耳内镜下手术治疗咽鼓管异常开放症

Endotoscopic treatment of abnormal patulous Eustachian tube

目的探讨耳内镜下以骨蜡为材料行咽鼓管鼓口粘膜下半堵塞术治疗咽鼓管异常开放症的疗效、复发率及其优点。方法回顾性分析我科2002年1月～2011年6月收治的45例(56侧)经保守治疗无效后采用耳内镜下手术治疗的咽鼓管异常开放症患者资料。所有患者均在局部麻醉后,在耳内镜下分离外耳道皮瓣至鼓环,将鼓环连同鼓室粘膜一起分离开,暴露咽鼓管的鼓室口。取骨蜡少许,适形后置入分离开的鼓口粘膜下,至患者耳鸣消失。治愈标准:患者自觉症状消失,耳内镜检查鼓膜随呼吸扇动消失,鼓室压力曲线恢复正常;好转标准:患者自觉症状大部分消失或减轻,耳内镜检查呼吸时鼓膜偶有扇动,鼓室压力曲线基本正常;无效:自觉症状无改善,呼吸时鼓膜扇动仍明显,鼓室压力曲线异常。术后门诊随访半年～9年。结果治愈40例48侧,治愈率85.7%;好转5例8侧(2例单侧,3例双侧),好转率14.3%;无效率0%。同时,未观察到任何不良反应。结论耳内镜下以骨蜡为材料行咽鼓管鼓口粘膜下半堵塞术治疗咽鼓管异常开放症疗效好且微创,值得临床推广。

Objective To report treatment outcomes of endoscopic bone wax submucosal semi-blockage in patients with abnormal patulous Eustachian tube, Methods Data from 45 cases （56 ears） of patulous Eustachian tube treated in our depart- ment from January 2002 to June 201 lwith endotoscopic surgery after failure of conservative treatment were retrospectively an- alyzed. The procedure was conducted under local anesthesia. Using an otoendoscope, skin flap of external acoustic meatus was elevated to the annulus tympani. The mucosa of tympanic cavity was then elevated to expose the ostium tympanicum tuba auditiva. A small amount of appropriately molded bone wax was placed underneath the dissected mucosa near the ostium tym- panicum tuba auditiva and adjusted until the patient reported resolved autophony. Criteria for complete resolutions included resolution of all symptoms reported by patient, no undulation of tympanic membrane with respiration, and normal range tympa- nometry. Criteria of improvement included resolution of most symptoms, occasional undulation of tympanic membrane with respiration and near normal range tympanometry. No effect： no relief of symptoms reported, pronounced undulation of tympan- ic membrane with respiration and abnormal tympanometry. Patients were followed up after surgery for 0.5 to 9 years. Results Symptoms were completely resolved in 40 patients （48 ears） （85.7%）, and improved in 5 patients （g ears） （14.3%） including 2 single side cases and 3 bilateral side cases. No side effect was observed. Conclusions Endotoscopic submucosal half-block- age with bone wax can yield excellent outcomes in treating abnormal patulous Eustachian tube, and, is minimally invasive. Its application is worth considering.