咽鼓管球囊扩张术联合鼓膜置管治疗难治性分泌性中耳炎的疗效分析

Efficacy of balloon eustachian tuboplasty combined with tympanic tube insertion in the treatment of Refractory Otitis Media with Effusion

目的通过咽鼓管球囊扩张术(BET)加鼓膜切开置管术(TBI),治疗难治分泌性中耳炎,分析其疗效。方法15例(15耳)从2017年1月至2019年1月收治的难治性分泌性中耳炎患者(ROME),术前经硬性耳内镜、电子鼻咽镜、纯音测听、声导抗、咽鼓管压力测定(TMM),以及经过规范药物治疗、鼓膜穿刺以及不少于3次鼓膜置管手术治疗,效果不佳。全麻下施行BET+TBI手术治疗,术后随访12月。用视觉评分量表(VAS)评分对术前及术后1、6和12个月时Valsalva难易程度、耳闷塞感、耳痛进行主观症状评估。对其术前和术后1、3、6、9和12个月的咽鼓管功能问卷(ETDQ-7)调查进行得分均值比较。并在术后12月复诊时进行满意度问卷调查。结果术后1、6、12月Valsalva难易程度、耳闷塞感、耳痛程度较术前显著降低,差异有统计学意义(P<0.05);术后ETDQ-7评分较术前显著降低(P<0.05);术后12月满意度问卷调查表表明13名患者(86.7%)对治疗过程满意。结论咽鼓管球囊扩张术+鼓膜切开置管术治疗难治性分泌性中耳炎,大部分患者的术后症状明显改善。其近期和中期疗效均显著,总体治疗满意度高。

Objective To report efficacy of balloon eustachian tuboplasty(BET)combined with tympanic tube insertion(TBI)in the treatment of refractory otitis media with effusion.Methods A study was conducted in 15 patients(15 ears)with refractory otitis media with effusion(ROME)between January 2017 and January 2019.All the patients underwent the preoperative assessments of oto-endoscope,electronic nasopharyngeal endoscopy,prue tone audiometry,acoustic immittance and Eustachian tube pressure measurement(TMM).These patients had failed to respond to medicine,multiple tympanic membrane puncture and at least 3 times tympanic tube insertion before our study.BET+TBI surgery was performed in all the 15 patients.All cases were followed over 12 months.Subjective symptoms including the difficult level of valsalva,aural fullness and earache were assessed by visual rating scale(VAS score)preoperatively and at 1,6,12months after surgery.In addition,the mean scores of Eustachian tube dysfunction questionnaire-7(ETDQ-7)before surgery were compared with those at 1,3,6,9 and 12 months.A satisfaction questionnaire survery was also conducted at 12 months after surgery.Results VAS scores at 1,6,12 months after surgery were significantly lower than those before surgery,the difference was statistically significant(P<0.05).ETDQ-7 score after surgery was significantly lower than that before surgery(P<0.05).The 12 months follow-up questionnaire survey showed that 13 patients(86.7%)were satisfied with the treatment.Conclusion Both short-and medium-term Symptoms can be significantly improved in most patients with refractory otitis media with effusion undergoing BET+TBI,with overall high satisfaction scores.