鼓膜膨胀不全的临床特征及治疗

Clinical Features and Treatment of Tympanic Membrane Atelectasis

沙晓铮;孙淑萍;卢伟;左彬;张静;

1:郑州大学第一附属医院耳科

摘要

目的探讨鼓膜膨胀不全的临床特征与治疗方法。方法回顾性分析2011年6月至2013年8月诊断为鼓膜膨胀不全且治疗后随访完整的86例(104耳)患者的临床资料,其中鼓膜膨胀不全Ⅰ级27耳给予药物治疗,Ⅱ级39耳给予鼓膜切开置管术,Ⅲ级22耳给予软骨鼓室成型术,Ⅳ级16耳给予乳突根治+软骨鼓室成型术。观察治疗前及治疗后一年鼓膜、纯音测听、声导抗及颞骨CT情况,比较治疗前后纯音听阈气骨导差(ABG)。结果60例83耳鼓膜膨胀不全耳的颞骨CT显示:1鼓膜膨胀不全ⅠⅡ级(轻度)45耳中乳突气化不良30耳(66.7%),中耳乳突软组织影25耳(55.6%),无听骨链破坏、鼓室盾板破坏、胆脂瘤形成;ⅢⅡ级(轻度)45耳中乳突气化不良30耳(66.7%),中耳乳突软组织影25耳(55.6%),无听骨链破坏、鼓室盾板破坏、胆脂瘤形成;ⅢⅣ级(重度)38耳中乳突气化不良30耳(78.9%),中耳软组织影17耳(44.7%),听骨链破坏23耳(60.5%),鼓室盾板破坏22耳(57.8%);轻、重度鼓膜膨胀不全组之间乳突气化程度差异无统计学意义(P>0.05),但轻度组中耳乳突有软组织影的耳数比例高于重度组,差异有统计学意义(P<0.05);2104耳术前平均ABG为28.74±8.04dB,术后一年约为16.42±7.24dB,各级患耳术后ABG均较术前明显降低,差异有统计学意义(均为P<0.05);治疗前各级鼓膜膨胀不全耳间ABG两两比较差异均有统计学意义,分级越高,ABG越大。结论鼓膜膨胀不全分级越高,病变破坏越严重,ABG越大;鼓膜膨胀不全应分级治疗,保守治疗无效时尽早行手术治疗,治疗的关键是改善中耳通气。

关键词

鼓膜;膨胀不全;治疗

基金项目(Foundation):

作者

沙晓铮;孙淑萍;卢伟;左彬;张静;

参考文献

1 Ostrowski VB,Bojrab DI.Minimally invasive laser contraction myringoplasty for tympanic membrane atelectasis[J].Otolaryngol Head Neck Surg,2003,128:711.

2 Pfaltz CR.Retraction pocket and development of cholesteatoma in children[J].Adv Otorhinolaryngol,1988,40:118.

3 Dornhoffer J.Cartilage tympanoplasty:indications,techniques,and outcomes in a 1,000-patient series[J].Laryngoscope,2003,113:1844.

4 Elsheikh MN,Elsherief HS,Elsherief SG.Cartilage tympanoplasty for management of tympanic membrane atelectasis:is ventilatory tube necessary[J].Otol Neurotol,2006,27:859.

5 Dornhoffer JL.Surgical management of the atelectatic ear[J].Am J Otol,2000,21:315.

6 Danner CJ.Middle ear atelectasis:what causes it and how is it corrected[J].Otolaryngol Clin North Am,2006,39:1211.

7 Dornhoffer JL.Hearing results with cartilage tympanoplasty[J].Laryngoscope,1997,107:1094.

8 Ozbek C,Ciftci O,Ozdem C.Long-term anatomic and functional results of cartilage tympanoplasty in atelectatic ears[J].Eur Arch Otorhinolaryngol,2010,267:507.

9 Sade J,Berco E.Atelectasis and secretory otitis media[J].Ann Otol Rhinol Laryngol,1976,85(2Suppl 25Pt 2):66.

10 Li Y,Hunter LL,Margolis RH,et al.ProspectⅣe study of tympanic membrane retraction,hearing loss,and multifrequency tympanometry[J].Otolaryngol Head Neck Surg,1999,121:514.

11 Sade J,Avraham S,Brown M.Atelectasis,retraction pockets and cholesteatoma[J].Acta Otolaryngol,1981,92:501.

12 Borgstein J,Gerritsma TV,Wieringa MH,et al.The Erasmus atelectasis classification:proposal of a new classification for atelectasis of the middle ear in children[J].Laryngoscope,2007,117:1255.

13 Yoon TH,Schachern PA,Paparella MM,et al.Pathology and pathogenesis of tympanic membrane retraction[J].Am J Otolaryngol,1990,11:10.

14 Magnuson B.The atelectatic ear[J].Int J Pediatr Otorhinolaryngol,1981,3:25.

15 Garside JA,Antonelli PJ,Singleton GT.Canalplasty for chronic tympanic membrane atelectasis[J].Am J Otolaryngol,1999,20:2.

16 隋秀丽,王燕.乳突气房发育与分泌性中耳炎[J].中华耳鼻咽喉科杂志,1996,31:12.

17 Borgstein J,Gerritsma T,Bruce I,et al.Atelectasis of the middle ear in pediatric patients:safety of surgical intervention[J].Int J Pediatr Otorhinolaryngol,2009,73:257.

18 张静,卢伟,孙淑萍,等.鼓膜置管术治疗鼓膜膨胀不全的疗效分析[J].听力学及言语疾病杂志,2014,22:142.

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