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镫骨肌和鼓膜张肌切断术对梅尼埃病患者生活质量的影响

[Effect of the stapedius and tensor tympani muscles tenotomy on the quality of life of patients suffering from Ménière's disease].

作者信息

Szirmai Ágnes, Maihoub Stefani, Molnár András, Fent Zoltán, Tamás László, Polony Gábor

机构信息

Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika,Semmelweis Egyetem, Általános Orvostudományi KarBudapest, Szigony u 36., 1083.

出版信息

Orv Hetil. 2020 Feb;161(5):177-182. doi: 10.1556/650.2020.31634.

Abstract

Tenotomy of the tendon of the stapedius and tensor tympani (TT) muscles is a minimal-invasive surgical therapeutic procedure in Ménière's disease (MD). It has been assumed that the TT medializes the stapes into the oval window, resulting in changes in perilymphatic pressures of the inner ear. By cutting the tendons of both middle ear muscles, they affect the pressure dynamics by not augmenting this pressure even further. The immediate and long-term investigation of the effect of middle ear muscle tenotomy on the quality of life of patients suffering from Ménière's disease, measured by the Dizziness Handicap Inventory (DHI) and the Tinnitus Handicap Inventory (THI). A follow-up study of 22 patients with definite, unilateral Ménière's disease had undergone tenotomy under general or local anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients. The statistical analysis was completed by using the IBM SPSS V24 software. Since the parameters did not show normal distribution, non-parametric test (Mann-Whitney U test) was used. The significance level was specified as p<0.05. A statistically significant reduction of DHI scores was noted in all patients. The tinnitus significantly reduced and all of the patients mentioned improved symptoms of MD. Although the follow-up period is short, and the pathomechanism (decrease of stapes medialization in the oval window) is not exactly clear, tenotomy seems to be a successful promising surgical treatment method with a high reduction of dizziness handicap score in conservative therapy-resistant Ménière's disease. Orv Hetil. 2020; 161(5): 177-182.

摘要

切断镫骨肌和鼓膜张肌肌腱是梅尼埃病(MD)的一种微创手术治疗方法。据推测,鼓膜张肌将镫骨向卵圆窗内侧移位,导致内耳外淋巴压力发生变化。通过切断中耳两块肌肉的肌腱,它们不会进一步增加这种压力,从而影响压力动态。通过眩晕 handicap 量表(DHI)和耳鸣 handicap 量表(THI)对中耳肌肉切断术对梅尼埃病患者生活质量影响的即时和长期研究。对 22 例明确的单侧梅尼埃病患者进行了随访研究,这些患者在全身或局部麻醉下通过耳内入路接受了肌腱切断术。比较了所有患者术前和术后的 DHI 值。使用 IBM SPSS V24 软件完成统计分析。由于参数未显示正态分布,因此使用非参数检验(曼-惠特尼 U 检验)。显著性水平设定为 p<0.05。所有患者的 DHI 评分均有统计学意义的降低。耳鸣明显减轻,所有患者均提到梅尼埃病症状有所改善。虽然随访期较短,且病理机制(卵圆窗镫骨内侧移位减少)尚不完全清楚,但肌腱切断术似乎是一种成功且有前景的手术治疗方法,对于保守治疗无效的梅尼埃病,其眩晕 handicap 评分有显著降低。《匈牙利医学周报》。2020 年;161(5):177 - 182。

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