激素内镜下咽鼓管注入和鼓膜穿刺注入对慢性分泌性中耳炎患者近期疗效、气导听阈及复发率的影响

A comparative study of short term effect,air-conduction thresholds and recurrence rate by intratympanic steroid aerosol inhalation via eustachian tube and intratympanic steroid injections via the tympanic puncture in patients with chronic secretory otitis

目的观察内镜下咽鼓管注入激素和鼓膜穿刺注入激素对慢性分泌性中耳炎患者的近期疗效、气导听阈及复发率的影响。方法选取2014年1月—2016年1月于杭州师范大学附属萧山第一医院耳鼻喉科门诊治疗的88例慢性分泌性中耳炎患者作为研究对象。按照随机数表法分为咽鼓管注入组和鼓膜穿刺注入组,每组各44例。鼓膜穿刺注入组局麻后于监视器监控下进行鼓膜穿刺,吸净积液并注入激素;咽鼓管注入组在鼻内镜下做咽鼓管吹张,局麻后经空气压缩泵雾化布地奈德给药,雾气经咽鼓管入鼓室,2组患者治疗时间为15 d。于2组患者治疗前1~2 d、治疗后15 d测听力水平,测试250、500、1 000、2 000、4 000 Hz气导听阈,比较2组患者的近期疗效、气导听阈及复发率。结果 2组患者在年龄、病程、症状体征、纯音测、声阻抗等方面差异无统计学意义(P>0.05)。术后6个月2组患者治疗的总有效率分别为90.9%与93.2%,差异无统计学意义(P>0.05),但咽鼓管注入组在治愈与有效两方面均较鼓膜穿刺注入组差异有统计学意义(P<0.05)。2组在复发率上差异并无统计学意义(P>0.05)。2组患者在250、500、1 000、2 000、4 000 Hz气导听阈治疗后均较治疗前有所降低(P<0.05),但2组患者间差异并无统计学意义(P>0.05)。结论内镜下咽鼓管注入激素和鼓膜穿刺注入激素治疗慢性分泌性中耳炎患者疗效明显,咽鼓管注入激素治愈率更高,两者复发率相当,均能降低患者的气导听阈。

Objective To observe the short term effect, air-conduction thresholds and recurrence rate by intratympanic steroid aerosol inhalation via eustachian tube and intratympanic steroid injections via the tympanic puncture in patients with chronic secretory otitis media. Methods Total 88 cases of chronic secretory otitis media in our hospital between Jan- uary,2014 and January,2016 were enrolled into eustachian tube inhalation group and tympanic membrane puncture injec- tion group with 44 cases in each group. After local anesthesia, the tympanic membrane puncture injection group performed tympanic puncture guided by nasal endoscope, followed by absorption of effusion and hormone injection;while the eusta- chian tube inhalation group performed the inflation of the eustachian tube guided by nasal endoscope, then budesonide aerosol inhalation delivery via eustachian tube into tympanic cavity. The course in both groups was 15 days. The 250,500, 1 000,test 2 000,4 000 Hz air conduction threshold and listening ability were measured at 1 -2 d before the treatment and 15 d after the treatment. The short term effect, air-conduction thresholds and recurrence rate were compared between the two groups. Results There was no significant difference between the two groups in age, course of disease, symptoms and signs, pure tone test and acoustic impedance terms （P 〉 0.05 ）. Six months after the treatment, the total effective rate of the eustachian tube inhalation group and tympanic membrane puncture injection group was 90.9% and 93.2%, respec- tively, there was no significant difference between the two groups （P 〉 0.05 ） ;however, the cure and effectiveness of the eustachian tube injection group showed significant difference to the eustachian tube inhalation group （P 〈 0.05 ）. There was no significant difference in the recurrence rate between the two groups （P 〉 0.05 ）. The air conduction threshold at 250,500,1 000 ,test 2 000,4 000 Hz in both groups decreased after the treatment（P 〈0.05） ,but there was no statistical significance between the two groups （P 〉 0.05 ）. Conclusion Both intratympanic steroid aerosol inhalation via eustachian tube and intratympanic steroid injections via the tympanic puncture in the treatment of chronic secretory otitis media were obviously effective, with the approximate recurrence rate. They can reduce the air conduction threshold. The tympanic puncture injection is with a higher cure rate.