电视鼻内镜下咽鼓管吹张联合注药治疗慢性分泌性中耳炎疗效观察

目的探讨咽鼓管吹张术在慢性分泌性中耳炎治疗上的优劣及改进方法。方法将92例分泌性中耳炎患者随机分为治疗组（电视监视鼻内镜下咽鼓管吹张联合注药）48例及对照组（波氏球法咽鼓管吹张）44例,治疗后3个月后复查比较。结果3个月后复查治疗组复发1例,对照组复发8例,治疗组复发1病例改为鼓膜置管,对照组复发8例中,5例先后改为电视监视鼻内镜下咽鼓管吹张联合注药后好转,3例改为鼓膜置管。两组4例因鼻咽咽121黏膜瘢痕而改为鼓膜置管。结论电视监视鼻内镜下咽鼓管吹张联合注药治疗慢性分泌性中耳炎具有视野清楚,操作简便,创伤小的特点,避免了盲目性,是传统方法无法做到的。     

分泌性中耳炎64例分析

分泌性中耳炎是耳鼻喉科常见疾病之一,是以鼓室积液及听力下降为主要特征的中耳非化脓性炎症疾病,可分为急、慢性两种.目前认为分泌性中耳炎主要由咽鼓管功能障碍、感染和免疫反应等因素引起.我科2006-08-2010-04共收治分泌性中耳炎患者64例(72耳),现将结果报告如下.     

鼻内镜下经咽鼓管抽液注药治疗鼓室积液临床体会

目的 探讨鼻内镜下经咽鼓管抽液注药治疗鼓室积液的疗效。方法 70例(78耳)鼓室积液患者在鼻内镜明视下用直径为lmm的硬膜外麻醉导管从咽鼓管咽口插入行咽鼓管吹张和疏通后抽液，并在鼓室内注入头孢拉定0.5 9、曲安奈德40 mg、糜蛋白酶4000U混合液lml，每周2次，治疗3次。结果 经治疗后随访6个月以上，治愈52耳(66.67％)，有效19耳(24.36％)，无效7耳(8.97％)，总有效率达91.03％。全部病例治疗后均无中耳感染、听力减退、持续性眩晕等并发症。结论 鼻内镜下经咽鼓管抽液注药治疗鼓室积液具有疗效显著、操作简便、治疗部位准确、并发症少、不破坏鼓膜生理结构等特点，有较好的临床应用价值。     

鼻内镜手术后并发分泌性中耳炎的临床探讨

目的探讨鼻内镜手术后分泌性中耳炎发生的原因。方法为50例78侧慢性鼻窦炎患者行鼻内镜鼻窦手术,手术前后检查咽鼓管功能,术后随访检查咽鼓管咽口,分析分泌性中耳炎的发生率及原因。结果50例78侧手术中,术前咽鼓管功能正常70耳,异常8耳,术后咽鼓管功能正常56耳,异常22耳,差异有统计学意义（P〈0．05）：术后咽鼓管功能正常组中咽鼓管咽口肿胀8耳,咽鼓管功能异常组中咽鼓管咽口黏膜肿胀16耳,差异有统计学意义（P〈0．05）;术后6例10耳发生分泌性中耳炎中,9耳咽鼓管咽口肿胀,1耳咽鼓管咽口正常,差异有统计学意义（P〈0．05）。结论鼻内镜手术后可能会出现咽鼓管咽口炎性肿胀,导致咽鼓管功能障碍至分泌性中耳炎。     

鼻咽癌调强适形放射治疗后分泌性中耳炎的临床观察

目的 观察分析鼻咽癌调强适形放射治疗后分泌性中耳炎发生情况.方法 通过CT或MRI检查,随访观察170例(340耳)调强放疗后并发的分泌性中耳炎的鼻咽癌患者,分析其发生情况.结果 发现放疗前分泌性中耳炎的发病率为96(28.2％)耳,并随着肿瘤分期增高而增高;放疗前有放疗后不变或加重61 (17.9％)耳,放疗后好转35 (10.3％)耳;放疗前无分泌性中耳炎者,放疗后发生新的分泌性中耳炎78 (22.9％)耳.结论 鼻咽癌调强放适形疗后并发分泌性中耳炎较文献报道常规的二维放疗低,临床症状较轻,提高了患者的生存质量.     

鼻内镜下手术治疗鼻咽癌放疗后鼻窦炎的临床观察

目的探讨鼻咽癌(nasopharygeal carcinoma,NPC)放疗后鼻窦炎的鼻内镜手术治疗的临床疗效。方法对34例鼻咽癌放疗后并发鼻窦炎患者,经鼻腔冲洗及药物保守治疗3个月以上未愈,采用鼻内镜下手术治疗,术后随访6～18个月,观察其疗效。结果34例中,治愈28例(51.1%),好转5例(46.5%),无效1例(2.3%),总有效率97.7%。7例发生鼻腔粘连,经定期鼻内镜检查及鼻腔清理而治愈。结论鼻内镜下手术治疗放疗后鼻窦炎疗效显著,术后定期随访并作鼻腔清理可防止鼻腔粘连及复发。     

鼻内镜下手术治疗鼻咽癌放疗后鼻窦炎的临床观察

目的探讨鼻咽癌（nasopharygeal carcinoma,NPC）放疗后鼻窦炎的鼻内镜手术治疗的临床疗效。方法对34例鼻咽癌放疗后并发鼻窦炎患者。经鼻腔冲洗及药物保守治疗3个月以上未愈,采用鼻内镜下手术治疗,术后随访6-18个月,观察其疗效。结果34例中,治愈28例（51．1％）,好转5例（46．5％）,无效1例（2．3％）,总有效率97．7％。7例发生鼻腔粘连,经定期鼻内镜检查及鼻腔清理而治愈。结论鼻内镜下手术治疗放疗后鼻窦炎疗效显著,术后定期随访并作鼻腔清理可防止鼻腔粘连及复发。     

鼻咽癌放疗后渗出性中耳炎的原因及影响因素

目的分析鼻咽癌放疗后发生渗出性中耳炎的相关原因及影响因素。方法选择放疗前无并发渗出性中耳炎的常规分割放疗鼻咽癌病例102例(204耳),观察放疗后渗出性中耳炎发生情况。结果102例(204耳)鼻咽癌患者放疗后渗出性中耳炎的发生率为43.1%(88/204),其中46耳在放疗后6个月内发生渗出性中耳炎,占放疗后渗出性中耳炎的52.3%(46/88),中耳受照剂量为53.8~79.79Gy的患者渗出性中耳炎的发生率为54.4%,受照剂量为~70.0Gy者渗出性中耳炎的发生率为64.0%。年龄≤47岁发生率为52.8%,>47岁组发生率为63.0%(p=0.029)。肿瘤侵及鼻咽侧壁的患者渗出性中耳炎发生率较高(p=0.021;OR=2.358)。行鼻咽部清洗者渗出性中耳炎发生率较低(p=0.029;OR=0.184)。结论中耳受照剂量、患者年龄、鼻咽侧壁侵犯以及是否行鼻咽清洗是鼻咽癌患者放疗后渗出性中耳炎发生的主要影响因素;鼻咽清洗可减少渗出性中耳炎的发生,对改善患者的生存质量有重要意义。     

鼻内镜下咽鼓管手术治疗分泌性中耳炎的疗效观察

目的:研究分泌性中耳炎患者采用鼻内镜下咽鼓管手术治疗的临床效果。方法:病例样本为2017年12月~2019年12月时间段我院收治的90例分泌性中耳炎患者,分组方式为随机数字表法,平均划分为两组,即研究组和对照组,两组样本量保持一致,n=45,对照组患者治疗方案为常规鼓膜切开置管术,研究组患者治疗方案为鼻内镜下咽鼓管手术,研究比较组间手术效果。结果:评估组间临床治疗总有效率,研究组高于对照组(P<0.05),评估组间不良反应反应发生率,研究组对于对照组(P<0.05)。结论:分泌性中耳炎患者采用鼻内镜下咽鼓管手术治疗临床效果显著,不良反应发生率低,值得临床推广应用。     

内镜引导下咽鼓管吹张激素给药治疗分泌性中耳炎效果观察

目的 分析内镜引导下咽鼓管吹张激素给药在分泌性中耳炎患者中的应用效果。方法 选择深圳市萨米医疗中心2021年1月—2022年12月收治的分泌性中耳炎患者中抽取94例作为研究对象,随机数字表法分为对照组47例与观察组47例。对照组采用常规治疗以及波氏法咽鼓管吹张治疗,观察组采用常规治疗联合内镜引导下咽鼓管吹张激素给药。对比观察两组患者治疗前后7项咽鼓管功能障碍症状评分量表（the seven-item Eustachian tube dysfunction questionnaire,ETDQ-7）评分、治疗有效率、并发症不良反应发生率以及疾病复发情况。结果 治疗前,两组患者ETDQ-7评分组间比较差异无统计学意义（P> 0.05）;治疗后,两组患者ETDQ-7评分均显著降低,且观察组评分低于对照组（P <0.05）。观察组治疗有效率为95.74%(45/47),显著高于对照组的82.98%(39/47)(P <0.05)。观察组并发症以及不良反应发生率6.38%(3/47)、复发率6.38%(3/47)均显著低于对照组21.28%(10/47)、82.98%(39/4...     

放疗联合化疗治疗局部晚期鼻咽癌的疗效观察

目的 观察局部晚期鼻咽癌患者单纯放疗和放疗联合化疗的疗效和毒副作用。方法 将89例Ⅲ～Ⅳa期鼻咽癌患者随机分为两组，研究组（A组）45例，放疗同期应用化疗（化疗方案：顺铂20mg／a，静脉滴注，第1～5天；氟脲嘧啶500mg／a，静脉滴注，第1～5天；亚叶酸钙0．2g／a，静脉滴注，第1～5天）；对照组（B组）44例，单纯放疗。结果 研究组和对照组的完全缓解率、颈淋巴结残留率分别为82．22％、75．00％和11．54％、26．09％，差异无统计学意义，P〉0．05。2年及5年生存率分别为53．33％、47．73％和26．67％、20．45％，差异无统计学意义，P〉0．05。两组毒副作用差异有统汁学意义，研究组胃肠道反应、骨髓抑制比对照组明显增大，P〈0．05。结论 放疗联合化疗对局部晚期鼻咽癌的疗效提高不能完全肯定。     

两种术式联合治疗分泌性中耳炎的可行性研究

目的研究两种术式联合治疗分泌性中耳炎的可行性,探讨其临床适用性。方法将从2012年5月—2013年9月在我院接受治疗的56例分泌性中耳炎患者作为研究对象,按照随机数表法将患者随机分为实验组和对照组两组,对照组患者采用鼓膜置管术进行治疗,实验组患者采用鼓膜置管联合腺样体切除术进行治疗。观察记录两组患者治疗后临床疗效以及并发症的发生情况,并进行比较。结果治疗后,实验组患者总有效率为92.9%,对照组为71.4%,两组对比,差异有统计学意义（χ2=4.3826,P=0.0363）。结论鼓膜置管联合腺样体切除术治疗分泌性中耳炎效果良好,并发症少,适合临床长期推广应用。     

吉西他滨联合奈达铂同期放化疗治疗晚期鼻咽癌的临床研究

目的 观察吉西他滨联合奈达铂同期放化疗治疗晚期鼻咽癌的临床疗效.方法 将76例晚期鼻咽癌患者按随机数字表法分为两组,观察组38例采用吉西他滨联合奈达铂同期放化疗,对照组38例采用氟尿嘧啶联合顺铂同期放化疗,观察比较两组的临床疗效和不良反应.结果 观察组的总有效率为84.2％(32/38),明显高于对照组的60.5％(23/38),差异有统计学意义(P＜0.05).两组1年生存率比较差异无统计学意义[89.5％(34/38)比76.3％(29/38)](P＞ 0.05).观察组消化道反应发生率和口腔溃疡发生率分别为42.1％(16/38)和7.9％(3/38),均明显低于对照组的73.7％(28/38)、31.6％(12/38)(P＜ 0.05),而两组骨髓抑制发生率比较差异无统计学意义[31.6％(12/38)比23.7％(9/38)](P＞ 0.05).结论 吉西他滨联合奈达铂同期放化疗治疗晚期鼻咽癌,能够明显提高临床疗效,减少不良反应.     

Pneumococcal vaccine impact on otitis media microbiology: A New Zealand cohort study before and after the introduction of PHiD-CV10 vaccine

We compared the microbiology of middle ear fluid (MEF) in two cohorts of children having ventilation tube (VT) insertion; the first in the era of 7-valent Streptococcus pneumoniae conjugate vaccine (PCV7) and the second following introduction of the ten-valent pneumococcal vaccine (PHiD-CV10).MethodsDuring 2011 (Phase 1) and again in 2014 (Phase 2) MEF and NP samples from 325 children and 319 children were taken at the time of VT insertion. A matched comparison group had NP swabs collected with 137 children (Phase 1) and 154 (Phase 2). Culture was performed on all NP and MEF samples with further molecular identification of Haemophilus species, serotyping of S. pneumoniae, and polymerase chain reaction (PCR) testing on all MEF samples.ResultsIn Phase 2 immunisation coverage with ⩾3 doses of PHiD-CV10 was 93%. The rate and ratios of culture and molecular detection of the 3 main otopathogens was unchanged between Phase 1 and Phase 2 in both MEF and NP. Haemophilus influenzae was cultured in one quarter and detected by PCR in 53% of MEF samples in both time periods. S. pneumoniae and Moraxella catarrhalis were cultured in up to 13% and detected by PCR in 27% and 40% respectively of MEF samples. H. influenzae was the most common organism isolated from NP samples (61%) in the children undergoing VT surgery whilst M. catarrhalis (49%) was the most common in the non-otitis prone group. 19A was the most prominent S. pneumoniae serotype in both MEF and NP samples in Phase 2. Of Haemophilus isolates, 95% were confirmed to be non-typeable H. influenzae (NTHi) over both time periods.ConclusionFollowing implementation of PHiD-CV10 in New Zealand, there has been no significant change in the 3 major otopathogens in NP or MEF in children with established ear disease. For these children non-typeable H. influenzae remains the dominant otopathogen detected.     

氨溴索治疗豚鼠分泌性中耳炎后咽鼓管黏膜的超微结构研究

目的应用氨溴索治疗豚鼠分泌性中耳炎后,用超微细胞化学方法观察豚鼠咽鼓管黏膜细胞超微结构。方法用已制成分泌性中耳炎的豚鼠分成2组,分别用氨溴索及生理盐水注入鼓室,电镜及光镜下观察咽鼓管黏膜上皮超微结构的变化。结果2组在病理方面有显著差异,氨溴索治疗组咽鼓管上皮的纤毛及微绒毛病变轻。结论应用氨溴索治疗豚鼠分泌性中耳炎前后咽鼓管黏膜上皮板层体样结构的数量增加,结构迅速恢复。     

Genetic and functional evidence for a role for SLC11A1 in susceptibility to otitis media in early childhood in a Western Australian population

Otitis media (OM) is a common disease in early childhood characterised by inflammation of the middle ear. Susceptibility to recurrent acute OM (rAOM; ⩾3 episodes AOM in 6 months) and chronic OM with effusion (COME; middle ear effusion ⩾3 months) is 40–70% heritable. Three bacterial pathogens commonly associated with OM, Streptococcus pneumoniae (Sp), non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mc), have been observed within adenoids and as facultative intracellular pathogens that invade and survive in mononuclear cells. Case/pseudo-control conditional logistic regression analysis of variants in the SLC11A1 gene, initially identified for its role in resistance to intra-macrophage pathogens in mice, revealed association with OM at four polymorphisms (P_best = 0.025) in 531 families (660 affected children) from the Western Australian Family Study of Otitis Media. This included association at the functional promoter GTn polymorphism (rs34448891) with alleles that regulate high (allele 3; odds ratio = 1.2, 95% CI 1.00–1.44, P = 0.04) versus low (allele 2; odds ratio = 0.83, 95% CI 0.69–0.99, P = 0.04) SLC11A1 expression. Haplotype and stepwise conditional logistic regression analyses support a single genetic effect in the proximal region of SLC11A1, with the haplotype 3_C_C_G across rs34448891_rs2276631_rs3731865_rs2695343 significantly (P = 0.008) over-transmitted to affected offspring. Stratified analysis showed no association with OM in children who had undergone adenoidectomy (296 children), whereas children with adenoids intact (364 children) showed improved significance at the GTn polymorphism (allele 3: odds ratio = 1.38, 95% CI = 1.10–1.75, P = 0.006). Quantitative RT/PCR demonstrated high expression of SLC11A1 in mononuclear cells isolated from adenoid tissue, with a trend for decreased expression with increasing copies of GTn allele 2. Expression of SLC11A1 was enhanced at 12 (P = 1.2 × 10⁻³) and 24 h (P < 1.0 × 10⁻⁴) after infection of Mono-Mac-6 cells with NTHi. This study identifies SLC11A1 as a novel candidate for OM susceptibility, particularly in children with adenoids intact. Further analysis in other cohorts is required to validate these observations.     

护理干预在鼻咽癌患者放疗中的应用分析

目的探讨护理干预对鼻咽癌放疗不良反应的影响。方法尽早对在放疗过程中出现的不良反应进行有预见性的观察与护理,保证放疗计划顺利进行。结果98例鼻咽癌患者,在医生和护士的密切配合下,放疗顺利完成,达到了预期效果。结论针对鼻咽癌患者在放疗前中后施行护理干预,能有效减轻患者放疗不良反应,提高鼻咽癌患者的生活质量。     

有创和无创方法治疗分泌性中耳炎的临床研究

目的 比较有创和无创方法治疗分泌性中耳炎的临床疗效.方法 将76例(94耳)分泌性中耳炎患者按随机数字表法分为两组,有创组38例(48耳),无创组38例(46耳).有创组行耳内窥镜下鼓膜切开置管抽取积液,并用α-糜蛋白酶和地塞米松溶液冲洗1～2次;无创组行鼻内窥镜下咽鼓管吹张并经咽鼓管咽口注入糜蛋白酶和地塞米松1～2次.比较两组的临床疗效.结果 随访6～12个月,有创组总有效率为95.8%(46/48),无创组总有效率为93.5%(43/46),两组总有效率比较差异无统计学意义(P＞0.05);有创组鼓室导抗图恢复正常时间为(37.5±5.9)d,无创组为(38.6±6.1)d,两组比较差异无统计学意义(P＞0.05);有创组纯音测听检查听力提高(20.4±2.7)dB,无创组纯音测听检查听力提高(19.9±2.5)dB,两组比较差异无统计学意义(P＞0.05).结论 有创和无创方法治疗分泌性中耳炎均有满意效果,医师可以根据患者具体情况选择合适的方案.

Abstract：

Objective To compare the clinical effects of invasive and non-invasive therapy in treatment of otitis media with effusion. Methods Seventy-six patients (94 ears) with otitis media with effusion were divided into two groups by random digits table. The invasive group (38 cases, 48 ears) was treated by oto-endoscopic myringotomy and grommet insertion and chymotrypsin with dexamethasone washing for 1-2 times; and the non-invasive group (38 cases, 46 ears) was treated by eustachian tube blowing under nasal endoscopy and injecting chymotrypsin and dexamethasone for 1-2 times. The clinical effects between the two groups were compared. Results The patients were followed up for 6-12 months. The total effective rate was 95.8%(46/48) in the invasive group and 93.5%(43/46) in the non-invasive group, the difference was not statistically significant (P ＞ 0.05 ). The ear pressure chart recovery time was (37.5 ± 5.9) d in the invasive group and (38.6 ± 6.1 ) d in the non-invasive group, the difference was not statistically significant (P ＞ 0.05 ). The pure tone audiometry hearing improved ( 20.4 ± 2.7 ) dB in the invasive group and ( 19.9 ±2.5) dB in the non-invasive group, the difference was not statistically significant (P ＞ 0.05 ). Conclusion Both of invasive and non-invasive therapy in treatment of otitis media with effusion have good results, the doctors should choose the appropriate solution according to the patients' condition.     

治疗鼻咽癌放射治疗后鼻窦炎的临床观察

目的 观察鼻内窥镜手术在治疗鼻咽癌放疗后鼻窦炎的疗效。方法 对28例经药物保守治疗一年后无效的鼻咽癌放疗后鼻窦炎患者行鼻内窥镜直视下手术治疗。结果 随访2～4．5年，经过鼻内窥镜直视下手术治疗后，鼻窦炎患者获治愈者12例，有效16例，有效率为（100％）。结论 在治疗鼻咽癌放疗后鼻窦炎中，择期应用鼻内窥镜手术具有重要的临床治疗价值。