目的:评价咽鼓管球囊成形术(BET)联合索环置入治疗慢性扩张咽鼓管功能障碍(CDETD)的疗效。
方法:对在耳鼻咽喉头颈外科接受BET的19例CDETD患者进行了回顾性研究,上海交通大学医学院附属新华医院,从10月起,2014年9月,2016年。这些患者的年龄范围为10至67岁。所有患者均行内镜术前评估,鼓室测压,纯音测听法,纤维鼻咽内窥镜检查,咽鼓管压力测量(TMM),CT和MRI。这些病人对药物没有反应,在我们的研究之前,多次鼓膜穿刺和至少2次索环插入。对5例患者(5耳)进行了BET,其他14例患者(23耳)进行了BET+索环插入。术前及术后1、3、6、9、12个月采用咽鼓管评分(ETS)和咽鼓管功能障碍问卷-7(ETDQ-7)评估这些患者咽鼓管功能的变化,分别。此外,主观症状,包括valsalva的难度水平,术前和术后1、6和12个月通过视觉评定量表(VAS评分)评估耳饱胀和耳痛。比较手术前1、3、6、9和12个月的平均得分。记录术后不良反应及并发症,如耳痛,鼻出血等等。
结果:手术前的Valsalva评分和VAS评分分别为8.286±0.189和8.571±0.221。听觉饱满度的Valsalva评分和VAS评分分别为3.714±0.317,2.393±0.434,手术后一个月,显着减少,与术前评分比较(P<0.05)。术后6个月、12个月VAS评分与术前比较差异有统计学意义(P<0.05)。术后ETS评分明显高于术前(P<0.05)。术后ETDQ-7评分明显低于术前(P<0.05)。这些患者的主观满意度为84.2%。
结论:BET简单安全,并发症少,对于CDETD联合索环插入治疗有效。
OBJECTIVE: To evaluate the efficacy of balloon Eustachian tuboplasty (BET) combined with grommet insertion in the treatment of chronic dilation Eustachian tube dysfunction (CDETD).
METHODS: 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.
RESULTS: 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). ETS score after surgery was significantly higher than that before surgery (P<0.05). ETDQ-7 score after surgery was significantly lower than that before surgery (P<0.05). The subjective satisfaction in these patients was 84.2%.
CONCLUSIONS: BET is simple and safe, with fewer complications, and effective for the treatment of CDETD combined with grommet insertion.