耳内镜对耳的检查应用研究

目的探索在耳疾和耳科手术中对常规耳镜和显微镜不易窥清的潜隐部位进行临床检查的价值。方法选用直径2.7mm、4.0mm的30°、70°不同角度的耳内镜对外耳道、鼓膜、中耳等在不同角度进行检查或手术评估。结果在236例患者241耳中,外伤性鼓膜穿孔91耳,蓝鼓膜2耳,外耳道肉芽肿2耳,外耳道皮内痣2耳,外耳道胆脂瘤5耳,咽鼓管功能通畅者10耳,咽鼓管功能不良者14耳,分泌性中耳炎8耳,慢性化脓性中耳炎单纯型8耳,骨疡型3耳,胆脂瘤型21耳,并使用耳内镜进行手术前后检查单纯乳突凿开术11耳,乳突根治术7耳,乳突根治联合鼓室成形术14耳。复查耳常规、耳显微术后14耳,分泌性中耳炎术后10耳。结论耳内镜检查研究为耳疾病,以及耳常规、耳显微手术和耳内镜手术提供了可靠的辅助和治疗方法。     

耳内镜下鼓膜置管术与鼓膜穿刺术治疗分泌性中耳炎的效果比较

目的比较耳内镜下鼓膜穿刺术与鼓膜置管术治疗分泌性中耳炎的临床效果。方法将94例分泌性中耳炎患者按随机数字表法分为A、B组,每组47例。A组行耳内镜下鼓膜置管术治疗,B组行耳内镜下鼓膜穿刺术治疗。观察2组的临床疗效、中耳积液消退时间、术前术后听力的变化及术后并发症发生情况。结果 A组与B组治疗总有效率分别为93.62%、74.47%,2组比较差异有统计学意义(χ~2=6.425,P=0.011);A组中耳积液消退时间、术后气导与骨导听力值、术后并发症发生率均较B组显著减少(P<0.05或P<0.001)。结论耳内镜下鼓膜置管术治疗分泌性中耳炎效果优于耳内镜下鼓膜穿刺术,可有效缩短中耳积液消退时间,促进鼓膜愈合,改善临床症状,提高听力,减少术后并发症。     

慢性鼻窦炎合并分泌性中耳炎46例

目的：探讨慢性鼻窦炎合并分泌性中耳炎的治疗方法。方法：对慢性鼻窦炎合并分泌性中耳炎患者，在行鼻内镜鼻窦手术时，对有鼻甲肥大、息变的病例进行鼻甲手术处理，改善鼻腔通气；同时，为所有病例行鼓膜置管改善中耳负压。结果：行鼻甲手术改善通气的病例鼓膜拔管后分泌性中耳炎复发率低于未行鼻甲手术者，有统计学意义。结论：合并有分泌性中耳炎的慢性鼻窦炎患者，要注意改善鼻腔通气。     

儿童分泌性中耳炎67例治疗体会

目的应用中耳穿刺及中耳腔注药方法加咽鼓管吹张、部分加腺样体刮除术治疗儿童分泌性中耳炎。方法用内镜常规加用鼓气耳镜常规检查鼓膜，可以准确发现鼓室积液，并应用中耳穿刺及中耳腔注药方法加咽鼓管吹张，对腺样体肥大的患儿全麻下行常规腺样体刮除术。结果2006～2008年67例儿童分泌性中耳炎的治疗取得了安全、快速、良好的治疗效果。结论中耳穿刺及中耳腔注药方法治疗儿童分泌性中耳炎疗效较好，效果可靠。     

耳内镜下鼓膜修补术65例分析

20世纪90年代,国外学者就开始应用耳内镜技术进行中耳外科辅助手术,取得了满意的效果[1],近年来国内亦有报道[2]。本次研究对65例外伤性鼓膜穿孔及慢性中耳炎单纯型病人行耳内镜下鼓膜修补术,取得了满意的效果,现报道如下。     

鼻内镜下腺样体切除联合鼓膜穿刺治疗小儿分泌性中耳炎并腺样体肥大的疗效

目的观察鼻内镜下腺样体切除术联合鼓膜穿刺治疗小儿分泌性中耳炎并腺样体肥大的临床疗效。方法对45例（84耳）分泌性中耳炎并腺样体肥大患儿行鼻内镜下腺样体切除术,同时采用鼓膜穿刺治疗。观察45例（84耳）患儿治疗后有无并发症发生及临床疗效等情况。结果 45例（84耳）患儿获随访6~12个月。其中治愈70耳,有效9耳,无效5耳;总有效率为94.05%。复查鼻内镜示：鼻咽部创面光滑,无粘连、残留、圆枕及咽鼓管咽口损伤。无中耳感染、出血及听力减退等并发症发生。结论腺样体切除术联合鼓膜穿刺治疗分泌性中耳炎并腺样体肥大疗效显著,是一种治疗分泌性中耳炎并腺样体肥大的有效方法。     

耳内窥镜检查在中耳手术中的应用

目的：观察耳内窥镜检查在中耳手术中的应用。方法：５５耳中耳疾病患者，其中单纯型慢性化脓性中耳炎１５耳，胆脂瘤型化脓性中耳炎２５耳，分泌性中耳炎１５耳。分别在手术中及前、后进行耳内窥镜检查。结果：耳内窥镜检查能观察到手术显微镜不易观察到的部位，如：上鼓室、后鼓室、鼓窦入口、咽鼓管鼓口等，易于发现中耳病变，降低病变复发率。结论：耳内窥镜检查为中耳显微手术提供了良好的辅助手段。     

腺样体切除术联合耳内镜鼓膜置管术治疗儿童分泌性中耳炎的临床效果

目的探讨腺样体切除术联合耳内镜鼓膜置管术治疗儿童分泌性中耳炎的临床效果。方法选择儿童分泌性中耳炎患儿60例,按照手术方式的不同随机将其分为两组,每组30例。对照组患儿行腺样体切除联合耳内镜下鼓膜穿刺术治疗,观察组患儿行腺样体切除术联合耳内镜下鼓膜置管术治疗。比较分析两组患儿术后恢复效果以及术后并发症发生率。结果与对照组比较,观察组患儿中耳积液时间有所缩短,差异有统计学意义(P0.05);观察组术后并发症总发生率较低于对照组,差异有统计学意义(P0.05)。结论腺样体切除术联合耳内镜鼓膜置管术治疗分泌性中耳炎患儿,可有效缩减其中耳积液时间,减少或抑制术后并发症的发生。     

鼻内镜下鼓膜置管术治疗分泌性中耳炎效果评价

分泌性中耳炎（SOM）是以传导性聋及鼓室积液为主要特征的中耳非化脓性炎性疾病,可分为急性和慢性两种。冬季多发,听力下降、耳胀闷阻塞感及耳鸣是其三大症状。对于反复发作的保守治疗无效的分泌性中耳炎患者,鼓膜切开置管术是有效治疗方法。我院耳鼻咽喉科在鼻内镜下行鼓膜置管术88例（100耳）,取得了较好疗效,现报告如下。     

耳内镜下鼓膜置管术治疗分泌性中耳炎

目的探讨耳内镜下鼓膜置管术治疗分泌性中耳炎的疗效。方法应用耳内镜下鼓膜置管术治疗分泌性中耳炎患者86例(142耳)。结果所有置管均一次完成,术后7～12个月复查78例(132耳),疗效显著,纯音测听平均为21.6dB,听阈平均提高28dB。结论耳内镜下鼓膜置管术视野清晰、创伤小、疗效好,是一种简单易行、安全有效的治疗分泌性中耳炎的手术方法。     

数码图像内镜系统在颅底外科的应用

目的：进一步探讨内窥镜技术在颅底外科的应用价值。方法：在应用常规内窥镜手术进行颅底手术的基础上,根据不同的患者及病变,结合使用特种内窥镜及数码图像技术辅助进行颅底手术。结果：进行颅底手术共４７ 例,年龄最小为２ 岁半,最大７２ 岁,其中脑脊液鼻漏探查修补１３ 例,全部成功;视神经减压５ 例,３ 例视力改善。颅内外沟通瘤联合手术７ 例,４ 例痊愈,１ 例好转,２ 例失访。其它２２ 例不同的病例也获得较好效果。结论：内窥镜数码图像系统使颅底手术操作条件得到进一步改善。由于视角大,图像清晰,手术可做得更加精细彻底,创伤小,部分病例可明显提高疗效。     

CT中耳仿真内窥镜成像对中耳结构空间解剖关系的显示价值

背景:中耳结构复杂、细微,位置深而隐匿.CT仿真内窥镜成像可利用螺旋CT容积扫描数据重建出空腔器官内表面的立体图像,类似纤维内镜所见.目的:验证64排螺旋CT中耳仿真内窥镜对中耳正常结构的显示能力以及在病变中耳中的临床应用价值.设计、时间及地点:验证性对比观察,于2005-10/2006-03在中山大学附属第一医院放射科完成.对象:选择33例(66耳)疑有中耳疾病行双耳螺旋CT检查患者,其中正常35耳;病变31耳包括慢性化脓性中耳炎24耳,慢性化脓性中耳炎乳突根治术后复发2耳、中耳癌2耳、外耳道异物肉芽肿1耳及颞骨骨折2耳.方法:行颞骨64排螺旋CT容积扫描,软组织算法密集重建后,利用Navigator软件行中耳CT仿真内窥镜成像.所有CT仿真内窥镜成像均与常规二维CT图像及手术对照.主要观察指标:观察的主要结构包括各听小骨及其间的关节、上中下鼓室、鼓窦及外耳道、鼓室各壁结构、面隐窝、鼓室天盖、锤骨前、上韧带、砧骨后韧带及后鼓室的结构.结果:100%的CT仿真内窥镜图像可清晰显示正常中耳大部分听小骨及鼓室各壁结构,68.6%(24/35)及74.3%(26/35)的CT仿真内窥镜图像可分别清晰显示镫骨前、后脚,而且CT仿真内窥镜图像可清晰显示后鼓室重要解剖结构.慢性化脓性中耳炎病例中,CT仿真内窥镜显示锤骨柄、砧骨长脚骨质破坏与手术所见的符合率为91.7%(22/24),锤骨头、砧骨短脚、镫骨脚骨质骨质破坏的符合率分别为95.8%(23/24),100%(24/24)及87.5%(21/24):1耳中耳癌中CT仿真内窥镜可清晰、立体显示鼓室盖、鼓岬及外半规管的骨质破坏;1耳颞骨骨折中CT仿真内窥镜可清晰显示锤砧关节脱位.中耳CT仿真内窥镜成像平均耗时约10 min.结论:64排螺旋CT中耳CT仿真内窥镜可以清晰显示中耳的正常解剖细节,对病变中耳骨质破坏显示的符合率较高,且CT仿真内窥镜耗时不长,可以临床常规使用.     

Endoscopic ear surgery: A case series and first United Kingdom experience

AIM: To present the United Kingdom's first case series of 70 otological cases of endoscopic and non-endoscopic ear surgeries.METHODS: Prospective case series incorporating a range of endoscopic procedures performed using a 4 mm, 18 cm rigid endoscope, performed by a single surgeon at a single centre. Primary outcome measures included mean average pre and post-operative air-bone gap hearing thresholds and duration of surgery.RESULTS: Thirty-eight patients underwent endoscopic assisted ear surgery and 32 underwent non-endoscopic assisted ear surgery. In both surgical groups, there was a significant difference between pre and post-operative mean air-bone gaps(P = 0.02). Mean operating time was comparable between both groups. Eight patients developed post-operative complications.CONCLUSION: Endoscopic ear surgery can be performed safely in a range of otological procedures. This has the potential to become a well-established surgical option for middle ear surgery in the near future. Advantages and limitations are discussed.     

耳内镜下经鼓室口行咽鼓管球囊扩张治疗伴有慢性化脓性中耳炎的延迟开放型咽鼓管功能障碍的临床研究

目的 对伴有慢性化脓性中耳炎的延迟开放型咽鼓管功能障碍（ETD）患者,在实施中耳乳突手术的基础上联合行耳内镜下咽鼓管鼓室口球囊扩张术,以探讨耳内镜下治疗的有效性。方法 选取2016年2月-2021年2月来该院就诊的伴有慢性化脓性中耳炎的延迟开放型ETD患者50例,按随机分配原则分为观察组和对照组,各25例。观察组采用中耳乳突手术联合耳内镜下咽鼓管鼓室口球囊扩张术,对照组采用中耳乳突手术联合鼻内镜下咽鼓管咽口球囊扩张术。比较两组患者术前及术后1年咽鼓管功能障碍评分（ETDQ-7）及术后复发率。结果 两组患者组内术前与术后1年ETDQ-7评分比较,差异有统计学意义（P <0.05）。观察组术后乳突腔引流通畅,未出现脓性渗出液。观察组术后1年复发率明显低于对照组,两组患者比较,差异有统计学意义（P <0.05）。结论 对伴有慢性化脓性中耳炎的延迟开放型ETD患者,在实施中耳乳突手术的基础上,行耳内镜下咽鼓管鼓室口球囊扩张术,较行鼻内镜下咽鼓管咽口球囊扩张术更加安全,且术后复发率低,效果更好。故在可能的情况下,对伴有慢性化脓性中耳炎的延迟开放型ETD患者行中耳乳突手术联合耳内镜下咽...     

鼓室球体瘤误诊3例分析并文献复习

目的：探讨鼓室球体瘤的误诊原因及诊断方法。方法：对2003-2006年住院并经手术和病理证实的3例鼓室球体瘤患者的临床资料进行分析。结果：3例均以听力下降,耳闷胀感为临床特征,类似分泌性中耳炎。增强CT、MR、DSA检查均见异常。取耳后乳突径路完整切除肿瘤。结论：单纯依靠症状及特征,鼓室球体瘤容易误诊为分泌性中耳炎或胆固醇肉芽肿,CT、MR、DSA有助于确诊。     

Microendoscopy in rhinology

Summary

The endoscope is well established as a useful tool in rhinology, but endoscopes with a diameter of less than 2.5 mm have yet to prove their worth. The tapered 1.7 mm conventional lens endoscope has great potential for out-patient examination, providing improved patient comfort with little sacrifice in visibility. The development of fused silica image bundles, made up of 4–5 (im diameter pixels has led to “microfibrescopes” of 0.5–1 mm diameter. While these can reach areas which are inaccessible to larger endoscopes, they are restricted by the amount of light which they can deliver and can only provide a view when close-up. These limitations restrict the use of microfibrescopes in paranasal sinus surgery, but they have potential in the diagnosis of disorders of the lacrimal system. The author's experience is discussed.     

电视内窥镜在喉显微外科手术中的应用

目的：评估电视内窥镜在喉显微外科手术中的应用价值。方法：18例在传统显微喉镜下施行手术时由于暴露困难或存在观察盲区而无法完成手术的病例，改用电视内窥镜进行手术，总结手术效果。结果：18例患者中17例在电视内窥镜下顺利完成手术，效果满意。结论：在支撑喉镜的基础上应用电视内窥镜进行喉显微外科手术，不强调支撑喉镜将会厌撑起到直视下完全暴露喉腔病灶，通过不同角度内窥镜就能全面观察喉腔情况，其视野图像清晰、彩色、动态，具有较强的立体感。电视内窥镜可以替代传统显微喉镜完成绝大多数显微手术，而且可以完成某些在传统显微喉镜因视野暴露不佳或存在现察盲区而无法完成的手术。     

慢性中耳炎的螺旋CT扫描多方位重建和仿真内镜诊断

目的探讨多层螺旋CT（multi-slice computed tomography,MSCT）扫描多方位重建（multi-planar reformation,MPR）和仿真内镜（CT virtual endoscopy,CTVE）在慢性中耳炎诊断中的应用价值。方法对53例（65耳）慢性中耳炎患者行螺旋CT高分辨率横轴位扫描,层厚1.0mm,骨算法,FOV9.6cm,间隔0.1mm密集重建。重建后数据进行多方位成像和听骨链CT仿真内镜成像。结果本组53例中65耳CT显示异常,其中双侧12例24耳,单侧41耳。慢性中耳炎46耳,胆脂瘤12耳,肉芽肿7耳。本组病例横轴位高分辨率CT（HRCT）图像和MPR图像可以清晰显示病变部位和范围,CTVE能立体显示听骨链空间形态和结构。结论横轴位HRCT及MPR可以显示中耳炎全部信息。CTVE能直接显示听骨链立体影像,但不能区分内表面密度差异,CT仿真内镜对慢性中耳炎仅可以做辅助诊断。     

Acute otitis media: Part I. Improving diagnostic accuracy

Acute otitis media is overdiagnosed. Symptoms are neither sensitive nor specific for the diagnosis of otitis media; fever and ear pain are present in only one half of patients. Undue reliance on one feature--redness of the tympanic membrane--and failure to assess tympanic membrane mobility with pneumatic otoscopy contribute to inaccurate diagnoses. Adequate visualization of the tympanic membrane is often impaired by low light output from old otoscope bulbs and blockage of the ear canal by cerumen. Distinguishing acute otitis media from otitis media with effusion is clinically important because antibiotics are seldom indicated for the latter condition. A key differentiating feature is the position of the tympanic membrane: it is usually bulging in acute otitis media and in a neutral position or a retracted position in otitis media with effusion. Tympanometry and acoustic reflectometry can be useful adjunctive tools to confirm the presence of fluid in the middle ear. Selective use of tympanocentesis in cases of refractory or recurrent middle ear disease can help guide appropriate therapy and avoid unnecessary medical or surgical interventions.     

Advantages of endoscopically assisted surgery for attic cholesteatoma

Combined use of an operating microscope and a middle ear endoscope seems to be helpful for selecting an appropriate surgical technique and for identifying more patients in whom cholesteatoma can be removed by a trans-canal approach alone. To investigate whether attic cholesteatoma can be treated by a trans-canal approach alone, a review was performed of patients who had undergone endoscopically assisted tympanoplasty and the outcome of surgery was compared with the preoperative CT findings. Using a rigid endoscope (3 mm in diameter and 6 cm in length with a viewing angle of 30 degrees ), twenty eight patients were examined to determine whether total resection of the cholesteatoma was possible by trans-canal atticotomy alone. According to the CT findings, total resection of cholesteatoma was possible by trans-canal atticotomy combined with the use of a rigid endoscope not only in 4 patients with the shadow localized in the epitympanum on preoperative CT scans but also in 18 out of 24 patients with the shadow extending from the epitympanum to the distal mastoid air cells. This study indicates that the trans-canal approach with endoscopic guidance is a useful technique for the treatment of cholesteatoma.