鼻咽癌放疗后分泌性中耳炎的临床观察

Clinical observation of secretory otitis media following radiotherapy in patients with nasopharyngeal carcinoma

目的分析鼻咽癌(NPC)放疗后分泌性中耳炎(OME)的发病机理,探索临床有效的综合治疗方法。方法对35例(43耳)NPC放疗后OME患者,采用咽鼓管置管、冲洗并向鼓室注入地塞米松、α-糜蛋白酶、盐酸氨溴索混合药液,局部清理,治疗临近部位疾病,常规全身抗炎、营养神经、扩张血管、粘膜促排剂及皮质内固醇药物治疗。结果所有患者治疗前均有耳鸣、耳闷感及听力下降等症状;鼓室导抗图均为B型或C型。治疗后耳鸣消失31耳(72.09%)、好转8耳(18.6%)、无效3耳(6.9%),总有效率为90.69%。耳闷感消失35耳(81.40%)、好转6耳(13.95%)、无效2耳(4.65%),总有效率为95.35%。声导抗检查鼓室压图A型23耳(53.49%)、As型16耳(34.88%);B型2耳(4.65%);C型3耳(6.9%)。治疗后0、0.5、1.0、2.0 kHz气导听阈均值为(25.6±3.5)dBHL,而治疗前为(48.5±4.6)dBHL,其差异有统计学意义(P=0.001)。结论依据NPC放疗后OME的发病机理,有针对性地采取咽鼓管置管及注药冲洗等综合治疗手段,有利于咽鼓管功能的恢复,对提高NPC患者的生存质量具有重要意义。

Objective To analysis Pathogenesis of secretory otitis media （ OME） in patients with nasopharyn geal carcinoma （NPC） after radiotherapy, to search for its cause and identify effective combined Clinical treatment me thods. Methods Thirty five cases （43 ears）of OME in patients with NPC after radiotherapy were reviewed. Treat ments included endoscope guided catheterization of the Eustachian tube which also served as a pathway for intra tympanic application of dexamethasone , chymolase and ambroxol hydrochloride when indicated. Other treatments included use of systemic and local antibiotics, neurotrophic factors, vasodilators Mucous eccritic and steroids, supplemented by frequent debridement of the nasal and nasopharyngeal cavities and aggressive treatment of nasal and sinus diseases. Results Prior to treatments, all patients reported hearing impairment, tinnitus and fullness or pressure in the ear. Acoustic immittance tests showed type B or C tympanogram in all 43 ears. Follow ing treatment, tinnitus completely resolved or improved in 90.69% of the ears, fullness disappeared or improved in 95.35% of the ears, and tympanograms changed to types A （23 ears） orAs （16 ears） in 88.37% of the ears. The mean pure tone threshold over 0,0.5,1 and 2 kHz improved from 46. 8 ± 5.1 dB HL before treatment to 25.5 ±3.7 dB HL after treatment. Conclusion Targeted treatment of OME following radiotherapy in patients with NPC based upon analysis of individual Pathogenesis can be profit to recover tubal function and can significantly improve the life quality in these patients.