鼓膜微型管置入术治疗中耳不张的临床观察

Clinical observation of placement of tympanostomy microtube to treat middle ear atelectasis

目的 探讨鼓膜微型管植入术治疗中耳不张的临床疗效.方法 回顾分析26例（28耳）中耳不张的患者,以耳闷为主诉；耳镜检查见鼓膜内陷、光锥散乱或消失、鼓膜苍白无光泽；纯音测听气骨导差＞ 10 dB;声导抗鼓室负压；中耳不张分级Ⅰ～Ⅲ级.患者局麻下行鼓膜微型管置入术,术后随访6 ～12个月.结果 25耳术后耳闷症状消失,其中23耳微型管取出后2周声导抗检查提示鼓室压图由C型恢复为A型,平均听阈下降5 ～20 dB;2耳取管后1个月复发,耳闷症状和中耳负压重新出现.3耳置管失败或耳闷无改善,均为中耳不张Ⅲ级.26例患者取管后2周鼓膜均良好愈合,未出现感染、鼓膜穿孔等并发症.结论 鼓膜微型管置入术能有效解除鼓室负压,缓解耳闷,可用于Ⅰ～Ⅱ级中耳不张的治疗.

Objective To investigate the treatment efficacy of tympanostomy microtube placement surgery for middle ear atelectasis.Methods A retrospective analysis was conducted on 26 patients （28ears） with middle ear atelectasis,who complained fullness or pressure in the ears.Otoscope showed tympanic membrane invagination,scattered or disappeared cone of light,tympanic membrane was pale and dull.The pure tone audiometry air-bone gap 〉 10 dB.Acoustic immittance showed tympanic negative pressure.All the ears had atelectasis of Ⅰ-Ⅲ grade.Patients were performed tympanic membrane microtube placement under local anesthesia,and were followed up for 6-12 months.Results Twenty-five ears recovered from the fullness after operation,in which,23 ears reverted from type “C” to type “A” in acoustic immittance tests and the pure-tone average （PTA） of hearing thresholds were decreasing from 5 to 20 dB,while 2 ears relapse after removal of the microtube.Three ears with middle ear atelectasis of Ⅲ grade were ineffectiveness.All the 26cases had no complications including middle ear infection,tympanosclerosis,and permanent perforation after removal of the microtubes.Conclusions The placement of tympanostomy microtube can be used to treat middle ear atelectasis,especially to the patients with middle ear atelectasis of Ⅰ-Ⅱ grade as it is effective on elimination of middle ear negative pressure and remission of fullness.