分泌性中耳炎患者咽鼓管和管周结构动态CT扫描和三维重建

Cine CT and CT-3D Reconstruction Measurement of the Eustachian Tube and Peri-tube Structures in Patients with Secretory Otitis Media

目的观察分泌性中耳炎患者咽鼓管咽口开放和闭合状况,并了解管周结构、下鼻甲和咽隐窝对咽鼓管功能的影响。方法选取27例分泌性中耳炎(secretory otitis media,SOM)患者(SOM组),对其进行低剂量咽鼓管动态CT扫描,记录咽鼓管咽口的开放和闭合状况;对非分泌性中耳炎患者61例(对照组)进行鼻咽部CT薄层扫描,将两组患者的CT图像进行三维重建,观察下鼻甲及鼻咽部组织对应咽鼓管的关系,测量咽鼓管软骨段内侧壁的最大厚度,并观察咽隐窝的含气情况,分析以上因素对咽鼓管通气功能的影响。结果 27例SOM患者中23例咽鼓管咽口开放和闭合运动正常,4例明显可见肥大下鼻甲压迫咽鼓管前唇,咽口开放功能非常微弱;SOM患者患耳及健耳咽鼓管后壁最大厚度平均值分别为8.93±1.60mm和8.89±1.20mm,大于对照组(8.78±1.50mm),但差异无统计学意义(P>0.05);SOM组患耳及健耳咽隐窝明显变浅或含气消失耳数分别为69.05%(29/42)与58.33%(7/12),明显高于对照组(17.21%,21/122),差异有统计学意义(P<0.05)。结论咽鼓管通气功能下降可能与肥大的下鼻甲压迫咽鼓管前唇、咽鼓管圆枕及咽鼓管内侧壁粘膜慢性炎症、鼻咽部软组织的横向压迫等因素有关,其中鼻咽部软组织对咽鼓管特定软骨段的压迫可能是咽鼓管阻塞的重要原因。

Objective To observe the opening movement of eustachian tube pharyngeal orifice in patients with secretory otitis media（SOM）by cine CT to mearsure the thickness of the lateral ET wall,and to evaluate the roles played by those peri-tube structure in the pathogenesis of ET obstruction.Methods Twenty-seven SOM patients as experiment group underwent low-radiation dose cine CT scans of the ET,the image were reconstructed into a cine image to see the opening movement of the eustachian tube pharyngeal orifice.The CT scan of sixty-four nonSOM patient as control group was performed.The images were reconstructed to show the relationship among the inferior turbinate,the nasopharyngeal soft tissue and the eustachian tube.These serial images were analyzed to measuring the thickness of the lateral wall of ET cartilage segment and to find out whether the gas exist in the pharyngeal recess.Results The opening movement of the pharyngeal orifice was observed in 23 SOM patients,the mean thickness of the lateral wall of ET cartilage segment in ithe ears studied and healthy ears of SOM patients are 8.93±1.6mm and 8.89±1.2mm,respectively,much larger than those of in non-SOM patients,but with no static significance.The pharyngeal recess in 69.0%（29/42）affected ears of som patients and 58.3%（7/12）in healthy ears were gas free.This rate in som patients was significantly higher than that in the non-SOM patient group.ConclusionThe etiologies of dysfunction of eustachian tube may include hypertrophic inferior turbinate,chronic inflammation of eustachian tube mucosa,compression of the nasal pharyngeal soft tissue.The compression of the nasal pharyngeal soft tissue may play an important role in the obstruction of the specific cartilage segment of the ET.