鼓室和咽鼓管冲洗治疗早期粘连性中耳炎

摘要

目的:探讨提高早期粘连性中耳炎疗效的有效方法.方法:1995～2004年用地塞米松和糜蛋白酶注射液对105例早期粘连性中耳炎患者进行鼓室和咽鼓管冲洗治疗,并对鼓室和咽鼓管冲洗治疗前后的语言频率气导和气骨导差、鼓室压,鼓室和咽鼓管冲洗治疗前后鼓室功能曲线、镫肌反射变化和咽鼓管通气功能的恢复等进行统计、分析.结果:经过1～4个疗程鼓室和咽鼓管冲洗治疗后,随访半年以上,105例粘连性中耳炎中,83例(79.05%)粘连症状消失,听力提高.语言频率的听阈、气骨导差和声导抗各项观察指标,治疗后3、6个月时与治疗前比较,差异均有高度统计学意义(均P<0.01);14例(13.33%)无效;8例(7.62%)粘连症状加重,选择手术治疗.结论:利用早期粘连性中耳炎鼓室为可逆性的病变这一关键阶段,应用地塞米松和糜蛋白酶注射液对早期粘连性中耳炎进行鼓室和咽鼓管冲洗治疗,不仅可直接有效地清除纤维蛋白原、凝胶基质等有害生物活性物质,而且可直接作用尚未完全粘连部位的粘连介质降解和溶解,阻止粘连的发生.%Objective: To explore the effective method to improve the efficacy of early phase adhesive otitis media (AOM).Methods: From 1995 to 2004, 105 cases of patients with the earlier period AOM were procedured by the mixed solution of Dexamethasone and Chymotrypsin with irrigation of tympanic cavity and eustachium. The measurement data of speech frequency air conduction, air-bone conduction gap, and pressure of tympanometry were observed before and after the irrigation of tympanic cavity and eustachium. The enumeration data of tympanometry, stapedius muscle reflex, and the ventilation function of eustachium were also observed at the same time. Results: 83 of 105 cases (79.05％) by 1-4 courses of treatment for irrigation of tympanic cavity and eustachium, after more than half a year follow up, the adhesive symptom disappeared and the hearing improved. Data revealed that after treatment of 3, 6 months the hearing threshold of speech frequency, air-bone Gap, and the acoustic immittance significantly influenced by the irrigation compared with before treatment (all P＜0.01). 14 of 105 cases (13.33％) were invalid. 8 of 105 cases (7.62％) adhered symptom worsen, they were under taken surgical procedures. Conclusion: The important turning point stage of reversible pathological changes for earlier period AOM would be utilized. The tympanic cavity and eustachium of earlier period AOM is irrigated by the mixed solution of Dexamethasone and Chymotrypsin, it would not only directly effectually clear harmful biology active material, such as fibrinogen, gelatum substratum and so on, and also directly effectually be effect on the adhered medium which the position has not been completely adhered to degrade and solve, the AOM may be prevented to take place.