Choi Yeonjoo, Kang Woo Seok, Ha Seung Cheol, Lee Sang Hun, Ahn Joong Ho, Chung Jong Woo, Park Hong Ju
Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2022 Nov;15(4):319-325. doi: 10.21053/ceo.2022.00129. Epub 2022 May 4.
This study aimed to evaluate long-term changes after balloon dilation of the Eustachian tube (BDET) in chronic otitis media (COM) patients with Eustachian tube (ET) dysfunction that persisted after tympanomastoidectomy (TM).
We retrospectively reviewed the medical records of consecutive patients who were diagnosed with COM and ET dysfunction and underwent TM at our tertiary hospital from 2016 to 2017. The tympanic membrane status, the presence of a ventilation tube, ability to perform the Valsalva maneuver, and audiologic changes after dilation of the ET were analyzed.
This study included 20 patients (with 21 ears) who underwent TM but could not perform the Valsalva maneuver, showed a persistent air-bone gap, and eventually underwent BDET (male:female, 8:13; right:left, 11:10). Four ears showed perforation of the tympanic membrane after TM. Among the remaining 17 ears, 15 ears underwent ventilation tube insertion before BDET, while two ears underwent ventilation tube insertion and BDET simultaneously. Although none of the patients were capable of the Valsalva maneuver before BDET, 13 (62%) were able to perform the Valsalva maneuver successfully after BDET. When evaluating the tympanic membrane status at the latest follow-up, ventilation tubes were still present in eight ears. In the other 13 ears, intact tympanic membranes were present in nine out of 11 ears n the successful Valsalva group, whereas none of them were intact in the unsuccessful Valsalva group (P=0.014). The successful Valsalva group after BDET showed an improved air-bone gap of 8.9±12.4 dB, while the unsuccessful Valsalva group showed an aggravated air-bone gap of 3.8±11.8 dB at 1 year after BDET; this difference was statistically significant (P=0.031).
The Valsalva maneuver could be performed successfully after BDET by 62% of patients with COM and ET dysfunction. BDET is helpful for successful hearing improvement and improved tympanic aeration in COM patients with ET dysfunction.
本研究旨在评估在鼓室乳突切除术后（TM）咽鼓管功能障碍仍持续存在的慢性中耳炎（COM）患者中，咽鼓管球囊扩张术（BDET）后的长期变化。
我们回顾性分析了2016年至2017年在我院接受TM且诊断为COM和咽鼓管功能障碍的连续患者的病历。分析了鼓膜状态、通气管的存在情况、进行瓦尔萨尔瓦动作的能力以及咽鼓管扩张后的听力学变化。
本研究纳入了20例（21耳）接受TM但无法进行瓦尔萨尔瓦动作、存在持续气骨导差并最终接受BDET的患者（男:女 = 8:13；右:左 = 11:10）。4耳在TM后出现鼓膜穿孔。在其余17耳中，15耳在BDET前插入了通气管，2耳同时进行了通气管插入和BDET。尽管在BDET前没有患者能够进行瓦尔萨尔瓦动作，但13例（62%）患者在BDET后能够成功进行瓦尔萨尔瓦动作。在最近一次随访评估鼓膜状态时，8耳仍有通气管。在另外13耳中，成功进行瓦尔萨尔瓦动作的组中，11耳中有9耳鼓膜完整，而在未成功进行瓦尔萨尔瓦动作的组中无一例鼓膜完整（P = 0.014）。BDET后成功进行瓦尔萨尔瓦动作的组在BDET后1年气骨导差改善了8.9±12.4 dB，而未成功进行瓦尔萨尔瓦动作的组气骨导差恶化了3.8±11.8 dB；这一差异具有统计学意义（P = 0.031）。
62%患有COM和咽鼓管功能障碍的患者在BDET后能够成功进行瓦尔萨尔瓦动作。BDET有助于改善患有咽鼓管功能障碍的COM患者的听力并改善鼓膜通气。
