咽鼓管球囊扩张治疗慢性分泌性中耳炎

Clinical Observation of Balloon Eustachian Tuboplasty for Chronic Otitis Media with Effusion

目的探讨咽鼓管球囊扩张术(balloon eustachian tuboplasty,BET)治疗慢性分泌性中耳炎的疗效。方法选取经传统方法治疗无效的伴咽鼓管功能障碍的慢性分泌性中耳炎患者39例(48耳),其中16例(19耳)行单独BET治疗,12例(14耳)行BET+鼓膜穿刺治疗,11例(15耳)行BET+鼓膜置管治疗,随访12个月。术前及术后进行耳内镜、纯音测听、声导抗检查及咽鼓管评分(eustachian tube score,ETS)和咽鼓管功能障碍评分问卷(7-item eustachian tube dysfunction questionnaire,ETDQ-7)评分,比较术前及术后12个月时0.5、1、2、4kHz 4个频率的平均听阈及气骨导差,分析疗效。结果单独BET治疗的19耳中,术后6耳(31.6%)无积液复发,10耳(52.6%)鼓膜穿刺后积液无复发,3耳(15.8%)行鼓膜置管;BET+鼓膜穿刺治疗的14耳中,术后10耳(71.4%)无积液复发,2耳(14.3%)行鼓膜穿刺后积液无复发,2耳(14.3%)鼓膜置管;BET+鼓膜置管治疗的15耳中,12耳(80.0%)拔管后积液无复发,3耳(20.0%)拔管后积液复发。术后12个月时,48耳中,除1耳复发、7耳未拔管外,余40耳有效,总有效率83.3%(40/48)。术前及术后1、3、6、12个月48耳ETS评分分别为0.54±0.77(M=0)、4.33±1.58、5.00±1.79、5.17±1.78、5.29±1.65分,ETDQ-7评分分别为5.42±1.07、3.04±1.35、2.54±1.52、2.21±1.17、2.00±1.08分,与术前相比较,术后ETS评分升高、ETDQ-7评分降低,差异均有统计学意义(P<0.01)。术后12个月时平均听阈(26.40±9.10dB HL)及气骨导差(3.67±2.24dB)较术前(分别为41.72±10.49dBHL、16.67±4.41dB)明显降低(P<0.01)。结论对于伴咽鼓管功能障碍的慢性分泌性中耳炎,BET联合合理的鼓膜穿刺或置管术更有利于术后咽鼓管功能的恢复和疾病的转归。

Objective To investigate the efficacy of transnasal endoscopic balloon eustachian tuboplasty（BET）for treatment of chronic otitis media with effusion（COME）and the related management.Methods A total of 39 patients（48 ears）with eustachian tube dysfunction of COME were enrolled,who relapsed under traditional treatment.Sixteen patients（19 ears）were performed BET only,12 patients（14 ears）were performed BET and tympanocentesis,while 11 patients（15 ears）were performed BET as well as grommet insertion.All the patients were followed up for 12 months,received otic endoscopy examination,pure tone audiometry and acoustic immittance both preoperatively and postoperatively.An average of pure tone threshold and air bone gap of 0.5,1,2,4 kHz at 12 months postoperatively were compared with preoperative values.Changes of eustachian tube function in these patients were assessed by eustachian tube score（ETS）and 7-item eustachian tube dysfunction questionnaire（ETDQ-7）before and 1,3,6 and 12 months after surgery.Data were recorded for subsequent efficacy analysis.Results19 ears were performed BET only,among which 6 ears（31.6%）did not have effusion recurrence,while effusion remained in 13 ears（68.4%）.10 ears（52.6%）had no further effusion recurrence after tympanocentesis admitted while the other 3 ears（15.8%）failed and needed further grommet insertion.14 ears were admitted BET and synchronous tympanocentesis,among which 10 ears（71.4%）did not have effusion recurrence,while effusion remained in 4 ears（28.6%）.2 ears（14.3%）had no further effusion recurrence after tympanocentesis admitted while the other 2 ears（14.3%）failed and needed further grommet insertion.15 ears were admitted BET and synchronous grommet insertion,among which 12 ears（80.0%）did not have effusion recurrence after the tube extracted 6 months postoperatively,while the other 3 ears（20.0%）had effusion again.Overall,the total effective rate of the three groups was 83.3% at 12 months postoperatively.Preopertively and at 1,3,6 and 12 months postoperatively,the ETS were0.54±0.77（M=0）、4.33±1.58、5.00±1.79、5.17±1.78、5.29±1.65,respectively,and the ETDO-7 scores were 5.42±1.07、3.04±1.35、2.54±1.52、2.21±1.17、2.00±1.08,respectively.Compared with preoperative values,the ETS at all time points were siginificantly increased postoperation while the ETDO-7 scores decreased（all P〈0.01）,and both average of pure tone threshold and？air bone gap were siginificantly decreased at 12 months postoperatively as well（P〈0.01）.Conclusion BET may lead to a favorable therapeutic efficacy for COME.It is beneficial to the recovery of eustachian tube function and the prognosis of the disease while the patients were admitted BET combining tympanocentesis or grommet insertion according to the middle ear condition during the operation.