咽鼓管钛镍支架置入治疗和预防中耳炎粘连

Preliminary report of NiTi shape memory alloys stent for intraeustachian tube plalcement to prevent and treat adhesive otitis media

目的 探讨咽鼓管软骨段钛镍合金支架置入治疗和预防粘连性中耳炎的可行性。方法 5 6例粘连性中耳炎 ,2 7例渗出性中耳炎 ,5 2例无耳疾的鼻病患者 (为对照 )作了咽鼓管咽口检查 ;2例尸头的咽鼓管解剖 ;8例 (侧 )粘连性中耳炎和顽固性渗出性中耳炎作了软骨段钛镍合金支架 (国产材料自制 )置入。设计制作了安装器。结果 咽口形态被分类为宽敞、狭小、缝隙 3种类型 ,粘连性中耳炎组分别有 2 0 ,31,5例 ;渗出性中耳炎组有 9,13,5例 ;鼻病对照组有 4 5 ,7,0例。支架置入后 :4例粘连性中耳炎患者都取得了 (乏氏法 )通畅 ,鼓室充气良好 ,听力增进 (语言频率气骨差分别比术前缩小 15和 30dB)。 4例顽固性渗出性中耳炎中 2例鼓室充气 ,气骨差闭合 ,随访 12～ 2 8个月仍保持良好。另 2例捏鼻鼓气已经通畅 ,取出了鼓膜置管。 8例支架置入者均没有任何异常不适 ,1个月内都呈现咽鼓管内黏膜反应性肿胀伴黏液渗出 ,1～ 2个月后肿胀消失 ,捏鼻鼓气通畅。结论 咽鼓管软骨段置入钛镍合金支架治疗和预防粘连性中耳炎具有良好效果 ,没有发生咽鼓管异常开放的不良反应。

Objective To explore and assess NiTi shape memory alloys stent intraeustachian tube placement prevent and treat adhesive otitis media. Methods The patients were divided into 3 groups (A:56 cases of adhesive otitis media, B:27 cases of otitis media with effusion, C:52 cases as control). In all cases of eustachian orifices were inspected by endoscope. 2 autopsy eustachian tubes were dissected. NiTi shape memory alloys stent intraeustachian tube plasment was perfomed in 8 cases to prevent and treat adhesions of middle ear with seld-designed . Results The eustachian orifice can be divided into three types: wide, narrow and fissure like instolle. In group A, wide, narrow, fissure like showed 20, 31, 5; respectively in group B: 9, 13, 5; in group C: 45, 7, 0. There was significant difference in three gorup (A,B, versus C χ 2=29.66,25.44 respectively, P<0.0001). The comparison between group A and B showed no significant difference (χ 2=1.59, P>0.05). Autopsy of eustachian tube: cartilage length was 30 mm, trapeziform, floor width was 11 mm, tip width was 4 mm. 4 cases of adhesive otitis media gained good ventilation as during valsalva method with audiometry promotion 15-30 dB after NiTi shape memory alloys stent placements. Two of 4 cases of otitis media with refractory effusion, gained A-B gap close, follow up over 12 months; the other was good at valslva's and gave up ventilation tube. Eight case had no patulous and any side-effect after NiTi shape memory alloys placement. Conclusions Adhesive otitis media can be prevented and treated by placing NiTi shape memory alloys stent with no patulous or other side-effect.