咽鼓管球囊扩张术治疗难治性分泌性中耳炎的策略和疗效分析

Balloon eustachian tuboplasty for refractory secretory otitis media

目的探讨咽鼓管球囊扩张术(balloon eustachian tuboplasty,BET)在难治性分泌性中耳炎中的治疗效果以及其围手术期的处理策略。方法收集难治性分泌性中耳炎患者20例(25耳)。同期行BET并鼓膜切开置管术(2例前期行鼓膜穿刺术)。随访3个月以上。记录手术前后咽鼓管功能问卷评分(ETDQ-7)、鼻内镜、纯音测听、鼓室图及Val-salva动作下颞骨CT检查情况。结果 2耳前期行BET并鼓膜穿刺者,术后4周内均复发;23耳同期行BET并鼓膜切开置管术者,术后3个月ETDQ-7评分、纯音测听(4PTA)阈值均较术前明显降低(P<0.05);颞骨CT提示乳突及鼓室内软组织影均消失或不到术前的5%。12耳在BET术后3个月拔管,其中6耳恢复正常,另6耳在拔管后8周内复发,予重新切开置管。结论 BET联合鼓膜切开置管治疗难治性分泌性中耳炎能获得良好的短期疗效。坚持规律的Valsalva锻炼以及3个月以上时间的鼓膜置管才能保证长期效果。

Objective To study the efficacy of balloon eustachian tuboplasty （BET） in treating refractory secretory oti-tis media as well as treatment strategies. Method Twenty cases （25 ears） of refractory secretory otitis media were included. All cases underwent myringotomy and grommet insertion combined with BET （early auripuncture were performed in 2 cas-es）. All cases were followed for 3 months or more. The eustachian tube dysfunction questionnaire （ETDQ-7）, endoscopy, pure-tone audiometry （PTA）, tympanograms and temporal CT data were collected before and after treatment. Results The 2 ears that received auripuncture and BET showed recurrence of secretory otitis media again within 4 weeks. The remaining 23 ears showed significantly decreased EDTQ-7 scores and pure-tone thresholds （P〈0.05）, with soft tissue shadows in tem-poral CT being gone or less than 5%of that seen preoperatively. The tube was extracted in 12 ears 3 months after insertion, with 6 of them showing signs of secretory otitis media again within 8 weeks and receiving repeated myringotomy and grom-met insertion. Conclusions Simultaneous myringotomy and grommet insertion with BET can produce satisfying short-term results in refractory secretory otitis media. Meanwhile, Valsalva maneuvers and sometimes prolonged tube insertion are vital to the long-term outcomes.