鼓室成形术后的咽鼓管功能检测及意义

目的探讨咽鼓管功能对慢性化脓性中耳炎鼓室成形术后疗效的影响。方法用咽鼓管鼓室-气流动态图(tube-tympanoaerodynamicgraphy,TTAG)法及音响法对53耳鼓室成形术后的咽鼓管功能进行检测,并分析鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况;并用鼻窦镜观察咽鼓管咽口,分析咽鼓管咽口与咽鼓管功能的关系。结果53耳鼓室成形术后咽鼓管功能正常37耳,其中29耳鼓膜生长良好;咽鼓管功能异常16耳中,有4耳鼓膜生长良好,比较咽鼓管功能正常耳与异常耳鼓膜生长良好耳数,两者有显著性差异(P<0.05);53耳术后有9耳咽鼓管咽口充血肿胀,其中2耳咽鼓管功能正常,7耳咽鼓管功能不良,提示术后咽鼓管功能障碍与咽鼓管咽口病变有关。结论慢性化脓性中耳炎鼓室成形术后咽鼓管功能与疗效关系密切,术后咽鼓管功能障碍可能是导致手术失败的原因之一。     

慢性化脓性中耳炎的咽鼓管功能对手术疗效的影响

目的探讨慢性化脓性中耳炎咽鼓管功能改变对手术疗效的影响.方法分析40耳行鼓室成形术的慢性化脓性中耳炎的咽鼓管功能与手术疗效的关系.咽鼓管功能检查用正-负压试验、TTAG法及音响法,咽鼓管鼓室口及咽口的观察分别用鼓室镜及鼻窦镜,对比分析咽鼓管功能改变与病变部位的关系,并比较鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况.结果慢性化脓性中耳炎的咽鼓管功能与鼓室口病变程度相关,鼓室口病变轻者,咽鼓管功能良好;而鼓室口病变重者咽鼓管功能不良.40耳鼓室成形术后咽鼓管功能良好耳鼓膜生长良好,咽鼓管功能不良耳鼓膜生长欠佳;两者均有统计学意义.结论慢性化脓性中耳炎咽鼓管功能与鼓室成形术效果关系密切,咽鼓管功能障碍可能是导致手术失败的重要因素之一.     

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。     

咽鼓管功能障碍的慢性化脓性中耳炎治疗分析

目的 探讨合并咽鼓管功能障碍的慢性化脓性中耳炎病例的适宜手术方案。 方法 收集咽鼓管功能障碍的慢性化脓性中耳炎病例68耳,分为观察组(28耳),同期行中耳乳突手术及咽鼓管球囊扩张术,对照组(40耳),仅行中耳乳突手术。术前,术后3个月、6个月、12个月分别以ETDQ-7评分、听阈、气骨导差进行对比。 结果 观察组术后6~12个月随访气导平均听力改善率为89%(25/28),干耳率93%(26/28)。对照组听力改善率为75%(30/40),干耳率95%(38/40)。观察组术后3~6个月EDDQ-7评分及听阈达到较明显缓解,但术后6~12个月上述指标有加重趋势。观察组及对照组术后听力均比术前听力提高,有统计学差异,两组的术后听力相对比,观察组优于对照组,有统计学意义。 结论 在咽鼓管功能障碍的慢性化脓性中耳炎患者中,中耳手术同期咽鼓管球囊扩张术较单纯中耳手术的听力改善率高,改善程度高,重新内陷率低,重新粘连率低,干耳率无明显差别。术后3~6个月患者咽鼓管相应症状达到较明显缓解,6~12个月症状有反复。     

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。     

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。     

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。     

分泌性中耳炎和慢性鼻-鼻窦炎患儿咽鼓管咽口形态及功能的观察与分析

目的：观察分泌性中耳炎及慢性鼻-鼻窦炎患儿咽鼓管咽口及其周围形态的改变并检测其功能,为临床治疗提供客观依据。方法：将150例患儿分为分泌性中耳炎组（50例）、慢性鼻-鼻窦炎组（50例）及对照组（50例,无分泌性中耳炎及慢性鼻-鼻窦炎的声嘶患儿）,在电子鼻咽喉镜直视下观察各组咽鼓管咽口及其周围形态的改变,用声导纳仪检测各组患儿的咽鼓管功能状态,并进行统计学分析。结果：①分泌性中耳炎组咽鼓管咽口的形态学改变高达94%,慢性鼻-鼻窦炎组则为80%,2组差异无统计学意义（P〉0.05）,但与对照组比较均差异有统计学意义（均P〈0.05）。②分泌性中耳炎组70%存在咽鼓管功能障碍,慢性鼻-鼻窦炎组26%存在咽鼓管功能障碍,2组比较差异有统计学意义（P〈0.05）,且2组与对照组（2%）比较均差异有统计学意义（均P〈0.05）。结论：分泌性中耳炎及慢性鼻-鼻窦炎患儿存在咽鼓管功能障碍、咽鼓管咽口及其周围形态的改变;咽鼓管功能障碍在分泌性中耳炎的发病中占主导作用,与慢性鼻-鼻窦炎比较,咽鼓管功能障碍较咽鼓管咽口的形态改变更有差异性。     

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。     

Patulous eustachian tube in long-term survivors of nasopharyngeal carcinoma

This article reports on 21 long-term (10 years) survivors of nasopharyngeal carcinoma, divided into 2 groups: those subjected to an inflation-deflation test and a clearance function test in a longitudinal study, and those receiving sonotubometry in a cross-sectional study. On the inflation-deflation test, 12 (55%) out of 22 ears had a patulous eustachian tube, and on sonotubometry, 10 (50%) out of 20 ears also revealed a patulous eustachian tube. Except for 4 ears with chronic otitis media, the ears had resolved to a normal eardrum appearance at 10 years postirradiation. The phenomenon might be attributed to both restoration of the impaired tubal function and the development of a patulous tube.     

慢性化脓性中耳炎活动期鼓室成形术的临床观察

目的探讨慢性化脓性中耳炎活动期鼓室成形术的可行性和疗效。方法对37例单侧慢性化脓性中耳炎活动期患者在恢复咽鼓管功能、清除病变的同时行鼓室成形术,随访观察近期及远期疗效。结果术后1年复查,30例鼓膜形态正常,3例鼓膜再穿孔,4例鼓膜内陷。纯音测听气骨导差(air bone gap,ABG)平均缩小10dB者10例,15~20dB者15例,25~30dB者7例,无变化5例。结论慢性化脓性中耳炎活动期可行鼓室成形术。彻底清除病变,恢复中耳通气功能是手术成功的关键。     

鼻内镜下咽鼓管置管治疗分泌性中耳炎

目的 探讨在鼻内镜视频下,自咽鼓管咽口插入胶管并留置治疗分泌性中耳炎的效果.方法 在鼻内镜视频系统下,经咽鼓管咽口插入鼓室腔,外侧端固定于面颊部,定期抽液,冲洗、注药,痊愈后观察10天拔管.结果 21耳均插管顺利,无不良反应.其中18耳一次插管治愈,占85.7%,3耳经2次插管治愈,占14.3%.总治愈率100%.结论 通过鼻咽部咽鼓管置管术,视野清晰,操作方便,治疗时间短,复发率低,无明显后遗症,是治疗分泌性中耳炎的理想选择.     

颞骨CT和咽鼓管功能检查对胆脂瘤型中耳炎咽鼓管鼓室口病变的诊断意义

目的：探讨颞骨高分辨率CT（HRCT）和咽鼓管功能检查对胆脂瘤型中耳炎患者术前咽鼓管鼓室口病变的诊断价值。方法：回顾性分析38例（41耳）胆脂瘤型中耳炎患者术前颞骨HRCT扫描和咽鼓管功能综合测试仪检查结果，并与术中显微镜下探查咽鼓管鼓室口处病变情况进行对比分析。结果：颞骨HRCT发现咽鼓管鼓室口软组织占位影34耳；术中发现鼓室口病变32耳，其中为肉芽组织22耳和胆脂瘤4耳，脓团堵塞3耳，鼓室口周围黏膜肥厚肿胀2耳，黏膜粘连闭锁1耳。咽鼓管功能障碍37耳，其中为阻塞型32耳，闭锁不全型5耳。结论：对胆脂瘤型中耳炎患者术前进行颞骨HRCT扫描和咽鼓管功能检查，对术中有目的地处理咽鼓管鼓室口的病变，制定手术方案和预估治疗效果具有重要意义。     

咽鼓管测压对儿童分泌性中耳炎疗效评估的价值

目的 探讨儿童分泌性中耳炎(otitis media with effusion,OME)治疗前后咽鼓管测压(tubomanometry,TMM)对预测OME预后的价值.方法 66例(98耳)OME患儿(中耳炎组,其中单耳34例,双耳32例)分别在治疗前及正规药物治疗后1月内进行声导抗和TMM测试,记录鼓室导抗图类型及咽鼓管评分(eustachian tube scores,ETS)值,并比较二者之间关系,以单耳患者的正常耳(34耳)作为正常对照组.结果 治疗前,中耳炎组ETS平均值(2.27±1.98分)低于正常对照组(5.14±0.98分)(P＜0.01),鼓室导抗图B型耳的ETS平均值(1.70±1.68分)低于C型耳(3.02±2.11分)(P＜0.01).治疗后中耳炎组ETS平均值(3.62±1.85分)显著高于治疗前(P＜0.05),但治疗后鼓室导抗图B型耳的ETS平均值(3.58±1.69分)与C型耳(3.98±1.45分)差异无统计学意义(P＞0.05),B型耳的ETS提高值(1.84±1.7分)高于C型耳(0.72±0.03分)(P＜0.05).无论B型耳还是C型耳,有效组治疗前后ETS平均值及治疗前后ETS差值均高于无效组(P＜0.01).结论 儿童分泌性中耳炎患耳治疗后ETS值提高,咽鼓管功能改善;治疗前鼓室导抗图B型耳的ETS值较C型耳低,治疗后B型耳的ETS提高值高于C型耳;TMM可为临床评估儿童OME预后提供一定参考.     

中耳粘连手术治疗的疗效观察

中耳粘连是耳外科治疗的难题之一.为总结20年来手术治疗的体会和教训,对105例(129耳)的治疗情况进行了回顾性分析.对中耳粘连进行了分类,表明选择正确的手术方式有助于听力的改善;亦表明异物作为隔离物是不可取的;要进一步提高手术疗效尚有待进一步的探讨.     

The eustachian tube midportion in infants

The eustachian tube midportion in infants and children was measured in 44 eustachian tubes from normal temporal bones and 11 eustachian tubes from temporal bones harboring acute otitis media. The temporal bones were serially sectioned, and the lumina of the eustachian tubes' midportions were measured with the aid of a grid mounted on a microscope. These measurements showed that the eustachian tube lumen grows to a small degree with age. Each age group showed a considerable variation in the range of the luminal area compatible with natural biologic distribution. No statistically significant difference was found in the sizes of the midportions of the eustachian tube lumina from temporal bones that harbored acute otitis media when compared with the lumina of the eustachian tube midportions from normal ears.     

Surfactant and isoprenaline effect on eustachian tube opening in rats with acute otitis media

Purulent otitis media was induced in 12 middle ears of Sprague-Dawley rats by inoculation of pneumococci type 3. The pressure required to open the eustachian tube was recorded 4 days later and was found to be 3.05 +/- 0.10 kPa (mean +/- SEM), which was 1.08 +/- 0.15 kPa lower than the mean value obtained in a control group of healthy rats (P less than or equal to .001). We also measured the effects of pulmonary surfactant instilled into the middle ear as well as isoprenaline injected intravenously. The presence of surfactant further reduced the pressure opening level by 0.72 +/- 0.05 kPa; this reduction did not differ from that found in the control group (P greater than .8). Isoprenaline reduced the pressure opening level in the control group by 0.20 +/- 0.03 kPa (P less than or equal to .001), and no reduction was found in the rats with otitis media. Although the part played by surface tension-lowering factors in eustachian tube function is still uncertain, such factors apparently also exert an effect in the inflamed tube. However, isoprenaline, which is considered to act by the secretion of surface tension-lowering substances, did not facilitate opening of the eustachian tube in rats with acute otitis media.     

Mastoid volume and eustachian tube function in ears with cholesteatoma

Eustachian tube function, as measured by the pressure equalizing technique, and the mastoid air cell area were compared among ears with traumatic eardrum perforations, ears with chronic otitis media, and cholesteatomatous ears. A statistically significant difference among the three groups was found regarding the residual positive pressure after swallowing, with the poorest function found in the cholesteatoma group. Also, the ability to reduce a negative pressure was found to be inferior in the cholesteatoma group compared with the others. The mean mastoid air cell area measured on the x-ray film was smallest among ears with cholesteatoma and differed significantly among the groups. These disturbances in the active eustachian tube function as well as the volume of the middle ear cleft, including the mastoid air cell system, were found to be characteristic among ears with acquired cholesteatomas.     

Chronische Tubendysfunktion und ihre Folgeerkrankungen bei Erwachsenen mit einseitiger Lippen-Kiefer-Gaumen-Spalte

BACKGROUND: While almost all children with cleft palate develop eustachian tube dysfunction, this tends to normalize with age although it remains impaired in a number of patients. METHODS: Eustachian tube function was evaluated by tympanometry in 40 patients with an average age of 19.9 years. The number of patients with chronic otitis media, a sequelae of chronic eustachian tube dysfunction, was determined microscopically and from the patient's history. Hearing was assessed by pure tone RESULTS: Eustachian tube dysfunction was found bilaterally in 25% of the patients and unilaterally in 6%, while chronic otitis media was found in 32.5% and 12.5%, respectively. The hearing level did not differ between the side of the cleft and the opposite side (P=0.562). CONCLUSION: Nearly a third of the adult patients still suffered from eustachian tube dysfunction. Pathological tympanograms and chronic otitis media usually occurred bilaterally. A relationship between the side of the cleft and the side on which the eustachian tube dysfunction or its sequelae occurred was not apparent. The main reason seems to be the continuing bilateral muscular insufficiency in opening the eustachian tube.