头颈部恶性肿瘤放疗后分泌性中耳炎鼓膜置管疗效观察

观察头颈部恶性肿瘤放疗后分泌性中耳炎(secretoryotitismedia,SOM)鼓膜置管的疗效。采用陶瓷通气管对30例(49耳)头颈部恶性肿瘤放疗后经治疗无效的SOM患者进行鼓膜置管和随访,对治疗耳的听力,伴随症状的改变和咽鼓管功能进行对比。随访3个月~6年,治愈7耳,治愈率为14%,有效40耳,总有效率为96%,6耳(12%)咽鼓管功能好转,所有重复置管的耳功能均得到不同程度的改善。置管后耳漏发生率为29%,鼓膜穿孔发生率为12%。鼓膜置管对该类患者咽鼓管功能恢复和耳功能改善均有帮助。     

头颈部肿瘤放射治疗后分泌性中耳炎的研究进展

头颈部肿瘤尤其是鼻咽癌放疗后分泌性中耳炎发病率高达16%-26%。放射治疗引起局部组织水肿、血管扩张、粘膜损害，引起中耳包括咽鼓管相关肌肉组织的纤维化，从而导致咽鼓管通气功能障碍。在放疗后6个月，咽鼓管功能损害达高峰。放射治疗后肿瘤消失，但炎症及放射后水肿仍可导致咽鼓管功能障碍及分泌性中耳炎。放疗后5年随访发现，放射剂量在80Gy以下者，咽鼓管功能均有改善，放疗后咽鼓管功能正常及开放状态者比较，放射剂量差别无统计学意义。放疗后2年随访，鼓膜切开或置管术后耳漏发生率很高；5年和10年随访分泌性中耳炎有自愈倾向，并渐成咽鼓管开放状态。     

经耳内窥镜鼓室置管治疗鼻咽癌放疗后渗出性中耳炎疗效观察

目的:评价经耳内窥镜鼓室置管治疗鼻咽癌放疗后渗出性中耳炎的疗效.方法:对我院24例(36耳)鼻咽癌放疗后渗出性中耳炎行经耳内窥镜鼓膜置管术,并观察听力、中耳功能的变化.结果:治愈12耳,占33.33%.有效14耳,占38.89%.总有效率72.22%.无效6 耳,占13.89 %.出现并发症 4 耳,占11.11%,患耳长期流脓.结论:经耳内窥镜鼓膜置管术是一种有效的治疗鼻咽癌放疗后渗出性中耳炎的方法.     

鼻咽癌放射治疗后分泌性中耳炎的临床观察

目的 探讨鼻咽癌患者放射治疗后分泌性中耳炎的发生，寻找有效的防治措施。方法 观察104例（208只耳）鼻咽癌患者放疗前后分泌性中耳炎的发生。结果 鼻咽癌患者放疗后分泌性中耳炎的发生率为44.1%(64/145只耳），放冶后6个月，分泌性中耳炎的发生率达高峰，为50.1%(33/64只耳）。放疗所致分泌性中耳炎与电离辐射对中耳的直接损伤和放疗前中耳负压升高有密切关系。结论 改进放射治疗设野技术，使用有效药物，采取鼓膜置管和鼓膜切开等方法对防治分泌性中耳炎的发生有一定用处，但其耳瘘发生率很高。     

鼻咽癌3-D计划放射治疗后放射性中耳炎的临床分析

背景与目的:中耳咽鼓管损害高峰发生在放疗后半年,并且在很多病例可持续终身,至今为止临床上尚无有效的治疗方法,寻求放射治疗中中耳鼓室及咽鼓管更好的保护仍是放射治疗医师面临的责任,在精确放疗技术应用逐渐普遍的今天,肿瘤周围正常组织和器官的保护受到越来越多的重视,但到目前为止,有关中耳放射损伤的研究报道极少。我们采用回顾性分析的方法,通过比较鼓室腔及骨性段咽鼓管剂量分布与放疗后分泌性中耳炎的发生率,评价在鼻咽癌3-D计划放射治疗中中耳功能保护的可能性,同时了解放疗后时间、化疗、T分期等因素对结果的影响。方法:40例80耳有完整听力学检查材料的鼻咽癌3-D计划放射治疗的患者进入此项研究。所有病例放疗前后均经耳部检查,电测听及声阻抗测听,放疗后随访时间为6~24个月。电测听以500,1 000,2 000,4 000 Hz听阈平均值计算气骨导差,声阻抗根据鼓室图分为A、B、C 3型,A型为正常鼓室图,B型为中耳鼓室积液,C型为咽鼓管功能不良。结果:79耳符合声阻抗分析条件。放疗后62%耳与放疗前保持不变,13%耳得到改善,25%耳恶化。鼓室腔及骨性段咽鼓管剂量分布在恶化耳与其他各组耳之间比较差异有显著性。80耳电测听分析结果,放疗后无变化耳58%,改善耳12%,恶化耳30%。分析剂量因素对声阻抗结果的影响,恶化组的鼓室腔及骨性段咽鼓管平均受照剂量为(5379.81±706.01)cGy,不变组的平均受照剂量为(4735.72±812.30)cGy,改善组的平均剂量为(4652.86±809.78)cGy;分析剂量因素对电测听结果的影响,恶化组的中耳及骨性咽鼓管平均受量为(5229.38±778.11)cGy,不变组的平均受量为(4719.64±744.82)cGy,改善组的平均剂量为(4702.38±922.21)cGy。统计分析发现3组的剂量差异有显著性。T分期变化及1年内或1年后时间分组对听力测试结果的影响差异有显著性,而化疗对听力测试结果的影响不明显。结论:在鼻咽癌3-D放射治疗中,如将鼓室腔及骨性段咽鼓管剂量控制在4700 cGy以下,则可明显减少延迟性放射性中耳炎的发生率。对中耳鼓室腔及骨性段的保护随着肿瘤体积的增大可能性减少。放射性中耳功能损伤发病高峰在1年内,在放疗前具有正常听觉功能者,放疗1年后有更多的机会从放射损伤中恢复。     

咽鼓管球囊扩张术治疗鼻咽癌放疗后咽鼓管功能障碍的效果观察

目的 探讨咽鼓管球囊扩张术(BDET)治疗鼻咽癌放疗后咽鼓管功能障碍(ETD)的临床效果。方法 选取2017年1月至2019年6月间黄梅县人民医院收治的62例手术治疗的鼻咽癌放疗后ETD患者,按照随机数字表法分为观察组和对照组,每组31例。对照组患者采用鼓膜置管术治疗,观察组患者采用BDET治疗,比较两组患者的临床效果、视觉模拟评分及咽鼓管功能障碍评分。结果 术后12个月,两组患者气导听阈、平均气骨导差和鼓室压图比较,差异均有统计学意义(均P<0.05)。观察组患者手术治疗总有效率为83.9%,高于对照组的51.6%,差异有统计学意义(P<0.05)。术后12个月时,两组患者耳闷、听觉模糊、耳痛及耳鸣评分均降低,且观察组均低于对照组,差异均有统计学意义(均P<0.05)。术后12个月时,两组患者咽鼓管功能障碍评分均降低,且观察组低于对照组,差异均有统计学意义(均P<0.05)。结论 BDET治疗鼻咽癌放疗后ETD,可有效改善患者的气导听阈、平均气骨导差、鼓室压图及咽鼓管测压,提高术后VAS和咽鼓管功能障碍评分,治疗总有效率优于鼓膜置管术。     

鼻咽癌放疗后致咽鼓管异常开放症1例

患者,男,43岁,因鼻出血1周于1999年12月26日住院(住院号：352968)。患者于1985年因鼻咽癌行放射治疗,放疗量NPDT70Gy,两年前开始右耳常能听到呼吸气流声,同时伴右耳颞部间歇性胀闷不适,症状渐重,左耳亦偶见类似症状,自觉双耳听力无明显变化,无耳漏史。体查：鼻腔、鼻咽部干燥,粘膜无光泽,鼻甲轻度萎缩,双侧鼓膜完整,色稍暗,标志大致清楚。电子纤维鼻咽镜检查：双侧咽鼓管口宽大,可窥及咽鼓管软骨段大部,吞咽时咽鼓管口组织活动微弱,管径无变化。软腭外观僵硬,吞咽时活动幅度极小。鼓膜镜检查：患者用力呼吸时右耳鼓膜出现明显扇动,左耳鼓膜扇动微弱。纯音测听检查：双耳轻度感音神经性耳聋,语频平均听阈右耳21dB,左耳15dB。咽鼓管功能检查：双耳咽鼓管异常开放。患者住院10天,鼻出血治愈后要求出院,对咽鼓管异常开放未能做进一步的处理。 讨论 咽鼓管异常开放症临床并不少见,但鼻咽癌放疗后致咽鼓管异常开放者则少见报道。鼻咽癌放疗时,咽鼓管处于射野之中,射野内正常的咽鼓管粘膜、粘膜下层的弹力纤维及脂肪垫受损萎缩,从而使咽鼓管管腔扩大。另外,司咽鼓管开放的腭帆张肌等由于受放射损害,疤痕形成或纤维化,这些肌肉出现萎缩缩短僵硬,处于一种高张力状态,也是阻碍咽鼓管闭合的一个原因。这些损害的改变是缓慢而持久的,与血管的缓慢供血障碍有关,本例是在放疗后12年才出现症状。由于绝大多数鼻咽癌病人放疗后都有不同类型、不同程度的并发症存在,所以对病人危害不重的放疗后咽鼓管异常开放症一般不易发现。 [编辑及校对：龙小年]     

鼻咽癌放射治疗对中耳功能的影响及分泌性中耳炎的预防

目的 探讨放射治疗绎鼻咽癌患者中 功能的影响，寻找有效的防治措施。方法 观察１６３例鼻咽癌患者放疗前后分泌性中耳炎的发生及中耳压的改变。结果 鼻咽癌患者施疗后中耳炎的发生率为４１．６％（１０２／２４５只耳），其中放疗后６个月之内分泌性中耳炎发生率达４７．１％（４８／１０２只耳），放疗所致分泌性中耳炎与电离辐射对中耳的直接损伤和放疗前中耳负压的升高有密切的关系。结论 发生分泌性中耳炎是放射治疗对鼻咽     

耳、鼻、咽、喉（051266-051309）

051266 影响大型听神经瘤术后面神经功能的局部因素，051267 听神经瘤的锁孔手术治疗，051268 鼓胰部分切除术治疗鼻咽癌放疗后分泌性中耳炎的临床价值，051269 拓扑替康对鼻咽癌放射增敏机制的研究，051270 鼻咽癌首程放疗后颈部淋巴结复发因素探讨。     

鼓膜置管术与鼓室注药治疗鼻咽癌放疗后分泌性中耳炎的疗效分析

目的探讨鼓膜置管术与鼓室注药治疗鼻咽癌放疗后分泌性中耳炎的临床疗效。方法 2010年4月至2012年1月间收治的鼻咽癌放疗后分泌性中耳炎患者128例,按治疗方式分为对照组(n=64)和试验组(n=64)。对照组采用盐酸氨溴索鼓室注药,试验组采用鼓膜置管术。比较两组患者的临床疗效、言语频率及并发症发生率。结果对照组和试验组患者的治疗总有效率分别为65.6%和87.5%,试验组患者的疗效明显优于对照组,差异有统计学意义(χ2=4.267,P<0.05)。对照组和试验组患者的并发症发生率分别为50.0%和15.6%,试验组患者的并发症发生率明显低于对照组,差异有统计学意义(χ2=8.576,P<0.05)。试验组患者的言语频率明显低于对照组,差异有统计学意义(t=3.202,P<0.05)。结论采用鼓膜置管术治疗鼻咽癌放疗后分泌性中耳炎的临床疗效优于鼓室注药。     

Effectiveness of Intratympanic Dexamethasone in Otitis Media with Effusion Resistant to Conventional Therapy

The aim of this study was to determine the efficiency of intratympanic dexamethasone (ITD) injections as a new treatment modality in otitis media with effusion resistant to conventional therapy. We planned a nonrandomized prospective study to determine the safety and effectiveness of the direct administration of dexamethasone into middle ear cavity with chronic eustachian tube dysfunction. This study was applied on 75 ears of 64 patients aged from 12 to 60 years. ITD received 47 ears of 41 patients who had previously been treated by medical or surgical therapy middle ear effusion without resolution classified as study group. They were taken conventional medical therapy again 28 ears of 23 patients classified as a control group. ITDs were administered 0.5 ml/4 mg per mm directly in antero-superior quadrant of tympanic membrane. These injections were repeated once a week for 4 weeks. Results were evaluated by using audiometric and tympanometric measurements 1 and 3 months after the treatments. Audiometric measurement shows that 9.91 dB improvement in the mean air–bone gap 15.17 dB in air conduction (AC) pure-tone averages (PTA) and 5.25 dB bone conduction (BC) PTA. But the control group data showed only 2 dB improvement in the mean air–bone gap, 3 dB AC–PTA and 1.36 dB BC–PTA. Tympanometric improvement was found. In 28 ears of patients (59.6%) like type B or C converted to type A in study group without complication but only in three ears (10.7%) of control group. ITD administration to the middle ear is safe and effective for the treatment of otitis media with effusion or chronic eustachian tube dysfunction. No complications like tympanic membrane perforation and/or sensorineural hearing loss have occurred.     

鼻咽癌患者放疗后耳聋的危险因素和临床处理

目的：了解鼻咽癌患者放疗后耳聋的影响因素探索耳聋的处理方法。方法：观察220例鼻咽癌患者放疗后耳聋的发生情况,对耳聋者鼓室行穿刺抽液。分析患者性别、年龄、鼻咽肿瘤T分期、侧壁侵犯、放疗前分泌性中耳炎等因素与放疗后出现耳聋的关系。结果：鼻咽癌患者放疗后耳聋的发生率为46．82％,放疗后6个月内发生率为52．42％。患者性别、年龄、鼻咽肿瘤T分期等因素对放疗后耳聋的发生无显著性影响（P〉0．05）,肿瘤侵犯鼻咽侧壁和放疗前有分泌性中耳炎与放疗后耳聋的发生显著相关（P〈0．01）。结论：肿瘤侵犯鼻咽侧壁和放疗前有分泌性中耳炎是放疗后耳聋的危险因素。鼻咽癌患者放疗后耳聋的处理目前比较好的是重复鼓室穿刺抽液配合适时倒佩戴助听器。     

Eustachian tube function test: a new dimension in the management of CSOM

Poor eustachian tube function is a major cause of both failure of tympanoplasty as well as the persistence of otorrhoea in chronic suppurative otiis media. In this study, Eustachian tube function tests were carried out on 631 ears of CSOM using an impedance audiometer and the results were analysed. The study showed that impaired tubal function is not only the major cause of persistent/recurrent otorrhoea in CSOM but is also an important contributory factor for failure of tympanoplasty: The results of tympanoplasty were found to be significantly poor when carried out in ears having poor tubal function as compared to ears with normal tubal function.     

Bilateral Type 1 Tympanoplasty in Chronic Otitis Media

A theoretical risk of iatrogenic sensorineural hearing loss during surgery has induced a reluctance to perform bilateral tympanoplasty type I among some otosurgeons. This paper presents results of bilateral surgery in 14 patients (28 ears). Fourteen patients with bilateral, dry tympanic membrane perforations caused by chronic otitis media were selected prospectively for bilateral tympanoplasty type I (28 ears) at a tertiary referral center. All patients had a HL corresponding to the size and localization of the perforation (no suspicion of ossicular chain defect or other pathology). Mean age was 37.5 years. There were seven males and seven females in our study. All but five ears were operated through an endaural or endomeatal approach, and five ears operated by postaural approach. The Underlay technique was used in all cases. Total ten cases operated using Fascia Lata and four cases operated using Temporalis fascia as graft material. Follow-up examination and hearing tests (pure tone audiometry) were performed up to 20 months after surgery. The graft take rate was 96%, with no retraction pockets or displaced grafts observed during follow-up. One patient had small residual perforation which healed at the end of 3 months. Hearing improved significantly, and the air-bone gap was significantly reduced. The air-bone gap was closed to within 10 dB in 92% and within 20 dB in 100% of the ears. Surprisingly good hearing was found during postoperative, bilateral ear canal gauze packing. Iatrogenic sensorineural HL did not occur. We conclude that bilateral myringoplasty is safe, with good results, reduces costs, and leaves the patient satisfied. The hearing impairment during postoperative ear canal packing is surprisingly modest and readily acceptable by the patients.     

Inflation-deflation test as a predictor of aditus patency in patients with chronic suppurative otitis media

Aims

To assess eustachian tubal function (ETF) preoperatively in patients with chronic suppurative otitis media (CSOM) with central perforation by performing the inflation-deflation test. To correlate the results of the inflation-deflation test with the finding of aditus patency or block in patients with CSOM

Study design

Prospective, cohort

Setting

Tertiary care hospital

Subjects

Eighty adult patients with chronic suppurative otitis media and central perforation were recruited into the study. There were 45 males and 35 females.

Methods

All patients underwent preoperative inflation-deflation test followed by cortical mastoidectomy and tympanoplasty. The patency of the aditus was assessed intraoperatively.

Main outcome measure

Equalization of pressure on inflation-deflation test and intraoperative assessment of aditus patency

Results

Of a total of 80 patients, 49 patients were found to have discharging ears and 31 had dry ears at the time of surgery. In dry ears the inflation-deflation test had a sensitivity of 93% in predicting aditus patency although the specificity was lower at 67%. In discharging ears the sensitivity in predicting aditus patency was 72% and the specificity was 67%.

Conclusion

The eustachian tube inflation-deflation test is a sensitive test for predicting aditus patency in patients with dry ears but less so in patients with discharging ears. Hence, it could be used in the former to avoid unnecessary exploration of the mastoid.     

Ear surgery without microscope; is it possible

Our experience of endoscope usage in otological surgery is presented. We included 17 patients with secretory otitis media for grommet insertion, 49 cases of myringoplasties and 6 cases of ossiculoplasties operated between May 2005 and 2008. All the procedures were performed through transcanal route. The success rate regarding perforation closure was 91.5% and average air-bone gap improved from 22.24–12.28 db in myringoplasty group and from 27.5–13 db in ossiculoplasty group. Secretory changes subsided in 16 out of 17 patients in secretory otitis media group. Endoscopic surgery offers many advantages over microscopic surgery which have been discussed.     

鼻咽癌放疗后耳聋的临床分析

目的 了解鼻咽癌放疗后耳聋的现状。方法 对162例（316耳）鼻咽癌放疗后耳聋患者进行纯音听阈测试，并对测试的结果进行统计学分析。结果 神经性耳聋占26.6%(84/316)，传导性耳聋占4.7%(15/316)，混合性耳聋占68.7%(217/316);95。3%（301/316）的耳有骨导听损，放疗后10年内耳聋患者骨导听损较轻，放疗10年后耳聋患者骨导听损明显加重；73.4%(232/316)的聋耳有气导听损，放疗后不同时间段传导性耳聋和混合性耳聋的平均骨气导差稳定在27dB左右。结论 骨导听损虽然广泛，但程度较轻，发展缓慢；气导听损相对恒定，但程度较重。放疗后的耳聋主要是气导听损所致。通过治疗，有望得以控制。