慢性鼻窦炎I型患者鼻内镜术后鼻音及鼻腔通气程度的变化

Changes of Nasality and Nasal Patency after Endoscopic Sinus Surgery for Patients with Chronic Sinusitis

目的通过对慢性鼻窦炎I型患者行内窥镜鼻窦手术(endoscopic sinus surgery,ESS)前后鼻音及鼻腔阻力检测,探讨ESS后鼻腔鼻窦共鸣特性的改变及鼻腔阻力的变化特点。方法对资料记录完整的75例成人慢性鼻窦炎I型患者(1期38例,2期15例,3期22例),ESS前后使用鼻声图仪和鼻压计分别对鼻音和鼻阻力进行检测。结果I型1期患者术后1月鼻音和总鼻阻力与术前无明显变化;进一步研究发现,单侧上颌窦炎对鼻音有一定影响,手术后1月及3月基本恢复正常;单侧额窦炎或蝶窦炎对鼻音无明显影响。I型2期和3期患者术后1月总鼻阻力无明显改变,而鼻音较术前改善(P<0.05),但仍低于正常范围,术后3月术腔上皮化后,鼻音基本恢复正常。结论对于慢性鼻窦炎I型患者,ESS术后虽然总鼻阻力正常,鼻音仍在一段时间里表现异常。若术中过多破坏鼻腔、鼻窦正常结构,使鼻腔、鼻窦的共鸣特性发生了改变,可能对从事语音工作者(如播音员、外语及语言老师)的语音产生影响。

Objective The purpose of this study was to describe the changes of resonance characteristics of the nasal cavity, including nasal sinuses, and nasal airway resistance （NAR） after endoscopic sinus surgery （ESS）, through objective measurement of nasality and NAR before and after ESS. Methods 75 patients received the examinations of nasality and NAR using Nasometer and Atmos Rhinomanometer before and after ESS, separately. ReSults There was no noticeable changes in nasality and total NAR for type Ⅰ patients at stage one, but further study showed that simple maxillary sinusitis had effects on nasality while frontal sinusitis and sphenoid sinusitis failed to. The total NAR of type Ⅰ stage 2 and stage 3 patients did not show significant changes one month after ESS, whereas nasality was ameliorated compared with that before operation（ P 〈 0. 05 ）, even though still below the normal range. Nasality almost recovered 3 months after operation. Conclusion For the patients with sinusal lesion alone, nasality still remaines abnormal for a certain period of time, although the total NAR becomes normal. This indicates that nasality may not be improved immediately after ESS. On the other hand, some undesirable effects may occur to the voice professionals, such as radio announcers, if the resonance characteristics of the nasal cavity were changed due to the excessive destruction of its normal structure.