鼻内窥镜下经咽鼓管咽口注药治疗慢性分泌性中耳炎119例

Treatment of Chronic Secretory Otitis Media by Earcatheter Irrigation Under Nasal Endoscope: a report of 119 cases

【目的】探讨在内窥镜下经咽鼓管咽口注入药物治疗慢性分泌性中耳炎（SOM）的疗效。【方法】慢性分泌性中耳炎患者119例（184耳）,男性78例、女性41例,平均年龄38.7（6-68）岁。34例（68耳）患者中18例确诊腺样体肥大,16例变应性鼻炎,34例患者经咽鼓管仅灌注一次药物治愈;33例（40耳）患者为慢性鼻窦炎,鼻息肉或鼻中隔偏曲,清除鼻咽和咽鼓管口的脓性分泌物,经咽鼓管咽口灌注药物2-4次;51例（76耳）鼻咽癌放疗后的患者,先行鼻咽部瘢痕松解、脓痂清除及咽鼓负管咽口扩张注药6-9次。【结果】腺样体肥大和变应性鼻炎34例患者一次性注药恢复正常,仅1例注药2次;33例慢性鼻窦炎,鼻息肉或鼻中隔偏曲患者中25例一次治疗完全康复,8例患者经2-4次治疗后康复;52例鼻咽癌放疗后的患者须经反复注药6-9次治疗才痊愈。【结论】因鼻腔、鼻窦、鼻咽病变导致慢性分泌性中耳炎,在治疗原发疾病的同时,经咽鼓管咽口置管注药是治疗最为有效的方法。此方法创伤小、痛苦轻、疗效好。

[Objective]To explore the treatment of obstinate secretory otitis media（SOM） by earcatheter irrigation under endoscope. [Methods]One hundred and nineteen cases （184 sides） with SOM, including 78 male and 41 female（average 38.7 years old）, were irrigated with drugs through pharyngotympanie tube under endoscope. 34 cases （68 sides） including 18 adenoid hypertrophy and 16 allergic rhinitis were irrigated with drugs through pharyngotympanie tube only once. 33 cases （40 sides） including chronic sinusitis, nasal polyp and deflection of nasal septum were irrigated with drugs through pharyngotympanie tube for 2-4 times after cleaning purulent secretion of the nasopharynx or pharyngotympanie tube. 51 cases （76 sides） with nasopha ryngeal carcinoma after radiotherapy were irrigated with drugs through pharyngotympanie tube for 6- 9 times after nasopharynx scar solution and purulent secretion cleaning. [Results] All the cases of secretory otitis media were cured by irrigation with drugs through pharyngotympanie tube under endoscope. 34 cases of ade noid hypertrophy and allergia rhinitis received only once therapy. 33 cases with chronic sinusitis, nasal polyp or deflection of nasal septum were cured by irrigation with drugs through pharyngotympanie tube for 2 - 4 times. 51 cases with nasopharyngeal carcinoma after radiotherapy were cured by irrigation with drugs through pharyngotympanie tube for 6 - 9 times. [Conclusion] For obstinate secretory otitis media, irrigation with drugs through pharyngotympanie tube under endoscope is the most effective approach on the basis of primary disease therapy.