Balloon dilation of Eustachian tube combined with tympanostomy tube insertion and middle ear pressure equalization therapy for recurrent secretory otitis media

Objective: To report outcomes of balloon dilation Eustachian tuboplasty combined with tympanostomy tube insertion and middle ear pressure equalization therapy in treatment of recurrent secretory otitis media. Methods: Fifty one patients with recurrent secretory otitis media (62 ears) underwent balloon dilation of Eustachian tube and tympanic tube insertion under general anesthesia, followed by long term middle ear pressure equalization therapies. The Eustachian tube score (ETS) and Eustachian tube function questionnaire (ETDQ-7) were used for pre- and postoperative (up to 12 months) evaluation of Eustachian tube functions. Results: The mean ETS score was 2.34 ± 0.97 preoperatively, and 6.17 ± 1.54, 7.23 ± 1.62, 8.24 ± 1.97, and 7.63 ± 1.86 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). The ETDQ-7 score was 4.82 ± 1.07 preoperatively, and 2.20 ± 0.54, 2.32 ± 0.68, 2.53 ± 0.79, and 2.67 ± 0.76 at 1, 3, 6 and 12 months postoperatively, respectively (P < 0.05). Conclusion: Balloon dilation of Eustachian tube combined with tympanostomy and catheterization resulted in significant improvement of subjective symptoms and objective evaluation of Eustachian tube functions in most patients with recurrent secretory otitis media, as indicated by the ETS and ETDQ-7 scores, demonstrating high levels of efficacy and patient satisfaction.

THE EFFECT OF EXOGENOUS SURFACTANT ON THE EUSTACHIAN TUBE FUNCTION IN THE GERBIL MODEL OF SECRETORY OTITIS MEDIA

Objective To investigate the effect of exogenous surfactant on Eustachian tube opening function. Methods This reasarch measures for the Eustachian tube opening pressure by injection of surface active substance into middle ear space, studying the effect of surfactant on Eustachian tube opening function. Results It has been showed that the injection of killed streptococcus pneumoneac bacteria by the transtympanic route, successfully developed a secretory otitis media model. Eustachian tube opening pressure in ears with SOM was significantly greater than those without effusion ( P <0.01). Irrigation the middle ear space with surfactant resulted in a dramatic decrease in eustachian tube passive opening pressure in both normal and patients ( P <0.01). Conclusion The results indicate that flushing with exogenous surfactant by the transtympanic rote reduce of eustachian tube surface tension, and it benefits the Eustachian tube opening.

Eustachian tube involvement in a patient with relapsing polychondritis detected by magnetic resonance imaging:A case report

BACKGROUND Relapsing polychondritis(RP)is a rare inflammatory disease involving the systemic cartilage,such as the auricle,trachea,and bronchiole,among others.A patient with RP shows variable symptoms based on the involved cartilage.CASE SUMMARY A 72-year-old Japanese woman with a history of redness of the bilateral auricles for 3 d was referred to a clinician.The clinician prescribed antibiotics to the patient;however,the symptoms worsened;thus,she was referred to our hospital.Head and neck magnetic resonance imaging(MRI)showed edematous auricle with remarkable contrast,fluid collection in the bilateral mastoid cells,suggesting otitis media.The eustachian tube(ET)on the right side was also edematous with contrast enhancement.The patient was suspected of RP according to the diagnostic criteria.A biopsy of the auricular cartilage was performed by an otorhinolaryngologist,confirming pathological proof of RP.Treatments with steroids were immediately administered thereafter.CONCLUSION We highlight a rare case of RP with radiologically confirmed involvement of ET in the MRI.

Tympanometry, a Prognostic Indicator of Myringoplasty with Assessment of Eustachian Tube Function

Objective: To determine Eustachian tube function in tubotympanic type of chronic ear disease and to correlate Eustachian tube function with pathological change in middle ear mucosa. Materials and Methods: A prospective study of the cases of tubotympanic type of chronic suppurative otitis media was undertaken. Patients were subjected to clinical examination followed by audiometry tests and impedence audiometry to determine eustachian tube functions. Patients were then subjected to myringoplasty and eustachian tube function were then reassessed post operatively. Results: In our study, out of 30 cases who underwent myringoplasty, 21 cases had successful surgical outcome and 9 cases were failed. Out of 24 cases of good Eustachian tube function, 21 cases had successful surgical outcome intends of taking up graft, absence of otorrhea and improvement in hearing. In remaining 3 cases, there was recurrence of otorrhea with central perforation. All the 6 cases with poor Eustachian tube function had surgical failure. Conclusion: The prognosis of the middle ear reconstructive surgery has direct correlation with Eustachian tube functions and Eustachian tube function tests should be a routine investigation in all the cases planned for surgical reconstruction of the middle ear.

The rat eustachian tube:Anatomical, histological, and radiological features

Purpose: This study investigated the anatomical and histological characteristics of the rat Eustachian tube(E-tube)and the feasibility of Eustachian tubography in a rat model.Materials and methods: Fifteen male Wistar rats were used in this study, and the bilateral E-tubes of each rat were examined. Ten E-tubes were used for anatomical studies, another ten for histological analysis, and the other ten for Eustachian tubography. Five rats were euthanized and decapitated, and ten E-tubes were dissected to describe the anatomy of the E-tube. Ten E-tube specimens obtained from five other rats were sectioned to investigate Etube histology. Eustachian tubography was performed on the bilateral E-tubes of the other five rats using the trans-tympanic approach.Results: The rat E-tubes consisted of bony and membranous parts. Cartilage and bone tissue covered only the bony part. The E-tubes’ mean diameter and overall length were 2.97 mm and 4.96 mm, respectively. The tympanic orifices’ mean diameter was 1.21 mm. The epithelium of E-tubes was mainly composed of pseudostratified ciliated and goblet cells. Eustachian tubography was successfully performed on both sides of the E-tube for each rat.The technical success rate was 100%, the average running time was 4.9 min, and no procedure-related complications occurred. On tubography images, the E-tube, tympanic cavity, and nasopharynx could be identified because of the visualization of bony landmarks.Conclusion: In this study, we described the anatomical and histological features of rat E-tubes. With the aid of these findings, E-tube angiography was successfully performed using a transtympanic approach. These results will facilitate further investigation of E-tube dysfunction.

Eustachian tube teratoma: A case report

BACKGROUND Mature teratoma composed of all three basic germ cell layers of the head and neck is a rare disease.Teratomas involving the temporal bone are particularly scarce.CASE SUMMARY A 48-year-old male patient with a history of chronic otitis of the left ear from infancy,for which he had been operated on twice,was referred to our hospital for chronic otitis,cholesteatoma and a middle ear mass.Computed tomography(CT)scan and magnetic resonance imaging(MRI)revealed a eustachian tube teratoma,in which the anterior lower part and posterior upper part were connected by a thin membranaceous tissue.The mass was removed completely under general anesthesia by mastoidectomy.As of last follow-up(2 years post-surgery),the disease had not relapsed.CONCLUSION Pre-operative CT and MRI are necessary for eustachian tube teratoma.Complete surgical resection provided excellent prognosis.

咽鼓管球囊扩张联合鼓膜置管术治疗复发性分泌性中耳炎疗效的meta分析

目的利用meta分析的方法探讨咽鼓管球囊扩张(Balloon dilatation eustachian tuboplasty,BET)联合鼓膜置管术(Tympanostomy tube insertion,TTI)治疗复发性分泌性中耳炎的临床疗效及安全性,为临床提供循证医学证据。方法本研究采用PubMed,Embase,Web of Science,Clinical Trials,Cochrane Library,CNKI,CBM,维普,万方数据库,检索关于BET联合TTI与单纯性鼓膜置管治疗复发性分泌性中耳炎的随机对照试验,检索时限截止至2019年10月1日。根据纳入与排除标准筛选文献并提取相关数据,并使用Cochrane偏倚风险评估工具对纳入文献进行质量评价,采用Revman5.3软件对纳入文献进行Meta分析。结果研究共纳入7篇随机对照试验,包括377例患者,其中实验组188例,对照组189例。meta分析显示咽鼓管球囊扩张联合鼓膜置管术与单纯鼓膜置管在治疗复发性分泌性中耳炎方面,两组差异有统计学意义(P<0.0001),BET联合TTI治疗术后总有效率优于单纯鼓膜置管组。两种治疗方式对气骨导差的改善存在明显差异(P=0.03)。咽鼓管功能主观评分ETDQ-7改善方面,随访6、12个月差异均有统计学意义(P<0.00001)。结论BET联合TTI治疗复发性分泌性中耳炎疗效优于单纯鼓膜置管术,安全可靠,临床可选择使用。

地塞米松磷酸钠联合咽鼓管球囊扩张术治疗难治性分泌性中耳炎临床价值研究

目的:探讨地塞米松磷酸钠联合咽鼓管球囊扩张术治疗难治性分泌性中耳炎的临床价值。方法:选取难治性分泌性中耳炎患者66例,并随机分为对照组和研究组,各33例。研究组给予地塞米松磷酸钠联合咽鼓管球囊扩张术治疗;对照组给予咽鼓管球囊扩张术治疗。比较两组治疗后临床疗效及并发症发生情况。于治疗前后,采用咽鼓管功能障碍问卷-7(ETDQ-7)评分对咽鼓管功能障碍进行评估;采用纯音测听检测气骨导差值及纯音听阈值;采用纯音听阈测试及声导抗测听检测静态声顺值及平均听阈值;检测白细胞介素-8(IL-8)、IL-5、肿瘤坏死因子-α(TNF-α)、CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)比值。结果:研究组治疗后总有效率高于对照组(P<0.05)。与对照组比较,研究组治疗后第3天ETDQ-7评分、气骨导差值、纯音听阈值、听力水平、血清IL-8、IL-5、TNF-α及CD8^(+)水平降低,静态声顺值、血清CD4^(+)水平、CD4^(+)/CD8^(+)比值升高(均P<0.05)。研究组并发症总发生率低于对照组(P<0.05)。结论:地塞米松磷酸钠联合咽鼓管球囊扩张术治疗难治性分泌性中耳炎可改善患者听力,降低炎症反应,提高免疫功能,从而增强治疗疗效,且安全性较好。

咽鼓管球囊扩张联合鼓膜切开置管对慢性复发性分泌性中耳炎疗效的Meta分析

目的系统评价咽鼓管球囊扩张联合鼓膜切开置管对慢性复发性分泌性中耳炎的治疗效果。方法在万方,中国知网(CNKI),维普(VIP),中国生物医学文献(CBM),PubMed,Web of science,Cochrane library等中外文数据库中检索自建库以来至2020年3月有关咽鼓管球囊扩张治疗慢性复发性分泌性中耳炎的相关文献。将所有相关文献严格按照纳入排除标准进行筛选,并依据Cochrane文献质量评价表对最终纳入文献进行质量评估。采用Revman 5.3软件对纳入文献的有效率、ETDQ-7评分、骨气导差、平均听阈、声导抗、耳内镜检查、不良反应发生率等结局指标进行Meta分析。结果最终纳入文献14篇,共计14个RCT实验710例患者(790耳),试验组351例患者(395耳),对照组359例患者(395耳)。试验组采用咽鼓管球囊扩张联合鼓膜切开置管,对照组为单纯鼓膜切开置管。Meta分析结果显示:试验组各个随访时间段的有效率均高于对照组,差异具有统计学意义(P均<0.000 01);在各个随访时间段中,试验组的ETDQ-7评分均低于对照组且差异具有统计学意义(P均<0.000 01);随访1个月及6个月后,两组的骨气导差变化无统计学差异。随访12个月后,试验组患者的骨气导差较对照组改善明显,差异具有统计学意义(P<0.05);试验组的平均听阈、声导抗及耳内镜检查的改善情况优于对照组,差异具有统计学意义(P均<0.05);另外,试验组患者的不良反应发生率低于对照组,差异具有统计学意义(P<0.05)。结论相比单纯鼓膜切开置管,咽鼓管球囊扩张联合鼓膜切开置管对慢性复发性分泌性中耳炎疗效较好,症状改善更明显且不良反应发生率较小。

咽鼓管球囊扩张术和鼓膜置管术治疗慢性分泌性中耳炎疗效的Meta分析

目的 通过Meta分析系统评价咽鼓管球囊扩张术(balloon dilation eustachian tuboplasty,BET)和鼓膜置管术(tympanostomy tube insertion,TTI)在慢性分泌性中耳炎(chronic secretory otitis media,CSOM)治疗中的疗效。方法 计算机检索中英文数据库中发表的关于CSOM的研究,检索时限从建库至2020年3月,严格按照纳入排除标准筛选文献并进行Meta分析。结果 共计纳入8篇文献,共500例(504耳)患者,其中BET组250例(253耳)和TTI组250例(251耳),BET组治疗有效率较高[OR=3.4,95%CI(2.04,5.64)]。根据研究类型亚组分析,BET治疗CSOM有效率均高于TTI组(P<0.05)。根据咽鼓管功能障碍评分(7-item Eustachian tube dysfunction questionaire,ETDQ-7)亚组分析,术后6、12、18个月,BET组评分均低于TTI组(P>0.05)。根据PTA亚组分析,术后12个月,BET组PTA低于TTI组(P<0.05)。根据Valsava评分亚组分析,术后6个月,BET组Valsava评分低于TTI组(P<0.05)。根据术后并发症和复发率进行亚组分析,TTI组(7.79%,20%)均高于BET组(1.72%,0%)。结论 在考虑治疗有效率、PTA、Valsava评分、并发症和复发率方面,BET治疗CSOM的短期疗效优于TTI。

探讨试管婴儿技术(IVF-ET)患者心理情况及护理效果

目的：分析实施试管婴儿技术（IVF-ET）患者的心理情况与护理的效果。方法随机选择我院2011年3月～2013年4月所收治的试管婴儿技术患者2500例，分作对照组和研究组各1250例，对照组采用常规的护理手段实施护理，研究采用健康护理手段实施护理，对比两组心理情况与护理的效果。结果采用不同方法护理后，研究组患者的忧郁、焦虑、躯体化及人际关系敏感心理方面的水平低于对照组，研究组妊娠终止的结局明显优于对照组，差异有明显的统计学意义（P＜0.05）。结论对试管婴儿技术患者实施健康护理，能够有效的缓解患者的心理问题，提高护理效果，减少术后并发症情况，在临床上具有重要的实践意义。

Long Term Outcomes of Cross-Hatching Eustachian Tuboplasty

Objective: To review the long term outcomes of cross-hatching Eustachian Tuboplasty (ChEt) in patients with chronic obstructive Eustachian tube dysfunction (COETD), as well as assess the clinical factors associated with surgical success. Study Design: Retrospective case series review. Setting: Tertiary healthcare institution. Methods: This is a retrospective review of non-revision ChET for COETD. Follow-up period was 5 years. The inclusion criteria were persistent otitis media with effusion, conductive hearing loss of 5 or more years, and constant COETD related-symptoms. The curvature of the posterior cushion was modified using an argon laser to alter the spring of the cartilage alleviating the obstructed valve’s aperture. Several clinical factors were reviewed in relation to the successful opening of Eustachian tube valve. Results: One hundred and twenty patients, 72 males/48 females, average age 42.4 + 2 years old, met study inclusion criteria. COETD patients/ obstructive causes were: Posterior cushion hypertrophy, 68 (56.6%);Tensor Veli and Levator Veli Palatini muscles hypertrophy, 15 (12.5%);Remarkable mucosal hypertrophic disease, 37 (30.8%). Total of ET tubes was 198. Bilateral 143 (72.2%), 55 unilateral (27.7%) ET valve was seen more open postoperatively on simple endoscopy (SE) and slow motion video analysis (SMVEA). There were no complications. Mean pure tone average improved by 20 dB postoperatively;P = 0.015. Mean immitance changes in tympanometric measurements improved postoperatively at least 0.10 mmhos in 91% of the patients (P = 0.010). Resolution of symptoms was considered a successful outcome. Failure correlated with the severity of disease. Conclusion: High rates of improvement (96%) were achieved. ChEt is a promising technique for the treatment of

经鼓室口咽鼓管球囊扩张术的疗效及咽鼓管功能的影响

目的探讨经鼓室口咽鼓管球囊扩张(balloon dilatation Eustachian tuboplasty,BET)联合腺样体消融术对慢性分泌性中耳炎(chronic secretory otitis media,CSOM)患儿的疗效及咽鼓管功能的影响。方法选取2020年6月~2022年12月间在中山市小榄人民医院就诊的CSOM患儿82例作为研究对象,采用随机数字表法分为对照组和观察组,每组41例。对照组接受腺样体消融术+鼓膜切开置管术治疗,观察组接受腺样体消融术+鼓膜切开置管术+BET术。比较两组手术相关指标及住院时间、临床症状、咽鼓管功能、临床疗效及随访6个月并发症及复发情况。结果两组术中出血量比较,差异无统计学意义(P>0.05),与对照组相比,观察组手术时间更长,住院时间更短(P<0.05)。与对照组相比,观察组中耳积液消失时间、耳鸣消失时间、鼓膜愈合时间、听力恢复时间均更短(P<0.05)。与治疗前相比,治疗后两组咽鼓管评分(Eustachian tube score,ETS)升高、咽鼓管功能障碍评分量表(Eustachian tube dysfunction questionnaire-7,ETDQ-7)评分降低(P<0.05),观察组ETS评分高于对照组,ETDQ-7评分则低于对照组(P<0.05)。观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(14.63%vs.9.76%,P>0.05),与对照组相比,观察组复发率更低,差异具有统计学意义(21.95%vs.2.44%,P<0.05)。结论经鼓室口BET联合腺样体消融术有助于提高CSOM患儿的临床疗效,改善咽鼓管功能,促进术后恢复,减少复发率,且并发症发生率低。

奥美拉唑在分泌性中耳炎合并咽喉反流患者中的治疗价值

目的:探讨奥美拉唑在分泌性中耳炎(SOM)合并咽喉反流(LPR)患者中的治疗价值。方法:选取单侧或双侧SOM合并LPR患者82例,根据治疗方案不同将患者分为治疗组(35例)和对照组(47例)。所有患者均给予鼓膜穿刺术、配合使用鼻部激素、口服黏液促排剂和抗组胺药物1个月。治疗组同时给予患者抗反流宣教及足疗程奥美拉唑抗反流干预。随访3个月,比较两组患者治疗前后气骨导差、七项咽鼓管功能障碍症状评分量表(ETDQ-7)评分及临床疗效。结果:两组治疗后第1~3个月气骨导差较治疗前降低(均P<0.05)。治疗组治疗后第1~3个月气骨导差低于对照组(均P<0.05)。两组患者治疗后第1~3个月ETDQ-7评分较治疗前降低(均P<0.05)。治疗组治疗后第1~3个月ETDQ-7评分较对照组降低(均P<0.05)。治疗后第2、3个月,治疗组总有效率高于对照组(均P<0.05)。结论:对于SOM合并LPR患者,奥美拉唑能改善咽鼓管功能,提高听力水平及SOM治疗效果。

中耳积液中IL-10、LTD4表达与分泌性中耳炎患者术后咽鼓管阻塞的关系

目的探讨中耳积液中白介素-10(IL-10)、白细胞三稀D4(LTD4)表达与分泌性中耳炎患者术后咽鼓管阻塞的关系。方法回顾性分析,收集信阳职业技术学院附属医院2019年1月至2022年12月行手术治疗的120例分泌性中耳炎患者的临床资料,所有患者术前均进行中耳积液中IL-10、LTD4检查,均完成术后为期6个月的随访。依据患者术后咽鼓管阻塞发生情况进行分组,将随访期间31例并发咽鼓管阻塞的患者临床资料纳入发生组,将其余89例未并发咽鼓管阻塞的患者临床资料纳入未发生组。查阅并记录研究所需资料,将可能的因素纳入,经多因素logistic回归分析检验分泌性中耳炎患者术后咽鼓管阻塞的影响因素,分析中耳积液中IL-10、LTD4表达与分泌性中耳炎患者术后咽鼓管阻塞的关系。结果单因素分析发现,发生组中耳积液中IL-10、LTD4水平高于未发生组,咽鼓管功能不良占比高于未发生组,差异有统计学意义(P<0.05)。经多因素logistic分析结果显示,中耳积液中IL-10、LTD4水平高、咽鼓管功能不良是分泌性中耳炎患者术后并发咽鼓管阻塞的危险因素(OR>1,P<0.05)。结论中耳积液中IL-10、LTD4表达与分泌性中耳炎患者术后咽鼓管阻塞具有密切关系,二者水平高表达是分泌性中耳炎患者术后并发咽鼓管阻塞的危险因素。

鼻内镜直视下低温等离子射频消融腺样体切除术对OSAHS患儿术后疼痛、通气功能及咽鼓管功能的影响

目的探究鼻内镜视角下低温等离子射频消融腺样体切除术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿术后疼痛、通气功能及咽鼓管功能的影响。方法回顾性选取2019年12月至2022年12月唐山市妇幼保健院收治的OSAHS患儿143例纳入研究。按照随机数字表法将其分为观察组(n=71)和对照组(n=72)。观察组行鼻内镜直视下低温等离子射频消融腺样体切除术干预,对照组行鼻动力切割腺样体切除术干预。观察并比较两组患儿手术前及手术后2、8、24 h的疼痛行为量表[面部表情、下肢活动、整体活动、哭泣情况、安抚难度(FLACC)]评分,手术前及手术后6个月的呼吸道通气功能相关指标[呼吸紊乱指数(RDI)、氧减指数(ODI)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO_(2))]变化情况,咽鼓管功能,手术前及手术后6个月的生活质量[OSAHS特异性生活质量问卷(OSA-18)]。结果观察组手术后2、8、24 h的FLACC评分和对照组手术后24 h的FLACC评分均较手术前降低,且观察组手术后2、8 h的FLACC评分分别为(8.75±1.34)、(8.18±1.12)分,均低于对照组[(10.33±0.72)、(10.19±1.75)分],差异均有统计学意义(P<0.05)。手术后6个月,两组的RDI、ODI、AHI均较手术前降低,LSaO_(2)均较手术前升高,且观察组的RDI、ODI、AHI分别为(2.18±0.62)次/min、(10.13±4.78)h、(19.42±4.22)次/min,均显著低于对照组[(3.97±0.75)次/min、(15.79±3.09)h、(24.72±5.32)次/min],LSaO_(2)为(73.92±9.84)%,显著高于对照组[(54.13±9.98)%],差异均有统计学意义(P<0.05)。手术后6个月,观察组的最大鼓室压差值较手术前升高,两组的咽鼓管功能障碍发生率均较手术前降低,差异均有统计学意义(P<0.05);观察组手术后6个月的最大鼓室压差值为(24.45±2.85)daPa,显著高于对照组[(14.97±2.79)daPa],咽鼓管功能障碍发生率为2.82%,低于对照组(12.50%),差异均有统计学意义(P<0.05)。手术后6个月,两组OSA-18评分均较手术前降低,且观察组手术后6个月的OSA-18评分为(38.75±5.24)分,低于对照组[(50.93±5.49)分],差异均有统计学意义(P<0.05)。结论鼻内镜直视下低温等离子射频消融腺样体切除术治疗OSAHS患儿具有显著疗效,可有效减轻患儿术后疼痛,改善其通气功能、咽鼓管功能及生活质量。

咽鼓管功能对行Ⅰ型鼓室成形术的慢性中耳炎患者短期听力影响分析

目的 通过对耳内镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎患者的临床资料分析,探讨咽鼓管功能对其听力影响。方法 收集诊断为慢性化脓性中耳炎患者42例,结合声导抗正负压平衡试验和咽鼓管功能障碍评分量表(ETDQ-7)将分为咽鼓管功能障碍患者作为研究组(25例),将咽鼓管功能正常患者作为对照组(17例),对比分析两组患者手术前后听力的变化。结果 研究组术前与术后气导平均听阈、骨导平均听阈均高于对照组,差异具有统计学意义(P <0.05);研究组术后气导平均听阈和骨导平均听阈的改善值均高于对照组,差异无统计学意义(P> 0.05);研究组术后4 k Hz气导听阈改善值低于对照组,差异无统计学意义(P> 0.05);研究组术后8 k Hz气导听阈改善值低于对照组,差异有统计学意义(P <0.05)。结论 良好的咽鼓管功能不会增加Ⅰ型鼓室成形术对慢性化脓性中耳炎患者平均听力的改善程度,但有利于患者术后高频听力的恢复。

香烟烟雾对中耳黏膜组织损伤及听力影响的研究进展

吸烟是全球的一个重大公共健康问题,其对健康的危害众所周知。近年来,香烟烟雾对人体耳部疾病和听力影响的报道越来越多。香烟烟雾中的有害物质可导致中耳黏膜组织损伤、咽鼓管表面活性物质减少、引起炎症反应、使病原菌侵袭力增强,甚至影响机体免疫功能引发中耳疾病。另外,香烟烟雾中的有害成分还可损害耳蜗毛细胞,通过影响人体正常的听觉系统血液循环来导致听力损失。我们将香烟烟雾对中耳-咽鼓管黏膜组织损伤及听力的影响研究进展作一综述。

Ⅰ型鼓室成形术疗效与咽鼓管功能的相关性分析

目的探讨慢性化脓性中耳炎(CSOM)Ⅰ型鼓室成形术的疗效与咽鼓管功能的关系。方法对100例诊断为CSOM的患者行Ⅰ型鼓室成形术,根据术前咽鼓管功能测试结果分为咽鼓管功能正常组(对照组)和咽鼓管功能障碍组(观察组)。术后随访6个月,记录并分析患者的听力结果和鼓膜愈合情况。结果对照组鼓膜愈合率为91.70%(44/48),观察组为78.80%(41/52),2组差异有统计学意义(P<0.05)。对照组和观察组术后的纯音听阈(PTA)和气骨导差(ABG)均低于术前(P值均<0.05);2组患者在术前及术后6个月的PTA和ABG差异均有统计学意义(P值均<0.05),术前与术后的PTA差值和ABG差值的差异无统计学意义(P值均>0.05)。结论咽鼓管功能状态对CSOMⅠ型鼓室成形术后患者的听力恢复无显著影响,但会影响术后的鼓膜愈合率。因此,在鼓室成形术前评估咽鼓管功能是很有必要的,有助于初步预测患者术后的恢复情况。

慢性化脓性中耳炎患者咽鼓管功能检测和结果分析

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。