腭裂对中耳传音和咽鼓管功能的影响

目的：了解腭裂对中耳传音和咽鼓管功能的影响及其影响的程度。方法：对４１例腭裂患者进行耳科学常规检查、咽鼓管咽口形态观察、声导抗测试,并与听力正常人进行对照。结果：腭裂患者中鼓膜病变率达８９．０％,咽鼓管咽口呈裂隙状形态达５９．５％,鼓室压图异常达８３．１％,镫骨肌反射消失率达８４．４％,与正常人对照,有极显著性差异。腭裂患者并发分泌性中耳炎的比率为７４．０％。结论：由于腭裂患者存在鼻另碚的易感染性     

腭裂患者的中耳功能和听力障碍

腭裂患常伴中耳功能障碍和听力损失，本对其发病情况、主要病因及治疗方法等进行综述，期望腭裂患得到更好的康复。     

腭裂对中耳影响的临床观察

通过对２５例腭裂患者进行纯音测听、鼓室压图、乳突Ｘ线和临床体征等观察，并进行了分析，结果显示：３８％患者为轻度听力减退（听阈２５～４０ｄＢ），８％患者为中度听力减退（听阈４１～７０ｄＢ），鼓室图中Ｂ型曲线占３２％，Ｃ型曲线占１２％；三种类型腭裂的听力和鼓室压图结果并无显著性差异（Ｐ＞０．０５），乳突Ｘ线表现除１例双耳呈气化型乳突和２例４耳乳突呈硬化型乳突外，其余均为板障型乳突。认为大部分腭裂患者均有中耳功能障碍，主要是通过影响咽鼓管所致。     

成人腭裂合并中耳炎的临床特征分析

目的 分析成人腭裂合并中耳炎患者的临床特点、手术治疗及预后.方法 收集7例既往行腭裂修补术患者,于2015年11月～2019年5月在我院确诊为中耳炎并行手术治疗,分析其临床表现、手术疗效及预后情况.结果 7例患者中6例中耳胆脂瘤,1例慢性化脓性中耳炎,接受腭裂修补术平均年龄10岁,6例行开放式乳突切开+鼓室成形术,1例...     

腭裂患者咽鼓管咽口的观察

腭裂患者由于先天的解剖结构缺陷,导致吞咽、语音、听力等生理功能障碍,腭裂患者的中耳功能障碍和听力下降的发生率明显高于正常人,据国内外文献报告,腭裂患者伴中耳病变的发病率为46%～84%,伴听力障碍26%～58%.     

腭裂修复术对中耳功能的影响

目的研究腭裂修复术对中耳功能的影响.方法腭裂修复前检查声阻抗及听觉诱发电位.选择鼓室图为B型,声镫骨肌反射阴性,V波反应阈≥30dB的患儿60例,左60耳,右60耳,按术后半年对声阻抗检查,脑干听觉诱发电位检查的结果进行统计学处理.结果手术前、后V波反应阈及鼓室图差异均有显著性(P＜0.01).结论腭裂修复术有益于中耳功能的改善.     

腭裂修复术对中耳功能的影响

为研究腭裂修复术对中耳功能的影响，应用声导抗及耳镜检查，以４３例腭裂患者于腭理解修复术前及术后半年，进行分泌性中耳炎（ＳＯＭ）发病情况及中耳功能检测。资料显示：ＳＯＭ发病率术前为６１．６３％，≤９岁患儿发病率高于〉９岁患儿；腭裂类型对ＳＯＭ的发生率无影响；腭裂修复术后患者ＳＯＭ发病率有所下降，中耳功能较有均有明显改善２，表明腭裂患者ＳＯＭ发病率高，腭裂修复术能够使患者的中耳功能得到一定程度的改善。     

牙齿覆咬合与咽鼓管功能障碍的关系

中耳炎是儿童的常见疾病。目前认为咽鼓管的角度、宽度和长度可影响其功能 ,上、下颌骨的发育异常(如腭裂、腭骨高穹隆、牙齿覆咬合等 )也可影响其功能 ,为了研究儿童牙齿覆咬合与咽鼓管机能障碍(ETD)的关系 ,该作者自 1999年 2月至 1999年 12月对 10 5例 2～ 6岁耳鼻喉科门诊病人进行颌关系的测量。测量者具有对咬合关系的知识 ,但对耳咽管的状态不了解。中耳疾病的确定依据耳鼻喉科病历记录 ,已放置通风管或需放置通风管的患儿均被划入病例组 ,对有急、慢性中耳炎无需放置通风管的患儿均被除外。置管原则依据美国耳鼻喉学会的标准。此外…     

腭裂修复术对患儿中耳功能的影响

目的 观察腭裂修复术对患儿中耳功能和听力的影响,为患儿听力问题的合理治疗提供依据.方法 197例患儿分为低年龄组（3～7岁）和高年龄组（8～12岁）.耳内镜下检查鼓膜像及咽鼓管咽口,鼓室图及纯音听阈测定.术后6个月复查.结果 患儿鼓膜的不可逆性病变8～12岁组明显高于3～7岁组.患儿咽鼓管咽口多呈裂隙状、圆脐状或过度宽大,咽鼓管咽口周围黏膜充血肿胀,有分泌物、食物残渣存留,术后得到明显改善.3～7岁组术后听力提高及A型鼓室图明显优于8～12岁组.结论 腭裂修复术后的软腭能分隔口腔和鼻腔,减少了鼻咽部感染的机会,有利于中耳功能恢复和听力的提高.提倡患儿早期手术,耳科医师应早期参与到治疗过程中,使患儿的中耳疾病在早期得到有效治疗.     

中耳胆脂瘤手术同期行咽鼓管球囊扩张的临床观察

目的评价改良完壁式乳突根治加鼓室成形术同期行咽鼓管球囊扩张治疗中耳胆脂瘤并咽鼓管功能障碍的临床疗效。方法选取中耳胆脂瘤并咽鼓管功能障碍患者共64例,所有患者术前通过正负压平衡试验、鼓室滴药、Valsalva动作难易程度评分均证实为咽鼓管功能障碍。将患者随机分为对照组和观察组,其中对照组36例,观察组28例,对照组改良完壁式乳突根治加鼓室成形术,观察组行改良完壁式乳突根治加鼓室成形术并同期咽鼓管球囊扩张,记录两组术前及术后咽鼓管功能问卷评分（ETDQ 7）、干耳时间、纯音电测听及鼓室导抗图检查结果,比较两组患者的治疗效果。结果所有患者成功接受手术,术后随访6个月至1年,术前ETDQ 7评分、Valsalva测试、正负压平衡试验及纯音电测听（4PTA）对照组和观察组无统计学差异（P>0.05）;术后6个月对照组和观察组ETDQ 7评分、纯音测听（4PTA）阈值均较术前明显降低（P<0.05）;术后6个月对照组和观察组ETDQ 7评分、纯音测听（4PTA）阈值、鼓室导抗图、鼓膜内陷征象及干耳时间两组对比差异有统计学意义(P均<0.05)。结论咽鼓管功能不良是中耳胆脂瘤的一个重要因素,小样本随访发现改良完壁式乳突根治加鼓室成形术同期咽鼓管球囊扩张治疗中耳胆脂瘤并咽鼓管功能障碍的短期效果良好,但其远期疗效有待对更大样本进一步观察。     

The relationship between middle ear pressure and deviated nasal septum

The deviated nasal septum may be associated with middle ear problems, particularly on the side of nasal obstruction. This study aims to find out whether middle ear pressure (MEP) correlates with the degree of nasal obstruction secondary to a deviated nasal septum, and to examine changes in MEP following septal surgery. Patencies of the nasal passages (measured with a peak nasal inspiratory flowmeter) and MEP (measured with tympanometer) of 55 patients were obtained prior to surgery and 7.5 (6–10) months post-operatively [median (range)]. Forty patients completed the study. Results were analysed by linear regression. In the ear on the side of nasal blockage, MEP was -25.7±28.4 mm water pre-operatively, and following surgery increased significantly to -2.9±30.4 mm water (mean±sd ) (P < 0.001). Pre-operatively, it was inversely related to the difference in patencies between the two nasal passages (r = -0.32, P < 0.02). Post-operatively, its improvement correlated with the degree of reduction of asymmetry of airway patency (r = 0.56, P < 0.001).     

试析Toynbee现象与中耳压力的关系

采用声管测定法，声阻抗测定法和鼻咽压力测定法，研究在Ｔｏｙｎｂｅｅ试验时叶耳压力，咽鼓管开放时程和鼻咽和时程三者间的关系，同时，测定 腔填塞前后鼓室 力的变化，并用糖精法测定鼓膜穿孔者于鼻腔填塞前后的粘膜纤毛运动情况。     

Reflux of nasopharyngeal content into middle ear through the eustachian tube

Whether nasopharyngeal content passes into the middle ear in patients without any head and neck pathology during the recovery phase of anesthesia is shown with an objective and prospective method. Thirty-eight patients, 21 female and 17 male, aged between 17 and 76, were included in the study. During the recovery phase of general anesthesia, 10 ml of 5 mCi Tc-99m-MAA was administered intranasally to the patients with a 10-F catheter. A manometer-adapted cuffed intubation tube was placed in the nasal passage so that the cuff was located at the choana. The pressure changes reflecting to the nasopharynx were recorded. The patients were extubated 10 min after the radionuclide was applied. The scintigraphic evaluation was done at the end of the 1st hour of the application of radionuclide. Transmission and emission views were taken with a gamma camera. Passage of nasopharyngeal content into the middle ear via the eustachian tube was not a statistically significant observation. The mean value of maximum pressure reflecting from the nasopharynx did not differ significantly between patients. Our study does not support the hypothesis that nasopharyngeal content passes directly through the eustachian tube into the middle ear and causes deleterious effects.     

Seasonal allergic rhinitis and its effects on Eustachian tube function and middle ear pressure

Middle ear pressure was recorded from 396 ears and aural symptoms enquired of 198 adult subjects with seasonal allergic rhinitis. Evidence of Eustachian tube dysfunction was found in 24% of subjects. Increased duration of exposure to pollen over a further 2 weeks increased the incidence of Eustachian tube dysfunction to 48%. The development of Eustachian tube dysfunction did not correlate with the severity of nasal symptoms.     

Test-retest variability of eustachian tube responses in children with persistent middle ear effusion

Summary In our previous studies on eustachian tube function in children with middle ear effusion, we found that many ears were evacuated by the act of sniffing. When subjects were tested repeatedly, however, responses to sniffing were very variable. In order to study the spontaneous variability, a total of 51 subjects (81 ears) were retested. The results of the retest were very similar to those of the first test when all the ears were considered as a group. However, in individual ears pronounced variability was seen. In the sniff test, responses changed qualitatively in 30% of the ears, and in 27% of the ears there was a change in the ability to equalize pressure by swallowing. Thus, the results of the group were highly reproducible, while at the same time individual results were highly variable with time.     

Treatment of persistent middle ear effusion in cleft palate patients

Objectives

The goals of the research project are to learn how to individualize otologic care for cleft palate patients and to be able to counsel families of children with cleft palate on the benefit of tympanostomy tubes, hearing issues and risks of multiple sets of tubes.

Methods

The study is a retrospective chart review. Patients with a cleft palate with or without a cleft lip born between 1 January 2000 and 31 December 2005 referred to the Connecticut Children's Medical Center Craniofacial Department were included in the study. The patients were offered individualized ear surgery (PE tube placement) only if persistent middle ear fluid was present for over 3 months with a conductive hearing impairment. The primary outcome measures included the newborn hearing screening results, number of ear tube surgeries, and complications of PE tube insertion.

Results

There were 86 patients with cleft palate spectrum with or without cleft lip (45 females and 41 males). Twelve had undocumented newborn hearing evaluations. Of the 74 evaluable results, 61 (82%) passed the newborn hearing screening, 8 (11%) failed and 5 (7%) were inconclusive. By 5 years old, 84 (98%) patients received at least one set of ear tubes for persistent middle ear fluid with conductive hearing impairment, while 2 received no tubes (2%). Of those who received ear tubes, the range was 1-6 with a mean of 1.7. Twelve patients (14%) had tympanosclerosis. Eight patients (9%) had eardrum perforation. One patient had myringoincudopexy. Of the 86 patients, 12 had undocumented newborn hearing evaluations. Of the 74 evaluable results, 61 (82%) passed the newborn hearing screening, 8 (11%) failed and 5 (7%) were inconclusive.

Conclusions

(1) The majority of children born with cleft palate do not have middle ear fluid at birth. (2) Most children with cleft palate will likely develop persistent middle ear fluid with conductive hearing loss. Risks of complications from ear tubes in cleft palate patients are few and manageable using standard sized ear tubes.     

Ventilation of the atelectatic ear

The absorption of gas from the middle ear-mastoid air cell system causes an average pressure decrease of 5 cm water per hour. Interference with the normal opening of the Eustachian tube causes increased negative pressure build-up, which stops gas absorption from the middle ear. High carbon dioxide tension is associated with metaplastic changes of mucosal stem cells into mucus producing cells. Ventilation of the middle ear is necessary for removal of the negative pressure as well as of the excess carbon dioxide. The problems associated with longterm ventilation tubes are reviewed, and some future prospects of permanent ventilation tubes are discussed.