中耳术后鼓索神经损伤的药物治疗

Medical treatment of chorda tympani nerve injury in patients undergoing surgical treatments for otitis media

目的观察中耳手术中鼓索神经损伤导致的味觉障碍患者应用药物干预的疗效,探讨中耳术中鼓索神经保护的必要性。方法选取中耳手术后鼓索神经损伤引起味觉障碍患者共40例,男18例,女22例。Ⅰ型鼓室成形术4例,Ⅱ型鼓室成形术7例,开放式乳突切开+鼓室成形术18例,完璧式乳突切开+鼓室成形术6例,上鼓室切开+鼓室成形术5例;随机分为治疗组和对照组各20例。治疗组采用甲钴胺针剂0.5 mg/次肌内注射,1次/d;维生素B12片/次,3次/d,口服,疗程30 d;对照组仅观察随访不予任何处理。测试患者术后1周、1个月、3个月味觉恢复情况。结果治疗组与对照组味觉测试结果在术后1周对比无明显差异(P>0.05),1、3个月对比差异有统计学意义(P<0.05)。结论中耳手术后鼓索神经损伤导致的味觉障碍,药物治疗有助于患者味觉的恢复,中耳术中应注意保护鼓索神经。

Objective The purpose of this study is to investigate whether clinical drug intervention is necessary for patients with dysgeusia caused by chorda tympani nerve injury,and to evaluate the necessity of preserving chorda tympani nerve in routine surgical procedure for otitis media.Methods Forty patients with dysgeusia caused by chorda tympani nerve injury were divided into two groups,with 20 patients in each group,including 4 cases of type Ⅰ tympanoplasty,7 cases of type Ⅱ tympanoplasty,18 cases of canal-wall-down mastoidectomy and tympanoplasty,6 cases of canal-wall-up mastoidectomy and tympanoplasty,5 cases of atticotomy and tympanoplasty.Patients in experimental group received drug treatment while those in control group did not receive any treatment.Their taste function at 1 week to 3 months postoperatively were evaluated.Results There was a significant difference in recovery from dysgeusia between experimental and control group at 1 month and 3 months postoperatively(P<0.05).Conclusion Drug treatment is feasible for patients with dysgeusia caused by chorda tympani nerve injury in tympanoplasty.Chorda tympani nerve should be protested during middle ear operation.