Ⅰ型鼓室成形术中咽鼓管功能的评估及其对疗效的影响

Evaluation of Eustachian Tube Function in Type Ⅰ Tympanoplasty and Its Effect on Treatment Outcomes

目的通过对采用Ⅰ型鼓室成形术治疗慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者的临床资料进行分析,探讨咽鼓管功能及其评估对其疗效的影响。方法分析64例(64耳)采用I型鼓室成形术治疗CSOM的患者资料,根据咽鼓管功能检测(ETS)结果分为咽鼓管功能障碍组及咽鼓管功能正常组。观察声导抗正-负压平衡法与ETS两种检测方法的一致率及两组患者术前及术后的气导听阈值变化、气骨导差值变化、鼓膜愈合、听力改善、干耳时间和并发症等指标情况。结果声导抗正-负平衡法与ETS两种检测方法一致率为76.56%,咽鼓管功能正常组和咽鼓管功能障碍组患者术后的气导听阈值和气骨导差均低于术前(P<0.05),两组在术前及术后(3个月、6个月)的气导听阈值、气骨导差及其差值变化,听力改善率、干耳时间等指标差异有统计学意义(P<0.05);而两组患者在的鼓膜愈合率、术后干耳率及术后并发症发生率差异均无统计学意义(P>0.05)。结论声导抗正负压平衡法结合ETS检测法对鼓膜穿孔患者进行主客观咽鼓管功能检测,可提高咽鼓管功能检测的准确率,可作为咽鼓管功能检测的补充手段。

Objective To evaluate effects of Eustachian tube function on the efficacy of type Ⅰ tympanoplasty in the treatment of chronic suppurative otitis media(CSOM). Methods Patients who had undergone type Ⅰ tympanoplasty(n=64) were categorized as having dysfunctional or normal Eustachian tube function based on their Eustachian tube scores(ETS). Correlation between positive/negative pressure equilibrium tympanometry test and ETS, air conduction thresholds, air-bone gap, healing of tympanic membrane, rate of hearing improvement, time to dry ear and complications were compared between the two groups. Results Positive/negative pressure equilibrium test correlated with ETS in76.56% of the cases. Both air conduction thresholds and air bone gap improved after operation(P<0.05). Pre-and postoperative(3 and 6 months) air conduction thresholds and air bone gap(as well as their changes), rate of hearing improvement and time to dry ear showed statistically significant differences between the two groups(P<0.05), but not rate of tympanic membrane healing, rate of dry ear or postoperative complications(P>0.05). Conclusion Positive/negative pressure equilibrium tympanometry test combined with ETS detection can be used to improve accuracy Eustachian tube function evaluation in patients with tympanic membrane perforation.