鼓膜穿刺药物注射对改善慢性分泌性中耳炎患者骨导听阈效果的对照研究

Comparative study of tympanic membrane puncture and drug injection to improve bone conduction audiometry in patients with chronic secretory otitis media

目的观察鼓膜穿刺不同药物注射对改善慢性分泌性中耳炎患者骨导听阈的效果。方法 将2014年1月-2015年12月在我科住院的198例慢性分泌性中耳炎患者随机分成观察组99例（鼓膜穿刺清耳液注射）、对照组99例（鼓膜穿刺地塞米松＋氨溴索＋糜蛋白酶混合液注射）。采用升5降10法进行骨导听阈测试,记录0.250、0.500、1.000、2.000、4.000 k Hz骨导听阈,进行各组治疗前后、两组治疗后比较,并比较两组临床疗效。结果 两组治疗前后骨听阈检测结果比较,0.250、0.500、1.000、2.000、4.000 k Hz的骨听阈差异有统计学意义（P〈0.01）,两组治疗后0.250、0.500、1.000、2.000、4.000 k Hz的骨听阈比较,差异无统计学意义（P〉0.05）。观察组总有效率为92.93%,对照组为90.91%,差异无统计学意义（P〉0.05）。结论 鼓膜穿刺注射清耳液与地塞米松＋氨溴索＋糜蛋白酶混合液均能改善慢性分泌性中耳炎患者的骨导听阈,鼓膜穿刺注射清耳液的临床疗效略高于地塞米松＋氨溴索＋糜蛋白酶,且清耳液无不良反应,值得临床推广应用。

Objective To observe effect of tympanic membrane puncture and different drugs injection to improve bone conduction threshold in patients with chronic secretory otitis media.Methods 198 hospitalized patients with chronic se- cretory otitis media in our department from January 2014 to December 2015 were randomly divided into 99 cases in observation group （Tympanostomy and clear ear fluid injection） and 99 cases in the control group （tympanostomy and Dexamethasone＋Ambroxol＋Chymotrypsin injection）.The 0.250,0.500,1.000,2.000,4.000 kHz bone conduction hearing threshold were recorded by 10-liter five-drop method of bone conduction audiometry,which were compared in each group before and after treatment and between two groups after treatment.The clinical efficacy was compared between two groups.Results 0.250,0.500,1.000,2.000,4.000 kHz bone hearing thresholds had statistical difference in each group before and after treatment （P〈0.01）,there was no significant difference between two groups after treatment （P〉0.05）.Total effective rate in the observation group was 92.93%,in the control group with 90.91%,there was no significant difference in clinical efficacy （P〉0.05）.Conclusion The injection of clear ear fluid and Dexamethasone＋Ambroxol＋Chymotrypsin in tympanostomy could improve bone conduction hearing threshold for patients with chronic otitis media.The clinical efficacy of injecting clear ear fluid in tympanostomy is slightly higher than Dexamethasone ＋ Ambroxol ＋ Chymotrypsin,and clear ear fluid is not toxic side effects,which is worthy of clinical application.