TTI联合鼓室注射地塞米松治疗分泌性中耳炎的疗效及并发症比较

Comparison of the Efficacy and Complications of TTI Combined with Intratympanic Injection of Dexamethasone in the Treatment of Secretory Otitis Media

目的:探讨鼓膜置管术(TTI)联合鼓室注射地塞米松治疗分泌性中耳炎的疗效及并发症的影响。方法:选取2019年10月至2021年8月于郑州市第七人民医院耳鼻咽喉科就诊的86例分泌性中耳炎的患者为研究对象,按照随机数字表法将其分为观察组和对照组,各43例。对照组采用TTI治疗,观察组采用TTI联合鼓室注射地塞米松治疗。通过比较术前,术后1周、术后2周时,两组患者鼓室图情况、气导与骨导听阀评估治疗疗效,比较术后2周,两组患者耳鸣严重程度(耳鸣问诊与评估表),两组患者并发症(感染、置后穿孔、耳漏)发生率。结果:与术前比较,术后1周,观察组A型患者比例明显增加,差异具有统计学意义(P<0.05);两组患者骨导阈值显著下降,且观察组明显低于对照组,差异具有统计学意义(P<0.05);两组患者耳鸣问诊与评估表分数显著降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。术后2周时,观察组和对照组A型患者比例均明显增加,且观察组数量多于对照组,差异具有统计学意义(P<0.05);两组患者的气导和骨导阈值均显著降低,且观察组明显低于对照组,差异具有统计学意义(P<0.05);观察组和对照组患者的耳鸣问诊与评估表分数显著降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。两组患者感染、置后穿孔、耳漏及并发症总发生率比较,差异无统计学意义(P>0.05)。结论:TTI联合鼓室注射地塞米松可改善患者听力,对提升分泌性中耳炎的治疗疗效可起到积极作用,且加用地塞米松对并发症发生风险影响较小。

Objective To investigate the effect and complications of tympanotomy tube insertion(TTI)combined with intratympanic injection of dexamethasone in the treatment of secretory otitis media.Methods A total of 86 patients with secretory otitis media treated in the department of otolaryngology,Zhengzhou Seventh People's Hospital from October 2019 to August 2021 were selected as the research subjects,and they were divided into an observation group and a control group according to random number table method,with 43 cases in each group.The control group was treated with TTI,and the observation group was treated with TTI combined with intra-tympanic injection of dexamethasone.The treatment efficacy was evaluated by comparing the tympanogram,air conduction and bone conduction valve of patients in the two groups before,1 week and 2 weeks after surgery.The severity of tinnitus(tinnitus consultation and evaluation table)and the incidence of complications(infection,posterior perforation and otorrhea)in the two groups were compared 2 weeks after surgery.Results Compared with before surgery,1 week after surgery,the proportion of type A patients in the observation group was significantly increased,and the difference was statistically significant(P<0.05).The bone conduction threshold of the two groups was significantly decreased,and the bone conduction threshold of the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).The scores of tinnitus inquiries and assessment sheets in the two groups were significantly decreased,and the scores of tinnitus inquiries and assessment sheets of the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05).Two weeks after surgery,the proportion of type A patients in the two groups were significantly increased,and the number of observation group was more than that of the control group,the differences were statistically significant(P<0.05).The threshold values of air and bone conductance in the two groups were significantly decreased,and the threshold values of air and bone conductance of the observation group was significantly lower than that of the control group,the difference was statistically significant(P<0.05).The scores of tinnitus consultation and assessment table in the two groups were significantly decreased,and the scores of tinnitus consultation and assessment table of the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);There was no significant difference in the total incidence of infection,posterior perforation,otorrhea and complications between the two groups(P>0.05).Conclusion TTI combined with intratympanic injection of dexamethasone can improve patients'hearing and play a positive role in improving the therapeutic effect of secretory otitis media.Moreover,the addition of dexamethasone has little effect on the risk of complications.