慢性化脓性中耳炎患者咽鼓管功能检测和结果分析

Eustachian Tube Function in Patients with Chronic Suppurative Otitis Media

目的系统性评估慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者咽鼓管功能障碍(eustachian tube dysfunction,ETD)发生率,并对常用几种咽鼓管功能检测方法的结果进行综合比较,探讨咽鼓管功能评估的最佳方法组合。方法选择2021年3月至2022年11月在中山大学附属第三医院耳鼻咽喉头颈外科接受住院手术治疗的CSOM患者116例(合并中耳胆脂瘤17例)。应用7项咽鼓管功能障碍问卷(7-item eustachian tubedysfunctionquestionnaire,ETDQ-7)评分、咽鼓管鼓室气流动态图(tubotympanoaerodynamicgraphy,TTAG)法、音响法、动态慢动作视频内镜(dynamic slow motion video endoscopy,DSVE)法检测和评估咽鼓管功能,对上述4种检查方法评估ETD阳性率、结果一致性进行分析,比较患耳与健耳咽鼓管功能。结果116例(120耳)完成ETDQ-7法、TTAG法和音响法检测,85例(88耳)完成DSVE法检查。ETDQ-7评分、TTAG法、音响法、DSVE法检测ETD阳性率分别为53.3%(64/120)、70.0%(84/120)、45.8%(55/120)、94.3%(83/88)。TTAG法与DSVE法的一致率最高;音响法与DSVE法一致率最低;ETDQ-7评分、TTAG法和音响法一致性较好。单耳CSOM患者患耳ETDQ-7评分、TTAG法ETD阳性率均高于健耳,差异均有统计学意义(P<0.05);患耳DSVE法、音响法ETD阳性率与健耳比较,差异无统计学意义(P>0.05)。结论CSOM患者中ETD发生率较高,TTAG法检测ETD具有较高的敏感性。主观、客观检测方法联合应用,即ETDQ-7评分结合TTAG法和音响法,可提高CSOM患者咽鼓管功能检测结果准确性。

Objective To report eustachian tube dysfunction(ETD)in chronic suppurative otitis media(CSOM)and optimal combination of methods for ET function evaluation.Methods A total of 116 patients with CSOM,including 17 with middle ear cholesteatoma,admitted to the Department of Otorhinolaryngology Head and Neck Surgery,Third Affiliated Hospital of Sun Yat-sen University,between March 2021 and November 2022,underwent ET function evaluation using the 7-item eustachian tube dysfunction questionnaire(ETDQ-7),tubo-tympano-aerodynamicgraphy(TTAG),sonotubometry,and dynamic slow motion video endoscopy(DSVE).The rate of positive results and consistency of the four methods were analyzed,and ET function was compared between the affected ear and the healthy ear.Results A total of 116 patients(120 ears)received the tests.The rate of ETD detection for ETDQ-7,TTAG,sonotubometry,and DSVE was 53.3%(64/120),70.0%(84/120),45.8%(55/120)and 94.3%(83/88),respectively.TTAG showed the highest agreement with DSVE,while sonotubometry showed the lowest.ETDQ-7,TTAG and sonotubometry showed good agreement.Patients with unilateral CSOM had a significantly higher ETDQ-7 score and positive rate of ETD by TTAG in the affected ear compared to the healthy ear(P<0.05),but not in DSVE grading or sonotubometry(P>0.05).Conclusion Patients with CSOM have a high incidence of ETD.TTAG is highly sensitivity for ETD detection.A combination of ETDQ-7 with TTAG and sonotubometry can improve the accuracy of ET function testing in CSOM patients.