难治性分泌性中耳炎术后听力影响因素分析  

Analysis of Postoperative Hearing Outcomes in Refractory Secretory Otitis Media

作　　者：冯晓华[1] 龙孝斌[2] 汪建[1] 陈勇挺[1] 付晓燕[1] 

机构地区：[1]广州军区广州总医院耳鼻咽喉科,广州510010 [2]南方医科大学附属珠江医院耳鼻咽喉头颈外科,广州510282

出　　处：《中华耳科学杂志》2013年第3期444-447,共4页Chinese Journal of Otology

摘　　要：目的探讨难治性分泌性中耳炎采用乳突轮廓化并行鼓膜置管和单纯鼓膜置管术后,患者听力的改变及其有无差异,并对影响术后听力改变的可能因素进行分析。方法回顾性分析2001年3月～2011年6月收治的难治性分泌性中耳炎患者52例(86耳),其中20例(33耳)行乳突轮廓化联合鼓膜置管治疗,32例(53耳)仅行鼓膜置管治疗,所有患者均在鼓膜置管术后3～6个月拔管。分析影响术后听力改变的可能因素,涵盖性别、年龄、鼓室黏膜、乳突轮廓化、中耳积液性质、脱管史、耳溢液史、留管时间等。结果乳突轮廓化联合鼓膜置管组术后听力提高30耳(90.9%);单纯鼓膜置管组术后听力提高38耳(71.7%)。两组相比有显著性差异(χ2=4.535,P=0.033)。对影响难治性分泌性中耳炎患者术后听力的可能因素行多因素统计学分析,提示患耳脱管史(OR=13.425,P<0.05)、中耳CT结果(OR=0.057,P<0.05)是影响术后听力的主要因素。结论患耳脱管史和中耳CT结果是影响难治性分泌性中耳炎患者术后听力的重要因素,尤其对于中耳CT提示病变范围较广时,应在鼓膜置管基础上清除中耳鼓室、鼓窦和乳突病变,扩大中耳鼓室、乳突气房容积,改善中耳腔持续负压状态,并建立乳突、鼓室至鼓膜置管通畅引流,对提高听力防止并发症有积极治疗作用。Objective To report postoperative hearing after ventilation tube placement with or without mastoidectomy for refractory secretory otitis media and analyze factors influencing postoperative hearing. Methods of Fifty two cases （86 ears） of refractory secretory otitis media were retrospectively analyzed, of which 20 （33 ears） underwent ventilation tube placement with mastoidectomy and 32 （53 ears） underwent only ventilation tube placement. Tympanic membrane ventilation tube was pulled out 3 to 6 months later. Postoperative hearing outcomes were analyzed using logistic regression analysis. Factors analyzed in- cluded gender, age, tunica mucosa tympanica, mastoidectomy, effusion of middle ear cavity, removal of tube, otorrhea, tube use time, etc. Results Hearing improved in 30 of the 33 ears （90.9%） receiving mastoidectomy and ventilation tube placement, and in 38 of the 53 ears （71.7%） undergoing simple ventilation tube placement （X2=4.535, P=0.033）. Removal of tube and middle ear CT results were the factors that showed a significantly favorable correlation to postoperative hearing outcomes. Conclusion Removal of tube and middle ear CT results show a favorable relation to postoperative hearing outcomes in refractory secretory otitis media. Eradication of middle ears lesions, expanding middle ear space and mastoid air cell volume, reducing middle ear cavity negative pressure and improving drainage of the mastoid and tympanic cavity all have positive effects on treatment out- comes and on preventing complications.

关 键 词：中耳炎 难治性 分泌性 乳突轮廓化 鼓膜置管术 听力 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]