(1.79%),C型12耳(10.71%)。治疗后0.5、1.02.0kHz气导听阈均值为(28.5±3.0)dBHL,而治疗前为(47.0±5.0)dBHL,其差异有统计学意义(P<0.01)结论:依据EBM的原则,有针对性地对NPC放疗后SOM的发病机制的各个环节采取对因治疗,是非常有效和切实可行的,对提高NPC患者的生存质量具有重要意义。     

Is surgery of the inner nose indicated before tympanoplasty? Effects of nasal obstruction and reconstruction on the eustachian tube

BACKGROUND: When tympanoplasty is to be done in a patient suffering from chronic otitis media, usually potential interactions between middle ear mucosa, Eustachian tube function, and the nose and nasopharynx are considered. Poor tubal function goes along with a diminished success rate of tympanoplasty. On the other hand, pathological findings in the nose or the nasopharynx are often said to be responsible for inadaequate tubal function. Consequently, many authors feel that surgery of the nose should be performed before tympanoplasty if septal deviation or hypertrophy of the conchae is seen in a patient with chronic otitis media. PATIENTS AND METHODS: In order to better understand interactions between nasal pathology and Eustachian tube function, we utilized a pressure chamber to examine 50 patients undergoing septoplasty and conchotomy. Besides insufflation tests (Toynbee, Valsalva), we performed dynamic tubal examination with the dual-impedance method. Active parameters (positive and negative residual pressure) and passive parameters (tubal opening and tubal closing pressure) were recorded as the chamber pressure was varied. The aim of our investigation was to test if surgery of the nasal septum and the conchae really improves tubal function, thus evaluating indications for septoplasty before tympanoplasty. In addition, we explored the early and the late consequences of nasal surgery on tubal function. This was done to find out the optimal postoperative period during which tympanoplasty could be performed following septoplasty. RESULTS: In many of the patients, insufflation tests were negative and dynamic tubal parameters were outside normal value range before surgery of the nose. One week after surgery, active and passive parameters and insufflation tests even deteriorated in the majority of our patients. Six to 8 weeks after surgery, we observed a tendency towards normalization of tubal parameters. This was significant for tubal closing pressure, but not for the other parameters. Whereas passive tubal parameters showed considerable improvement in many patients, there was no real improvement of active tubal parameters in most patients. This tendency was observed several months after surgery of the nose as well. Despite this improvement of passive tubal function, we did not observe a complete normalization of mean values even after 4 to 6 months. In several patients (who were satisfied with functional results of septoplasty) tubal parameters were even worse some weeks or months after nasal surgery, but this was not subjectively registered by our patients. DISCUSSION: We conclude from our data that dysfunction of the Eustachian tube frequently occurs in patients with deviation of the nasal septum and the conchae. Septoplasty and conchotomy worsen tubal function during the early postoperative period, lasting for at least one week. In a later period, improvement of tubal function may occur but in many patients no effects of nasal surgery on Eustachian tube can be measured. Thus, septoplasty before tympanoplasty cannot be generally recommended in all patients with septal deviation. We suggest that it may be useful in cases with severe nasal pathology or chronic infection of the nose or the nasopharynx, if this is accompanied by poor tubal function. We recommend analysis of Eustachian tube function before deciding on therapeutic management. Individual findings in the specific patient should be the leading criteria in all cases. If septoplasty and conchotomia are done, tympanoplasty should not be performed in the same session or in the early postoperative period, but several months after nasal surgery.     

Endoscopic laser surgery in combined nasopharyngeal and middle ear pathology in children with conductive hypoacusis

Endoscopic laser surgery on lymphoid structures of the nasopharynx near the pharyngeal opening of the auditory tube was made with Lazon-10P laser in 67 children aged 3 to 14 years with documented exudative otitis media (EOM). All the children had conductive hypoacusis. Children who had tympanogram of type B and in whom otoscopy detected exudate behind the tympanic membrane were subjected to one-stage laser tympanostomy in the anteroinferior quadrant of the tympanic membrane followed by transtympanic drug introduction into the tympanic cavity. Tympanostoma closed spontaneously 3 weeks later. Normal hearing recovered in all the children. Diagnostic endoscopy of the nasopharynx can reveal causes underlying dysfunction of the auditory tube. The results demonstrate high efficacy of the methods allowing elimination of mechanical occlusion of the auditory tube in the region of its pharyngeal opening with one-stage intervention on the middle ear.     

咽鼓管球囊扩张术治疗慢性分泌性中耳炎的短期疗效观察

目的 观察咽鼓管球囊扩张术联合鼓膜切开置管治疗慢性分泌性中耳炎的短期疗效。 方法 对2014年8月至2016年12月诊断为慢性分泌性中耳炎并入院接受咽鼓管球囊扩张术联合鼓膜切开置管术治疗的19例21耳行短期疗效观察分析。评价的指标如下:纯音电测听气导均值(PTA)、气-骨导差(ABG)、声阻抗、耳内镜检查、颞骨CT扫描和主观满意度(VAS视觉模拟评分)。 结果 19例均于全麻下顺利完成手术,术后6个月鼓膜置管未脱落者予以取管。术后随访6~10个月,纯音电测听测试耳气导结果术后较术前有所提高。PTA从术前(59.5±21.5)dBHL降低到术后(52.0±31.0)dBHL(t=3.409, P=0.005), ABG从术前(35.5±17.5)dBHL降低到术后(21±16)dBHL(t=2.957,P=0.011), 76.19%的患者声阻抗鼓室图术后转为A型;3例5耳自觉听力和症状无明显改善,其中2例4耳鼓室积液持续存在,1例1耳取管后3周再次复发,予以持续置管。术后疗效满意度平均为(6.17±1.16)分。 结论 咽鼓管球囊扩张术联合鼓膜切开置管治疗慢性分泌性中耳炎短期疗效好。     

分泌性中耳炎患者鼻咽癌表面活性物质的检测

通过定量测定健康人及分泌性中耳炎患者鼻咽部灌洗液中代表面活性物质的卵磷脂含量,进一步证实鼻咽部表面活性物质的存在,在探讨ＳＯＤ的发病机理。方法采集健康人和ＳＯＭ患者鼻咽部灌洗液,用分光光度法测定卵磷脂含量并进行对照。     

Chronic otitis media with effusion sequelae in children treated with tubes

OBJECTIVE: To determine incidence and prevalence of middle ear sequelae and abnormal tympanometry results among children with chronic otitis media with effusion (OME) who received standard treatment with tympanostomy tubes. DESIGN: Prospective cohort study. SETTING: Community clinic and academic medical center.Patients A total of 140 children followed up for 8 years after tube treatment. MAIN OUTCOME MEASURES: Tympanic membrane perforation, atrophy, retraction, hearing loss, myringosclerosis, low static admittance (SA) and broad-peaked tympanogram, high SA and narrow-peaked tympanogram, and negative tympanometric peak pressure. RESULTS: Annual incidence of sequelae was typically greater during 3 to 5 years than 6 to 8 years of follow-up. Greatest increases in incidence during the 5-year follow-up were for atrophy (67%), high SA and narrow-peaked tympanogram (70%), and retraction pocket (47%). Prevalence of these sequelae also increased over time, whereas low SA and broad-peaked tympanogram and negative tympanometric peak pressure decreased during follow-up. Sequela tended to become bilateral over time, and concordance of different sequelae in the same ear was low (kappa, 0.05-0.42). CONCLUSIONS: Annual incidence of sequelae decreased during follow-up. This finding parallels decreasing incidence of OME and tube placement as children mature and demonstrates that sequelae are more likely to develop during active acute and chronic OME. The cumulative effect of incidence resulted in few ears free of sequelae by 8 years of follow-up. Based on this cohort of healthy children with OME, although the risk of sequelae decreased over time, functional and morphologic sequelae were prevalent and may put children at risk for continuing middle ear problems as they grow into adolescence and adulthood.     

Evidence of allergic inflammation in the middle ear and nasopharynx in atopic children with otitis media with effusion

BACKGROUND: Otitis media with effusion (OME) occurs in the setting of eustachian tube (ET) dysfunction. Previous studies have demonstrated a predominance of T helper 2 (Th2) mediators in the middle ear effusions (MEEs) of atopic children, suggesting that allergy plays a role in the pathogenesis of OME. Given that the middle ear is contiguous with the upper airway, the allergic inflammation seen in the middle ear of atopic patients with OME may also have been observed in the nasopharynx. OBJECTIVE: We hypothesize that atopic children have different cellular and cytokine profiles in MEE compared with nonatopic patients and that this allergic inflammation occurs in both the middle ear and the nasopharynx. METHODS: Forty-five patients undergoing both ventilation tube placement for OME and adenoidectomy for adenoid hypertrophy were recruited. The atopic status was determined for each patient using standard skin testing. The cellular and cytokine profiles of the MEEs and the torus tubarius and adenoid tissues were investigated using immunocytochemistry and in situ hybridization. RESULTS: Our results indicate that, within the atopic patient, there is a similar cellular and cytokine profile within the three regions sampled, with a predominant expression of interleukin-4 (a Th2 cytokine) and an increased infiltration of eosinophils compared with the nonatopic patient. CONCLUSION: These findings confirm the association of allergy with MEE and support the hypothesis that the middle ear may be an integral part of the United Airway Concept.