慢性化脓性中耳炎患者咽鼓管三维CT重建下特点分析

Characteristics analysis of three-dimensional computed tomography imaging of the eustachian tube lumen in patients with chronic suppurative otitis media

目的通过三维重建CT分析慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者的咽鼓管解剖,结合咽鼓管测压结果分析CSOM患者的咽鼓管特点及与咽鼓管功能相关性。方法收集CSOM患者60例(68耳),其中行咽鼓管测压检查示咽鼓管功能不通33耳,为不通组;咽鼓管功能通畅35耳,为通畅组。正常对照组6例(12耳)。所有受试者均采用多层螺旋CT分别行颞骨静态及Valsalva后CT扫描,并作咽鼓管三维重建,测量并比较三组软骨部全长、静态下软骨部开放区域、Valsalva后软骨部开放区域、软骨段与骨段之间的角度。结果 CSOM患者咽鼓管畅通组与不通组均较对照组全段软骨短(F=4.771,P=0.001),静态咽鼓管软骨段开放长度短(F=5.110,P=0.008),Valsalva后软骨开放长度短(F=5.214,P=0.008),但咽鼓管畅通组与不通组之间比较无统计学差异,咽管软骨段与骨段之间的角度三组间无统计学差异。7%CSOM患者存在咽鼓管骨段结构异常。结论CSOM患者咽鼓管全段软骨、静态开放、Valsalva后开放长度均短,且部分存在咽鼓管骨段结构异常。咽鼓管三维CT重建可直观显示咽鼓管异常结构及软骨段开放情况。

ObjectiveAnalyze characteristics of eustachian tube anatomic structure using three-dimensional（3D） computed tomography（CT）reformation in patients with chronic suppurative otitis media（CSOM）. Explore the relationship between anatomic structure and eustachian tube function by comparing the imaging result to eustachian tube pressure testing.Methods60 patients（including 68 ears）with CSOM and 6 age matched controls（including 12 eras）were recruited. Among 68 ears,33 ears which showed eustachian tube dysfunction in eustachian tube pressure test were set as eustachian tube dysfunction group（ETD）and the other 35 ears as normal eustachian tube function group（NETF）. All participants underwent CT scanning both in resting state and after performing Valsalva maneuver. 3D CT reformations were done and structural parameters were measured.ResultsSignificant difference were found among the ETD,NETF and control groups for whole cartilaginous portion length（F=4.771,P=0.001）,dilated cartilaginous portion length in resting state（F=5.110,P=0.008） and dilated cartilaginous portion length after Valsalva maneuver （F=5.214,P=0.008）. In further comparison,no significant difference was found between ETD and NETF groups. For the angle between bony portion and cartilaginous portion,no significant difference was found. In CSOM patients,7% showed bony portion abnormity.ConclusionIn CSOM patients,shorter whole cartilaginous portion length,dilated cartilaginous portion lengths in both resting state and after Valsalva maneuver are found. Bony portion abnormities also exist in some of these patients. 3D CT reformation is a valuable tool for showing eustachian tube structure and assessing its function.