61例中耳炎咽鼓管多层螺旋CT影像解剖学研究

目的通过多层螺旋CT多平面重组重建了解中耳炎耳咽鼓管与正常耳咽鼓管的解剖关系,为临床研究提供解剖学资料。方法设61例(85耳)中耳炎患者为病变组,设鼓膜完整的15例(30耳)经专科检查、纯音测听及声导抗检查排除中耳病变且咽鼓管功能正常者作为对照组,两组均采用多层螺旋CT分别行颞骨静态及动态CT扫描,且均行多平面重组重建,重建后分别测量其骨部、软骨部开放区域、软骨部闭合区域、软骨部有效闭合区域长度,并比较两组间的影像学差异。结果对照组鼓室前段直径(9.95±1.29)mm,骨-软骨接合部直径(3.89±0.50)mm,骨部长度(20.89±1.81)mm;病变组鼓室前段直径(9.85±0.83)mm,骨-软骨接合部直径(3.92±0.37)mm,骨部长度(20.51±2.13)mm;静态CT多平面重组重建:对照组开放区域长度(10.99±0.87)mm,闭合区域长度(36.90±6.73)mm,病变组开放区域长度(8.50±0.55)mm,闭合区域长度(42.26±7.19)mm;动态CT多平面重组重建:对照组有效闭合区域长度(10.20±3.96)mm,病变组有效闭合区域长度(33.32±9.44)mm。结论中耳炎耳咽鼓管与正常耳咽鼓管骨部无明显差异;静态下病变组软骨部闭合区域大于对照组软骨部闭合区域长度;动态下对照组咽鼓管软骨部闭合区域长度减小,开放区域长度增加,而病变组闭合区域长度改变不明显。     

鼻内窥镜下咽鼓管吹张注药对慢性分泌性中耳炎的疗效观察

目的:评价鼻内窥镜下咽鼓管吹张注药对慢性分泌性中耳炎(OMSC)的治疗效果。方法:将84例(124耳)OMSC患者随机分为二组。A组采用鼻内镜下咽鼓管吹张注药术;B组给予鼓膜穿刺抽液、鼓膜切开排液或鼓膜置管术;对随访半年的临床疗效及不良反应进行比较。结果:A组治愈36耳(58.1%),好转18耳(29.0%),无效8耳(12.9%);B组治愈20耳(32.3%),好转20耳(32.3%),无效22耳(35.4%)。并发症发生率A组为9.7%(6/62),表现为耳闷胀感或短暂眩晕,B组为32.3%(20/62),表现为中耳感染或鼓膜穿孔或耳漏。二组临床疗效及并发症发生率差异均有显著性统计学意义(P<0.05)。结论:鼻内窥镜下咽鼓管扩张注药法治疗OMSC安全、效果好,不良反应少。     

不同厚度耳屏软骨-软骨膜复合体在治疗化脓性中耳炎继发鼓膜穿孔中的效果

目的 分析不同厚度耳屏软骨-软骨膜复合体在治疗化脓性中耳炎继发鼓膜穿孔中的效果。方法 选取在我院治疗的化脓性中耳炎继发鼓膜穿孔患者168例为研究对象,按照随机数字表法分为观察组和对照组,每组84例。2组患者均接受鼓膜修补术治疗,观察组使用全厚耳屏软骨-软骨膜复合体修复材料,对照组使用半厚耳屏软骨-软骨膜复合体修复材料。观察2组患者术后外耳道形态,对比2组患者手术时间、住院时间、术中出血量、切口愈合时间及术前和术后3个月纯音听阈、疼痛视觉模拟评分法（VAS）评分、气导平均听阈、平均气骨导差,统计2组患者术后3个月并发症发生情况及术后3年复发率。结果 观察组术后外耳道形态正常率显著高于对照组（P<0.05）。2组患者手术时间、住院时间、术中出血量、切口愈合时间及术前和术后3个月纯音听阈、VAS评分、气导平均听阈和平均气骨导差对比,差异均无统计学意义（P>0.05）。观察组术后3个月并发症总发生率为7.14%,显著低于对照组的23.81%(P<0.05)。随访3年,观察组总复发率为18.42%,显著低于对照组的41.10%(P<0.05)。结论 鼓膜修补术中使用全厚耳...     

耳道全耳内镜下应用不同材料修补鼓膜对鼓膜穿孔患者预后的影响

目的:研究耳道全耳内镜下应用不同材料修补鼓膜对鼓膜穿孔患者预后的影响.方法:选取 2020 年 1 月至2023 年6 月期间上犹县人民医院收治的 70 例鼓膜穿孔患者.采用随机数字表法分为全厚软骨组 35 例和半厚软骨组 35 例.全厚软骨组厚度为 1 mm,半厚软骨组为 0.5 mm,两组均实施耳道全耳内镜下鼓膜修补术.比较两组手术情况(手术时间、术中出血量、耳屏愈合时间)、术前及术后3 m听力水平及疼痛视觉模拟评分(Visual Analogue Scale,VAS)、术前及术后 3 m气导平均听阈及平均气骨导差及术后并发症发生率.结果:两组手术时间、术中出血量及耳屏愈合时间比较无明显差异(P＜0.05);两组术前及术后 3 m的纯音听阈及VAS评分比较无差异(P＜0.05);两组术前及术后 3 m的气导平均听阈及平均气骨导差比较无差异(P＜0.05);全厚软骨组并发症发生率为5.71%,半厚软骨组为 22.86%,全厚软骨组明显低于半厚软骨组(P＜0.05).结论:耳道全耳内镜下应用不同材料修补鼓膜对鼓膜穿孔均可以有效改善患者手术情况、术后听力水平和疼痛评分,但全厚耳屏软骨-软骨膜复合体术后并发症较少.     

胆脂瘤型中耳炎术后不干耳的原因探讨

目的探讨胆脂瘤型中耳炎乳突根治术后不干耳的原因及防治方法。方法对38例乳突手术后不干耳患者的临床资料进行分析。结果38例术后1个月干耳15例,2个月干耳19例,3个月干耳4例;随访半年以上,乳突腔均干燥,听力与术前相近。结论术后不干耳的原因为病变组织清除不彻底胆脂瘤残留,咽鼓管感染,面神经嵴过高术腔引流不畅,外耳道狭窄,换药不当等诸多因素。术中应用显微镜及电钻,彻底清除病变组织,术腔引流通畅,重视术后术腔换药是提高乳突手术后干耳率的重要环节。     

自体软骨和Tos改良联合进路鼓室成形术在中耳手术中的应用

目的 探讨自体软骨和Tos改良联合进路鼓室成形术在中耳手术中的临床应用.方法 对23例胆脂瘤型中耳炎用Tos改良的联合进路行鼓室成形术进行治疗,去除的上鼓室外侧壁和后鼓室外侧壁,用耳屏软骨重建,再视镫骨状况,同时用部分听小骨赝复体(PORP)或全听小骨赝复体(TORP)行Ⅲ型听骨链重建.所有病例随访3至5年.结果 所有23例患者在术后4至6周获得干耳,鼓膜愈合好,形态正常.软骨重建的上鼓室和后鼓室外侧壁无1例内陷.术后1年纯音听力,言语频率(500、1000、2000、3000、4000Hz)气导较术前提高≥30dB者8例(34.78%),20～29dB者9例(39.13%),10～19dB者4例(17.39%),听力无改善者2例(8.69%).随访3年,听力稳定,5年内无胆脂瘤复发.结论 Tos改良的联合进路鼓室成形术是胆脂瘤型中耳炎手术治疗的好方法,既彻底清除病灶,又保留外耳道后壁完整,术后能获得良好的听力.Tos改良术因去除了上鼓室和后鼓室外侧壁,用软骨重建可有效的防止新生鼓膜的内陷和继发胆脂瘤形成.     

咽鼓管充气检查对心肌缺血患者QTd影响

先前的研究显示从心肌缺血到心肌梗死、从恶性心律失常到心脏猝死期间 QT离散度 (QTd)延长。目的　研究咽鼓管充气检查对冠状动脉疾病患者 QTd的影响。方法　研究对象为正常冠状动脉者 2 1例 ,稳定性心绞痛患者 35例 ,不稳定性心绞痛患者 2 9例 ,总共 85例 ,在咽鼓管充气检查紧张状态之前记录 12导心电图 (以 5 0 m m/ sec的速度 )。结果　在对照组和稳定性心绞痛组 (均差 =16 .10 m s,P<0 .0 0 0 ) ,对照组和不稳定性心绞痛组 (均差 =35 .2 6 ms,P<0 .0 0 0 ) ,QTd均有不同程度延长。在这些组之间均差相比较 (均差 =19.17ms) ,具有明显…     

鼓室成型术中齿突及上鼓室前隐窝处理的临床意义

目的：探讨鼓室成型术中齿突及上鼓室前隐窝处理的临床意义.方法：采用改良乳突根治＋鼓室成型术治疗37例慢性中耳乳突炎,其中胆脂瘤型23例、肉芽型14例.术中对齿突进行解剖观察,并对其前方的上鼓室前隐窝病灶进行探察与处理.结果：术中见齿突明显下垂的长骨嵴型者9例（24.32%）,短骨嵴型28例 上鼓室前隐窝发现胆脂瘤22例、水肿肉芽13例、另有2例黏膜光滑.37例干耳时间为1～3月,平均1.5月.听力以0.5 Hz、1.0 Hz、2.0 Hz（听力级）3个语言频率气导及气骨导差缩小的平均值评定.术后平均气骨导差（15.27±5.00）dB,较术前（34.95±7.52 ）dB明显缩小（P＜0.01）.结论：齿突前方为上鼓室前隐窝,常是胆脂瘤或肉芽病灶隐匿部位,鼓室成型术中切除齿突和开放上鼓室前隐窝有利于彻底清除病灶,可减少术后病灶残留和复发.     

耳内镜干、湿耳状态下Ⅱ型鼓室成形术疗效分析

目的比较耳内镜干、湿耳状态下Ⅱ型鼓室成形术的疗效, 评估湿耳下Ⅱ型鼓室成形术的可行性。方法回顾性队列研究。纳入安徽医科大学第一附属医院耳鼻咽喉头颈外科2018年1月—2020年10月40例耳内镜下Ⅱ型鼓室成形术的慢性中耳炎患者的临床资料。其中, 男14例、女26例, 年龄18～72岁。依据术前鼓室黏膜炎性状态分为湿耳组22例和干耳组18例。观察指标:(1)比较2组患者性别、年龄、病程、手术时间、术前骨气导差等基线资料;(2)比较2组患者术后3个月时听力改善情况;(3)观察2组患者鼓膜愈合情况, 比较手术前后4 kHz骨导听阈的变化以及术后并发症发生情况。结果 2组患者术后均获得干耳, 无再次流脓。(1)2组患者的年龄、病程、术前骨气导差、手术时间等基线资料比较差异均无统计学意义(P值均 > 0.05), 性别构成差异有统计学意义(P = 0.028)。(2)术后3个月听力改善情况:湿耳组、干耳组气导的平均听阈术前分别为(63.03±16.63)dB、(53.89±13.85)dB, 术后分别为(46.59±13.86)dB、(39.51±12.92)dB, 差异均有统计学意义(t...     

72例传导性聋患者多频稳态诱发电位与纯音测听的相关性

目的 探讨多频稳态诱发电位,即听觉稳态反应(ASSR)与纯音听阈在传导性聋患者诊断中的相关性.方法 对72例传导性聋患者的72耳分别行ASSR和纯占测听测试,并进行ASSR与纯音听阈的相关性分析.结果 对于传导性聋的诊断,ASSR反应阈与纯音听阈的相关性分析显示,在不同刺激声信号载波频率情况下二者的相关性:0.5 kHz(r=0.634,P>0.05)、1 kHz(r=0.792,P<0.05)、2 kHz(r=0.814,P<0.05)、4 kHz(r=0.927,P<0.01).除低频(0.5 kHz)外,随着频率增高,二者相关性越高.不同程度气骨导差传导性聋患者中,ASSR反应阈与纯音听阈的相关性:气骨导差≤30dB HL组(r=0.723,P<0.05),气骨导差31～60 dB HL组(r=0.816,P<0.05).结论 ASSR与纯音听阈有相关性,ASSR对传导性聋诊断有临床应用价值.     

The clinical and radiological status of contralateral ears in unilateral cholesteatoma patients

Purpose

To evaluate the clinical and radiological features and the risk of middle ear disease in the contralateral ears of unilateral cholesteatoma with clinical and radiological assessment.

Methods

Fifty-two patients with unilateral cholesteatoma and 30 control subjects underwent otoscopic and audiologic examination. Temporal bone computed tomography was performed to evaluate the pneumatization of the temporal bones, the status of anterior epitympanic space and eustachian tube. Then, the parameters of the temporal bone pneumatization were calculated.

Results

28 % of the contralateral ears in the cholesteatoma patients showed abnormal tympanic membrane findings. In the audiologic examination, 10 % of the contralateral ears showed moderate hearing loss and 3 % showed severe hearing loss. Aeration areas were 1.81 ± 1.01, 2.50 ± 1.31 and 4.49 ± 1.45 cm², aeration ratios were 24, 28 and 42 %, in cholesteatoma, contralateral and control ears, respectively. Development of the anterior epitympanic space and eustachian tube patency was reduced in contralateral ears relative to control ears.

Conclusions

The degree of temporal bone pneumatization, eustachian tube function, and development of the anterior epitympanic space are significantly decreased in the contralateral ears of unilateral cholesteatoma patients, and there is an increased risk of middle ear diseases. Continuous monitoring of the contralateral ear is crucial for early detection and optimal treatment of middle ear disease.     

Study of the auditory tube by ventilation scintigraphy with technetium-99m

The two essential regulating mechanisms of the middle ear pressure are the trans-mucosal gas exchange in the middle ear and the ventilation function of the eustachian tube (ET). The physiological mechanism of these both functions is not yet clear. The purpose of this study was to evaluate the role of the ET pressure equilibrium function by ventilation scintigraphy with technetium-99m. The rabbit animal model in vivo was used to study the presence and role of the ventilation of the tympanic cavity via auditory tube. The obtained results did not show any ventilation function of the ET despite active opening by muscle movement. In our experience, ventilation scintigraphy with technetium-99m is not a reliable method to study the auditory tube pressure equilibrium function in physiological conditions.     

Luminal development of the eustachian tube and middle ear: murine model.

The purpose of this study was to describe the luminal development of the murine eustachian tube and middle ear. Thirty specimens, aging from gestational day 11 to postnatal day 21, were investigated through the light microscopic observations. The present study also used digitizer, computer, and serially sectioned temporal bone specimens for three-dimensional reconstruction to measure the volume of the eustachian tube and middle ear cavity at different gestational and postnatal ages. The first pharyngeal pouch elongated during gestational day 12 to form the tubotympanic recess. Between gestational day 13 and 14 this tubotympanic recess extended to the middle ear area. A rapid increment in the volume of the tubotympanic recess was noted between gestational day 15 and 16. At this age, a definite division of the tubotympanic recess into the eustachian tube and middle ear cavity was observed. During the postnatal period, the maximum change of the middle ear volume was noted on postnatal day 11 when the mesenchymal tissue in the middle ear cavity disappeared completely.     

Effect of intranasal inoculation of Streptococcus pneumoniae on the structure of the surface carbohydrates of the chinchilla eustachian tube and middle ear mucosa

The changes in the cell surface carbohydrates of the eustachian tube (ET) and middle ear subsequent to the intranasal (i.n.) inoculation of Streptococcus pneumoniae (Spn) type 6A were studied in the chinchilla model of otitis media (OM) using a lectin histochemical technique with six different lectins (SNA, WGA, Succ WGA, BSL II, PNA, ECL). The labeling pattern revealed not only the removal of the terminal sialic acid, but also exposure of N-acetylglucosamine (GlcNAc), a component of the trisaccharide receptor for Spn previously identified on human pharyngeal cells. The removal of sialic acid residues progressed from the nasopharyngeal to the tympanic orifice and was most pronounced in those animals from which Spn could be isolated from the middle ear. Our data indicate an alteration of the normal lectin labeling pattern and exposure of GlcNAc restricted mainly to the roof and neck portion, along the course of the eustachian tube. Exposure of part or all of a Spn adherence receptor structure by the pneumococcal enzymes, may facilitate colonization, invasion of the middle ear, and induction of OM.     

分泌性中耳炎的外科治疗现状

分泌性中耳炎是耳鼻咽喉头颈外科常见和多发的中耳非化脓性疾病,是儿童听力下降的常见原因。听力下降伴耳闷、耳鸣及耳痛是其突出临床表现。对于保守治疗效果欠佳、影响患儿听力的SOM的处理在临床上一直是一个棘手的问题。通过外科手段干预成为了大多数临床医生的治疗方案,包括鼓膜手术、腺样体手术、咽鼓管手术等方法。本文现就国内外关于分泌性中耳炎的外科治疗现状做一综述。     

Development of the mucociliary system in the eustachian tube and middle ear: murine model.

In order to describe the developmental anatomy of the murine eustachian tube and its related structures, seventy six mice of ages ranging from gestational day 11 to postnatal day 21 were investigated through the light and electron microscopic observations. Development of the ciliated cells was seen concurrently in both the eustachian tube and middle ear on the 16 th gestation day, one day earlier than the epithelial secretory cells appeared in both the eustachian tube and middle ear. The number of ciliated cells and secretory cells increased rapidly after birth. Tubal glands were well identified with evidence of secretory activity around the time of birth. Thus, the findings of this study indicate that the mucociliary defense system starts to develop during the fetal stage and is well established immediately after birth.     

Surgical management of middle ear cholesteatoma and reconstruction at the same time

Introduction:

In the surgical management of cholesteatoma, one can opt for a closed technique (simple mastoidectomy) or open surgery (radical mastoidectomy). Open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery combines the advantages of both techniques, namely, adequate surgical exposure, eradication of cholesteatoma, and anatomical reconstruction of the middle ear structures.

Objective:

To evaluate the surgical results in the management of cholesteatoma through the technique of open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery.

Methods:

Prospective analytical observational study conducted between 2009 and 2012 with patients undergoing this surgical technique in the Hospital Universitario del Valle [University Hospital of Valle], performing preoperative clinical monitoring and quarterly postoperative tomography with previous assessments of hearing and pre- and postoperative audiometry.

Results:

Forty-five patients were studied. Mean postoperative follow-up was 28 months. Surgical success was achieved in 93.3% of patients, as measured by clinical and radiological follow-up. Hearing preservation was found after reconstruction of the hearing mechanism, based on measured audiometry, i.e., pure-tone average (PTA), using the statistical test for paired samples between preoperative and postoperative PTA. (95%CI -1.47-12.15). Residual cholesteatoma was present in 6.6% of cases; three to four times lower than the rate reported in the literature.

Conclusions:

This type of surgery can be considered a successful technique in the treatment of cholesteatoma in selected cases.     

Comparison of structural changes of cell surface carbohydrates in the eustachian tube epithelium of chinchillas infected with a Streptococcus pneumoniae neuraminidase-deficient mutant or its isogenic parent strain

Six different lectin probes were used to examine alterations of the cell surface carbohydrates in the chinchilla eustachian tube (ET) lumen subsequent to the intranasal (i.n.) challenge with the Streptococcus pneumoniae parent strain, D39, or its isogenic derivative, DeltaNA1, which is deficient in neuraminidase NanA. The labelling pattern revealed that the binding of wheat germ agglutinin (WGA), Erythrina cristagalli lectin (ECL), peanut agglutinin (PNA), Bandeiraea simplicifolia lectin II (BSL II) and succinylated wheat germ agglutinin (SWGA) were increased in the lumenal surface of the ET in the D39 inoculated cohort compared to the uninfected control, which indicated that N-acetylglucosamine (GlcNAc) and D-galactose residues were exposed. Concurrently, decreased labelling with Sambucus nigra agglutinin (SNA) indicated that there were few sialic acid residues remaining in the ET epithelium subsequent to i.n. inoculation with D39. The DeltaNA1 neuraminidase deficient mutant, however, did not induce any significant changes in the lectin labelling patterns, and was comparable to that of the control cohort. We propose that products of the nanA gene have a significant impact on the changes of the carbohydrate moieties in the ET epithelium and may be responsible for the previously reported increased ability of the D39 parent to colonize the nasopharynx and invade the middle ear.