自体血咽鼓管咽口黏膜下注射治疗咽鼓管异常开放症

Submucosal injection of autologous blood for the treatment of abnormal opening of Eustachian tube

目的探讨自体血咽鼓管咽口黏膜下注射治疗咽鼓管异常开放症的治疗效果。方法收集2002年1月~2013年12月我科门诊经保守治疗无效的咽鼓管异常开放症患者14例,共20耳,采用患耳咽鼓管咽口黏膜下自体静脉血注射进行治疗,记录治疗前后患耳鼓膜及咽鼓管咽口情况,并进行咽鼓管-鼓室气流动态(tubo-tympanic airflow dynamics,TTAG)法测定判定疗效。结果诊断为咽鼓管异常开放症患者,均见病变侧咽鼓管咽口闭合不全,呈裂隙状,坐位观察明显,TTAG法显示患耳外耳道压力随鼻咽腔压力变化而波动;病变侧咽鼓管咽口外侧壁注射自体血1~4次后,13耳症状完全消失,同侧咽鼓管咽口平静状态下能够闭合;7耳症状减轻,咽鼓管咽口未能完全闭合。所有治疗耳均无分泌性中耳炎等并发症发生。结论自体血咽鼓管咽口注射是一种安全、有效的治疗方法 ,由于简便易行。

OBJECTIVE To investigate the effect of submucosal injection of autologous blood on the treatment of abnormal opening of Eustachian tube. METHODS Fourteen patients(20 ears) with abnormal opening of Eustachian tube between January 2002 and December 2013 in outpatientdepartment of our hospital who were treated ineffectively by conservative method were included in this study. These patients were treated with submucosal injection of autologous blood under the direct vision with the endoscope guidance.The condition of tympanic membrane and pharyngeal opening of the Eustachian tube before and after the procedure were recorded, and also the tubotympanic airflow dynamics(TTAG)was measured before and after the procedure to determine the efficacy of the treatment. RESULTS In patients diagnosed as abnormal opening of Eustachian tube, incomplete closure of ET orifice or fissure shaped ET orifice were seen in diseased side ear. Measured TTAG on the diseased ear showed that the change of external auditory canal pressure was fluctuated with the change of nasophayngeal pressure. The diseased pharyngeal opening of the Eustachian tube was submucosally injected autologous blood 1-4 times. The site of injection was lateral side of the diseased pharyngeal opening of the Eustachian tube. After the treatment, 13 ears were cured, the symptoms disappeared, abnormal pharyngeal opening tended to be normal, meanwhile the symptoms of the other 7 ears were improved, but abnormal pharyngeal opening did not tend to be normal and the pharyngeal opening of the Eustachian tube cannot be completely closed. No complications such as otitis media with effusion were observed. CONCLUSION Autologous blood injection for the treatment of abnormal opening of Eustachian tube is a safe, simple and effective method. It is worth to be recommended for the treatment of abnormal opening of Eustachian tube.