慢性化脓性中耳炎的咽鼓管功能对手术疗效的影响

Functional changes of eustachian tube in chronic suppurative otitis media and it's influence on effects of tympanoplasty

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。

Objective To explore the changes of Eustachian tube function in chronic suppurative otitis media and it's influence on operative effects. Methods The relationship between eustachian tube function and curative effects of tympanoplasty was retrospectively analyzed in 40 ears with chronic suppurative otitis media. Eustachian tube function in patients with chronic suppurative otitis media was measured by inflation-deflation test, tubotympanoaerodynamic graphy (TTAG) and sonotubometry. The ostium tympanicum and the pharyngeal opening of Eustachian tube were observed by tele-otoscope or nasoendoscopy. To analyse the relationship between the changes of Eustachian tube function and the location of damage, the tympanic membranes of ears with normal Eustachian tube function were compared with the ears with abnormal Eustachian tube function after tympanoplasty. Results There was a relationship between the eustachian tube fuction of ears with chronic suppurative otitis media and the degree of damage of the ostium tympanicum. The damage of the ostium tympanicum of ears with normal tube function was trivial whereas the damage of the ostium tympanicum of ears with abnormal tube function was serious. The difference was significant. Among the 40 ears being subjected to tympanoplasty, the tympanic membranes of ears with normal tube function were better than the ears with abnormal tube function. Conclusion There was a relationship between the tube function of ears with chronic suppurative otitis media and the curative effects of tympanoplasty. The Eustachian tube disfunction may be an important factor on curative effects in paitents with chronic suppurative otitis media.