咽鼓管-鼓室气流动态法对咽鼓管异常开放症的诊断价值

目的 :探讨咽鼓管异常开放症的检测方法。方法 :比较鼓室导抗图法、Morim itsu法和咽鼓管 -鼓室气流动态法 (TTAG法 )检测 2 0耳咽鼓管异常开放症患者的阳性率。结果 :鼓室导抗图法阳性者 5耳 ,阳性率 2 5 % ,Morim itsu法阳性者 12耳 ,阳性率 6 0 % ,TTAG法阳性者 2 0耳 ,阳性率 10 0 %。结论 :TTAG法是诊断和随访咽鼓管异常开放症最有价值的手段。     

自体血咽鼓管咽口黏膜下注射治疗咽鼓管异常开放症

目的　探讨自体血咽鼓管咽口黏膜下注射治疗咽鼓管异常开放症的治疗效果。方法　收集2002年1月～2013年12月我科门诊经保守治疗无效的咽鼓管异常开放 症患者14例,共20耳,采用患耳咽鼓管咽口黏膜下自体静脉血注射进行治疗,记录治疗前后患耳鼓膜及咽鼓管咽口情况,并进行咽鼓管-鼓室气流动态（tubo-tympanic airflow dynamics,TTAG）法测定判定疗效。结果　诊断为咽鼓管异常开放症患者,均见病变侧咽鼓管咽口闭合不全,呈裂隙状,坐位观察明显,TTAG法显示患耳外耳道压力随鼻咽腔压力变化而波动;病变侧咽鼓管咽口外侧壁注射自体血1～4次后,13耳症状完全消失,同侧咽鼓管咽口平静状态下能够闭合;7耳症状减轻,咽鼓管咽口未能完全闭合。所有治疗耳均无分泌性中耳炎等并发症发生。结论　自体血咽鼓管咽口注射是一种安全、有效的治疗方法,由于简便易 行,值得在治疗咽鼓管异常开放症中推荐使用。     

鼻咽癌放疗后咽鼓管功能障碍的几种类型

目的：了解鼻咽癌放疗后咽鼓管功能障碍的类型及其影响。方法：对32例(50耳)鼻咽癌放疗后有咽鼓管功能障碍的患者进行常规检查、听力计检查、鼓室导抗图法检查、咽鼓管一鼓室气流动态法(TTAG)检查、咽鼓管音响法检查和内镜检查咽鼓管咽口。结果：咽鼓管异常开放2例(4耳)，患者症状较轻。咽鼓管粘连5例(7耳)，咽鼓管完全阻塞17例(27耳)，咽鼓管不全阻塞8例(12耳)，后三者症状相似，主要导致分泌性中耳炎。结论：鼻咽癌放疗后可导致不同类型的咽鼓管功能障碍，对耳功能产生损害，对其了解将有助于针对性治疗方法的确定。     

鼓室成形术后的咽鼓管功能检测及意义

目的探讨咽鼓管功能对慢性化脓性中耳炎鼓室成形术后疗效的影响。方法用咽鼓管鼓室-气流动态图(tube-tympanoaerodynamicgraphy,TTAG)法及音响法对53耳鼓室成形术后的咽鼓管功能进行检测,并分析鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况;并用鼻窦镜观察咽鼓管咽口,分析咽鼓管咽口与咽鼓管功能的关系。结果53耳鼓室成形术后咽鼓管功能正常37耳,其中29耳鼓膜生长良好;咽鼓管功能异常16耳中,有4耳鼓膜生长良好,比较咽鼓管功能正常耳与异常耳鼓膜生长良好耳数,两者有显著性差异(P<0.05);53耳术后有9耳咽鼓管咽口充血肿胀,其中2耳咽鼓管功能正常,7耳咽鼓管功能不良,提示术后咽鼓管功能障碍与咽鼓管咽口病变有关。结论慢性化脓性中耳炎鼓室成形术后咽鼓管功能与疗效关系密切,术后咽鼓管功能障碍可能是导致手术失败的原因之一。     

胆脂瘤中耳炎与咽鼓管上隐窝

目的探讨咽鼓管上隐窝及其与上鼓室空气通道的状态在胆脂瘤中耳炎发病过程中的意义。方法观察胆脂瘤中耳炎52例（52耳，观察组）及乳突气化良好无慢性中耳炎病史的外伤性面神经麻痹患者16例（16耳，对照组）术中咽鼓管上隐窝及其与上鼓室通道开放状态。结果对照组16耳均呈清晰的咽鼓管上隐窝结构，呈膜性闭锁4耳（25．0％）。观察组52耳（100％）咽鼓管上隐窝与上鼓室前方呈完全闭锁，无相通病例。与对照组差异有统计学意义（Х^2=46．421，P=0．000）。其中骨性闭锁34耳（65．4％），膜性闭锁18耳（34．6％）；上鼓室空间狭小。全组均为硬化或气化不良型乳突。结论咽鼓管上隐窝与上鼓室的气流通道闭塞更容易造成上鼓室和乳突负压状态，可能是形成胆脂瘤的原因之一；咽鼓管上隐窝与上鼓室通道的解剖学变异可能是胆脂瘤中耳炎的易患因素。提示胆脂瘤中耳炎行完壁式鼓室成形术时开放该通道可能有助于防止术后复发。     

颞骨CT和咽鼓管功能检查对胆脂瘤型中耳炎咽鼓管鼓室口病变的诊断意义

目的：探讨颞骨高分辨率CT（HRCT）和咽鼓管功能检查对胆脂瘤型中耳炎患者术前咽鼓管鼓室口病变的诊断价值。方法：回顾性分析38例（41耳）胆脂瘤型中耳炎患者术前颞骨HRCT扫描和咽鼓管功能综合测试仪检查结果，并与术中显微镜下探查咽鼓管鼓室口处病变情况进行对比分析。结果：颞骨HRCT发现咽鼓管鼓室口软组织占位影34耳；术中发现鼓室口病变32耳，其中为肉芽组织22耳和胆脂瘤4耳，脓团堵塞3耳，鼓室口周围黏膜肥厚肿胀2耳，黏膜粘连闭锁1耳。咽鼓管功能障碍37耳，其中为阻塞型32耳，闭锁不全型5耳。结论：对胆脂瘤型中耳炎患者术前进行颞骨HRCT扫描和咽鼓管功能检查，对术中有目的地处理咽鼓管鼓室口的病变，制定手术方案和预估治疗效果具有重要意义。     

分泌性中耳炎C型鼓室导抗图咽鼓管功能的检测

目的：探讨分泌性中耳炎（ＳＯＭ）、鼓室导抗图为Ｃ型患者的咽鼓管功能。方法：检测捏鼻吞咽法和捏鼻鼓气法后的鼓室导抗图,峰压点的移动进行量化处理,评价３０例ＳＯＭ（４２耳）的咽鼓管功能,并与正常对照组相比较。结果：咽鼓管功能障碍者５２．３８％,与正常对照组相比有显著性差异（Ｐ〈０．０５）。结论：咽鼓管功能障碍是ＳＯＭ的病因之一,但并非唯一因素。     

鼻咽癌放疗后咽鼓管功能障碍的评估

目的 通过综合的检测方法对鼻咽癌放疗后的咽鼓管功能障碍进行评估。方法 用鼓室导抗图法、咽鼓管一鼓室气流动态法(TTAG)、咽鼓管音响法、正-负压平衡试验法和内镜检查咽鼓管口两端等综合方法，对23例(35耳)鼻咽癌放疗后有咽鼓管功能障碍的病人进行检查和评估。结果 23例35耳中，21例3l耳表现为咽鼓管阻塞，其中完全阻塞15例21耳，不完全阻塞6例10耳；2例4耳为咽鼓管异常开放。结论 简单的检查不足以了解鼻咽癌放疗后所导致的咽鼓管功能障碍，采取多种方法的综合检查才能对咽鼓管功能障碍的性质和程度进行准确的评估。     

一种新型咽鼓管功能检查方法的评价

目的对一种咽鼓管功能检查方法进行评估。方法以JK-05A型咽鼓管功能检查仪和声导抗仪对103例(206耳)门诊病人进行检查,并对两种检查结果进行kappa一致性系数检验。结果咽鼓管主动开放功能检查(音响法)与一种被动开放功能检查(声阻抗法或TTAG法)的组合,与经典声阻抗检查的结果最为接近,是一种较好且实用的组合检查方式。结论 JK-05A型咽鼓管功能检查仪具有一定的临床应用价值。     

伴咽鼓管功能异常的慢性中耳炎患者术中行咽鼓管冲洗的临床意义研究

目的　探讨伴咽鼓管功能异常的慢性中耳炎患者术中行咽鼓管冲洗的临床意义。方法　选择2016年8月～2017年12月本院耳鼻咽喉科住院部收治123例伴咽鼓管 功能异常的慢性中耳炎手术患者，随机分为试验组67例（术中行咽鼓管冲洗）及对照组56例（术中不予处理咽鼓管）。所有患者接受鼓室成形术，并根据病情决定是否同期行乳突改良根治术。术后随访1年，分析两组患者术后干耳时间、听力变化、中文版慢性耳病调查量表（Chinese version of the chronic ear survey，CCES）评分变化、鼓膜愈合情况、咽鼓管功能恢复情况。结果　两组患者术后仅干耳时间差异无统计学意义，而术后声导抗结果、鼓膜愈合率、平均听阈改善值、气骨导差改善值、CCES评分改善值等指标，以上指标两组间比较，差异均有统计学意义（P 均＜0.05）。结论　伴咽鼓管功能异常的慢性中耳炎患者，术中行咽鼓管冲洗能改善术后咽鼓管功能，进而获得更好生活质量及听力，提高术后疗效。     

慢性化脓性中耳炎的咽鼓管功能对手术疗效的影响

目的探讨慢性化脓性中耳炎咽鼓管功能改变对手术疗效的影响.方法分析40耳行鼓室成形术的慢性化脓性中耳炎的咽鼓管功能与手术疗效的关系.咽鼓管功能检查用正-负压试验、TTAG法及音响法,咽鼓管鼓室口及咽口的观察分别用鼓室镜及鼻窦镜,对比分析咽鼓管功能改变与病变部位的关系,并比较鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况.结果慢性化脓性中耳炎的咽鼓管功能与鼓室口病变程度相关,鼓室口病变轻者,咽鼓管功能良好;而鼓室口病变重者咽鼓管功能不良.40耳鼓室成形术后咽鼓管功能良好耳鼓膜生长良好,咽鼓管功能不良耳鼓膜生长欠佳;两者均有统计学意义.结论慢性化脓性中耳炎咽鼓管功能与鼓室成形术效果关系密切,咽鼓管功能障碍可能是导致手术失败的重要因素之一.     

Eustachian tube patency and function in tympanoplasty with cartilage palisades or fascia after cholesteatoma surgery.

OBJECTIVE: To compare the Eustachian tube patency and function after tympanoplasty with either cartilage palisades or fascia grafting after one-stage surgery in children with tensa cholesteatoma. STUDY DESIGN: In children operated for tensa cholesteatoma, cartilage palisade tympanoplasty was performed in 32 ears and fascia tympanoplasty in 29 ears. The patency of the Eustachian tube was evaluated by the Valsalva maneuver before the operation, 1 to 3 months after the operation, and at a follow-up examination 46(1/2) months later (median). Eustachian tube function was evaluated by the nine-step inflation/deflation tympanometric test and the Toynbee test at the follow-up examination. Otomicroscopy and hearing evaluation were performed before and after surgery as well as at the follow-up. MAIN OUTCOME MEASURES: Eustachian tube patency and function. Hearing, postoperative eardrum perforation/retraction, and cholesteatoma recurrence. RESULTS: The Valsalva maneuver was positive in 30% of the ears before the operation, in 65% primarily after the operation, and in 78% at the follow-up examination. A poor tubal function was found in 57% at follow-up. Overall, the late functional hearing results were better in ears with a positive Valsalva maneuver. There were no differences in tubal patency or function in relation to graft material, cholesteatoma, and tympanoplasty type. In ears with a poor tubal function, the hearing results were significantly better in the palisade group (63% success), compared with the fascia group (17% success). All of the four perforations, most of the retractions, and a single moist eardrum were found in the fascia group at the reevaluation. We found no correlation between the condition of the eardrum and the Eustachian tube function at the last evaluation. However, in ears with a poor tubal function, a nonretracted, nonperforated drum was found with higher frequency in the palisade group. Decision matrix analysis showed that the last postoperative Valsalva maneuver was the best predictor of the drum condition at the reevaluation. CONCLUSIONS: The Eustachian tube patency frequently improves after tympanoplasty after cholesteatoma surgery in children, regardless of graft material. The patency and function of the Eustachian tube seem to be without relation to graft material, cholesteatoma, or tympanoplasty type. Cartilage palisade tympanoplasty may be a better reconstruction technique after cholesteatoma surgery, especially in ears with a poor tubal function.     

Physiotherapy of Eustachian tube dysfunction in adults--preliminary report

The paper presents preliminary results of Eustachian tube dysfunction treatment with the use of vibroaerosols in adult patients. 21 patients aged 16-73 y.o. (mean age 49 y.o) have been included in the study. The treatment included inhalation of medicines individually selected for the patient, based on the results of the physical examination. The patients have been divided into 2 groups, depending on the type of tympanogram. Group I included patients with type A tympanogram and abnormal Eustachian tube patency test result. Group II comprised of patients with type B or C tympanogram and abnormal Eustachian tube patency test result. After treatment, subjective improvement has been observed in 88.9% of the ears, objective improvement in 61.5% of the ears. In group II, objective improvement observed by the change of tympanogram has been observed in 85% of ears. Lack of correlation between objective and subjective improvement have been observed in 26% of the ears. In 11.1% of the ears no benefit from treatment has been observed. The correlation between subjective and objective improvement has been observed in 74% of ears. It appears that treatment with the use of vibroaerosols is beneficial for patients with Eustachian tube dysfunction.     

Abnormal middle ear pressures during experimental influenza A virus infection--role of Eustachian tube function

Introduction: Experimental infection of adults with influenza A virus, rhinovirus or RSV causes abnormal ME pressure in some, but not all subjects. The hypothesis tested in this study is that the response variability is caused by constitutional differences in the functioning of the Eustachian tube. Methods: 18 adult subjects were experimentally infected with influenza A virus. On five occasions before virus exposure, middle ear pressure (by tympanometry) and Eustachian tube function (by sonotubometry) were recorded bilaterally. Tests were repeated on days 1 through 8 and 10 after infection. Individual ears were classified with respect to the number of pre-exposure, positive sonotubometric testings and the middle ear pressure response to infection was compared between ears with Eustachian tube openings at all pre-infection test sessions (GR-A) and those with at least one negative test (GR-B). Results: Pre-exposure, 19, six, four, four, one and two ears had tubal openings on five, four, three, two, one and zero sessions, respectively. For that period, GR-A had significantly lesser average intra-ear and intra-group middle ear pressure variances compared to GR-B, but there were no between-group differences in the average middle ear pressure or in the number of observations of abnormal middle ear pressure. After virus exposure, middle ear pressure variances and the number of abnormal observations increased and the average pressure decreased in both groups, but the effects were more pronounced for GR-B ears. Conclusions: These results support the hypothesis that pre-existing good Eustachian tube function reduces the otological complications of viral upper respiratory tract infection.     

Eustachian tube function after transmyringeal ventilation

This study anus at determining the effect of transmyringeal ventilation on Eustachian tube functions. Seventy ears clinically diagnosed as having otitis media with effusion or grade I and II retraction of pars-tensa of tympanic membrane were treated with antiallergics, decongestants, mucolytics, and antibiotics as required for maximum upto three months. In forty-five ears that showed neither symptomatic nor audiometric improvement, transmyringeal ventilation was restored by myringotomy and ventilation tube insertion. There after, Eustachian tube functions were assessed by using pressure equilibration test. The post-operative audiograms showed mean hearing gain of 16. 6 dB (S D±7.9) in majority (96%) of the ears. At first week 93% ears could not either totally or partially equilibrate positive or negative pressure. The percentage in the poor function group remained 91% even at the end of 6 months showing no significant effect of ventilation tube insertion on active ET functions.     

The effect of ventilation tube insertion or trans-tympanic silicone plug insertion on a patulous Eustachian tube

Conclusions This study suggests that long-term ventilation tube insertion is the first-choice surgical treatment for a ‘sniff-type’ patulous Eustachian tube (PET). When treating a refractory PET, it is important to determine whether the patient had a habitual sniff. Objectives PET patients were divided into two groups: patients with a habitual sniff (sniff-type PET) and those without a habitual sniff (non-sniff-type PET). This study examined the effects of ventilation tube insertion or silicone plug insertion in each group. Methods Surgical procedures such as ventilation tube insertion or trans-tympanic silicone plug insertion were performed for these patients. Tubotympanoaero-dynamic graphy (TTAG) was also performed to determine the mechanisms underlying these treatments. Results There were 11 cases (17 ears) of sniff-type PET and 20 cases (27 ears) of non-sniff-type PET. An improvement in symptoms was found in 72.7% of the patients who underwent silicone plug insertion (66.7% for sniff-type PET and 74.1% for non-sniff-type PET) and in 90.9% of the patients who underwent ventilation tube insertion for sniff-type PET. In TTAG assessments, many sniff-type PET patients showed significant synchronous changes at high levels of pressure (over 40 daPa) in the external auditory meatus and nasopharynx when performing a slight Valsalva manoeuvre (below 200 daPa).     

Ⅰ型鼓室成形术中咽鼓管功能的评估及其对疗效的影响

目的通过对采用Ⅰ型鼓室成形术治疗慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者的临床资料进行分析,探讨咽鼓管功能及其评估对其疗效的影响。方法分析64例(64耳)采用I型鼓室成形术治疗CSOM的患者资料,根据咽鼓管功能检测(ETS)结果分为咽鼓管功能障碍组及咽鼓管功能正常组。观察声导抗正-负压平衡法与ETS两种检测方法的一致率及两组患者术前及术后的气导听阈值变化、气骨导差值变化、鼓膜愈合、听力改善、干耳时间和并发症等指标情况。结果声导抗正-负平衡法与ETS两种检测方法一致率为76.56%,咽鼓管功能正常组和咽鼓管功能障碍组患者术后的气导听阈值和气骨导差均低于术前(P<0.05),两组在术前及术后(3个月、6个月)的气导听阈值、气骨导差及其差值变化,听力改善率、干耳时间等指标差异有统计学意义(P<0.05);而两组患者在的鼓膜愈合率、术后干耳率及术后并发症发生率差异均无统计学意义(P>0.05)。结论声导抗正负压平衡法结合ETS检测法对鼓膜穿孔患者进行主客观咽鼓管功能检测,可提高咽鼓管功能检测的准确率,可作为咽鼓管功能检测的补充手段。     

Longitudinal assessment of eustachian tube function in children

Eustachian tube function was evaluated in 27 children (32 ears) with tympanostomy tubes at 6-week intervals for 12 to 30 months. Using a modified inflation-deflation test of passive and active ventilatory function, it was found that the ears had persistent functional obstruction. Most ears exhibited no significant change in tubal function throughout the observation period. There was no difference in the ventilatory function when the nasal airway was congested (other than due to purulent upper respiratory tract infection) and not congested. However, significant seasonal effects on Eustachian tube ventilatory function were recorded: function was poorer in the winter than in the summer. No relationship was found between Eustachian tube ventilatory function and the age of the child.