咽鼓管球囊扩张成形术联合鼓膜置管治疗慢性延迟开放型咽鼓管功能不良的疗效分析  

Efficacy of balloon Eustachian tuboplasty combined with grommet insertion in the treatment of chronic dilation Eustachian tube dysfunction

作　　者：秦欢[1] 杨军[1,2,3] QIN Huan;YANG Jun(Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China;Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases;Ear Institute, Shanghai Jiaotong University School of Medicine)

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科,上海200092 [2]上海市耳鼻疾病转化医学重点实验室 [3]上海交通大学医学院耳科学研究所

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第6期465-469,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：申康三年行动计划(No:16CR4007A)

摘　　要：目的:探讨咽鼓管球囊扩张成形术(BET)联合鼓膜置管治疗慢性延迟开放型咽鼓管功能不良(ETD)的临床效果。方法:收集2014-10-2016-09期间在上海交通大学医学院附属新华医院耳鼻咽喉头颈外科诊断为慢性延迟开放型ETD患者19例(28耳)。所有患者术前均经耳内镜、鼓室图、纯音听阈、纤维鼻咽镜、咽鼓管压力测定(TMM)、CT和MRI评估。所有患者均曾接受过保守药物治疗、鼓膜穿刺、至少2次鼓膜置管治疗,效果较差。19例患者中5例(5耳)患者接受单纯BET术,14例(23耳)患者接受BET加鼓膜置管术。记录这些患者术前及术后1、3、6、9和12个月时的咽鼓管功能问卷(ETDQ-7)调查及同期咽鼓管功能评分(ETS)。同时用视觉评分量表(VAS)评分对术前及术后1、6和12个月时Valsalva难易程度、耳闷塞感、耳痛进行主观症状评估。对其术前和术后1、3、6、9和12个月进行得分均值比较。记录术后不良反应及有无并发症,如耳痛、鼻出血等。结果:术前Valsalva、耳闷塞感VAS评分为(8.286±0.189)、(8.571±0.221),术后1个月Valsalva、耳闷塞感VAS评分为(3.714±0.317)、(2.393±0.434),Valsalva、耳闷塞感评分显著降低(P<0.05);术后6、12个月VAS评分较术前相比均差异有统计学意义(P<0.05)。术后的ETS评分较术前明显升高,差异有统计学意义(P<0.05);术后的ETDQ-7评分较术前显著降低(P<0.05);患者主观满意度为84.2%。结论:BET手术操作简单,并发症少,安全,BET联合鼓膜置管可有效治疗慢性延迟开放型ETD。Objective：To evaluate the efficacy of balloon Eustachian tuboplasty（BET）combined with grommet insertion in the treatment of chronic dilation Eustachian tube dysfunction（CDETD）.Method：A retrospective study was performed in 19 patients with CDETD who underwent BET at the Department of Otolaryngology-Head and Neck Surgery,Xinhua Hospital Affiliated with Shanghai Jiaotong University School of Medicine,from October,2014 to September,2016.The ages of these patients ranged from 10 to 67 years.All the patients underwent the preoperative assessment of oto-endoscope,tympanometry,pure tone audiometry,fiber nasopharyngeal endoscopy,Eustachian tube pressure measurement（TMM）,CT and MRI.These patients had failed to respond to medicine,multiple tympanic membrane puncture and at least 2 times grommet insertion before our study.BET was performed in 5 patients（5 ears）,and BET＋grommet insertionwas performed in other 14 patients（23 ears）.The changes of Eustachian tube function in these patients was assessed using the Eustachian tube score（ETS）and Eustachian tube dysfunction questionnaire-7（ETDQ-7）preoperatively and 1,3,6,9 and 12 months after surgery,respectively.In addition,subjective symptoms including the difficulty level of valsalva,aural fullness and earache were assessed by visual rating scale（VAS score）preoperatively and at 1,6,and 12 months after surgery.The mean scores before surgery were compared with that at 1,3,6,9 and 12 months.Postoperative adverse reactions and complications were recorded,such as earache,nosebleeding and so on.Result：Valsalva score and VAS score for aural fullness before surgery were 8.286±0.189 and 8.571±0.221,respectively.Valsalva score and VAS score for aural fullness were 3.714±0.317,2.393±0.434,respectively,at one month after surgery,which were decreased significantly,as compared with the scores before surgery（P〈0.05）.VAS score at 6 months and 12 months after surgery were statistically significant compared with those before surgery（P〈0.05）.ET

关 键 词：咽鼓管 咽鼓管功能不良 咽鼓管球囊扩张成形术 咽鼓管功能评分 咽鼓管功能问卷 

分 类 号：R764[医药卫生—耳鼻咽喉科]