咽鼓管功能障碍在慢性化脓性中耳炎患者中的发生情况分析

摘要

目的 探讨成人慢性化脓性中耳炎患者的咽鼓管功能障碍发生情况,为临床诊断与治疗提供参考依据.方法 采用正-负压平衡试验结合纯音测听、咽鼓管鼓室-气流动态图法,检测241例(266耳)慢性化脓性中耳炎鼓膜穿孔患者(A组)和53例(60耳)外伤性鼓膜穿孔(B组)的咽鼓管主动和被动开放功能,分析咽鼓管功能障碍的发生率.结果 A组的咽鼓管平均开放压(155.62±33.71daPa)显著高于B组(67.39±16.57daPa)(P<0.05).正压平衡试验中A组有207耳(77.82%)的外耳道鼓室压可以恢复至50daPa以下,负压平衡试验A组有50耳(18.80%)不能降到100daPa以下,而B组均能恢复至50daPa以下(100%),两组有显著性差异(P<0.05).A组有47例(17.67%)无法完成Valsalva动作或困难,B组均能成功完成Valsalva动作.A组纯音测听ABG>30dB的比例(96.62%)与B组(95%)相比无显著性差异,其最大鼓室压差(17.28±.33daPa)大于B组(14.53± 4.06daPa),A组咽鼓管的主动及被动开放功能较B组差,差异有统计学意义(P<0.05).综合分析得A组咽鼓管阻塞型95耳,咽鼓管闭锁不全型76耳,即A组ETDF的发生率为64.29%(171/266).B组咽鼓管闭锁不全型2耳,58例为正常,ETDF的发生率为3.33%(2/60),两组有显著性差异(P<0.05).此外研究表明,CSOM患者的咽鼓管功能障碍以阻塞型为主,其中胆脂瘤型和骨疡型中耳炎多表现为咽鼓管功能障碍.CSOM患者的咽鼓管功能障碍亦与其鼓膜穿孔的部位及大小有关.结论 咽鼓管功能障碍的发生率在CSOM患者中较高,其咽鼓管功能与CSOM类型、鼓膜穿孔有关.%Objective To investigate the occurrence of eustachian tube dysfunctionchronic in adult chronic suppurative otitis media to provide reference for the clinical diagnosis and treatment. Methods Active opening function, passive opening function and incidence of eustachian tube dysfunction were detected by inflation-deflation balance test combined with sonotubometry and tube-tympano aero dynamic graphy in 241 patients (266 ears) with chronic suppurative otitis media (group A) and 53 patients (60 ears) with traumatic tympanic membrane perforation (group B). Results The average opening pressure of eustachian tube in group A (155.62±33.71daPa) was higher obviously than that in group B(67.39±16.57daPa) (P<0.05). In inflation balance test, external auditory canal pressure of 207 ears (77.82%) in group A could be restored to less than 50daPa, in deflation test, 50 ears (18.80%) in group A couldn,t be returned to less than 100daPa, while the external auditory canal pressure in group B all returned to less than 50daPa (100%), the difference had statistical significance between the two groups (P<0.05). There were 47ears (17.67%) could not complete Valsalva action successfully in group A, but all completed successfully in group B. The difference in the ratio of ABG>30dB in the two groups was not obviously. Maximum tympanic pressure difference in group A (17.28 ±.33daPa) was greater than group B (14.53 ± 4.06daPa), group A had poorer eustachian tube active and passive opening functions than group B (P<0.05). Comprehensive analysis showed that 95 ears were eustachian tube obstruction, 76 ears were eustachian tube incomplete lack in group A, that was to say, the incidence of ETDF was 64.29 (171/266). In Group B, 2 ears were eustachian tube incomplete lack, the others were normal, the incidence of ETDF was 3.33%(2/60), the difference had statistical significance between the two groups (P<0.05). In addition, the chief eustachian tube dysfunction in CSOM patients was obstruction, most CSOM patients with cholesteatoma or caries revealed eustachian tube dysfunction. Tympanic membrane perforation also had effect on eustachian tube dysfunction in CSOM patients. Conclusions Eustachian tube dysfunction had high incidence in CSOM patients, and eustachian tube function related to CSOM type and tympanic membrane perforation.