Sen-En Rifu Otological Surgery Center, Miyagi, Japan; Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
Sen-En Rifu Otological Surgery Center, Miyagi, Japan; Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
Auris Nasus Larynx. 2023 Dec;50(6):859-865. doi: 10.1016/j.anl.2023.03.007. Epub 2023 Mar 29.
To evaluate Eustachian tube (ET) function after Kobayashi plug surgery based on the tympanic membrane (TM) findings and active opening (AO) of the ET assessed with sonotubometry.
A retrospective survey of medical records identified 74 ears of 66 patients with patulous ET (PET) received transtympanic insertion of the Kobayashi plug. Excluding the six ears (6 patients) with abnormal preoperative TM, sixty-eight ears of 60 patients were found to have normal TM preoperatively. Among these 68 ears, there were 51 ears in which sonotubometry was performed both before and after surgery to evaluate whether the AO of the ET was positive or not.
Out of the 68 ears with normal preoperative TM, 52 ears (76.5%) were judged successful (sum of complete relief and significant improvement). The postoperative TM was normal in 41 ears (60.3%), while 27 ears (39.7%) had abnormal TM findings postoperatively. The success rate was 75.6% (31/41) in ears with normal postoperative TM, while it was 77.8% (21/27) in ears with abnormal TM. Success in maintaining normal postoperative TM was found in 45.6% (31/68) of the total ears treated. Out of the 51 ears in which sonotubometry was performed both before and after surgery, AO was preoperatively positive in 88.2% of the ears (45/51), while it was positive in 64.7% (33/51) postoperatively. In thirty-four ears with normal TM postoperatively, AO was positive in 24 ears (70.6%), while it was positive in 9 out of 17 ears (52.9%) with abnormal postoperative TM. The success rate was 70.6% (36/51) for the 51 ears in which AO was assessed both pre- and postoperatively, and it was 66.7% (22/33) in ears with positive AO postoperatively, while it was 77.8% (14/18) in ears without AO postoperatively. The incidence of ears either having normal postoperative TM or positive AO postoperatively was 84.3% (43/51). Abnormal postoperative TM findings without effectiveness were found in 8.8% (6/68).
The obstructive dysfunction of the ET is a calculated risk but did not occur in most ears after plugging with the Kobayashi plug. Therefore, routine insertion of the VT at the same time as the initial surgery is not recommended for PET cases that are adequately followed up.
通过鼓室图和声顺测听评估咽鼓管（ET）功能，以评估 Kobayashi 栓手术后的 ET 功能。
回顾性分析了 66 例患者 74 耳的病历，这些患者因咽鼓管扩张症（PET）接受了经鼓室 Kobayashi 栓植入术。排除术前鼓膜异常的 6 耳（6 例），发现术前 60 例患者中有 68 耳鼓膜正常。在这 68 只耳朵中，有 51 只耳朵在术前和术后均进行了鼓室图和声顺测听，以评估 ET 的 AO 是否为阳性。
在术前鼓膜正常的 68 只耳朵中，52 只（76.5%）被判断为成功（完全缓解和显著改善的总和）。术后 41 只（60.3%）鼓膜正常，27 只（39.7%）术后鼓膜异常。术后鼓膜正常的成功率为 75.6%（31/41），而鼓膜异常的成功率为 77.8%（21/27）。术后鼓膜正常的总成功率为 45.6%（31/68）。在 51 只同时进行术前和术后声顺测听的耳朵中，术前 AO 阳性率为 88.2%（45/51），术后为 64.7%（33/51）。术后鼓膜正常的 34 只耳朵中，AO 阳性率为 70.6%（24/34），而术后鼓膜异常的 17 只耳朵中，AO 阳性率为 52.9%（9/17）。在术前和术后均进行 AO 评估的 51 只耳朵中，成功率为 70.6%（36/51），术后 AO 阳性的成功率为 66.7%（22/33），术后无 AO 的成功率为 77.8%（14/18）。术后鼓膜正常或 AO 阳性的耳朵发生率为 84.3%（43/51）。术后鼓膜异常但无疗效的发生率为 8.8%（6/68）。
ET 阻塞性功能障碍是一种计算风险，但在大多数接受 Kobayashi 栓植入术的患者中并未发生。因此，对于 PET 病例，不建议在初次手术后常规插入 VT。
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