Ho W K, Wei W I, Yuen A P, Hui Y, Wong S H
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, PRC.
Am J Otolaryngol. 1999 Jan-Feb;20(1):12-5. doi: 10.1016/s0196-0709(99)90045-5.
To document the incidence of complications after myringotomy and grommet insertion in patients with nasopharyngeal carcinoma. The focus is on the incidence of otorrhea and perforation. The possible risk factors for these conditions and treatment response were studied.
We reviewed the records on 206 ears of 163 patients who suffered from nasopharyngeal carcinoma and underwent myringotomy and grommet insertion in a 7-year period. The follow-up period ranged from 4 weeks to 78 months (median, 9 months).
The overall incidence of otorrhea in these ears was 38%. Patients with nasopharyngeal carcinoma (NPC) had a significantly high incidence of postoperative discharge (chi2 test, P<.0001) compared with other patients who underwent myringotomy and grommet insertion. The mean interval between myringotomy and otorrhea was 19.8 weeks. Forty-seven per cent of the ears with a discharge developed otorrhea within 1 month. In 42%, the otorrhea responded to treatment and the ears became dry. After extrusion of the grommet, 29% of those ears with otorrhea ended with an eardrum perforation, and 24% of the ears showed recurrent effusion.
For patients with NPC who underwent myringotomy, there was a significant risk of otorrhea (49%) and persistent perforation (29%), and these complications were difficult to manage. We conclude that myringotomy and grommet insertion should not be routinely offered to NPC patients with middle ear effusion.
记录鼻咽癌患者鼓膜切开置管术后并发症的发生率。重点关注耳漏和鼓膜穿孔的发生率。研究这些情况的可能危险因素及治疗反应。
我们回顾了163例鼻咽癌患者在7年期间行鼓膜切开置管术的206只耳的记录。随访时间为4周～78个月（中位数为9个月）。
这些耳的耳漏总发生率为38%。与其他行鼓膜切开置管术的患者相比，鼻咽癌患者术后耳漏发生率显著较高（χ²检验，P<0.0001）。鼓膜切开与耳漏之间的平均间隔时间为19.8周。47%有耳漏的耳在1个月内出现耳漏。42%的耳漏经治疗后好转，耳内变干。鼓膜通气管脱出后，29%有耳漏的耳最终出现鼓膜穿孔，24%的耳出现反复积液。
对于行鼓膜切开术的鼻咽癌患者，存在显著的耳漏风险（49%）和持续性穿孔风险（29%），且这些并发症难以处理。我们得出结论，对于有中耳积液的鼻咽癌患者，不应常规进行鼓膜切开置管术。
