咽鼓管球囊扩张术治疗慢性分泌性中耳炎的疗效分析

Effectiveness of balloon eustachian tuboplasty on hronic otitis media with effusion

目的探讨咽鼓管球囊扩张术(balloon eustachian tuboplasty,BET)对慢性分泌性中耳炎的治疗效果及术后处理注意事项。方法收集慢性分泌性中耳炎患者39例(56耳),所有患者均曾接受过药物治疗、鼓膜穿刺及至少1次鼓膜置管治疗等传统的治疗方法,效果不佳。耳内镜检查确定中耳积液,声导抗B型图或C型图,咽鼓管测压(technique of tubomanometry,TMM)显示咽鼓管不通。所有患者均行BET,根据术中及术后情况确定是否行进一步的鼓膜穿刺或鼓膜置管。术后予随访6个月,观察鼓室积液、鼓室图及咽鼓管功能测试的变化情况及记录术后处理的情况。结果 54耳行BET顺利,2耳扩张不顺利术中行鼓膜置管。其中,8耳(14.3%)单纯行BET,6耳(75.0%)术后无积液再出现,2耳(25.0%)术后2周内仍有积液,各行鼓膜穿刺1次后无复发;46耳(82.1%)术中同时行鼓膜穿刺,20耳(43.4%)术后随访未见积液复发,23(50%)术后再行鼓膜穿刺后积液消失,3耳(6.5%)穿刺2次以上仍反复,再次置管。治疗有效率为91.1%(51/56)。术后半年,鼓室图及TMM测试提示患者咽鼓管功能较术前明显改善。结论对传统方法治疗无效的慢性分泌性中耳炎患者,BET可改善咽鼓管功能且获得良好的临床效果。

ObjectiveTo evaluate the effectiveness of balloon eustachian tuboplasty（BET）on chronic otitis media with effusion（COME）and the relative management.Methods Fifty-six ears（thirty-nine patients）of COME were included. All the patients had tried the traditional methods as medicine treatment,tympanic paracentisis and tympanic grommet for at least once but failed. Oto-endoscopy was used to confirmed the middle ear effusion,Impedance audiometry confirmed a type B or C tympanogram. R-value in tubomanometry（TMM） were admitted to evaluated the Eustachian tube function. BET was performed for all the patients and tympanic paracentisis or grommet insertion was admitted according to the middle ear condition during the operation and the follow-up. All the patients were followed up for 6 months. The main outcomes included the middle ear effusion,Rvalue in TMM,and tym-panogram.Results54 ears were successfuly performed BET, while 2 ears were failed and performed tympanic grommet. Eight ears （14.3%）were performed BET only,among which 6 ears（75.0%） did not have effusion recurrence,while effusion remained in two ears and tympanic paracentisis was admitted for once and then no further recurrence. Forty-eight ears（82.1%）were admited BET and synchro-nous tympanic paracentisis,among which twenty ears（43.4%）did not have effusion recurrence during the 6-month folow-up,twenty-three ears（50%）had effusion recurrent and were admited tympanic paracentisis and then recovered. However,the other three ears（6.5%）needed further grommet insertion. Overal,the effective rate of BET on COME was 91.1%（51/56）. Tympanogram and TMM test showed that the Eustachian function improved significantly at the 6-month post the BET operation.ConclusionFor COME patients that can not be cured by the traditional metholds,BET can impove their Eustachian function and achieve good clinical outcome.