儿童慢性分泌性中耳炎鼓室外耳道置管手术治疗的探讨

Surgery of ventilation tube insertion in the middle ear and the external auditory canal for chronic secretory otitis media in children

摘要:

目的：探讨鼓室外耳道置管手术治疗儿童慢性分泌性中耳炎的适应证及治疗效果。方法：回顾性分析接受鼓室外耳道置管手术的30例40耳慢性分泌性中耳炎儿童患者的临床资料。其中23耳鼓膜菲薄甚至部分粘连。40耳均接受了外耳道上、后壁皮肤切开，鼓室探查，鼓室外耳道置管手术。其中10例双耳手术病人1耳咽鼓管注药后行咽鼓管置管，1耳仅咽鼓管注药；余20例单耳手术病人仅行咽鼓管注药。结果：咽鼓管置管于术后5~8 d自行脱落，鼓室置管无1例脱落，术后6~8月拔管，鼓膜愈合良好。术后临床症状及听力检查达治愈标准35耳（35/40，87.5％），好转5耳（5/40，12.5％）。术后随访0.5～2年，1耳因鼓室积液再发再次置管，3耳间歇性有耳闷胀感而无主观听力下降，鼓室功能曲线C型4耳有3耳转为A型。结论：对于复发性、鼓膜菲薄弹性差或是部分粘连的慢性分泌性中耳炎儿童患者，采用鼓室外耳道置管手术便于探查清理鼓室咽鼓管病变，防止鼓膜损伤及置管脱落，减少复发；同时行咽鼓管置管对提高疗效无明显帮助。

Abstract:

OBJECTIVE: To study the therapeutic effect of ventilation tube insertion in the middle ear and the external auditory canal on chronic secretory otitis media in children. METHODS: A retrospective study on 30 patients (40 ears) with chronic secretory otitis media and who underwent the operation of middle ear exploration and ventilation tube insertion in the middle ear and the external auditory canal was performed. Poor tympanic membrane, even with adhesion, was seen in 23 ears. Ten patients had evidence of bilateral secretory otitis media. From this group one ear was first injected with drugs (dexamethasone, mucosolvin, etc) and then tube insertion into the auditory tube was performed; the other ear only received drug injections into the auditory tube. The remaining 20 patients who had evidence of unilateral secretory otitis media only received drug injections into the auditory tube. RESULTS: The tubes inserting into the auditory tube all dropped out 5-8 days after operation. None of the ventilation tubes into the middle ear dropped out and the patients' tympanum recovered after the ventilation tubes were removed (6-8 months after operation). The total cure rate was 87.5% (35/40) and the improvement rate was 12.5% (5/40). The operation of inserting tubes into the auditorytube did not improve the therapeutic effects. In the 0.5-2 years postoperative follow-up, middle ear effusions recurred in one ear, and three ears were transferred from type C to type A. CONCLUSIONS: The surgery of ventilation tube insertion in the middle ear and the external auditory canal for chronic secretory otitis media can prevent the tympanic membrane from damage and dropping out of the ventilation tube and reduce recurrence in children. It is a preferred selection for the patients with poor tympanic membrane or adhesive tympanic membrane. It is no use to insert the tube into the auditory tube for the improvement of therapeutic effects.