咽鼓管球囊扩张术治疗慢性化脓性中耳炎合并咽鼓管功能障碍的观察研究

Eustachian tube balloon dilatation in the treatment of chronic suppurative otitis media complicated with Eustachian tube dysfunction:an observation study

目的探讨咽鼓管球囊扩张术治疗慢性化脓性中耳炎合并咽鼓管功能障碍的临床效果。方法选择56例慢性化脓性中耳炎合并咽鼓管功能障碍患者为研究对象,依据治疗方案将其分为联合治疗组和常规治疗组,各28例。常规治疗组患者在全身麻醉下行完壁式乳突根治术+鼓室成形术治疗,联合治疗组患者在常规治疗组基础上同期行咽鼓管球囊扩张术治疗。对比两组术前、术后的七项咽鼓管功能障碍量表(ETDQ-7)评分、咽鼓管功能评分(ETS评分)、纯音听阈气导阈值及术后干耳时间、再流脓发生率。结果两组患者的ETDQ-7评分比较,差异有统计学意义(F_(组间)=15.770,P_(组间)<0.001);两组患者的ETDQ-7评分有随时间变化的趋势(F_(时间)=8.436,P_(时间)=0.004);分组与时间的交互效应不显著(F_(交互)=0.850,P_(交互)=0.430)。其中,术后3个月、6个月,两组患者的EDTQ-7评分均较术前降低,且联合治疗组评分低于常规治疗组(均P<0.05)。两组患者的ETS评分比较,差异有统计学意义(F_(组间)=247.300,P_(组间)<0.001),两组患者的ETS评分有随时间变化的趋势(F_(时间)=89.850,P_(时间)<0.001),分组与时间有交互效应(F_(交互)=17.440,P_(交互)<0.001)。其中,术后3个月、6个月,两组患者的ETS评分均较术前升高,且联合治疗组ETS评分均高于常规治疗组(均P<0.05)。术后6个月,两组纯音听阈气导阈值均较术前显著下降,且联合治疗组纯音听阈气导阈值低于常规治疗组(均P<0.05)。联合治疗组患者的干耳时间短于常规治疗组(P<0.05),但两组再流脓发生率差异无统计学意义(P>0.05)。结论对于慢性化脓性中耳炎合并咽鼓管功能障碍患者,在常规治疗的同期行咽鼓管球囊扩张术,能够改善患者咽鼓管功能,提高听力,缩短术后干耳时间。

Objective To investigate the clinical effect of Eustachian tube balloon dilatation in the treatment of chronic suppurative otitis media complicated with Eustachian tube dysfunction.Methods Fifty-six patients with chronic suppurative otitis media combined with Eustachian tube dysfunction were selected as the research objects.According to the treatment plan,they were divided into combined treatment group and conventional treatment group,with 28 cases in each group.Patients in the conventional treatment group were treated with canal wall-up radical mastoidectomy combined with tympanoplasty under general anesthesia,while those in the combined treatment group were treated with Eustachian tube balloon dilatation at the same time on the basis of the conventional treatment group.The preoperative and postoperative seven-item Eustachian tube dysfunction questionnaire(ETDQ-7)scores,Eustachian tube score(ETS),pure-tone audiometry air-conduction thresholds,postoperative dry ear time,and the incidence of postoperative secondary purulence were compared between the two groups.Results There were statistically significant differences in ETDQ-7 scores between the two groups(F_(between-groups0=15.770,P_(between-groups)<0.001);the ETDQ-7 scores of the two groups showed a trend of change with time(F_(time)=8.436,P_(time)=0.004);and there was a non-significant interaction effect between grouping and time(F_(interaction)=0.850,P_(interaction)=0.430).In particularly,at 3 months and 6 months after operation,the EDTQ-7 scores of patients in both groups were lower than those before operation,and the scores of the combined treatment group were lower than those of the conventional treatment group(all P<0.05).There was a statistically significant difference between the ETS scores of the two groups(F_(between-groups)=247.300,P_(between-groups)<0.001),a trend for the ETS scores of the two groups to change over time(F_(time)=89.850,P_(time)<0.001),and an interaction effect between grouping and time(F_(interaction)=17.440,P_(interaction)<0.001).At 3 months and 6 months after operation,the ETS scores of the two groups were higher than those before operation,and the ETS scores of the combined treatment group were higher than those of the conventional treatment group(all P<0.05).At 6 months after operation,the pure-tone audiometry air-conduction thresholds of the two groups was significantly lower than that before operation,and the pure-tone audiometry air-conduction thresholds of the combined treatment group was lower than that of the conventional treatment group(all P<0.05).The dry ear time of the patients in the combined treatment group was shorter than that of the conventional treatment group(P<0.05),but the difference in the incidence of secondary purulence between the two groups was not statistically significant(P>0.05).Conclusion For patients with chronic suppurative otitis media and Eustachian tube dysfunction,the balloon dilatation of Eustachian tube during the same period of conventional treatment can improve the Eustachian tube function,improve hearing,and shorten the postoperative dry ear time.