咽鼓管球囊扩张联合鼓膜置管治疗慢性分泌性中耳炎

The Efficacy of Balloon Dilation Eustachian Tuboplasty Combined with Tympanic Tube Insertion in the Treatment of Chronic Otitis Media with Effusion

赵然师;左汶奇;钱怡;胥正艳;钟时勋;

1:重庆医科大学附属第一医院耳鼻咽喉科

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摘要

目的探讨咽鼓管球囊扩张(balloon dilation eustachian tuboplasty, BET)联合鼓膜置管(tympanic tube insertion, TTI)治疗慢性分泌性中耳炎(chronic otitis media with effusion, COME)的疗效。方法以2018年4月至2019年6月确诊的67例(85耳)COME患者为研究对象,其中BET联合TTI治疗(BET+TTI组)29例(39耳),TTI治疗(TTI组)18例(23耳),BET治疗(BET组)20例(23耳);所有病例均随访6个月及以上。比较各组治疗前后的咽鼓管功能评分(eustachian tube score, ETS)、声导抗、纯音听阈均值(pure tone average, PTA)、气骨导差(air-bone gap, ABG)以及咽鼓管功能障碍7项问卷(7-item eustachian tube dysfunction questionnaire, ETDQ-7)的检查及评估结果。结果治疗后,BET组ETS从2.91±1.5分上升至5.3±2.3分(P<0.05),ETDQ-7评分由3.84±0.3分下降至1.30±0.31分(P<0.05),5例(6耳,26.09%)术后中耳再次积液;TTI组ETS从2.65±1.77分上升至3.52±2.41分(P>0.05),ETDQ-7从术前3.8±0.38分降为1.38±0.42分(P<0.05),1例患者(2耳,8.70%)拔管后复发,4耳仍未拔管;BET+TTI组ETS从术前2.44±1.73分升至5.28±2.05分(P<0.05),ETDQ-7由术前4.01±0.51分降至1.3±0.31分(P<0.05),3例(4耳,10.26%)复发,2耳仍未拔管。三组间ETS评分改变量两两比较显示,TTI组低于其余两组(P<0.05),BET组在术后1周及2周的ETDQ-7评分高于其余两组(P<0.05),ABG改变值则低于其余两组(P<0.05)。结论 BET治疗COME安全有效,BET联合TTI更有利于COME患者迅速改善症状和咽鼓管功能恢复。

关键词

慢性分泌性中耳炎;咽鼓管球囊扩张;鼓膜置管

基金项目(Foundation):

重庆市卫计委医学高端后备人才项目基金资助项目(2017HBRC002)

作者

赵然师;左汶奇;钱怡;胥正艳;钟时勋;

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慢性分泌性中耳炎咽鼓管球囊扩张鼓膜置管

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赵然师左汶奇钱怡胥正艳钟时勋