el-Guindy A
Department of Otolaryngology, Head and Neck Surgery, Tanta School of Medicine, Egypt.
Acta Otolaryngol. 1998 Sep;118(5):692-6. doi: 10.1080/00016489850183197.
Since return of normal ventilation of the middle ear is a prerequisite for maintenance of an effusion-free ear state after tube fallout, it was our policy to study the tubal function in patients with chronic otitis media with effusion that had been treated with ventilation tubes (VT), and to correlate the manometric with the endoscopic findings. Normal manometric and endoscopic results indicated good tubal function, with an effusion recurrence rate of 11.1%. Abnormal manometric and endoscopic results indicated organic 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, correction of the organic tubal obstruction must precede VT removal if recurrence of effusion is to be prevented. Whenever tubal obstruction is diagnosed as functional or idiopathic, ventilation of the middle ear should be maintained by frequent intubation or the insertion of long-term VT, and a guarded prognosis given.
由于中耳恢复正常通气是鼓膜置管脱落后维持无积液耳状态的前提条件，我们的策略是研究接受鼓膜置管（VT）治疗的慢性分泌性中耳炎患者的咽鼓管功能，并将压力测量结果与内镜检查结果相关联。压力测量和内镜检查结果正常表明咽鼓管功能良好，积液复发率为11.1%。压力测量和内镜检查结果异常表明存在器质性咽鼓管阻塞，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”病变方面不可或缺。因此，若要防止积液复发，必须在取出鼓膜置管之前纠正器质性咽鼓管阻塞。每当咽鼓管阻塞被诊断为功能性或特发性时，应通过频繁插管或插入长期鼓膜置管来维持中耳通气，并给出谨慎的预后判断。
