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[鼓膜置管治疗放射性中耳炎伴积液的疗效及并发症处理]

[Therapeutic outcome and complication management of grommet insertion for radiotherapy induced otitis media with effusion].

作者信息

Lei Li, Wang Danni, Hao Xinping, Ma Xiaobo, Li Yongxin, Zhao Shouqin, Zheng Jun, Han Demin

机构信息

Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Apr;34(4):334-337. doi: 10.13201/j.issn.2096-7993.2020.04.011.

Abstract

To evaluate the therapeutic outcome and complication of grommet insertion for cancer patients in head and neck suffering from otitis media with effusion following radiotherapy. Retrospectively analyze the clinical data of grommet insertion in patients with head and neck cancer suffering from otitis media with effusion following radiotherapy. Fifty-five ears in 33 cases of cancer patients in head and neck with otitis media with effusion following radiotherapy had been performed grommet insertion. All patients were revisited seven days after operation, the phonetic frequency hearing in 55 ears had been improved in various degrees, and on average, it was increased 20.79 dB compared to that prior to the procedure. Sensation of the ear fullness had been disappeared in all the ears; the symptoms of tinnitus and headache were relieved in 80% of the patients. However, postoperative complications occurred in 67.3%(37/55) of the ears, including: ventilation tube falling out in 11(20%) ears, all of which had been re-catheterized; otorrhea in 10(18.2%) ears, which were healed after antibiotic treatment; Ventilation tube occlusion in 9(16.4%) ears, and they were recanalized after 5% sodium bicarbonate ear drops treatment; tympanic membrane retraction in 4(7.3%) ears, which were restored after eustachian tube blowing; eardrum perforation in 2(3.6%) ears without further treatment; the ventilation tube sliding into the tympanic cavity in 1(1.8%) ear, which was removed by surgery. The grommet was inserted more than twice in 31(56.4%) ears because of complications or recurrence of symptoms after grommet was removed. The grommet insertion is used for the treatment of radiotherapy-induced otitis media with effusion, which can improve the hearing and relieve the discomfort symptoms in ear in such patients. However, the incidence of postoperative complications is high and should be actively prevented to improve the therapeutic effect.

摘要

评估鼓膜置管术对放疗后出现中耳积液的头颈癌患者的治疗效果及并发症。回顾性分析放疗后出现中耳积液的头颈癌患者鼓膜置管术的临床资料。33例放疗后出现中耳积液的头颈癌患者的55耳接受了鼓膜置管术。所有患者术后7天复诊,55耳的语音频率听力均有不同程度提高,平均较术前提高20.79dB。所有耳的耳闷感均消失;80%的患者耳鸣和头痛症状得到缓解。然而,67.3%(37/55)的耳出现术后并发症,包括:11耳(20%)通气管脱出,均重新置管;10耳(18.2%)耳漏,经抗生素治疗后愈合;9耳(16.4%)通气管堵塞,经5%碳酸氢钠滴耳液治疗后再通;4耳(7.3%)鼓膜内陷,经咽鼓管吹张后恢复;2耳(3.6%)鼓膜穿孔,未进一步处理;1耳(1.8%)通气管滑入鼓室,经手术取出。31耳(56.4%)因并发症或取出通气管后症状复发而进行了两次以上鼓膜置管。鼓膜置管术用于治疗放疗引起的中耳积液,可改善此类患者的听力并缓解耳部不适症状。然而,术后并发症发生率较高,应积极预防以提高治疗效果。

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本文引用的文献

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Challenges of Hearing Rehabilitation after Radiation and Chemotherapy.放疗和化疗后听力康复的挑战。
J Neurol Surg B Skull Base. 2019 Apr;80(2):214-224. doi: 10.1055/s-0039-1677865. Epub 2019 Feb 4.

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