Complications following ventilation of the middle ear using Goode T tubes

This is a 3.5-year retrospective review on the insertion of 210 Goode T tubes into 182 ears of 93 patients. Otorrhea was noted postoperatively in 35.2% of the ears treated, with chronic drainage lasting longer than 4 months developing in more than 7% of the cases. Perforations were found in 34 ears (18.7%) following removal or extrusion of the T tubes; in 13 (7.1%) of these patients, chronic perforations requiring tympanoplasties developed. The literature was screened for additional studies addressing the complications associated with tympanostomy tubes. The documented incidence of perforations between conventional tubes and Goode T tubes was emphasized, and comparisons were made. Our findings indicate that, even with the immediate placement of paper patches following removal of all Goode T tubes, the percentage of tympanic membrane perforations resulting from the use of Goode T tubes is significantly greater than previously reported.     

Anterior subannular T-tube for long-term middle ear ventilation during tympanoplasty.

OBJECTIVE: A technique for providing long-term ventilation of the middle ear (ME) during tympanoplasty is described, and the results using this technique in 20 patients with chronic Eustachian tube dysfunction (ETD) are reported. STUDY DESIGN: This study was a retrospective, nonrandomized case review. SETTING: This study was conducted at an otology clinic in a tertiary referral center. PATIENTS: Twenty consecutive patients who underwent tympanoplasty with ETD, adhesive otitis media, or chronic otitis media with perforation were included in this study. INTERVENTION: All patients had a subannular T-tube placed anteriorly at the time of tympanoplasty for long-term ventilation of the ME space. MAIN OUTCOME MEASURES: The two main outcome measures were tube position and patency. Preoperative and postoperative hearing levels were also tested in most patients, and any complications were documented. RESULTS: Twenty patients (20 ears) received anterior subannular T-tubes at the time of tympanoplasty. Fourteen females and 6 males were evaluated (median age, 36 years; range, 7 to 72 years). All patients had ETD; 7 had adhesive otitis media, 10 had chronic otitis media, 8 had cholesteatoma, and 2 had cleft palate. All patients had conductive hearing loss and previous surgery. All patients underwent tympanoplasty; 11 had concomitant ossiculoplasty, and 5 had mastoidectomy. Follow-up ranged from 8 to 22 months (mean, 13.4 months). One patient was lost to follow-up. One tube extruded after 16 months. Two patients had persistent mild retraction of the tympanic membrane. All other tubes are patent and have not migrated or plugged. There has been no evidence of anterior blunting or ingrowth of epithelium around the tube. CONCLUSIONS: Anterior subannular T-tube placement is a simple, safe, and effective alternative for long-term ME ventilation in patients in whom standard transtympanic sites are not available. At their last follow-up visit, all but one patient had a patent tube. All MEs were aerated. This technique offers the advantage of ease of placement during simultaneous tympanoplasty, mastoidectomy, or ossiculoplasty. Longer follow-up is necessary to confirm these initial findings.     

Perforation rates after ventilation tube insertion: does the positioning of the tube matter?

A prospective study was performed of children undergoing bilateral ventilation tube insertion. One hundred and twenty-one children aged between 9 months and 10 years 3 months were admitted for surgery for secretory otitis media (glue ear). Each child had a ventilation tube inserted anteriorly in the tympanic membrane of one ear and posteriorly in the tympanic membrane of the other. They underwent regular clinical and audiological assessment until extrusion of the ventilation tubes occurred. Perforations were noted in 2.75% of tympanic membranes (4.6% of the children). The rate with posteriorly placed ventilation tubes was higher than with the anteriorly placed ventilation tubes (3.7% compared with 1.8%) though this is not statistically significant.     

First myringotomy with insertion of a modified Goode T-Tube: changing the perforation paradigm

BACKGROUND: Goode T-Tubes (Medtronic Xomed, Inc) have a bad reputation because of their residual tympanic perforation rate. However, these long-term tubes are mostly used in patients with chronic middle ear problems. On the other hand, "safer," short-term tubes may need to be reinserted in up to 20% of children. OBJECTIVE: To demonstrate that modified Goode T-Tubes inserted at the first myringotomy in normal children leave a perforation rate comparable to the rate reported in the literature for short-term tubes and may be extracted safely in the outpatient clinic when eustachian tube function is thought to be adequate. METHOD: This prospective study followed 58 children (100 ears) who had their modified Goode T-Tubes electively removed in the clinic, from October 2003 to November 2004. RESULTS: We found only one persistent perforation at the third follow-up (mean time 5.2 months). The tubes had been in place for an average of 2.9 years. The perforation healing rate was inversely related to intubation duration. Adenotonsillectomy seemed to favourably influence the speed of healing. The perforations healed faster when tubes were inserted for chronic middle ear effusion compared with recurrent acute otitis media. Age, gender, and the site of intubation were not related to persistent perforation. All of the tubes spontaneously extruded (13) healed without perforation. CONCLUSION: Modified Goode T-Tubes inserted at the first myringotomy and electively extracted allow for a longer middle ear ventilation period and have a perforation rate comparable to that of short-term tubes.     

鼻内镜下咽鼓管置管术治疗分泌性中耳炎

目的探索有效治疗分泌性中耳炎的方法。方法将分泌性中耳炎患者63例（78耳）随机分成两组：实验组：在鼻内镜下,对31例（38耳）分泌性中耳炎患者行咽鼓管置管术,留管并反复注药治疗;对照组：对32例（40耳）患者使用传统的鼓膜切开置管术治疗,术后随访6～9个月,比较两组疗效。结果实验组治愈16耳,占42．1％,好转18耳,占47．4％,总有效率89．5％：对照组：治愈8耳,占20．0％,好转21耳,占52.5％,总有效率72．5％。治疗后两组差异有显著性（P〈0．05）。结论在鼻内镜下行咽鼓管置管术是在直视下操作,通过咽鼓管的自然通道插入导管,不仅避免了损伤鼓膜,也避免了咽鼓管吹张的重复操作,为临床治疗分泌性中耳炎提供了一个良好途径。     

儿童鼓膜通气管留置时间与并发症关系

目的：研究儿童鼓膜通气管留置时间与并发症的关系。方法：364例（714耳）分泌性中耳炎（OME）患儿鼓膜置管后1～36个月取管,总结不同时间段取管并发症出现比例,并进行统计分析。结果：通气管留置1～6个月29例（55耳）,其中脱管1例（3．4％）,堵管3例（10．3％）,置管陷入鼓室0例,肉芽增生0例,胆脂瘤0例,耳漏2例（6．9％）,鼓膜穿孔0例;6～12个月96例（190耳）,其中脱管7例（7．3％）,堵管15例（15．6％）,置管陷入鼓室1例（1．0％）,肉芽增生0例,胆脂瘤0例,耳漏5例（5．2％）,鼓膜穿孔0例;留置12～24个月156例（308耳）,其中脱管14例（9．0％）,堵管20例（12．8％）,置管陷入鼓室2例（1．3％）,肉芽增生3例（1．9％）,胆脂瘤1例（0．6％）,耳漏4例（2．5％）,鼓膜穿孔0例;留置24～36个月83例（161耳）,其中脱管30例（36．1％）,堵管44例（53．0％）,置管陷入鼓室5例（6．0％）,肉芽增生3例（3．6％）,胆脂瘤2例（2．4％）,耳漏2例（2．4％）,鼓膜穿孔2例（2．4％）。全部病例未发现鼓室硬化者。结论：2年以内鼓膜通气管留置时间与并发症关系不大;2年以上脱管和堵管发生率显著增高,其他并发症发生率无显著增高。     

Comparison of the Goode T-tube with the Armstrong tube in children with chronic otitis media with effusion

Treatment of otitis media with effusion is focused on reaeration of the middle ear cavity. In achieving long-term aeration, the insertion of ventilation tubes that have a long duration of stay can be beneficial. The results are presented of a trial in which the Goode T-tube was compared with the Armstrong tube. Fifteen children were treated between 1981 and 1986 with a T-tube in one ear and a conventional tube in the other. The results are different with regard to duration of stay in the tympanic membrane. Re-insertions were necessary in 47 per cent in the Armstrong group and in 20 per cent in the T-tube group. Otorrhoea occurred in 20 per cent of the Armstrong and 13 per cent of the T-tube intubated ears. A persistent perforation was present in 6 per cent of the ears in both groups. It is concluded that the Goode T-tube is indicated primarily in cases when long-term ventilation is needed.     

A prospective randomized study of four commonly used tympanostomy tubes

Tympanostomy tube placement has clearly been shown to be an efficacious treatment for recurrent bouts of acute otitis media or chronic otitis media with effusion. However, there are few objective, prospective, randomized studies present in the literature to aid the clinical otolaryngologist with the proper tube choice for middle ear aeration. A prospective, randomized study was undertaken of four commonly used tympanostomy tubes. Shepard Teflon grommet, Armstrong beveled tube, Reuter-Bobbin tube, and Goode T-tube. This study was undertaken to determine which of these tubes had the fewest number of postplacement complications, including otorrhea, plugging, residual perforation, or chronic persistence in the tympanic membrane. Average follow-up was 17 months. The Shepard and Armstrong tubes showed a comparatively low rate of plugging and otorrhea. Both tubes had extrusion times that averaged less than 1 year. The Reuter-Bobbin tube had a much greater rate of plugging, compared to the other tubes. The T-tube had an increased incidence of otorrhea and persistence in the tympanic membrane well beyond 1 year. The T-tube was also the only tube in this study associated with residual perforations.     

The feasibility of office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion: the duPont Hospital experience.

OBJECTIVE: To determine the feasibility of inserting tympanostomy tubes in children using office-based laser-assisted tympanic membrane fenestration. METHODS AND MATERIALS: Study consisted of a retrospective review of the charts of all children who underwent office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion from July 1, 1998 to August 31, 2000. Tetracaine eardrops were used for topical anesthesia. Fenestration was achieved with the OtoLAM flashscanner laser (ESC Sharplan, Yokneam, Israel). RESULTS: Of the 127 patients (185 ears) who underwent laser-assisted tympanic membrane fenestration, 61 ears underwent tympanostomy tube insertion. Ten ears were treated for otitis media with effusion, 43 for recurrent acute otitis media, and eight for acute otitis media not responding to antibiotics. Fifteen ears had purulent effusion, five had a serous effusion, and 23 had mucoid middle ear fluid. Eighteen ears had no middle ear fluid. At the first follow-up visit, all tested ears had hearing of 20 dB or better. Two children had tubes that were blocked. Blockage occurred in ears that required more than one laser firing to penetrate the tympanic membrane. Otorrhea was present in 13 ears (21%). Otorrhea occurred exclusively in ears with purulent or mucoid middle ear fluid. CONCLUSIONS: Office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion is a safe and effective alternative to tube placement in the operating room. The outcome compares favorably with previously published data.     

Phosphorylcholine-coated antibiotic tympanostomy tubes: are post-tube placement complications reduced?

OBJECTIVE: To determine if a phosphorylcholine (PC) antibacterial coating on standard Armstrong beveled tympanostomy tubes (TT) reduced the incidence of post-tube placement complications. METHODS: A prospective cohort aged 8-51 months received bilateral TTs for otitis media with effusion between July 2002 and February 2004 at a tertiary care pediatric hospital. Seventy children were randomized to receive a PC-coated TT in one ear and an uncoated TT in the other. Otologic examinations at prescribed intervals over two years post-operatively ascertained the status of sequelae. We analyzed the incidence of TT complications: otorrhea, premature extrusion, persistent tympanic membrane perforations, granulation tissue, and ventilation tube lumen obstruction. RESULTS: There was no statistical difference in the incidence of any of these sequelae between standard and PC-coated tympanostomy tubes (p>0.05) during the 24-month-follow-up period. Results after 13 months of follow-up may have been affected by patients lost to follow-up and therefore a smaller sample size as the study continued. CONCLUSIONS: This study found that there is no statistically significant difference in the incidence of complications between uncoated and PC-coated fluoroplastic Armstrong beveled TTs.     

Effectiveness of laser-assisted myringotomy for otitis media in children

OBJECTIVE: To evaluate the effectiveness of OtoScan CO2 laser-assisted myringotomy (OtoLAM ESC/Sharplan) for acute otitis media and chronic otitis media with effusion (COME) in children. STUDY DESIGN: Retrospective review of 47 children with refractory acute otitis media (RAOM) or COME more than 3 months in duration in a pediatric otolaryngology practice. METHODS: Laser-assisted myringotomy was performed on 47 patients (79 ears) using the OtoLAM device. There were 28 children (ages 0.50-3 years) with RAOM and 19 children (ages 0.58-15 years) with COME. RESULTS: A total of 57.4% of procedures were considered treatment failures. Failures occurred in 53.6% of patients with RAOM on average +/-SD 3.89 +/- 2.16 weeks after the procedure and in 63.2% of patients with COME on average +/-SD 7.25 +/- 5.57 weeks after the procedure. Age, sex, microorganism isolated, myringotomy size, wattage, and laterality did not predict outcome. Ventilation tube insertion was performed in 27 (57.4%) patients. Two patients have persistent tympanic membrane perforations at 2 years. CONCLUSIONS: Laser-assisted myringotomy in children with RAOM and COME was associated with a high incidence of recurrence or persistence of disease and with perforation of the tympanic membrane. Recommendations for use of the OtoLAM should include discussion of high failure rates and the strong likelihood of subsequent ventilation tube insertion. The OtoLAM remains an option for office-based ventilation of the middle ear for families and patients where general anesthesia is a concern.     

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。     

A new ventilation tube for long-term middle ear ventilation

OBJECTIVES: The treatment of secretory otitis media often requires repeated tubulation of the tympanic membrane as the standard ventilation tubes are extruded before the disease of the middle ear has remitted. The T-tube and its modification have been developed to remain longer in situ, often requiring surgical removal. The rates of subsequent persisting tympanic membrane perforations and granulations around the tube have been unacceptably high. In the search for a long-term ventilation tube with fewer complications, the Duravent tube (Smith and Nephew) has been developed. The aim of the study was to estimate duration in situ and observe complications in using the Duravent tube compared with standard tubes and T- tubes. STUDY DESIGN: Retrospective study. METHODS: In all, 51 patients have been treated with the Duravent tube over a 2-year period. In all, 72 Duravent tubes have been inserted. All patients were subsequently invited for a follow-up examination at a median time of 28 months (range, 11-43 mo) after the tube insertion and were followed up for 5 years. RESULTS: The duration in situ was optimal with a median duration of 17 months. The Duravent tube was extruded spontaneously in all but four cases in which surgical removal was necessary. The rate of persisting perforations of the tympanic membrane was low (4.2%) compared with 24% after the use of the T-tube. Likewise, the usual complications connected with long-term ventilation tubes were less frequent (14% compared with 35% when using the T-tube). CONCLUSIONS: In the present study, the Duravent tube has proved superior to other known long-term ventilation tubes. The problem of granulations, otorrhoea, and tube occlusion was significantly less than reported in other studies using the T-tube.     

Long-term follow-up of otitis media with effusion in children: Comparisons between a ventilation tube group and a non-ventilation tube group

Objective

The objective of this study was to investigate the long-term outcomes in children with otitis media with effusion who received either medical treatment or ventilation tubes.

Methods

We retrospectively analyzed the medical records of 89 bilateral cases of otitis media with effusion in children who were recommended to receive ventilation tube insertion and were followed up for more than 5 years. Tympanic membrane was inspected by otoscopic examination. Hearing was evaluated with pure tone audiometry. The mean duration of follow-up was 8.4 years (range, 5.2–15.7 years). Twenty-three children were treated without surgery, while 22 were treated once by ventilation tube insertion and 44 were treated more than once by ventilation tube insertion.

Results

At the fifth year of follow-up, both groups of children who underwent ventilation tube insertion had more frequent tympanic membrane abnormalities than the medication group (8.7% in those treated without surgery, 72.7% in those treated once by ventilation tube insertion, and 88.6% in those treated more than once by ventilation tube insertion). Common tympanic membrane abnormalities were retraction (27.0%) and tympanosclerotic plaque (23.6%), regardless of the treatment modality. At the fifth year follow-up, the average air-conduction threshold was 10.0 dB (± 6.5 dB) in patients treated without surgery, 15.9 dB (± 11.2 dB) in patients treated once by ventilation tube insertion, and 17.8 dB (± 7.6 dB) in those treated more than once by ventilation tube insertion. The audiological difference was significant when we compared the hearing level of children treated by medication without surgery to the two ventilation tube groups.

Conclusion

Though ventilation tube insertion can resolve hearing loss quickly, there were more tympanic membrane abnormalities and a decline in hearing levels in our ventilation tube insertion group vs. the observation group measured 5 years later. Physicians should therefore be cautious when applying a ventilation tube in patients with otitis media with effusion and should explain the risks to patients who are a candidate for repeated ventilation tube insertion.     

Myringosclerosis after tympanostomy tube insertion: Relation with tube retention time and gender

Objective

To determine relationship between myringosclerosis and tube retention time and sex in children with chronic otitis media with effusion who were treated with tympanostomy tube insertion. Also, the relationship between myringosclerosis both sex and initial age of tube insertion were investigated.

Methods

A total of 101 children (195 ears) were reviewed. Ears were divided into four groups according to retention time of tympanostomy tubes. Group I: Retention time of tympanostomy tube less than 6 months. Group II: Retention time of tympanostomy tube from 6 months to 12 months. Group III: Retention time of tympanostomy tube of 12 months or more. Group IV: Myringotomy group without tympanostomy tube insertion.

Results

The order of the myringosclerosis rates were as follows from the highest to lowest one; group III (44.1%), group II (42.4%), group I (14.3%), and group IV (7.7%). Myringosclerosis was more common in group I compared with group IV, but the difference was statistically not significant (p > 0.05). There were no statistically significant differences in myringosclerosis rates between the group II and group III (p > 0.05). On the other hand, statistically significant differences were observed in myringosclerosis rates between group I and group II (p < 0.05), and between group I and group III (p < 0.05); also similar significant differences were present in myringosclerosis rates between group IV and group II (p < 0.05), and between group IV and group III (p < 0.05). There was no significant difference between preschool age group and school age group. Myringosclerosis was observed in 40% of boys and in 51.2% of girls.

Conclusion

Myringosclerosis is frequent in patients who underwent tympanostomy tube insertion. The frequency of myringosclerosis is much higher in tympanic membranes with tympanostomy tube insertion than tympanic membranes with myringotomy, and the location of sclerotic plaques does not always correspond to the tympanostomy area. The myringosclerosis rate was increased when the tympanostomy tubes stay on tympanic membrane for a long time. Highest myringosclerosis rates were observed if the extrusion time was 12 months or longer. In our analysis, sex and initial age of tube insertion were not significant factors for the development of myringosclerosis after extrusion of tympanostomy tubes.     

A 14-year prospective follow-up study of children treated early in life with tympanostomy tubes: Part 2: Hearing outcomes

OBJECTIVE: To determine hearing outcomes in young children receiving early and repeated tympanostomy tube insertion for recurrent acute otitis media or otitis media with effusion. DESIGN: Prospective 14-year follow-up. SETTING: Central Hospital of Central Finland, a tertiary care hospital.Patients Three hundred five consecutive infants and young children with otitis media received initial tympanostomy tube insertion at the age of 5 to 16 months. The final study group comprised 237 patients (77.7%) attending the 14-year checkups. MAIN OUTCOME MEASURES: At the 14-year checkups, children received clinical examinations and audiometric testing for the determination of bone and air conduction pure-tone thresholds. RESULTS: The mean pure-tone average of 177 healed ears was 4.3 dB. The mean pure-tone average of all ears was 5.8 dB, with significantly poorer results in ears with abnormal outcomes such as grade II or higher pars tensa retraction, otitis media with effusion, and tympanic membrane perforation. Thirteen (5.5%) of 237 ears had a hearing level worse than 15 dB, and the better ear hearing level was poorer than 15 dB in 3 patients. CONCLUSIONS: The hearing level of healed ears was comparable to that of age-matched normal ears. Hearing losses were infrequent, of slight grade, and, when present, almost exclusively conductive and related to unsuccessful otological outcomes. From the hearing point of view, repeated tympanostomy tube insertion for recurrent acute otitis media or otitis media with effusion early in life is a safe treatment.     

Hearing loss in young adults who had ventilation tube insertion in childhood

It is known that insertion of ventilation tubes can cause damage to the tympanic membrane and hearing deterioration in the long-term. To investigate long-term effects of recurrent otitis media and of ventilation tube insertion, we used a study group (n = 358 subjects), with or without a history of otitis media and/or ventilation tube insertion, derived from a birth cohort that had been followed for 16 years. At 18 years of age, a standardized audiometric and otoscopic examination was performed. We found that ventilation tube insertion in childhood was associated with a mean persistent hearing loss in young adults of about 5 to 10 dB at the group level with a sensorineural component of 3 to 4 dB. This hearing loss could not be explained by the disease load of otitis media in childhood. Repeated insertions of ventilation tubes caused a greater deterioration of hearing than did a single insertion. Structural changes of the tympanic membrane were a mediating factor in the causal relationship between ventilation tube insertion and hearing loss. We conclude that ventilation tube insertion in childhood may induce hearing deterioration in the long-term.     

Clinical studies on attic retraction]

Attic retraction was studied in 327 ears of 264 patients in whom photographs of the tympanic membrane were taken from 1983 to 1989. Attic retraction was investigated clinically on the basis of findings of the tympanic membrane in reference to the photographs and ear X-ray findings, including CT. Attic retraction was also observed in 4.5% of cases without inflammation, but its severity was mild. The incidence of attic retraction in cases of adhesive otitis media was 42.7% in mild adhesive otitis media (adhesive grade I) and 60.8% in severe adhesive otitis media (adhesive grade II), both incidences were significantly higher than the incidence of 23.8% in cases of otitis media with effusion. Thus, the incidence of attic retraction increased as the grade of adhesion became severer. In cases of otitis media with effusion, the incidence was significantly higher in the adult group (32.3%) than in the child group (17.4%). In many of the ears with otitis media with effusion, adhesive grade I and chronic otitis media, the severity of attic retraction was mild. There were more cases of milder retraction in the child group than in the adult group. Attic retraction underwent change with time in 2.8% of cases, and cholesteatoma occurred in 1.8% of cases. No improvement in attic retraction was achieved by insertion of a ventilation tube. Bilateral attic retraction was observed in 56.9% of the child group and 30.2% of the adult group, and the difference was statistically significant. Ear X-ray findings by Schüller's method revealed many ears with poorly developed mastoid cells and poor pneumatization.(ABSTRACT TRUNCATED AT 250 WORDS)     

Otological and audiological outcomes five years after tympanostomy in early childhood

OBJECTIVE: Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long-term follow-up studies have included even a minority of patients under 1 year old. We investigated long-term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes. STUDY DESIGN: Prospective follow-up. METHODS: Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyv?skyl?, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure-tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds). RESULTS: Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively. CONCLUSIONS: Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow-up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.     

咽鼓管冠脉球囊扩张联合鼓膜置管治疗复发性分泌性中耳炎

目的观察咽鼓管冠脉球囊扩张联合鼓膜置管治疗复发性分泌性中耳炎的疗效。方法将49例（65耳）复发性分泌性中耳炎患者随机分为A、B、C组,A组为试验组,接受咽鼓管球囊扩张联合鼓膜置管治疗,共16例（22耳）,B和C组是对照组,B组单纯接受咽鼓管球囊扩张治疗,共16例（21耳）,C组单纯接受鼓膜置管治疗,共17例（22耳）。所有球囊扩张器械使用冠状动脉球囊。患者术后1、3、6个月定期随访。术后通过咽鼓管功能障碍7项问卷评分（the seven item eustachian tube dysfunction questionair,ETDQ 7）、咽鼓管评分量表（eustachian tube score,ETS）及声导抗进行疗效评价。结果3组患者术后1、3、6个月咽鼓管功能均有提高。鼓膜愈合后复查,A型鼓室图逐渐增多。A组术后3、6个月ETDQ 7评分均较B组和C组低,对照组C组较B组低。术后3、6个月ETS得分A组均高于B、C组,对照组之间C组较B组高。 结论对于复发性分泌性中耳炎的患者咽鼓管球囊扩张联合鼓膜置管能显著改善患者咽鼓管功能,提高分泌性中耳炎的治疗效果。冠状动脉球囊价格较常规咽鼓管球囊便宜,用于治疗分泌性中耳炎取得了同样好的疗效。