el-Guindy A
Tanta University, Egypt.
Am J Otol. 1993 Nov;14(6):580-4.
Since good ventilation of the middle ear is a prerequisite to successful myringoplasty, it was our policy to study the tubal function in dry central perforation of the drum and to correlate the manometric with the endoscopic findings. Normal manometric results with patency of the tube (as proved by fluorescein-endoscopy) indicated good tubal function, with good prognosis for myringoplasty. Abnormal manometric results with failure of fluorescein to pass into the nasopharynx indicated mechanical tubal obstruction that was, in most cases, correctable. Nasal endoscopy proved to be indispensable in diagnosing, localizing, and even treating "hidden" lesions in their key areas that may be responsible for the obstruction. Thus, the correction of the mechanical tubal obstruction must precede ear surgery. Whenever tubal obstruction is diagnosed as functional or idiopathic, the ventilation of the middle ear should be facilitated during ear surgery by addition of a tympanostomy tube to the graft or drum remnant, with guarded prognosis.
由于中耳良好的通气是鼓膜成形术成功的前提条件，我们的策略是研究干性鼓膜中央穿孔时的咽鼓管功能，并将压力测量结果与内镜检查结果相关联。压力测量结果正常且咽鼓管通畅（荧光素内镜检查证实）表明咽鼓管功能良好，鼓膜成形术预后良好。压力测量结果异常且荧光素未能进入鼻咽部表明存在机械性咽鼓管阻塞，在大多数情况下这种阻塞是可以纠正的。鼻内镜检查被证明在诊断、定位甚至治疗可能导致阻塞的关键区域的“隐匿性”病变方面不可或缺。因此，在耳部手术前必须纠正机械性咽鼓管阻塞。每当咽鼓管阻塞被诊断为功能性或特发性时，在耳部手术期间应通过在移植物或鼓膜残端添加鼓膜造孔管来促进中耳通气，预后需谨慎。
