咽鼓管磁共振成像

咽鼓管位置隐蔽，解剖结构复杂，临床检查困难。磁共振成像具有良好的软组织分辨率和多层面成像的能力，因此可用于咽鼓管的检查。本文介绍了咽鼓管磁共振成像的临床应用及其进展。     

咽鼓管倾斜旁矢状位磁共振成像

目的 根据咽鼓管特殊的解剖结构进行咽鼓管倾斜旁矢状位磁共振成像.方法 选取3名志愿者(男2人,女1人)进行研究.应用3.0T超导型磁共振扫描仪,采用质子密度加权成像扫描(proton densityweighted imaging,PDWI)技术进行成像.首先获得头颅正中矢状位扫描图像,然后在此基础上沿双侧咽鼓管长轴所在平面进行咽鼓管倾斜轴位扫描,在获得图像上确定垂直于咽鼓管长轴的扫描线,进行平行于咽鼓管纵断面的倾斜旁矢状位扫描.将最终获得的原始数据通过多平面重建(multiplanar reconstruction,MPR),进一步修正扫描平面,并协助进行解剖结构识别.结果咽鼓管倾斜旁矢状位MRI图像显示咽鼓管软骨清晰,周围细小结构的软组织也能够辨认.结论 临床应用3.0T超导型磁共振扫描仪进行咽鼓管倾斜旁矢状位MR扫描,成像效果满意,操作简便易行,有助于咽鼓管相关疾病的诊断.     

颈静脉孔区薄层断层解剖学研究

目的 为临床颈静脉孔区影像学诊断提供断层解剖学依据。方法 利用生物塑化技术，将9例颈静脉孔区及相邻结构制成3个方位（横断、冠状位及矢状位）的薄层断层标本，观察各重要神经、血管在各方位上的出现范围、走行与毗邻关系。结果 在横断面上颈静脉孔连续5－6个层面显示，冠状断面连续7－8个层面显示，矢状断面连续10－11个层面显示。双重要层面的结构作了描述。结论 生物塑化薄片对颈静脉及相关神经、血管能够连续显示并准确分辨，对颈静脉孔区的影像诊断及手术有较高的价值。     

中国数字化可视人体咽鼓管薄层断层解剖研究

目的为临床影像诊断学提供咽鼓管及周围结构的精细断层解剖学资料。方法在中国数字化可视人体（Chinese visible human,CVH）头部数据集的基础上,按照常规头部轴位、冠状位以及咽鼓管长轴的倾斜轴位平面进行连续数字化重采样,采用连续追踪观察的方法,观察获得的3组薄层断层图像,研究咽鼓管及周围微细解剖组织结构的形态和毗邻关系。结果 CVH数据集咽鼓管轴位、冠状位及倾斜轴位图像解剖结构显示清晰,各有侧重,在倾斜轴位断层上,双侧咽鼓管全长同时被显示清楚。结论咽鼓管及周围解剖结构精细复杂,在常规MRI和CT图像上难于精确辨认。CVH数据集咽鼓管轴位、冠状位及倾斜轴位断层解剖研究为临床进行咽鼓管相关疾病的影像学检查提供断层解剖学资料。     

咽鼓管影像学

目的探讨咽鼓管影像学检查的临床应用情况。方法回顾性分析39例咽鼓管相关病变的影像学资料,重点观察咽鼓管及其周围结构被肿瘤侵犯的程度以及中耳渗出情况。结果部分咽鼓管相关疾病的常规轴位和冠状位CT和MRI图像可以很好的显示咽鼓管咽口、圆枕、咽鼓管纤维软骨部是否受累。相关疾病(肿瘤)压迫或侵犯咽鼓管软骨部造成咽鼓管阻塞,可以导致中耳和/或乳突积液,这种阻塞解除之后,中耳积液可以消失;如果病变只压迫了咽鼓管咽口或者只侵犯了圆枕,并不引起中耳积液。部分CT和MRI图像上重点显示了肿瘤本身情况,因此咽鼓管相关部位及中耳乳突观察不理想,全部病例的咽鼓管骨部显示都不明确,从而影响临床诊断。结论咽鼓管相关疾病的影像学资料能提示咽鼓管的部分结构是否受累,并对诊断提供一定帮助。     

小鼠咽鼓管及其腺体的解剖学研究

目的研究小鼠咽鼓管及其腺体的解剖结构,包括咽鼓管大体形态、黏膜上皮的移行及组成,腺体的分布、种类及组成。方法在解剖显微镜下分离出小鼠的咽鼓管及鼓室,常规石蜡包埋,5μm切片,苏木素-伊红(HE)和阿尔辛蓝-高碘酸Shiff(AB-PAS)染色,光学显微镜下观察。结果咽鼓管从鼓室向鼻咽部沿前内方向走行,平均长度约为1.53±0.08mm,宽度为0.22±0.03mm,高为1.14±0.08mm。小鼠咽鼓管可分为软骨部和膜部,软骨部主要被覆复层扁平上皮,膜部被覆多种上皮,其上份主要被覆复层扁平上皮,下份主要为假复层纤毛柱状上皮;咽鼓管腺体分布于咽鼓管的内侧壁和下壁,而外侧壁未发现有腺体分布。腺体可分浆液性、粘液性和混合性腺体,有导管开口于咽鼓管腔。结论咽鼓管黏膜上皮的结构及其腺体的位置分布提示咽鼓管黏膜及其腺体为一个有机的整体,对病原微生物进行有效的清除,共同维持着中耳腔的相对无菌环境。     

后循环缺血性眩晕磁共振成像研究

目的 探讨MRI在后循环缺血性眩晕诊断中的作用.方法 采用GE公司Signa Excite 3.0 T超导MRI设备,对75例后循环缺血性眩晕患者的MRI和磁共振血管成像(magnetic resonance angiography,MRA)检查结果进行回顾性分析,并按照不同的影像学表现将其分类.结果 75例血管性眩晕...     

突发性耳聋的磁共振成像研究进展

突发性耳聋是耳科常见疾病,先进的磁共振成像技术对突发性耳聋的病因诊断有一定的帮助,本文从磁共振结构影像学和功能影像学两个方面予以综述,以期对临床诊断路径选择提供帮助。     

结构磁共振成像和磁共振弥散张量成像应用于主观性耳鸣的研究进展

主观性耳鸣发病机制复杂,其发生不仅局限在听觉通路的异常,非经典通路的中枢可塑性变化也参与其中。随着影像学技术的发展,越来越多的学者试图利用结构磁共振成像(structural Magnetic Resonance Imaging,sMRI)和磁共振弥散张量成像(diffusion tensor imaging,DTI)对主观性耳鸣中枢机制进行探索。本文总结sMRI和DTI两种技术运用于主观性耳鸣中的研究进展,以期为耳鸣的发病机制及治疗提供新思路。     

单侧突发性聋患者脑磁共振扩散峰度成像研究

目的探讨单侧突发性聋患者脑部磁共振弥散峰度成像(diffasion kurtosis imaging, DKI)检查对突聋预后的评估作用。方法收集右侧突发性聋患者32例(突聋组),(病程≤3周,男16例,女16例,年龄39～73岁,平均52.31±8.59岁),正常对照组23例(男11例,女12例,年龄41～68岁,平均56.36±6.82岁),对照组和突聋组治疗前行常规磁共振检查及全脑DKI成像扫描;基于统计软件比较突聋组与正常对照组全脑DKI各参数图差异脑区;并根据治疗结果,将突聋组患者分为显效组(20例)和无效组(12例),再分别与正常对照组比较。结果双样本t检验结果显示,与正常对照组比较,突聋组左侧的颞上回、颞中回及颞下回、左侧的顶叶及枕叶等脑区的白质有不同程度的各向异性分数(FA)值减小,突聋组双侧额叶均有平均扩散峰度(MK)值及径向峰度(RK)值增加。突聋组的显效组20例和无效组12例分别与正常对照组比较,可见突聋组的轴向分度(AD)在右侧额上回、右侧额中回、左侧额中回减小,右侧中央后回减小,径向分度(RD)在左侧扣带回、左侧颞上回减小,扩散峰度各向异性(KFA)在左侧枕上...     

侧颅底塑化断层解剖及计算机辅助三维重建研究

目的：探讨侧颅底结构的断层解剖学特征，为此区域的病变和手术方法的选择提供解剖学依据。方法：采用生物塑化技术制作三套冠状面侧颅底结构的薄层切片，观察测量各个层面上重要结构的位置、毗邻关系，并用计算机提取图像后进行三维重建。结果：采用塑化技术制作的切片可以清晰显示侧颅底的骨质、肌肉、血管和神经等结构。侧颅底的结构可以通过上颌窦中部切面、咽鼓管咽口切面、卵圆孔切面、咽鼓管鼓口切面和内昕道切面分别展示，通过计算机对正常人侧颅底区域塑化薄层连续切片进行信号标定、提取和三维重建，成功地获得了蝶窦、三叉神经及其分支、颈内动脉、咽鼓管的离体图像。结论：薄层断面解剖可以准确定位侧颅底区域的重要结构及相互位置关系，三维重建图像形象逼真、准确，对侧颅底外科手术具有重要的意义。     

Laser vs microdebrider eustachian tuboplasty for the treatment of chronic adult eustachian tube dysfunction: A systematic review

ObjectivesMultiple treatments are described in the literature for the treatment of chronic Eustachian tube dysfunction but high-level quality evidence seems missing to support these treatments. This systematic review aimed to determine and compare the safety and efficacy of Laser Eustachian tuboplasty and Microdebrider Eustachian tuboplasty as a treatment for long-term Eustachian tube dysfunction.Data sourcesA total of 12 electronic databases were searched up to April 2018 for published and unpublished literature in the English language. References of included studies were checked.MethodsA systematic review was undertaken. Outcomes assessed were: primary outcomes-subjective improvement in symptoms (ETDQ-7), audiometric improvement of hearing, improvement of negative middle ear pressure noticed in tympanometry, objective improvement of tympanic membrane retraction. Secondary outcomes were-the ability to auto-insufflate Eustachian tube i.e. Valsalva manoeuvre, improved quality of life, passive tubal opening, tubomanometry, swallowing test, reduction in mucosal inflammation of Eustachian tube orifice in the nose, complications from the procedure, the need for further procedures. Results are reported in a narrative synthesis as a meta-analysis was not possible due to heterogeneous data.ResultsThree studies were included. All included studies were small-scale case series (13–38 participants). Studies were conducted outside the UK. Subjective and objective improvement of Eustachian tube function was reported in all studies. But all included studies were at high risk of bias and subject to multiple limitations. No major complications were reported in either study.ConclusionsBased on current evidence, it is not possible to recommend the clinical use of either of these two interventions i.e. Laser or Microdebrider Eustachian tuboplasty. Lack of controlled studies was identified as a gap in the evidence. Future research should be directed toward designing randomised controlled trials. These trials should use strict standard methodology and reporting criteria. Future trials should make use of consensus statement document about Eustachian tube dysfunction definition, diagnostic methods, and outcome assessment criteria to design clinical trials.     

咽鼓管功能障碍与球囊咽鼓管扩张技术的应用进展

咽鼓管功能障碍是导致中耳疾病的重要因素之一,临床上对咽鼓管功能障碍的判断方法及治疗方法很多,球囊咽鼓管扩张技术治疗咽鼓管功能障碍是一项简便、微创、疗效好的新方法。     

Mucociliary function of the eustachian tube in the eustachian tube dysfunction

Background: Most of the tests to evaluate the eustachian tube (ET) function are focused on the ventilation function of the ET.

Aim: Here we evaluate mucociliary function of the ET in patients with ET dysfunction.

Materials and methods: Ten patients with ET dysfunction were enrolled into the study. Six patients had chronic tympanic membrane retraction and four patients had chronic middle ear effusion (MEE). All patients had intact tympanic membranes. Tympanometry and clinical examinations were done to all patients. Mucociliary function was evaluated with technetium labeled albumin and blue dye. Tympanometry and clinical examinations were done to six patients with chronic tympanic membrane retraction and four patients with chronic middle ear effusion (MEE). Mucociliary function of the ET was evaluated with technetium labeled albumin and blue dye placed into middle ear through an intact tympanic membrane and followed from nasopharynx ET orifice (blue dye) and with gamma camera (technetium).

Results: Blue dye was observed in tubal orifice in six (6 of 10) patients during 30?min observation. Five of those patients (5 of 6) had tympanic membrane retraction and one patient (1 of 6) had MEE. Tracer activity decreased from middle ear in six (6 of 10) patients. Four of those patients had tympanic membrane retraction and two had MEE.

Conclusion: Mucociliary function of the ET seems to be better in patients with tympanic membrane retraction than patients with middle ear effusion.

Significance: Mucociliary function of the ET is an important function for middle ear aeration, blue dye test is easily available to be used also in clinical practice.     

Cartilage in the bony portion of the eustachian tube

Summary The distribution of cartilage in the bony section of the eustachian tube was studied by examining histological serial sections of 50 temporal bones of infants and adults. When cartilage was found to be present in the bony segments of the eustachian tube, its cross-sectional area was measured. Cartilage was seen in the isthmic region in all specimens. In the post-isthmic region it was present in all of the specimens taken from infants and in 92.3% of the adult specimens. In the pretympanic region cartilage was found in 34.6% of the infants' eustachian tubes and in 25% of the adults'. The results indicate that cartilage is also present in the bony part of the eustachian tube at all ages but diminishes in frequency the more the eustachian tube approaches the middle ear.     

Postnatal development of the eustachian tube glands

OBJECTIVE: To delineate a possible difference in the function of the eustachian tube (ET) between infants and adults. STUDY DESIGN: Morphometric and histopathological examination on the human temporal bones. METHODS: The secretory glands in the ET were studied in serial histological sections through the cartilaginous portion of the human ET obtained from 32 individuals whose ages ranged from 1 day to 19 years. Of these, 26 were normal control cases and 6 were cases with otitis media (OM). RESULTS: In both normal and OM groups, the distribution of the glands was predominantly in the medial side of the cartilaginous portion of the ET, and the volume of the ET glands was directly related to both the volume of the ET lumen and the patients' age. In normal cases, the relative proportion of the three types of acinar cells (mucous, serous, and mixed) varied among the different age groups. The cases in patients under 1 month of age had more mucous glands and fewer serous glands. In cases of the 1-month-old to 7-year-old age group, the three ET gland cell types came to be approximately equal. Relative proportion of the serous glands continuously increased with aging, and in cases of patients older than 7 years of age, serous glands were predominant over the other two components. CONCLUSION: It is assumed that the greater proportion of mucous glands and insufficient serous glands by 7 years of age reflects immature development, which may be one of the associated factors contributing to recurrent OM among infants.     

Reflux of nasopharyngeal content into middle ear through the eustachian tube

Whether nasopharyngeal content passes into the middle ear in patients without any head and neck pathology during the recovery phase of anesthesia is shown with an objective and prospective method. Thirty-eight patients, 21 female and 17 male, aged between 17 and 76, were included in the study. During the recovery phase of general anesthesia, 10 ml of 5 mCi Tc-99m-MAA was administered intranasally to the patients with a 10-F catheter. A manometer-adapted cuffed intubation tube was placed in the nasal passage so that the cuff was located at the choana. The pressure changes reflecting to the nasopharynx were recorded. The patients were extubated 10 min after the radionuclide was applied. The scintigraphic evaluation was done at the end of the 1st hour of the application of radionuclide. Transmission and emission views were taken with a gamma camera. Passage of nasopharyngeal content into the middle ear via the eustachian tube was not a statistically significant observation. The mean value of maximum pressure reflecting from the nasopharynx did not differ significantly between patients. Our study does not support the hypothesis that nasopharyngeal content passes directly through the eustachian tube into the middle ear and causes deleterious effects.