Li Li, Mao Yanyan, Hu Na, Yan Wenqing, Lu Yanqing, Fan Zhaomin, Wang Haibo, Han Yuechen
Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Otology Surgery, Shandong Provincial ENT Hospital, Jinan, China.
Department of Medical Imaging Center, Shandong Provincial ENT Hospital, Jinan, China.
Ann Palliat Med. 2021 Jul;10(7):7662-7670. doi: 10.21037/apm-21-1280.
The treatments for refractory secretory otitis media with effusion usually choose long-term grommet insertion. This study evaluated the effect of balloon eustachian tuboplasty combined with grommet insertion on the function and the opening length of the eustachian tube in patients with refractory otitis media with effusion.
Fifty-seven patients with refractory otitis media with effusion were enrolled. A three-dimensional reconstruction of an iohexol-enhanced computed tomography image was applied to evaluate the structural and length changes of the eustachian tube at both resting and Valsalva maneuver states. The grommet was removed 3 months after the operation and postoperative follow-up was carried out from 3 to 12 months. We performed pre- and post-operative observation of the following: appearance of the tympanic membrane, pure-tone audiometry threshold, eustachian tube score, seven-item Eustachian Tube Dysfunction Questionnaire scores (ETDQ-7), quantitative examination of eustachian tube function dynamic observation of tympanogram peak pressure point, and computed tomography examination of the eustachian tube.
The pure-tone audiometry at 1, 3, 6, 9, and 12 months postoperatively were all significantly lower compared to the preoperative value (all P<0.05). There was no significant difference between the pure-tone audiometry at 6 and 9 months postoperatively, neither was for the air-bone conduction gap at these time points. The quantitative examination peak pressure deviation was markedly increased at 6 months postoperatively compared with that before the operation (all P<0.05). The peak pressure deviation of tympanometry at 6 and 9 months postoperatively were both higher than the value at 12 months after surgery (P<0.05). The eustachian tube score at 1, 3, 6, 9, and 12 months postoperatively were notably higher than that before the operation (all P<0.05). A significant difference was also observed between the 6- and 12-month postoperative eustachian tube score (P<0.05). There was a significant difference in the ETDQ-7 scores at 6- and 12-month postoperatively (P<0.05). The quantitative examination peak pressure deviation and eustachian tube score were both correlated with development length of the eustachian tube after three-dimensional computed tomography reconstruction (P<0.05).
Eustachian tube balloon dilatation combined with grommet insertion is an effective treatment for refractory otitis media with effusion.
难治性分泌性中耳炎的治疗通常选择长期鼓膜置管。本研究评估了球囊咽鼓管成形术联合鼓膜置管对难治性分泌性中耳炎患者咽鼓管功能及开放长度的影响。
纳入57例难治性分泌性中耳炎患者。应用碘海醇增强计算机断层扫描图像的三维重建来评估咽鼓管在静息和瓦尔萨尔瓦动作状态下的结构和长度变化。术后3个月取出鼓膜通气管，并进行3至12个月的术后随访。我们对以下各项进行了术前和术后观察：鼓膜外观、纯音听力计阈值、咽鼓管评分、咽鼓管功能障碍七项问卷评分（ETDQ-7）、咽鼓管功能定量检查、鼓室图峰压点动态观察以及咽鼓管计算机断层扫描检查。
术后1、3、6、9和12个月的纯音听力计阈值均显著低于术前值（均P<0.05）。术后6个月和9个月的纯音听力计阈值之间无显著差异，这两个时间点的气骨导间距也无显著差异。术后6个月的定量检查峰压偏差与术前相比明显增加（均P<0.05）。术后6个月和9个月的鼓室图峰压偏差均高于术后12个月的值（P<0.05）。术后1、3、6、9和12个月的咽鼓管评分均显著高于术前（均P<0.05）。术后6个月和12个月的咽鼓管评分之间也存在显著差异（P<0.05）。术后6个月和12个月的ETDQ-7评分存在显著差异（P<0.05）。定量检查峰压偏差和咽鼓管评分均与三维计算机断层扫描重建后咽鼓管的发育长度相关（P<0.05）。
咽鼓管球囊扩张联合鼓膜置管是治疗难治性分泌性中耳炎的有效方法。
