咽鼓管逆行置管联合鼓膜穿刺治疗慢性分泌性中耳炎

Eustachian tube retrograde catheterization combined with tympanic membrane puncture for treatment of chronic secretory otitis media

目的观察咽鼓管逆行置管联合鼓膜穿刺治疗慢性分泌性中耳炎（chronic secretory otitis media,CSOM）的疗效。方法选取2009年5月至2011年9月73例（91耳）CSOM患者作为治疗组行咽鼓管逆行置管联合鼓膜穿刺,每天经导管向鼓室注入地塞米松5 mg,持续4～7 d后拔出导管。选取2007年4月至2009年4月59例（67耳）CSOM患者作为对照组行鼓膜切开置管,由通气管口注入地塞米松5 mg,通气管一般需置6~8周后取出或自然脱出。结果治疗组91耳中治愈78耳,好转13耳,无效0耳,总有效率为100.00%。对照组67耳中治愈36耳,好转23耳,无效8耳,总有效率为88.06%。治疗组疗效优于对照组,差异有统计学意义（P〈0.05）。结论咽鼓管逆行置管联合鼓膜穿刺治疗CSOM是一种疗效可靠、损伤小、不良反应少的治疗方法。

Objective To investigate the effect of eustachian tube retrograde catheterization combined with tympanic puncture for the treatment of chronic secretory otitis media（CSOM）.Methods 73 CSOM cases（91 ears） from May 2009 to September 2011 were selected as the treatment group and performed the eustachian tube retrograde catheterization combined with tympanic puncture,then injected dexamethasone 5 mg into the tympanic via catheter each day,and pulled out the catheter after 4-7 d.Other 59 CSOM cases（67 ears） from Apri 2007 to April 2009 were selected as the control group and performed the tympanic membrane incision for indwelling catheter and injected dexamethasone 5mg via catheter,the catheter was taken out after 6-8 weeks or naturally prolapsed.Results Among CSOM 91 ears,78 ears were cured,13 ears were improved,none was invalid.The total effective rate was 100%.Among 67 ears in the control group,36 ears were cured,23 ears were improved,8 ears were invalid,with the total effectove rate of 88.06%.The treatment group was superior to the control group with statistical difference between them（P〈0.05）.Conclusion Eustachian tube retrograde catheterization combined with tympanic membrane puncture to treat CSOM is effective and reliable with less damage and less adverse reactions.