Endo Shiori, Mizuta Kunihiro, Takahashi Goro, Nakanishi Hiroshi, Yamatodani Takashi, Misawa Kiyoshi, Hosokawa Seiji, Mineta Hiroyuki
a Department of Otorhinolaryngology/Head and Neck Surgery , Hamamatsu University School of Medicine , Hamamatsu , Shizuoka , Japan ;
b Department of Otorhinolaryngology , Iwata City Hospital , Iwata , Shizuoka , Japan.
Acta Otolaryngol. 2016 Jun;136(6):551-5. doi: 10.3109/00016489.2016.1143118. Epub 2016 Feb 23.
Conclusions This study suggests that long-term ventilation tube insertion is the first-choice surgical treatment for a 'sniff-type' patulous Eustachian tube (PET). When treating a refractory PET, it is important to determine whether the patient had a habitual sniff. Objectives PET patients were divided into two groups: patients with a habitual sniff (sniff-type PET) and those without a habitual sniff (non-sniff-type PET). This study examined the effects of ventilation tube insertion or silicone plug insertion in each group. Methods Surgical procedures such as ventilation tube insertion or trans-tympanic silicone plug insertion were performed for these patients. Tubotympanoaero-dynamic graphy (TTAG) was also performed to determine the mechanisms underlying these treatments. Results There were 11 cases (17 ears) of sniff-type PET and 20 cases (27 ears) of non-sniff-type PET. An improvement in symptoms was found in 72.7% of the patients who underwent silicone plug insertion (66.7% for sniff-type PET and 74.1% for non-sniff-type PET) and in 90.9% of the patients who underwent ventilation tube insertion for sniff-type PET. In TTAG assessments, many sniff-type PET patients showed significant synchronous changes at high levels of pressure (over 40 daPa) in the external auditory meatus and nasopharynx when performing a slight Valsalva manoeuvre (below 200 daPa).
结论 本研究表明，长期插入通气管是治疗“吸气型”咽鼓管异常开放（PET）的首选手术治疗方法。在治疗难治性PET时，确定患者是否有习惯性吸气动作很重要。目的 将PET患者分为两组：有习惯性吸气动作的患者（吸气型PET）和无习惯性吸气动作的患者（非吸气型PET）。本研究考察了每组中通气管插入或硅胶耳塞插入的效果。方法 对这些患者进行了通气管插入或经鼓膜硅胶耳塞插入等手术操作。还进行了咽鼓管鼓室空气动力学描记法（TTAG）以确定这些治疗方法的潜在机制。结果 有11例（17耳）吸气型PET患者和20例（27耳）非吸气型PET患者。接受硅胶耳塞插入的患者中72.7%症状得到改善（吸气型PET患者为66.7%，非吸气型PET患者为74.1%），而接受通气管插入的吸气型PET患者中90.9%症状得到改善。在TTAG评估中，许多吸气型PET患者在进行轻微瓦尔萨尔瓦动作（低于200 daPa）时，外耳道和鼻咽部在高压水平（超过40 daPa）出现明显的同步变化。
