咽喉反流干预对治疗反流相关的难治性分泌性中耳炎的疗效  

The curative effects of intervention to laryngopharyngeal reflux on the treatment of refractory secretory otitis media correlated with laryngopharyngeal reflux

作　　者：汤智平 吴志明 李文波 何畅 刘秀红 郑涛 TANG Zhi-ping;WU Zhi-ming;LI Wen-bo;HE Chang;LIU Xiu-hong;ZHENG Tao(Department of Otorhinolaryngology Head and Neck Surgery,Dongguan Tungwah Hospital,Dongguun 523129,Guangdong,China)

机构地区：[1]东莞东华医院耳鼻咽喉头颈外科,广东东莞523129

出　　处：《广东医学》2022年第4期482-486,共5页Guangdong Medical Journal

基　　金：东莞市社会科技发展(一般)项目(202050715046898)。

摘　　要：目的通过对伴有咽喉反流(laryngopharyngeal reflux,LPR)的难治性分泌性中耳炎(refractory secretory otitis media,RSOM)患者进行LPR干预治疗,评价有效的LPR干预在成人RSOM治疗中的作用效果。方法选取伴有LPR的RSOM成人患者50例(共66只患耳)为研究对象,所有患者均予以相同的RSOM治疗方案包括鼓膜切开置管术辅以相应的药物治疗,同时对所有患者进行LPR疾病健康宣教并建议服用足够疗程的质子泵抑制剂及促胃肠动力药,在随访过程中根据患者对LPR干预治疗的有效性不同将研究对象分为干预组和对照组。应用纯音听阈测试检查和咽鼓管功能障碍评分问卷(7-item eustachian tube dysfunction questionnaire,ETDQ-7)分析比较两组患者在治疗前后不同时期(治疗前及治疗后1、3、6、9、12个月)的气骨导差和咽鼓管功能情况,同时比较两组患者在治疗后12个月内RSOM的治疗有效率。结果所有患者经治疗后患耳的平均气骨导差均有缩小,治疗12个月后对照组患者的平均气骨导差由治疗前的(31.5±4.3)dB缩小至(19.3±3.9)dB,干预组患者的平均气骨导差由治疗前的(32.8±4.6)dB缩小至(10.2±2.9)dB;对照组患者治疗前和治疗后12个月的ETDQ-7评分分别为5.0(4.0,6.0)和4.5(4.0,6.0),干预组患者治疗前和治疗后12个月的ETDQ-7评分分别为5.0(3.5,6.0)和2.0(1.5,3.5),治疗后第6~12个月,干预组的ETDQ-7评分显著低于对照组(P<0.05);干预组患者RSOM的治疗有效率为78.3%,显著高于对照组的治疗有效率42.3%(P<0.05)。结论有效的LPR干预能改善反流相关的RSOM的治疗效果以及提高其治疗有效率。Objective To evaluate the clinical effect of effective intervention to laryngopharyngeal reflux(LPR)on the treatment of refractory secretory otitis media(RSOM)complicated with LPR in adults.Methods Fifty RSOM adult patients(totally 66 sick ears)complicated with LPR were recruited.All patients were provided with the same therapeutic schedule during the treatment of RSOM,including myringotomy with grommet insertion combined with relevant medical therapy.Meanwhile,all patients were given with health education about LPR disease,and given with proton pump inhibitor and gastrointestinal prokinetic agents for enough course.During follow-up process,all patients were divided to the intervention group or the control group according to their effectiveness of treatment on LPR.Pure tone audiometry and 7-item eustachian tube dysfunction questionnaire(ETDQ-7)were taken in different periods(prior treatment,and 1 month,3 months,6 months,9 months and 12 months after treatment)to compare the air bone gap and eustachian tube function.The curative effective rate of RSOM within 12 months after treatment were also compared.Results The mean air bone gap of the sick ears in all patients showed reduction after treatment.During the period of prior treatment to 12 months after treatment,the mean air bone gap in the control group decreased from(31.5±4.3)dB to(19.3±3.9)dB,while in the intervention group it decreased from(32.8±4.6)dB to(10.2±2.9)dB.Prior treatment and 12 months after treatment,the ETDQ-7 scores in the control group were 5.0(4.0,6.0)and 4.5(4.0,6.0),respectively;while in the intervention group the ETDQ-7 scores were 5.0(3.5,6.0)and 2.0(1.5,3.5),resepctively.The curative effective rate of RSOM in the intervention group(78.3%)was significantly higher than that in the control group(42.3%)(P<0.05).Conclusion Effective intervention to LPR can improve therapeutic efficacy and curative effective rate of RSOM complicated with LPR.

关 键 词：分泌性中耳炎 咽喉反流 干预 咽喉部疾病 

分 类 号：R764.21[医药卫生—耳鼻咽喉科] R766.5[医药卫生—临床医学]