难治性分泌性中耳炎术后听力影响因素分析

目的探讨难治性分泌性中耳炎采用乳突轮廓化并行鼓膜置管和单纯鼓膜置管术后,患者听力的改变及其有无差异,并对影响术后听力改变的可能因素进行分析。方法回顾性分析2001年3月～2011年6月收治的难治性分泌性中耳炎患者52例（86耳）,其中20例（33耳）行乳突轮廓化联合鼓膜置管治疗,32例（53耳）仅行鼓膜置管治疗,所有患者均在鼓膜置管术后3~6个月拔管。分析影响术后听力改变的可能因素,涵盖性别、年龄、鼓室黏膜、乳突轮廓化、中耳积液性质、脱管史、耳溢液史、留管时间等。结果乳突轮廓化联合鼓膜置管组术后听力提高30耳（90.9%）;单纯鼓膜置管组术后听力提高38耳（71.7%）。两组相比有显著性差异（χ2=4.535,P=0.033）。对影响难治性分泌性中耳炎患者术后听力的可能因素行多因素统计学分析,提示患耳脱管史（OR=13.425,P＜0.05）、中耳CT结果（OR=0.057, P＜0.05）是影响术后听力的主要因素。结论患耳脱管史和中耳CT结果是影响难治性分泌性中耳炎患者术后听力的重要因素,尤其对于中耳CT提示病变范围较广时,应在鼓膜置管基础上清除中耳鼓室、鼓窦和乳突病变,扩大中耳鼓室、乳突气房容积,改善中耳腔持续负压状态,并建立乳突、鼓室至鼓膜置管通畅引流,对提高听力防止并发症有积极治疗作用。     

咽鼓管球囊扩张术治疗难治性分泌性中耳炎的策略和疗效分析

目的探讨咽鼓管球囊扩张术(balloon eustachian tuboplasty,BET)在难治性分泌性中耳炎中的治疗效果以及其围手术期的处理策略。方法收集难治性分泌性中耳炎患者20例(25耳)。同期行BET并鼓膜切开置管术(2例前期行鼓膜穿刺术)。随访3个月以上。记录手术前后咽鼓管功能问卷评分(ETDQ-7)、鼻内镜、纯音测听、鼓室图及Val-salva动作下颞骨CT检查情况。结果 2耳前期行BET并鼓膜穿刺者,术后4周内均复发;23耳同期行BET并鼓膜切开置管术者,术后3个月ETDQ-7评分、纯音测听(4PTA)阈值均较术前明显降低(P<0.05);颞骨CT提示乳突及鼓室内软组织影均消失或不到术前的5%。12耳在BET术后3个月拔管,其中6耳恢复正常,另6耳在拔管后8周内复发,予重新切开置管。结论 BET联合鼓膜切开置管治疗难治性分泌性中耳炎能获得良好的短期疗效。坚持规律的Valsalva锻炼以及3个月以上时间的鼓膜置管才能保证长期效果。     

完壁式乳突切开联合面隐窝开放治疗儿童分泌性中耳炎

目的 探讨完壁式乳突切开联合面隐窝开放在治疗儿童分泌性中耳炎中的临床价值.方法 回顾性分析2005年6月至2007年6月中山大学附属第二医院耳鼻咽喉头颈外科收治的17例(19耳)反复发作,行鼓膜置管3次以上无效的儿童分泌性中耳炎患者的临床资料,19耳均接受完壁式乳突切开联合面隐窝开放术治疗,其中7耳术中探杳咽鼓管欠通畅,同期行鼓膜置管术,置管后1～3个月拔管.结果 19耳中耳乳突炎性组织的病理检杳结果显示,9耳为中耳胆固醇肉芽肿,10耳为炎性肉芽.术后19耳均获痊愈,鼓膜形态正常.鼓室压图为A型曲线者16耳,C型曲线者3耳,且负压均在150 mm H2O(1 cm H2O=O.098 kPa)内.术后3个月纯音测听骨气导差均在15 dB以内,随访2～3年无复发.结论 儿童分泌性中耳炎如果反复发作,在多次行鼓膜置管无效的情况下,可考虑采用完壁式乳突切开联合面隐窝开放术式彻底清除病灶,从而建立长期有效的咽鼓管、鼓室、鼓窦、乳突的通气引流,该术式有效.     

耳内镜下鼓膜置管联合腺样体切除术治疗儿童分泌性中耳炎

目的 探讨同期耳内镜下鼓膜置管联合腺样体切除术治疗儿童分泌性中耳炎的疗效、听力变化、复发率及并发症等.方法 对80例(132耳)病史超过3个月,保守治疗无效的4～12岁儿童分泌性中耳炎患者分为两组,A组42例(72耳)采用在耳内镜下同期行鼓膜置管联合腺样体切除术治疗,B组38例(60耳)则仅在耳内镜下行鼓膜置管而不行腺样体切除术.结果 A、B组术后纯音听力均提高.A组术后中耳积液平均时间为(8.5±1.2)天,通气管脱落或取出后3个月分泌性中耳炎复发率为8.3%,并发中耳感染率为2.7%;B组积液时间为(10.3±1.4)天,分泌性中耳炎复发率为21.7%,中耳感染率为11,7%.结论 耳内镜下鼓膜置管术联合腺样体切除治疗儿童分泌性中耳炎可改善听力,能缩短中耳积液时间,减少复发率及继发中耳感染的发生率.对儿童分泌性中耳炎伴有腺样体肥大的患者施行鼓膜置管联合腺样体切除术是最合理的治疗方法.     

耳内镜下鼓膜置管与鼻镜下腺样体切除治疗分泌性中耳炎患者的临床效果观察

目的 观察耳内镜下鼓膜置管与鼻镜下腺样体切除治疗分泌性中耳炎患者的临床效果.方法 选择我院2019年1月-2020年10月收治的108例分泌性中耳炎患者,根据不同的治疗方案进行分组,参照组54例患者采取耳内镜下鼓膜置管治疗方法,研讨组54例患者采用耳内镜下鼓膜置管与鼻镜下腺样体切除治疗,观察并分析其临床效果.结果 手术...     

桉柠蒎肠溶软胶囊联合鼓膜置管治疗慢性分泌性中耳炎

目的 比较桉柠蒎肠溶软胶囊联合鼓膜置管与单纯鼓膜置管治疗慢性分泌性中耳炎的疗效。方法 将60例(72耳)慢性分泌性中耳炎患者随机分成实验组30例(38耳)和对照组30例(34耳)。对照组给予患者耳内镜下鼓膜置管,实验组在对照组的基础上联合应用口服桉柠蒎肠溶软胶囊,随访6个月,比较两组的疗效。结果 实验组治愈21例(26耳),好转6例(8耳),无效3例(4耳),总有效率34/38;对照组治愈16例(16耳),好转7例(8耳),无效7例(10耳),总有效率24/34,实验组疗效优于对照组(P=0.043)。结论 桉柠蒎肠溶软胶囊联合鼓膜置管治疗慢性分泌性中耳炎,疗效明显优于单纯鼓膜置管,患者治愈率提高。     

骨导听阈提高的难治性分泌性中耳炎临床分析

目的探讨骨导听阈提高的难治性分泌性中耳炎病因、诊断及治疗。方法回顾性分析2001年3月～2011年3月期间收治的骨导听阈提高的难治性分泌性中耳炎患者96例（148耳）临床资料,并以是否伴有腺样体肥大、变应性鼻炎或乳突病变分为3组。结果所有患耳均行鼓膜切开置管术,同时A组患者42例（70耳）并行腺样体切除术;B组患者22例（32耳）术后给予口服抗组胺药物及鼻用激素治疗;C组患者32例（46耳）予乳突手术治疗。鼓膜置管术后所有患耳于术后6个月拔管,78例（125耳）患者骨导听阈恢复正常;16例（21耳）患者骨导言语频率平均提高约11~25dBHL;2例（2耳）患者骨导听力无明显改善。术后91耳声导抗图为A型;21耳为B型;36耳为C型。结论提示伴有腺样体肥大、变应性鼻炎或乳突病变之难治性分泌性中耳炎与患者骨导听阈提高相关联,通过手术联合药物治疗解除相关致病因素、可有效提高患者骨导听力水平,阻止病情进一步发展,临床疗效满意。     

乳突切除术治疗分泌性中耳炎

目的：探讨乳突切除术治疗分泌性中耳炎的疗效。方法：回顾性分析22例（24耳）行乳突切除手术的分泌性中耳炎患者,其中行完壁式并面隐窝开放手术20耳,开放式手术4耳,同期行鼓膜切开置管术3耳。术后6个月拔管,测试术前、术后的听力。结果：所有患者术后均未出现听力下降,19耳有不同程度的听力提高,鼓室导抗图为A型曲线者17耳,C型曲线者7耳。术后随访6-36个月,未见中耳炎复发。结论：对反复发作、长期迁延经治疗无效的分泌性中耳炎,乳突切除术可改善乳突、鼓窦、鼓室和咽鼓管的通气引流,减少分泌性中耳炎的复发。     

鼓膜置管和胆脂瘤

鼓膜置管被认为是有效治疗难治性分泌性中耳炎、反复发作的急性中耳炎的常用手术方法,且部分学者认为置管可改善中耳通气而预防胆脂瘤的形成。但近年来有学者对此持有不同观点。为探讨鼓膜置管与继发性胆脂瘤形成之间的关系,回顾性分析1978～1990年间到耳鼻喉科-头颈外科门诊行鼓膜置管儿童的临床资料,随访1～20年。共有2829例(5575耳)患者,置管年龄1.2～14岁(平均为4.8岁)。4793耳置管1次,567耳置管2次,215耳置管3次及3次以上。共置6701管,其中聚乙烯管6269个,置管时间1～26个月(平均8.8个月);Goode-T管432个,置管时间8～50个月(平均20.4…     

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。     

漂浮导管扩张咽鼓管治疗放疗后分泌性中耳炎

目的：了解鼻咽癌(NPC)放疗后分泌性中耳炎(SOM)咽鼓管功能，以及漂浮导管扩张咽鼓管治疗该病的临床价值。方法：使用咽鼓管功能综合检查仪检测21例(37耳)NPC放疗后SOM患者的咽鼓管功能；在鼻内镜直视下将漂浮导管导入咽鼓管内扩张咽鼓管，治疗NPC放疗后咽鼓管阻塞引起的SOM。结果：21例NPC放疗后SOM中，咽鼓管功能为正常型2耳，阻塞型21耳，闭锁不全型8耳，开放型6耳。漂浮导管扩张咽鼓管治疗NPC放疗后SOM，有效率为43．2％(16／37)。结论：NPC放疗后SOM的咽鼓管功能障碍，多以阻塞型为主，应用漂浮导管扩张咽鼓管是一种有效的治疗方法。     

局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎

目的：探讨局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎的临床疗效。方法收集顽固性分泌性中耳炎患者20例（24耳）,于门诊局麻下,结合鼻内镜经鼻腔径路行咽鼓管咽口球囊扩张,并行鼓膜置管。所有患者均于术后3个月拔出T型管。结果术后随访6个月,18例患者耳闷塞感、听物朦胧感症状明显减轻,未再出现鼓室内积液。2例术后仍有耳内闷胀及听力下降,耳内镜检查示鼓室积液未吸收,再次置入T型通气管后症状改善。结论局麻下行咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎疗效显著,对于改善咽鼓管功能方法安全可行,并发症极小,是一种微创的新方法。     

鼓膜置管联合药物灌注治疗难治性分泌性中耳炎的疗效分析

目的观察鼓膜切开置管联合药物灌注治疗难治性分泌性中耳炎的疗效。方法将2011年11月～2012年4月入住郑州大学第一附属医院及2011年6月～2012年10月入住商丘市第一人民医院的符合难治性分泌性中耳炎诊断的患者109例纳入临床研究,随机分为实验组和对照组,实验组为54例,对照组为55例,实验组采用鼓膜切开置管加药物灌注治疗（地塞米松磷酸钠注射液＋注射用糜蛋白酶）,对照组采用单纯鼓膜切开置管治疗;进行治疗前以及治疗后1个月、12个月时耳的言语频率平均听阈检测,对比治疗前及治疗后12个月的峰压值、静态声顺值;观察两组患者的总体治疗有效率。结果实验组患者的总体治疗有效率达85.19%,显著高于对照组65.45%;实验组患者治疗前后的耳峰压值、静态声顺值改善显著好于对照组;实验组患者治疗1个月、12个月后的言语频率平均听阈改善情况显著好于对照组。结论鼓膜切开置管加药物灌注治疗治疗难治性分泌性中耳炎的疗效显著。     

A study of inflammatory mediators in the human tympanosclerotic middle ear

OBJECTIVE: To analyze immunocompetent cells as well as 2 factors involved in inflammation and also thought to be involved in bone remodeling-interleukin 6 (IL-6) and inducible nitric oxide synthase in the human middle ear, including the tympanic membrane. DESIGN: Biopsy specimens were obtained from the human middle ear and tympanic membrane during surgery. Using an immunohistochemical technique, the expression of macrophages, T cells, B cells, IL-6, and inducible nitric oxide synthase were analyzed. MATERIALS: Nine biopsy specimens from tympanic membranes in children having a transtympanic ventilation tube inserted as a treatment for secretory otitis media and 11 biopsy specimens from tympanosclerotic plaques from patients with chronic otitis media and tympanosclerosis. RESULTS: More positively stained specimens showing macrophages, B cells, and IL-6 were seen in the biopsy specimens from children with secretory otitis media compared with the biopsy specimens from patients with chronic otitis media and tympanosclerosis. The biopsy specimens from patients with chronic otitis media and tympanosclerosis more often showed positive stainings for inducible nitric oxide synthase than the biopsy specimens from children with secretory otitis media. The presence of IL-6 and inducible nitric oxide synthase was shown by staining to be mostly in the surface cells, while macrophages and B cells were stained deeper in the tissues, in connective tissue, or around sclerotic lesions. CONCLUSIONS: The 2 patient groups differed in antigen presentation so that macrophages, B cells, and IL-6 were labeled more frequently in patients with secretory otitis media, that is, an early phase of the disease. Inducible nitric oxide synthase was seen more frequently in the patients with already established tympanosclerosis in a later phase of the disease.     

Autoinflation as a treatment of secretory otitis media. A randomized controlled study.

This study was undertaken to evaluate the effect of a new method of autoinflation as an alternative treatment of secretory otitis media. Up to 80% of all children experience one or more episodes of eustachian tube dysfunction and secretory otitis media before school age. Common treatment of this condition is insertion of a ventilation tube in the tympanic membrane. Because of the very high incidence of secretory otitis media in childhood, insertion of ventilation tubes is the most frequently performed operation under general anesthesia in children. In addition to possible anesthetic complications, insertion of ventilation tubes may be associated with purulent suppuration, pathologic findings in the eardrum, and hearing impairment. One hundred children were consecutively randomized to undergo either autoinflation, using a new device, or placed in a control group. The children were between 3 and 10 years of age and were entered into the study after having had secretory otitis media for at least 3 months, as verified by tympanometric findings. Tympanometry was repeated at 2 weeks and at 1, 2, and 3 months after the children were entered into the study. After 2 weeks of autoinflation, the tympanometric conditions were improved in 64% of ears, unchanged in 34%, and deteriorated in the remaining 2%. In the control group, tympanometric findings were improved in 15% of ears, unchanged in 71%, and deteriorated in the remaining 14%.     

Implications of laser assisted tympanostomy in adults.

OBJECTIVES: To assess outcome in adult individuals undergoing laser-assisted tympanostomy without ventilation tube placement. STUDY DESIGN: Case series with 2-month follow-up. SETTING: Faculty practice, research protocol, tertiary care academic medical center. PATIENTS AND METHOD: Laser-assisted tympanostomy was performed on a total of 142 ears (108 individuals). Indications included serous otitis media with effusion (66 ears/47 patients), functional eustachian tube dysfunction (48 ears/36 patients), acute otitis media (19 ears/16 patients), and endoscopic visualization of the middle ear (9 ears/9 patients). INTERVENTION: The laser-assisted tympanostomy procedure is performed with a CO2 laser under local anesthesia on an outpatient basis. MAIN OUTCOME MEASURES: Patency time of the tympanostomy, presence of fluid after the closure of the tympanostomy, tympanometry and tone audiometry findings, relief of symptoms. RESULTS: Middle ear disease was resolved after the closure of tympanostomy in 47.9% of patients with serous otitis media with effusion. In 79.1% of patients with functional eustachian tube dysfunction, symptoms were diminished. All patients with acute otitis media had a satisfactory outcome. Laser-assisted tympanostomy was found to be quite helpful in patients undergoing middle ear endoscopy. CONCLUSIONS: Laser-assisted tympanostomy without ventilation tubes provides a safe alternative surgical option in adult patients in certain cases. The selection criteria for this procedure are addressed in detail.     

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.     

咽鼓管置管术与鼓膜置管术治疗分泌性中耳炎疗效比较

目的比较咽鼓管置管术与鼓膜置管术治疗分泌性中耳炎的疗效,为分泌性中耳炎的治疗方式提供依据。方法 将71例（86耳）分泌性中耳炎患者随机分成实验组（36例,44耳）与对照组（35例,42耳）。实验组在鼻内镜直视下行咽鼓管置管术,每日;中洗后鼓室注药治疗;对照组行鼓膜切开并置管。术后随访6个月,比较两组疗效。结果实验组治愈21耳（47．73％）,显效19耳（43．18％）,无效4耳（9.09％）。对照组治愈12耳（28．57％）,显效17耳（40．48％）,无效13耳（30．95％）。实验组治疗有效率为90．91％,显著高于对照组69．05％（P〈0．05）,实验组治疗后平均听阈为20．95dB,显著好于对照组28．25dB（P〈0．01）。结论鼻内镜下咽鼓管置管术疗效明显优于鼓膜置管术,联合药物管腔内注入可有效恢复咽鼓管功能,且避免了鼓膜损伤,符合微创原则,是治疗分泌性中耳炎的理想选择。     

Ventilation tubes and cochlear implants: what do we do?

OBJECTIVE: To determine current practice management with respect to ventilation tubes and cochlear implants. STUDY DESIGN: Questionnaire. SETTING: All members of the American Neurotology Society were sent questionnaires. MAIN OUTCOME MEASURES: Members were asked a series of questions including how they deal with ventilation tubes before cochlear implantation, how they manage serous otitis media in patients undergoing cochlear implantation, and how they manage otitis prone children with cochlear implants. RESULTS: Two hundred and twenty members returned questionnaires. Surgeons who replied perform an average of 25 implants per year: 15 in adults and 10 in children. Analysis of the data revealed a wide practice variation between surgeons. Fifty-six percent of surgeons will place a cochlear implant in a patient with a clean, dry ventilation tube in place. More than half the surgeons will place a ventilation tube in a child with serous otitis media, let the ear settle down, and perform the cochlear implant at a second operation. Wide variation in the management of otitis prone children with cochlear implants exists with respect to placement of ventilation tubes. Only 5% of surgeons reported any complications with cochlear implants that they attributed to ventilation tubes. There were a number who suggested their practice had changed since the recent identification of issues involving meningitis in implantees. CONCLUSION: Wide practice variation exists with the management of ventilation tubes in cochlear implant patients. On the basis of the results of this survey, it is acceptable to place cochlear implants in patients with clean, dry ventilation tubes. It also acceptable to place ventilation tubes in otitis prone children with cochlear implants. Despite theoretic concerns, the reported incidence of complications is low.     

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。