05咽鼓管球囊扩张术在咽鼓管相关疾病的应用

咽鼓管球囊扩张术在咽鼓管相关疾病的应用

梁茂金，郑亿庆，张志钢，许耀东，区永康，陈穗俊，杨海弟，司瑜，陈玲，邱

泽恒

通讯作者：郑亿庆，email：yiqingzheng@

[摘要]目的：探讨咽鼓管球囊扩张术在咽鼓管相关疾病中的治疗效果及其适应症。方法：连续收集咽鼓管相关疾病患者46例（74耳），男25例，女21例，年龄18岁~70岁；其中症状性咽鼓管功能不良22例，分泌性中耳炎15例，鼓膜膨胀不全4例，上鼓室内陷袋2例，梅尼埃病3例。所有患者术前咽鼓管测压均证实咽鼓管阻塞性功能不良，并行咽鼓管球囊扩张术。用视觉评分量表（VAS评分）对耳闷塞感、听物朦胧感、耳内水泡声、耳鸣等进行主观症状评估，记录术前，术后1周、1个月及3个月评分情况。结果：术前、术后1周耳闷塞感、听物朦胧感VAS评分：8.2±1.4 vs. 2.0±1.2，6.2±1.2 vs.3.1±0.8,耳闷塞感、听物朦胧感评分显著降低（P<0.05）；术后1月，症状耳闷塞感、听物朦胧感症状持续消失，术后3个月，症状无反复。结论：咽鼓管球囊扩张术对阻塞性咽鼓管不良及咽鼓管相关的中耳疾病短期治疗效果良好，长期治疗效果有待观察，可能为解决咽鼓管相关疾病提供一个新的途径。

关键词：咽鼓管球囊扩张术，咽鼓管功能不良，分泌性中耳炎，膨胀不全，内陷袋

Eustachian tube balloon dilation(balloon dilation eustachian tuboplasty) in

eustachian tube related diseases

[Abstract]Objective: to examine the effect of Eustachian tube balloon dilation (ETBD) in treatment of eustachian tube related diseases and investigate the indications for ETBD. Methods:forty six patients (74 ears) of Eustachian tube dysfunction were recruited, 25 male and 21 female, age from 18 to 70 years old. Of which, 22 were diagnose of symptomatic Eustachian tube dysfunction，15 for otitis media with effusion, 4 for tympanic atelectasis, 2 for attic retraction pocket, and another 3 were Meniere's disease. Technique of tubomanometry (TMM) showed obstructive Eustachian tube dysfunction in all patients. All the patients were received ETBD and followed up with VAS evaluation of ear fullness, muffled hearing, poping sound in the ear and tinnitus. Results: ear fullness, muffled hearing released with one week (ear fullness：8.2±1.4 vs. 2.0±1.2，P<0.05, muffled hearing：6.2±1.2 vs.3.1±0.8, P<0.05）. No recurrence was seemed within one month. Poping sound in the ear and tinnitus were slight increase within one week, but released in one month post the operation. On one month post the operation, effusion disappeared in all 15 otitis media with effusion, 3 tympanic atelectasis recovered and 1 turned better. TMM retest showed all the Eustachian tube can be opened with swallow. Conclusions: ETBD have good short-term effect in obstructive eustachian tube dysfunction and eustachian tube related middle ear dysfunction. However, the long-term effect needs further study. ETBD might provide a good way to solve the eustachian tube related diseases.

Key words: Eustachian tube balloon dilation, Eustachian tube dysfunction, otitis media with effusion,atelectasis, retraction pocket

咽鼓管功能不良是耳科常见疾病，成人发病率约为1-5%[1]，70%儿童10岁前至少罹患一次急性咽鼓管不良，其常见症状为耳闷塞感、听物朦胧感等[2]，并且与分泌性中耳炎、鼓膜膨胀不全、上鼓室内陷袋，甚至慢性中耳炎，中耳胆脂瘤密切相关。咽鼓管功能不良相关疾病的治疗比较困难，保守药物治疗效果欠佳，鼓膜按摩、Valsalva咽鼓管吹张、鼓膜穿刺后症状仅可获得短时间缓解。由于咽鼓管功能不良，常致鼓膜菲薄，置管后易脱管，治疗效果亦不佳。并且长期中耳通气管也给患者生活带来很大的不便，并有反复中耳感染风险。此外，耳闷塞感、听物矇眬感等症状也严重影响患者生活质量。近年来，国外有不少报道咽鼓管球囊扩张对分泌性中耳炎的治疗效果良好[1-4]，但在国内尚无相关报道。

对象和方法

连续收集2013年4月~2013年8月至我院就诊主诉耳闷塞感，伴或不伴听力下降、听物矇眬感、耳鸣等症状,保守治疗效果不佳的患者46例，74耳，男25例，女21例，年龄18岁~70岁。诊断为症状性咽鼓管功能紊乱（有耳闷塞感等咽鼓管功能不良症状，鼓膜检查无明显异常，咽鼓管测压异常，无其他并发症）22例，分泌性中耳炎15例，鼓膜膨胀不全4例，上鼓室内陷袋2例，梅尼埃病3例。所有患者排除鼻咽部肿瘤、咽鼓管畸形等。

所有患者术前行耳镜检查评估鼓膜与中耳情况，鼻咽镜检查了解鼻咽部情况及评估球囊扩张术的可行性。颞骨高分辨CT评估中耳情况及排除颈内动脉、咽鼓管畸形，咽鼓管周占位。咽鼓管测压（technique of tubomanometry,TMM，Spinggle&Theis,Germany）提示咽鼓管功能不良(30 mbar无R值,40或50 mbar有R值或无)[1]。

咽鼓管球囊扩张术：气管内全麻，用1‰肾上腺素收缩鼻腔5分钟，0度鼻内镜检查鼻腔、鼻咽情况，在鼻内镜下将70（30，45）度的导管（图1a）的尖端置于咽鼓管鼻咽入口(图处，通过导管将导丝导入咽鼓管(图b)。水泵加压，打胀球囊(图1c)，缓慢加至10个大气压（在加压过程中可心率明显加快），维持2分钟，水泵减压，吸至负压，退出球囊及导丝，吸除咽鼓管周分泌物，术毕。对分泌性中耳炎患者，术中同步行穿刺抽液；上鼓室内陷袋患者，我们同期行鼓室探查及鼓室成形术。

图1 咽鼓管球囊扩张配套器械（Spinggle&Theis,Germany）

术后评估：所有患者行症状随访（门诊或电话随访），随访耳闷塞感、听物朦胧感、耳内水泡声、耳鸣，用VAS评分评估。同时分泌性中耳炎术后观察中耳积液及鼓膜恢复情况，鼓膜膨胀不全患者观察其恢复情况。

统计学方法：用SPSS 16.0行统计学分析，术前、术后VAS评分予均值±标准差表示，配对t检验比较VAS评分差异。P<0.05为有统计学差异。