鼓膜部分切除术治疗鼻咽癌放疗后分泌性中耳炎的临床价值

Clinical Application of Incomplete Tympanectomy for Secretory Otitis Media in Nasopharyngeal Carcinoma after Radiotherapy

背景与目的:对于放疗后咽鼓管功能已经严重受损的分泌性中耳炎,目前的治疗方法疗效有限。鼓膜穿孔可以避免分泌性中耳炎的复发,本研究旨在探讨鼓膜部分切除术治疗鼻咽癌放疗后分泌性中耳炎的临床价值。方法:经过综合的耳功能检测,确认鼻咽癌放疗后分泌性中耳炎患耳的咽鼓管功能已经严重受损后,对16例(18耳)符合条件的患者施行鼓膜部分切除术,对术后患者的听力及其它症状进行超过6个月的随访观察。结果:鼓膜部分切除术后61%(11/18)残留鼓膜穿孔,患者听力普遍提高,平均气骨导差由术前的30.1dB减至16.0dB,耳闷、耳鸣和头痛等症状基本消失。鼓膜部分切除术后鼓膜再愈合7耳(39%),术前和术后平均气骨导差分别是33.0dB和32.1dB。结论:鼓膜部分切除术治疗分泌性中耳炎疗效确切而持久,对鼓膜再愈合耳的听功能无损害。

BACKGROUND & OBJECTIVE: Efficacy of previous treatments on secretory otitis media ears with severely damaged eustachian tube function after radiotherapy is limited. Tympan perforation can avoid relapse of secretory otitis media. This study was to explore clinical value of incomplete tympanectomy for secretory otitis media in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. METHODS: After confirmed severely damaged eustachian tube function through comprehensive examinations, 16 NPC patients (18 ears) with secretory otitis media after radiotherapy received incomplete tympanectomy. All patients were followed up for more than 6 months. RESULTS: After operation, 11 of 18 (61%) ears remained tympan perforation, audition was improved at large in these ears, the average air-bone conduction difference decreased from 30.1 dB to 16.0 dB, other symptoms, such as aural fullness, tinnitus, and headache, basically disappeared. After operation, tympans closed up in 7 (39%) ears,the average air-bone conduction difference decreased from 33.0 dB to 32.1 dB. CONCLUSION: Incomplete tympanectomy may have a long and definite effect on secretory otitis media without any injury on audition after healing of tympan.