鼻咽癌放疗后分泌性中耳炎的循证治疗

目的:分析鼻咽癌(NPC)放疗后分泌性中耳炎(SOM)的发生机制,依据循证医学(EBM)的原则,探索一种有效的、针对其发病机制各个环节的治疗方法。方法:对106例(112耳)NPC放疗后SOM患者,采用全身和局部抗炎、神经营养、扩张血管及激素治疗;加强鼻腔、鼻咽局部清理,治疗鼻腔鼻窦疾病;采用咽鼓管置管、冲洗及注药等综合治疗措施。结果:所有患者治疗前均有耳鸣、耳闷塞感及听力下降等症状,鼓室导抗图均为B型。经综合治疗后,耳鸣:消失81耳(72.32%),好转25耳(22.32%),无效6耳(5.36%),总有效率为94.64%耳闷塞感:消失92耳(82.14%),好转18耳(16.07%),无效2耳(1.79%),总有效率为98.21%。声阻抗检查:鼓室曲线A型56耳(50.00%),As型42耳(37.50%),B型2耳(1.79%),C型12耳(10.71%)。治疗后0.5、1.02.0kHz气导听阈均值为(28.5±3.0)dBHL,而治疗前为(47.0±5.0)dBHL,其差异有统计学意义(P<0.01)结论:依据EBM的原则,有针对性地对NPC放疗后SOM的发病机制的各个环节采取对因治疗,是非常有效和切实可行的,对提高NPC患者的生存质量具有重要意义。

Evidence-based treatment of secretory otitis media in patients with nasopharyngeal carcinoma after radiotherapy

OBJECTIVE: According to the principle of Evidence-Based Medicine (EBM), to analyse the cause of SOM in patients with nasopharyngeal carcinomar (NPC) after radiotherapy and to explore the effective treatment methods of SOM in patients with NPC after radiotherapy. METHOD: One hundred and six cases (112 ears) of SOM in patients with NPC after radiotherapy were treated with comprehensive management,e. g application of general and local antibiotics,nerves nutrition medicine, blood vessel dilating drugs and hormone, reinforced clearance of nasal cavities and nasopharynx and treatment of the disease of nasal cavities and sinuses, in addition to inserting catheter into the tympanum and intratympanic application of medicine through the eustachian tube. RESULT: Before the comprehensive treatment, all patients had hearing impairment, tinnitus and/or the feeling of ear blocked. Acoustic immittance test showed 112 ears(100%) had Type B tympanogram. After the treatment, tinnitus (ears) disappeared in 81 ears (72.32%), relieved in 25 ears (22.32%) and no effect was seen in 6 ears (5.36%). The total efficiency was 94.64. The feeling of ear blocked disappeared in 92 ears (82.14%), relieved in 18 ears (16.07%) and no effect was found in 2 ears (1.79%). The total efficiency was 98.21%. Acoustic immittance test showed 56 ears (50%) had Type A tympanogram, 42 ears had Type As (37.50%), 2 ears had Type B (1.79%) and, 12 ear had Type Cs (10.71%). The mean hearing threshold of 0.5,1,2 kHz of pure-tone was (28.5 +/- 3.0) dBHL after the treatment, which was (47.0 +/- 5.0) dBHL prior to it. No otorrhea, or permanent scar obstruction in the eustachian tube was found after the treatment. CONCLUSION: It is very effective and practicable to treat SOM in patients with NPC after radiotherapy according to the principle of EBM and to aim directly at the cause of SOM in patients with NPC after radiotherapy. It is very significant to improve the life quality of patients with NPC after radiotherapy.