高压氧治疗突聋并发中耳气压伤25例临床分析

25 Case Analysis of Complicated Middle Ear Barotraumas Caused by Hyperbaric Oxygenation in Treatment Sudden Hearing Loss

目的分析高压氧治疗突聋并发中耳气压伤的原因及预防。方法回顾性分析2009年2月～2010年9月25例高压氧治疗中并发中耳气压伤的突聋患者的临床资料,从患者伴发疾病、心理状况、高压氧治疗方案、咽鼓管功能、中耳气压伤后鼓膜体征及治疗效果等方面加以探讨。结果 25例患者于高压氧治疗中均有情绪紧张,24例于治疗第1～2天、1例于治疗第14天在加压阶段并发中耳气压伤(鼓膜穿孔),其中,11例伴有上呼吸道感染,2例伴慢性肥厚性鼻炎,4例伴慢性鼻-鼻窦炎,8例患者咽鼓管功能异常。耳内窥镜检查见鼓膜充血Ⅰ度2例,Ⅱ度18例,Ⅲ度4例,Ⅳ度1例。全部患者经治疗后7～30天耳部症状消失,鼓膜标志正常,咽鼓管功能正常。结论伴发上呼吸道感染、鼻-鼻窦炎、咽鼓管功能障碍、高压氧治疗过程中加压及减压速度过快、患者情绪紧张等与高压氧治疗突聋并发中耳气压伤密切相关。伴发上呼吸道感染、鼻-鼻窦炎及咽鼓管功能不良者慎用高压氧治疗,治疗过程中控制好加压及减压速度。

Objective To analysis the etiopathogenisis and prevention of middle ear barotrauma with hyperbaric oxygenation treatment in sudden hearing loss.Methods We collected and retrospectively analyzed the clinical data of 25 sudden hearing loss patients a suffering from complicated middle ear barotraumas with hyperbaric oxygenation treatment at our hospital between February 2009 and September 2010.We studied their concomitant disease,the treatment plan of hyperbaric oxygenation,the function of eustachian tube and the sign of eardrum.Results All the patients felt nervous during the treatment.24 patients had middle ear barotrauma during hyperbaric oxygenation treatment on the first day with one occurring on the fourteenth day.There were 11 cases with upper respiratory infection,8 cases with eustachian tube disfunction,2 cases with hypertrophic inferior turbinate,and 4 cases with chronic rhinitis in all the 25 cases.2 cases showed congestionⅠdegree in the eardrum,18 cases congestionⅡdegree,4 cases congestion Ⅲ degree and 1 case congestion Ⅳ degree in the eardrum under otoscopy.After effective treatment all the cases were normal in the eardrum under otoscopy and in eustachian tube function.And the symptom of ears was disappeared.Conclusion Sudden hearing loss with naso-sinusitis or with the eustachian tube anatomic disfunction,over rapid increasing pressure and decreasing pressure and nervous emotion were all responsible for the middle ear barotraumas caused by hyperbaric oxygenation treatment.