Heermann J
HNO-Klinik, Alfried Krupp Krankenhaus, Essen.
HNO. 1988 Jan;36(1):13-5.
In elderly patients an unilateral sensorineural hearing loss is frequently associated with a relatively more patent eustachian tube on the involved side. A simple method of investigation is observation under the operating microscope during tubal inflation by the patient. In right-handed patients the abnormally patent tube most often lay on the left side. Powerful self inflation in these patients induces acute hearing loss and vertigo. Acute hearing loss is commoner on the left side. The air bone gap is greater at higher frequencies due to mobility of the stapes, loosening of the incudal joints and the tympanic membrane. In contrast the air bone gap is greater at lower frequencies in otosclerosis or malleus head ankylosis. Minor degrees improve after self inflation is prohibited. In most patients with abnormally patent eustachian tubes further therapy is not necessary after the patient has received precise advice. In only about 20% of the cases is the patient disturbed by a feeling of fullness in the ear, autophony and tinnitus. After stabilisation of weight and blood pressure, a septoplasty with correction of the posterior turbinates may reduce the exspiratory resistance. The most drastic treatment is a collagen injection around the tube. Patients with depression should be treated appropriately.
在老年患者中，单侧感音神经性听力损失常与患侧咽鼓管相对更通畅有关。一种简单的检查方法是在患者进行咽鼓管吹张时，在手术显微镜下观察。在右利手患者中，异常通畅的咽鼓管最常位于左侧。这些患者强力自行吹张会导致急性听力损失和眩晕。急性听力损失在左侧更为常见。由于镫骨活动、砧骨关节松动和鼓膜松弛，高频时气骨导差更大。相比之下，在耳硬化症或锤骨头固定时，低频时气骨导差更大。禁止自行吹张后，轻度情况会有所改善。在大多数咽鼓管异常通畅的患者中，在患者得到确切建议后无需进一步治疗。只有约20%的病例中，患者会受到耳内闷胀感、自听过响和耳鸣的困扰。体重和血压稳定后，行鼻中隔成形术并矫正后鼻甲可能会降低呼气阻力。最激进的治疗方法是在咽鼓管周围注射胶原蛋白。患有抑郁症的患者应得到适当治疗。
