慢性中耳炎咽鼓管鼓室口病变对咽鼓管功能的影响

目的 :探讨慢性中耳炎咽鼓管鼓室口病变与咽鼓管功能障碍的关系。方法 :用鼓室镜及咽鼓管功能检查仪对 4 4例 (45耳 )慢性中耳炎患者 ,进行术前咽鼓管鼓室口观察和咽鼓管功能检查 ,并对检查结果进行对比分析。结果 :4 5耳慢性中耳炎中 ,咽鼓管鼓室口正常 17耳 ,骨刺增生、黏膜肿胀等轻度病变者 18耳 ,黏膜肿胀或肉芽增生致管腔明显狭窄的重度病变有 10耳 ,其中 9耳咽鼓管功能呈阻塞型改变。结论 :咽鼓管鼓室口及骨部的骨刺增生、黏膜肿胀、肉芽形成是慢性中耳炎的常见病变 ,鼓室口及骨部的阻塞是导致慢性中耳炎咽鼓管阻塞的原因。     

慢性化脓性中耳炎咽鼓管鼓口病变与咽鼓管功能的相关性

1999年 8月～ 2 0 0 0年 7月我们用鼓室镜观察 44例慢性化脓性中耳炎术前患者的鼓室及咽鼓管鼓口 ,以了解鼓口的病变情况对咽鼓管功能的影响 ,现将结果报告如下。一、临床资料与检查方法1 临床资料 :慢性化脓性中耳炎术前患者 44例 (4 5耳 ) ,男 2 4例 ,女 2 0例 ,年龄 9～ 5 9岁。经过选择患者均为鼓膜中央性穿孔 ,并接受了手术治疗 ,术中证实为单纯型 2 4耳 ,胆脂瘤型 15耳 ,骨疡型 6耳。术前颞骨ＣＴ检查显示单纯型的鼓室、鼓窦及乳突无软组织影 ,无骨质破坏及听小骨破坏、吸收现象 ;而胆脂瘤型和骨疡型的鼓室、鼓窦及乳突有软组织影 ,有…     

颞骨CT在胆脂瘤型中耳炎中的诊断价值

目的：探讨颞骨高分辨率CT（HRCT）在胆脂瘤型中耳炎中的诊断价值。方法：回顾性总结1995年1月至1999年12月本院收治的胆脂瘤型中耳炎患者316例（330耳）。术前均按常规进行颞骨HRCT扫描，再经术中显微镜下探查，记录病变结果与HRCT表现进行对比分析，以探讨HRCT的诊断价值。结果：盾板、鼓室及彭窦天盖骨质缺损、乙状窦骨板骨质缺损等的术前HRCT与手术符合率100％。而神经骨管骨质缺损，水平半规管骨壁破坏的符合率分别为66．7％和78．9％。软组织占位符合率为100％，但是90％为胆脂瘤与肉芽混合型；听小骨受侵符合率为95％。结论：颞骨高分辨率CT对胆脂瘤型中耳炎的诊断，尤其对判定骨质缺损的范围与部位，制定手术方案和预估治疗效果，具有重要的指导意义。但CT诊断仍有其局限性，不能取代临床检查。     

胆脂瘤中耳炎与咽鼓管上隐窝

目的探讨咽鼓管上隐窝及其与上鼓室空气通道的状态在胆脂瘤中耳炎发病过程中的意义。方法观察胆脂瘤中耳炎52例（52耳，观察组）及乳突气化良好无慢性中耳炎病史的外伤性面神经麻痹患者16例（16耳，对照组）术中咽鼓管上隐窝及其与上鼓室通道开放状态。结果对照组16耳均呈清晰的咽鼓管上隐窝结构，呈膜性闭锁4耳（25．0％）。观察组52耳（100％）咽鼓管上隐窝与上鼓室前方呈完全闭锁，无相通病例。与对照组差异有统计学意义（Х^2=46．421，P=0．000）。其中骨性闭锁34耳（65．4％），膜性闭锁18耳（34．6％）；上鼓室空间狭小。全组均为硬化或气化不良型乳突。结论咽鼓管上隐窝与上鼓室的气流通道闭塞更容易造成上鼓室和乳突负压状态，可能是形成胆脂瘤的原因之一；咽鼓管上隐窝与上鼓室通道的解剖学变异可能是胆脂瘤中耳炎的易患因素。提示胆脂瘤中耳炎行完壁式鼓室成形术时开放该通道可能有助于防止术后复发。     

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.     

咽鼓管上隐窝与胆脂瘤型中耳炎病程关系的影像学研究

目的 观察不同病程的胆脂瘤型中耳炎患者咽鼓管上隐窝的大小,探讨咽鼓管上隐窝的形态学改变与病程的关系.方法 采用颞骨薄层CT摄片方法,对胆脂瘤型中耳炎患者的咽鼓管上隐窝的大小进行测量.结果 患耳的咽鼓管上隐窝形态较正常耳小,不同病程的胆脂瘤型中耳炎患者患耳咽鼓管上隐窝形态(前后径、垂直径与高度)改变无显著差异(t检验,P＞0.05).结论 患耳咽鼓管上隐窝与正常耳相比,其较小的形态可能在疾病发生前已经存在,而非疾病的发展过程中形成.提示咽鼓管上隐窝的形态可影响胆脂瘤型中耳炎的形成.在胆脂瘤型中耳炎的手术治疗中,尤其是完壁式鼓室成形术中,应在术中扩大咽鼓管上隐窝,改善中耳气体引流通道,以期减少术后复发.     

慢性中耳炎手术方法的选择

目的 探讨慢性中耳炎中耳乳突手术方式选择的依据.方法对160耳慢性中耳炎患者依据术前的高分辨CT（high resolution computed tomography,HRCT）检查并参考听力学,分别选择了鼓室成形术、一期乳突病变切除加鼓室成形术.结果依据术前HRCT检查,中耳乳突未发现阴影31耳行鼓室成形术,中耳乳突部分有阴影49耳行乳突病变切除加鼓室成形术（完壁式）,中耳乳突弥漫阴影或有骨破坏80耳行（开放式）乳突病变切除加鼓室成形术.术后干耳时间：7天～51天,平均23天.术后听力平均提高15 dB.结论160例慢性中耳炎手术方法的选择,主要以术前的HRCT为参考依据.     

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。     

分泌性中耳炎咽鼓管功能动态观察的临床意义

目的探讨分泌性中耳炎的咽鼓管功能状态和原因及对治疗的意义.方法动态观察分泌性中耳炎51耳的咽鼓管功能.用鼻内窥镜检查咽鼓管咽口,根据咽鼓管功能状态行咽鼓管吹张术或扩张术以及局部用药治疗.结果51耳中咽鼓管功能异常36耳,正常15耳.正常组中咽鼓管咽口充血狭窄或肿胀裂缝状8耳,异常组咽鼓管咽口充血狭窄或肿胀裂缝状32耳,两者差别有显著性(P＜0.05),咽鼓管功能异常与咽鼓管咽口病变有关;咽鼓管吹张术或扩张术和局部用药对分泌性中耳炎有效.结论咽鼓管咽口病变影响咽鼓管的功能,咽鼓管功能检查对治疗分泌性中耳炎有指导作用.     

慢性化脓性中耳炎患者术前颞骨CT检查对术式选择的意义

目的 探讨慢性化脓性中耳炎患者术前颞骨CT检查在术式选择中的作用.方法 101例慢性化脓性中耳炎患者术前行颞骨HRCT检查,结合听力学及耳内镜检查情况选择不同手术方式,并将术中所见(包括乳突、鼓窦、上鼓室以及听骨链及鼓室粘膜状态)与术前颞骨CT扫描结果比较.结果 101例患者中,39例术前CT显示乳突鼓窦未见密度增高影,均行鼓室成形术,其中术前CT显示听骨病变1例,而术中发现听骨链病变8例,二者符合率为12.5%(1/8);62例术前CT显示鼓窦、乳突腔有低密度影充填,但乳窦气房存在,无骨质吸收及破坏,鼓窦入口无扩大45例,行鼓室成形术,其中4例显示听骨链有病变,28例显示鼓室粘膜增厚,均行鼓室成形术,而术中发现听骨病变15例,鼓室黏膜病变19例,两种病变的术前CT与术中所见的符合率分别为26.67%(4/15)和67.86%(19/28);其余17例术前CT显示鼓室、鼓窦入口、乳突有低密度影充填,且乳窦气房骨质吸收和破坏,鼓室人口扩大,均行乳突根治+鼓室成形术,术前CT与术中所见一致,均可见听骨链及乳突、鼓窦病变.所有患者术后三个月的干耳率为93.07%(94/101),言语频率平均气导听力提高15～18 dB.结论 慢性化脓性中耳炎患者术前颞骨CT检查对听骨链、鼓室粘膜病变的评估的准确性有限,部分患者需要行颞骨高分辨率CT三维重建检查,不能仅凭CT决定术式,应结合听力学检查决定手术方式.     

Cholesteatoma in children: Recurrence related to observation period

From 1965 to 1978, 122 children with cholesteatoma had one-stage surgery. Follow-up examinations were carried out several times, with the last two taking place in 1980/81 and 1985/86. Ninety-eight percent of the children were seen at follow-up; the median observation time was 11 years, with a range of three to 21 years. The increase in recurrence rate with increasing observation time was analyzed. In 1980/81 there was a total recurrence rate of 12 percent of patients, including residual cholesteatoma in the tympanic cavity in 8%, in the attic in 2%, and recurrent cholesteatoma in 2%. In 1985/86 the recurrence rate had increased to 17%, distributed among residual cholesteatoma in the tympanic cavity in 10.6%, in the attic in 1.6%, and recurrent cholesteatoma in 4.8%. The recurrence rate was the same regardless of whether modified canal-wall-up mastoidectomy or canal-wall-down mastoidectomy had been employed. We conclude that cholesteatoma surgery should be individualized according to pathologic findings in the tympanic cavity, tubal function, and size of the mastoid air cell system. Small cholesteatomas confined to the tympanic cavity may be removed by tympanoplasty alone, without mastoidectomy. In ears with adhesive otitis, canal-wall-down mastoidectomy is preferred; and in ears with a reasonably good tubal function and a large air cell system, canal-wall-up mastoidectomy is recommended. The long-term results reported here seem to indicate that, in children, canal-wall-up mastoidectomy is preferable to canal-wall-down mastoidectomy.     

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。     

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。     

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.     

The effects of anesthesia of the tympanic membrane on eustachian tube function

In our previous histological studies of the tympanic membrane, we reported the presence of encapsulated nerve corpuscles that are capable of detecting middle ear pressure. Based on these findings, the relation between sensory receptors in the tympanic membrane and tubal function was examined in a clinical study. Tubal function was tested during Valsalva maneuvers and its active equilibration. Function was recorded as a change of the static compliance of the tympanic membrane on an otoadmittance meter. To paralyze the sensory receptors in the tympanic membrane, iontophoresis was used to induce anesthesia of the drum. Forty ears of 20 subjects were tested. All ears were able to equalize positive middle ear pressure without or with a single swallowing. After anesthesia, 13 ears needed more than two swallows and 4 ears failed to equalize middle ear pressure in spite of repeated swallowings. As eustachian tube function changed following anesthesia of the tympanic membranes, a neural connection between sensory receptors in the tympanic membrane and tubal muscles is suggested.     

Direct measurement of middle ear pressure through the eustachian tube

We report a method for measuring middle ear pressure through the eustachian tube. We used a 1-mm-diameter micro-tip catheter pressure transducer (Mikro-tip) and inserted this into the tympanic cavity through the eustachian tube. In preliminary studies, we measured four normal ears, two ears with tubal dysfunction, one ear with a dry perforation and 13 ears with otitis media with effusion (OME). Among those ears with OME, three showed negative middle ear pressure, three slight positive pressure and one normal pressure. These findings suggest that our transtubal method is reliable and useful for measuring middle ear pressure.     

Direct measurement of middle ear pressure through the eustachian tube

Summary We report a method for measuring middle ear pressure through the eustachian tube. We used a 1-mm-diameter micro-tip catheter pressure transducer (Mikro-tip) and inserted this into the tympanic cavity through the eustachian tube. In preliminary studies, we measured four normal ears, two ears with tubal dysfunction, one ear with a dry perforation and 13 ears with otitis media with effusion (OME). Among those ears with OME, three showed negative middle ear pressure, three slight positive pressure and one normal pressure. These findings suggest that our transtubal method is reliable and useful for measuring middle ear pressure.     

Evaluation of noninvasive eustachian tube function tests in normal adults

A causal association between eustachian tube (ET) dysfunction and otitis media (OM) has been documented. We present normative data for eustachian tube function (ETF) in an otologically normal population of 107 college-age subjects using two noninvasive methods: nine-step tympanometric testing and sonotubometry. The results show a 78% agreement between the two methods when one test session was performed. The nine-step test showed a 52% repeatability rate on three sequential test sessions while the sonotubometry test showed a 34% repeatability rate. The combined tests showed a 34% agreement for the three sequential tests. The findings reveal that the combination of the two tests identify 96% of normal subjects as having at least some tubal function present. Although both tests provide similar information regarding the presence of tubal opening, the sonotubometry method is more physiologic. Additional information shows that the average category of the nine-step test in a normal population was category 2, the mean duration of tubal dilation was 0.40 seconds, and the mean middle-ear pressure was -12 mm H₂O.     

Relationship of petrous temporal bone pneumatization to the eustachian tube lumen

OBJECTIVES/HYPOTHESIS: Objectives were to determine the incidence of petrous apex pneumatization and to define the relationship between a pneumatized petrous temporal bone and the eustachian tube lumen. STUDY DESIGN: Retrospective study with institutional review board approval including only adult patients. METHODS: One hundred head computed tomography (ct) scans and 204 petrous temporal bone CT scans performed at a tertiary teaching hospital were reviewed. The two senior authors (s.h.s., p.c.s.) independently reviewed the petrous temporal bone CT scans for grade of pneumatization. Pneumatized CT scans were then reviewed for the presence of a direct communication with the eustachian tube lumen. Significance was determined using the chi test and Pearson correlation of ranks. RESULTS: The incidence of peritubal cells opening into the eustachian tube anterior to the tympanic orifice was 92%. CONCLUSION: The direct communication of peritubal cells with the bony eustachian tube may play a role in the development of persistent cerebrospinal fluid rhinorrhea after cerebellopontine angle surgery.