咽鼓管球囊扩张术治疗慢性分泌性中耳炎的短期疗效观察

Short-term effect of eustachian tube balloon dilation in the treatment of chronic otitis media with effusion

目的观察咽鼓管球囊扩张术联合鼓膜切开置管治疗慢性分泌性中耳炎的短期疗效。方法对2014年8月至2016年12月诊断为慢性分泌性中耳炎并入院接受咽鼓管球囊扩张术联合鼓膜切开置管术治疗的19例21耳行短期疗效观察分析。评价的指标如下:纯音电测听气导均值(PTA)、气-骨导差(ABG)、声阻抗、耳内镜检查、颞骨CT扫描和主观满意度(VAS视觉模拟评分)。结果 19例均于全麻下顺利完成手术,术后6个月鼓膜置管未脱落者予以取管。术后随访6~10个月,纯音电测听测试耳气导结果术后较术前有所提高。PTA从术前(59.5±21.5)d BHL降低到术后(52.0±31.0)d BHL(t=3.409,P=0.005),ABG从术前(35.5±17.5)d BHL降低到术后(21±16)d BHL(t=2.957,P=0.011),76.19%的患者声阻抗鼓室图术后转为A型;3例5耳自觉听力和症状无明显改善,其中2例4耳鼓室积液持续存在,1例1耳取管后3周再次复发,予以持续置管。术后疗效满意度平均为(6.17±1.16)分。结论咽鼓管球囊扩张术联合鼓膜切开置管治疗慢性分泌性中耳炎短期疗效好。

Objective To explore the short-term efficacy of eustachian tube balloon dilation combined with tympanostomy tube insertion for the treatment of chronic otitis media with effusion. Methods A total of 19 cases（ 21 ears） of chronic otitis media with effusion were treated with eustachian tube balloon dilation combined with tympanostomy tube insertion from August 2014 to December 2016. The short-term curative effect was assessed using pure tone average（ PTA）,air-bone gap（ ABG）,acoustic impedance,ear endoscopy,temporal CT scan,and subjective satisfaction visual analog scale scores. Results Surgery was successfully completed in all 19 patients under general anesthesia. Six months later,patients whose tube was not self-shedding underwent tube removal. Postoperatively,mean PTA decreased from 59.5±21.5 d BHL to 52.0±31.0 d BHL（ t = 3.409,P = 0.005） and mean ABG decreased from 35.5±17.5 d BHL to21.0±16.0 d BHL（ t = 2.957,P = 0.011）. 76.19% of the patients had their acoustic impedance tympanogram changed to type A postoperatively. Three patients（ five ears） had no improvement in hearing or symptoms： two patients（ four ears） had ongoing tympanic cavity effusion,and one patient（ one ear） had recurrence three weeks after the catheter was removed and required placement of a second tube. Mean improvement in visual analog scale score was 6.17±1.16 points.Conclusion Eustachian tube balloon dilation in combination with tympanostomy tube insertion has a good short-term effect in the treatment of chronic otitis media with effusion.