Routine nasopharyngeal biopsy in adult secretory otitis media

This study was to determine whether routine examination under anaesthesia and nasopharyngeal biopsy in adults presenting with deafness due to secretory otitis media (SOM) is necessary for detection of nasopharyngeal malignancy. Two patient groups were studied. The first comprised 72 adults with SOM. Of these patients, 3 had nasopharyngeal tumours, 2 of whom also had cervical lymphadenopathy. The prevalence of malignancy in patients with SOM but no other suspicious signs was 1/72 (1.4%). The second group comprised 66 patients receiving treatment for nasopharyngeal neoplasms. In this group, 8 patients had SOM at presentation, 7 of whom had other features suspicious of malignancy. SOM as the sole presenting feature of nasopharyngeal malignancy was 1/66 (1.5%). EUA and biopsy of the nasopharynx is a cost effective investigation which continues to be indicated in adults presenting with deafness due to SOM.     

成人分泌性中耳炎的感染因素

对８６例成人分泌性中耳炎患者的中耳积液行涂片检查，细菌培养和鲎血试验，结果表明，分泌性中耳炎中耳腔中细菌和内毒素的存在是中耳积液发生或使积液迁延不愈的重要原因之一；内毒素检出率高于细菌分离率与与抗生素的使用密切相关、提示用抗生素治疗分泌性中耳炎对中耳积液的消退有积极意义。     

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。     

鼻咽癌放疗后分泌性中耳炎的治疗探索

目的探索鼻咽癌（nasopharyngeal carcinoma,NPC）放射治疗后分泌性中耳炎（secretory otitis media,SOM）的治疗方法。方法对63例（72耳）NPC放疗后SOM患者,采用综合治疗措施：全身和局部抗炎,神经营养,扩张血管,激素治疗;加强鼻腔、鼻咽局部清理,治疗鼻腔鼻窦疾病;咽鼓管置管、冲洗并向鼓室注入麻黄碱、氧氟沙星、地塞米松和α-糜蛋白酶混合药液。结果所有患者治疗前均有耳鸣、耳闷塞感、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45耳（62.50％）,好转17耳（23.61％）,无效10耳（13.89％）,总有效率86.11％;耳闷塞感消失57耳（79.17％）,好转11耳（15.28％）,无效4耳（5.55％）,总有效率94.45％;声阻抗检查鼓室曲线“A”型38耳（52.78％）,“As”型25耳（34.72％）,“B”型4耳（5.56％）,“C”型5耳（6.94％）;0.5、1.0、2.0kHz气导听阈均值从治疗前的（46.0±5.0）dBHL提高到治疗后的（25.8±3.5）dBHL,差异具有显著性（P〈0.001）。结论分析NPC放疗后SOM的发病机理,有针对性地采取对因治疗,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,可以在临床实践中加以应用和推广。     

Chronic secretory otitis media

Of 242 children and teenagers treated surgically for chronic secretory otitis media in 1972, 212 presented for evaluation 5 years later. Although the pure-tone audiometric threshold was 20 dB HL or better in 87.7% of the ears, only 40.6% were judged to be otoscopically normal. The findings at the first myringotomy for insertion of tympanostomy tubes were of no prognostic value for the course of the disease, and the presence of characteristics of middle ear fluid at subsequent myringotomies varied unpredictably. Adenoidectomy performed at an early stage, and in the presence of nasal obstruction, resulted in a significant reduction in the need for re-insertion of tympanostomy tubes.     

CT扫描对鼻咽癌并发分泌性中耳炎的辅助诊断意义

目的：探讨ＣＴ扫描对鼻咽癌（ＮＰＣ）并发分泌性中耳炎的辅助诊断意义。方法：观察１２７例ＮＰＣ放疗前、后患者的鼻咽、乳突ＣＴ片。结果：发现在不分期的情况下,放疗前分泌性中耳炎的发病率为５９％,Ｔ１￣４期,分泌性中耳炎的发生率渐次增高;且与肿瘤的发生部位有关。放疗前无分泌性中耳炎者,放疗后７０％的耳可发生分泌性中耳炎,放疗后３￣６个月是发生分泌性中耳为的高峰期。结论：ＣＴ扫描有助于ＮＰＣ患者放疗前后并     

咽鼓管置管在治疗鼻咽癌放疗后分泌性中耳炎中的价值

目的：探讨咽鼓管置管治疗鼻咽癌（NPC）放疗后分泌性中耳炎（SOM）的价值。方法：分析鼻内窥镜下经咽鼓管置管治疗106例(112耳) NPC放疗后SOM的疗效。结果：患者接受治疗后,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98.21%。无1例发生耳漏。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%)。治疗前后0.5、1.0、2.0?kHz气导听阈均值分别为（47.0±5.0）dBHL和（28.5±3.0）dBHL,两者具有统计学差异(P<0.001)。结论：咽鼓管置管治疗NPC放疗后SOM,对咽鼓管具有一定的支撑作用,能有效地避免耳漏。     

双管置入治疗鼻咽癌放疗后分泌性中耳炎

目的 探讨鼻咽癌放疗后分泌性中耳炎的治疗方法。方法 将60例(88耳)患者随机分为单管组和双管组, 每组30例(44耳)。单管组行常规鼓膜置管,双管组在置管引流的同时,在哑铃管上方置入直管(微)型预防插管,起通气作用。比较分析两组治疗效果及并发症。结果 随访10个月,两组有效率、6个月内堵管发生率相比差异有统计学意义,并发症差异无统计学意义。结论 治疗鼻咽癌放疗后伴发的分泌性中耳炎,双管置入鼓膜引流、通气优于单纯鼓膜置管引流。     

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。     

Adenoidectomy for secretory otitis media

Thirty years of treating secretory otitis media by what is presently considered an alternate approach is discussed. Early experience with using a polyethylene tube in one ear only led to a formal study of the efficacy of polyethylene tube use when combined with adenoidectomy or adenotonsillectomy. This study included 31 children with chronic bilateral secretory otitis media treated by tonsillectomy and adenoidectomy. At the time of surgery, one ear was intubated and the other served as a control with no treatment. Using audiometric criteria, it was found that there was no significant difference between the intubated and control ears after a 6- to 8-week follow-up. Also documented is a series of 425 children suffering from chronic secretory otitis media, all of whom were resistant to prior ear, nose, and throat or pediatric treatment. Fifty-three children had tonsillectomies and adenoidectomies without tube insertion and were followed up for at least 1 year. Audiometry was used to measure the result of therapy that was successful in more than 90% of the patients.     

Treatment of secretory otitis media

Blood serum of 38 patients with otitis media (14 men and 24 women), aged 16 to 55 years, was examined immunologically. The patients were subdivided into two groups that received identical traditional therapy. However the Group 2 patients were also given per os 0.5 g sodium nucleinate 3 times a day for 10 days. Before and after treatment all the patients underwent immunological tests which included measurements of T- and B-lymphocytes, T-helpers and T-suppressors as well as immunoglobulins M, A, G and complement. It was demonstrated that sodium nucleinate exerted beneficial clinical and immunological effects.     

The effect of erythromycin on the nasopharyngeal pathogens in children with secretory otitis media

Seventy-five children not older than 11 years, with secretory otitis media of more than 3 months' duration were randomly divided into two groups prior to myringotomy. One group remained untreated, whereas the other received erythromycin ethylsuccinate (Abboticin) in standard dosage for the last 10 days before surgery. Nasopharyngeal cultures were taken under general anaesthesia, which ensured an uniform mode of sampling. In the erythromycin-treated group the occurrence of Streptococcus pneumoniae (3%) and Branhamella catarrhalis (0%) was significantly lower than in the control group (35% and 32%, respectively); and the frequency of cultures with no pathogen was significantly higher in the treated group. The occurrence of Haemophilus influenzae remained essentially unchanged.     

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。     

分泌性中耳炎咽鼓管功能障碍的临床观察

目的：分析成人分泌性中耳炎咽鼓管主动和被动开放功能,方法：以正－负压平衡试验法,检测34耳外伤性鼓膜穿孔和57耳分泌性中耳炎鼓膜切开后的咽鼓管功能。结果：外伤性鼓膜穿孔耳的咽鼓管开放压分布在175－400kPa间,正压平衡试验时,经3次吞咽全部受检耳外耳道压力都降至所加压力的一半以下,负压平衡试验时,全部受检耳外耳道压力都有部分恢复。在57耳分泌性中耳炎耳中,咽鼓管开放压超过400kPa的11耳;正压平衡试验时,23耳不能恢复到压负荷的一半水平,负压平衡试验时,45耳经3次以上吞咽,外耳道鼓室压基本无变化。结论：成人分泌性中耳炎的咽鼓管功能,以负压平衡试验障碍为主,表现为主动开放功能不良。     

Immunoglobulin E in mucoid secretory otitis media

19 serum and 23 middle ear mucoid fluid samples from patients with chronic secretory otitis media (SOM) were analyzed for total IgE using the PRIST technique and for specific IgE against dog epithelium, house dust mite, milk, egg-white and wheat using the RAST technique. All serum samples showed IgE values well within the normal range, and the middle ear fluid-serum ratio for total IgE was less than 1. In three sera there was a weak (score 1) positive RAST result to milk (2 cases) and to egg-white (1 case). None of the middle ear fluids showed positive reactions. Routine clinical assessment of total and specific IgE is not indicated in SOM.