咽鼓管功能检测及咽鼓管球囊扩张术的研究进展

咽鼓管功能障碍(Eustachian Tube Dysfunction,ETD)是许多中耳疾病发病的重要因素,可以导致中耳通气不足,引起耳满胀感和耳鸣,此外,还可能引起分泌性中耳炎、鼓膜内陷和胆脂瘤等并发症,但是临床并没有针对ETD检测的金标准。目前对于咽鼓管功能的测量方法包括:内镜检查、咽鼓管测压(Tubomanometry,TMM)、声导抗测量(Acoustic immittance measurement)、咽鼓管声测(Sonotubometry)、咽鼓管功能障碍问卷(7-item Eustachian Tube Dysfunction Questionnaire,ETDQ-7),以及将临床表现结合客观检查综合得出的咽鼓管评分量表(Eustachian Tube Score,ETS)和在此基础上提出的咽鼓管评分-7量表(Eustachian Tube Score-7,ETS-7)。临床上存在多种旨在改善咽鼓管功能的药物及手术方法,但疗效欠佳,咽鼓管球囊的出现为ETD的治疗提供了新的手段。本文就咽鼓管功能的检测方法以及咽鼓管球囊扩张术在临床的应用进行综述,以期为探索实用客观的ETD诊治方法提供思路。     

小儿分泌性中耳炎的咽鼓管功能研究进展

分泌性中耳炎（secretory otitis media，SOM）是小儿的常见病和多发病。小儿SOM病因是多因素的，包括免疫反应、咽鼓管功能障碍、细菌和病毒感染、遗传以及环境因素，其中咽鼓管功能障碍（eustachian tube dysfunction，ETD）和免疫反应可能是两个核心因素。咽鼓管（eustachian tube，ET）是连接中耳与鼻咽部的通道，ET主要有通气、保护和清洁功能，三者相辅相成。咽鼓管功能障碍分为ET阻塞（开放障碍）和异常开放（闭合障碍）两类。ET阻塞又分为功能性阻塞和机械性阻塞，前者多为肌肉开放功能低下；后者由肿瘤、腺样体阻塞或黏膜肿胀所致。     

七项咽鼓管功能障碍症状评分量表在评估咽鼓管异常开放症中的应用分析

目的　探讨七项咽鼓管功能障碍症状评分量表（the seven-item Eustachian tube dysfunction questionnaire，ETDQ-7）对量化评估咽鼓管异常开放症（patulous Eustachian tube，PET）的可靠性及临床价值。方法　选取2016年4月～2019年10月于佛山市第二人民医院耳鼻咽喉科门诊就诊的PET成年患者34例（51耳）作为观察组，对照组20名（40耳），采用ETDQ-7分别对观察组和对照组进行问卷调查，计算得分情况，并通过Cronbach's α信度系数评判量表内部一致性、接收者操作特征曲线（ROC）明确量表诊断价值。结果　ETDQ-7作为PET调查量表，α信度系数为0.879，ROC曲线下面积（AUC）0.966，量表的灵敏度为96.1%，特异度85%。结论　ETDQ-7用于评估PET其信度可靠，价值高，能有效评判PET成年患者主观症状的严重程度。     

咽鼓管及其周围结构形态与功能的关系

咽鼓管（Eustachian tube,ET)局部解剖的异常，可引起其一定的功能障碍，也可能是分泌性中耳炎（secretory otiti media,SOM）的原因之一，对ET功能的发挥以及其形态维持和功能之间的关系研究发现在人类腭帆张肌（tensor veli palatini muscle,TVPM)是ET扩张的主要肌肉，腭帆提肌（levator veli palatini muscle,LVPM)收缩有助于关闭ET而起保护作用，ET内粘膜具有许多皱襞及瓣膜结构，ET管内含有表面活性物质（suractant),ET周围还有Ostmann氏组织组织（Ostmann′s fatty tissue,OF)及粘膜相关的淋巴组织（mucosaassociated lymphoid tissue,MALT)，这些结构的正常是ET发挥正常功能的前提。     

咽鼓管球囊扩张术和鼓膜置管术治疗慢性分泌性中耳炎疗效的Meta分析

目的　通过Meta分析系统评价咽鼓管球囊扩张术（balloon dilation eustachian tuboplasty,BET）和鼓膜置管术（tympanostomy tube insertion,TTI）在慢性分泌性中耳炎（chronic secretory otitis media,CSOM）治疗中的疗效。方法　计算机检索中英文数据库中发表的关于CSOM的研究,检索时限从建库至2020年3月,严格按照纳入排除标准筛选文献并进行Meta分析。结果　共计纳入8篇文献,共500例（504耳）患者,其中BET组250例（253耳）和TTI组250例（251耳）,BET组治疗有效率较高[OR=3.4,95%CI （2.04,5.64）]。根据研究类型亚组分析,BET治疗CSOM有效率均高于TTI组（P <0.05）。根据咽鼓管功能障碍评分（7-item Eustachian tube dysfunction questionaire,ETDQ-7）亚组分析,术后6、12、18个月,BET组评分均低于TTI组（P >0.05）。根据PTA亚组分析,术后12个月,BET组PTA低于TTI组（P <0.05）。根据Valsava评分亚组分析,术后6个月,BET组Valsava评分低于TTI组（P<0.05）。根据术后并发症和复发率进行亚组分析,TTI组（7.79%,20%）均高于BET组（1.72%,0%）。结论　在考虑治疗有效率、PTA、Valsava评分、并发症和复发率方面,BET治疗CSOM的短期疗效优于TTI。     

咽鼓管测压在判断儿童分泌性中耳炎疗效及预后中的作用

目的　探讨咽鼓管测压（tubomanometry，TMM）对儿童分泌性中耳炎疗效及预后的评估价值。方法　选取65例（88耳，其中单耳30例，双耳29例）就诊于我科的儿童分泌性中耳炎患者为实验组，以相应年龄儿童的正常耳（30耳）作为正常对照组，所有患者均行正规的药物治疗，根据治疗的效果分为有效组（65耳）和无效组（23耳）。并分别在治疗前后进行纯音测听、声导抗、耳内镜及TMM测试同时记录结果。结果　治疗前无论是有效组还是无效组咽鼓管评分（Eustachian tube scores，ETS）平均值均低于正常对照组（P <0.01）；治疗后ETS平均值均高于治疗前（P <0.05）；治疗前有效组ETS高于无效组（P <0.05）；有效组治疗后ETS与正常对照组之间差别无统计学意义（P >0.05），无效组治疗后ETS仍低于正常对照组（P <0.01）。结论　分泌性中耳炎患者的咽鼓管功能均存在不同程度的障碍，经过治疗，咽鼓管功能改善。ETS较高的患者，经治疗，咽鼓管功能可以恢复；ETS较低者，短期内咽鼓管功能难以恢复，应尽快采取其他的干预措施恢复咽鼓管功能。咽鼓管测压在对儿童分泌性中耳炎的疗效及预后的判断中可提供一定的参考价值。     

咽鼓管-鼓室气流动态图法检测健康人咽鼓管功能的应用探讨

目的：探讨咽鼓管一鼓室气流动态图法（TTAG法）对健康人群咽鼓管功能进行不同亚群分类的临床实用性。方法：对66例（132耳）健康人使用TTAG法采用Valsalva动作检测咽鼓管被动通气功能，并对结果和图形进行分析。结果：TTAG法检测阳性率为93．3％（124／132）。根据曲线特点和吞咽次数将阳性耳分为Ⅰ型77耳，Ⅱ型47耳，两型ET开放时鼻咽腔压力均值比较差异无统计学意义（P〉0．05），外耳道压力均值差异有统计学意义（P〈0．01）。结论：TTAG法对判定健康人群中咽鼓管功能不同亚群状态有一定临床应用价值。     

七项咽鼓管功能障碍症状评分量表的应用分析

目的探讨七项咽鼓管功能障碍症状评分量表(the seven-item Eustachian Tube Dysfunction Questionnaire,ETDQ-7)临床应用的可靠性及其诊断价值。方法 2014年9月-2015年4月在我院门诊就诊的阻塞性咽鼓管功能障碍(Obstructive Eustachian Tube Dysfunction,OETD)成年患者46例作为观测组,同期年龄相当的健康志愿者25例为对照组,采用七项咽鼓管功能障碍症状评分量表(ETDQ-7)分别对其行问卷调查。计算两组得分情况,通过Cronbachα信度系数考察量表内部一致性、受试者工作特异性曲线(Receiver Operating Characteristic,ROC)明确其诊断价值、Spear-man相关性分析检验年龄与量表得分的相关性。结果 ETDQ-7中文版信度系数为0.879,受试者工作特异性曲线下面积(area under the ROC curve,AUC)为0.974,量表的灵敏度和特异度分别为95.7%、99.2%,患者年龄与量表得分之间无相关性。结论 ETDQ-7中文版信度可靠,诊断价值较高,无年龄差异,能够有效地量化评估成人阻塞性咽鼓管功能障碍主观症状的严重程度。     

伴变应性鼻炎的咽鼓管功能不良患者综合治疗效果观察

目的探讨对伴有变应性鼻炎（AR）的咽鼓管功能不良患者综合治疗的有效性。方法选择26例（38侧）伴有AR的咽鼓管功能不良患者,取得患者知情同意并按随机分配原则分成两组。对照组单纯行咽鼓管球囊扩张术,13例患者中8例单侧5例双侧;治疗组应用黏液促排剂桉柠蒎肠溶软胶囊7d后行咽鼓管球囊扩张术＋术后口服桉柠蒎肠溶软胶囊7d,13例患者中6例单侧7例双侧。对照组和治疗组其他基础治疗相同（包括术前术后糠酸莫米松鼻喷雾剂喷鼻、术前地氯雷他定片口服等）。结果两组术后效果明显不同：咽鼓管咽口肿胀情况和耳闷胀感恢复情况采用χ~2检验行统计学分析（P〈0.05）,治疗组与对照组差异有统计学意义;两组术后听力恢复情况有统计学意义（P〈0.05）,治疗组听力恢复情况显著好于对照组;其并发症消退及听力恢复时间明显缩短（统计学行t检验,P〈0.05,治疗组与对照组差异有统计学意义）。结论运用咽鼓管球囊扩张术治疗伴有AR的咽鼓管功能不良患者,围手术期运用黏液促排剂（如桉柠蒎肠溶软胶囊等）较效果更明显、治愈率高,值得临床推广应用。     

变应性鼻炎与咽鼓管功能障碍：从百度指数到相关症状的研究

目的　研究变应性鼻炎（AR）患者咽鼓管功能状态。方法　利用百度指数,比较关键词“过敏性鼻炎”和“咽鼓管”搜索量及搜索人群分布情况。同时,收集45例AR患者及36名健康志愿者,行鼻部症状及咽鼓管功能评估,AR患者经规范治疗后复查。结果　百度指数显示,“过敏性鼻炎”和“咽鼓管”的搜索量及人群分布呈正相关（P <0.001）。45例AR患者中20例（44.4%）存在咽鼓管功能障碍,其中鼻塞视觉模拟量表评分与七项咽鼓管功能障碍症状评分量表评分呈正相关（P <0.05）;治疗后,AR患者七项咽鼓管功能障碍症状评分量表评分明显下降（P <0.001）。结论　AR可引起咽鼓管功能障碍,其中咽鼓管功能与鼻塞症状关系最为密切。咽鼓管功能状态可随鼻部症状的减轻而改善。     

Eustachian tube evaluation in patients with obstructive sleep apnea syndrome

Objectives: Investigate the presence of Eustachian Tube Dysfunction (ETD) in Obstructive sleep apnea (OSA) patients. Correlate the ET function and the severity of the sleep apnea syndrome. Correlate nasal resistance and nasal mucociliary clearance with the onset of ETD in these patients.

Materials and methods: Forty patients affected by OSA were enrolled in our clinical prospective study. Thirty patients were also investigated as a control group. All of the analyzed subjects underwent ENT examination, anterior rhinomanometry and test for mucociliary transport time. To evaluate Eustachian tube function the Eustachian tube score-7 (ETS-7) were employed.

Results: Twenty percent of the patients with a diagnosis of OSA had a diagnosis of ETD (ETS-7?≤?7) with a statistical difference with control group (p?=?.03). No differences regarding ETD in OSA sub-groups were found.

Conclusion: This study showed that ET blockage or delayed openings were found in most adult patients with OSA when evaluated by a sensible score as the ETS-7. Our data suggest that an evaluation of the Eustachian tube function should be performed in patients suffering from obstructive sleep apnea syndrome.     

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

ObjectiveTo evaluate the significance of Eustachian tube (ET) angles and ET pretympanic diameter on high resolution computed tomography (HRCT) Temporal bone in patients with chronic otitis media (COM).MethodsA retrospective study was carried out at Tertiary care centre. Group A included 92 ears with COM (38 patients with bilateral COM and 16 with unilateral COM); and Group B included 108 normal ears (54 patients with bilateral normal ears). Reid plane-ET angle, Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone, and compared in the two groups. Patients with chronic otitis media (Group A) were subdivided into Group A1 (Blocked ET) and Group A2 (Patent ET). The parameters were evaluated and compared in the subgroups too.ResultsThe mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41 ± 2.57 and 148.12 ± 3.43 respectively; whereas in Group B it was 27.56 ± 3.62 and 145.14 ± 4.34 respectively. Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients. ET pretympanic diameter was (5.37 ± 2.10) mm in Group A and (6.47 ± 2.40) mm in Group B. It was significantly less in patients with COM. A significant correlation was found between the ET patency and the two ET parameters (Reid plane-ET angle and pretympanic diameter).ConclusionsEustachian tube angles in adults may play a significant role in the etiology of chronic otitis media. Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.     

Efficacy of balloon Eustachian tuboplasty on the quality of life in children with Eustachian tube dysfunction

Abstract

Background: Balloon Eustachian Tuboplasty (BET) is used as a second-line treatment in cases in which adenoidectomy, paracentesis, and VT have failed. However, studies have not investigated the efficacy of this procedure as a first-line treatment.

Objectives: To evaluate the quality of life in children with chronic Eustachian tube dysfunction (ETD) after BET using the Otitis Media-6 (OM-6) questionnaire.

Methods: We retrospectively evaluated the data of 62 children with chronic dysfunction ETD and divided patients into the following groups: 30 cases underwent BET (group 1), and 32 cases underwent ventilation tube (VT) insertion from July 2016 to April 2018. The children’s parents were instructed to complete the OM-6 questionnaire preoperatively and at 6?weeks and 1?year postoperatively.

Results:. The average preoperative scores were higher than the postoperative scores, and the average 6-week postoperative scores were higher than the average 1-year postoperative scores for both groups 1 and 2. Further, the average 6-week postoperative scores from patients in group 2 were significantly higher than those in group 1.

Conclusion and significance: Our results demonstrate that BET may be a safe, first-line intervention that positively effects the quality of life in children with chronic ETD.     

Analysis on the correlation between Eustachian tube function and outcomes of type I tympanoplasty for chronic suppurative otitis media

Abstract

Background: The potential influence of Eustachian tube dysfunction (ETD) on the efficacy of tympanoplasty is controversial.

Objective: This study aims to investigate the correlation between Eustachian tube function (ETF) and outcomes of type I tympanoplasty for chronic suppurative otitis media (CSOM).

Materials and Methods: 53 patients with CSOM and receiving type I tympanoplasty were divided into a dysfunction group (Eustachian tube score; ETS ≤ 5points) and a normal group (ETS > 5 points) according to their preoperative ETS. During the one-year follow-up, the ETS, hearing results, and eardrum condition of the patients were recorded and analyzed.

Results: The ETS improved significantly from 2.57 (±1.73SD) to 4.68 (±2.00SD), while the mean air–bone gap (ABG) decreased significantly from 20.94 (±9.04SD) dB to 16.43 (±9.06SD) dB in the dysfunction group (p?<?.05). The postoperative ABG showed no significant difference in the two groups. The healing rate of the tympanic membrane was 96.43% in the dysfunction group, and 100% in the normal group.

Conclusions and significance: The ETF was significantly improved after type I tympanoplasty for CSOM combined with ETD, and the postoperative efficacy was not adversely affected. The ETD may not influence the outcomes of type I tympanoplasty for CSOM.     

Treatment of pharyngotympanic tube dysfunction

Eustachian tube dysfuntion intends to describe a variety of signs, symptoms, and physical findings that result from the impairment of ET function. A large variety of methods have been employed to assess ET function in the literature. Due to the lack of high level evidence, it is difficult to draw conclusions on the effectiveness of medical and surgical treatments. There are various medical and surgical interventions available for chronic obstructive ET dysfunction including balloon Eustachian tuboplasty (BET) and laser or microdebrider tuboplasty. Consensus on diagnostic criteria for ETD is required to define inclusion criteria of future trials. There is however emerging work with reassuring, but preliminary, results that suggest evidence for safety in the surgical management of ETD. Like many newly introduced techniques the current data remains limited to non-controlled case-series, with heterogeneous data collection methods and lacking substantial long-term outcomes. Nevertheless, short-term data provide favorable results. Current treatment options comprising BET and patulous ET surgery may be offered as a treatment possibility to selected patients.     

The role of immunomodulatory oligonucleotides in prevention of OVA-induced Eustachian tube dysfunction

OBJECTIVE: To evaluate the potential role of immunomodulatory oligonucleotides (IMO) in the prevention of OVA-induced Eustachian tube dysfunction (ETD) in a rat model. METHODS: Brown-Norway rats were sensitized to ovalbumin (OVA) and randomized to receive pre-treatment with IMO or phosphate buffered saline (PBS). After systemic sensitization, subjects received a transtympanic OVA challenge followed by evaluation of the Eustachian tube's dynamic function. RESULTS: Pre-treatment of OVA sensitized animals with IMO normalized passive opening and closing Eustachian tube pressures, improved active clearance of negative pressure in the middle ear, and resulted in reduced mean mucociliary transit times compared to untreated OVA-sensitized animals (P<0.001). CONCLUSION: These data demonstrate that pre-treatment with IMO prevent OVA-induced ETD in the rat. IMO treatment in the future may offer considerable promise in the management of OME in children.     

The efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube patient

Objective: To assess the efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube (PET) patients.

Methods: A prospective survey of medical records identified 36 patients and 47 ears with PET, and 15 patients and 15 ears as control. The ETDQ-7, patulous Eustachian tube handicap inventory-10 (PHI-10) and Likert scale were evaluated. PET patients were divided into two groups based on severity of symptoms using the PHI score.

Results: The Cronbach α value of the PET group was 0.765. The average total score of the ETDQ-7 in the control group was 7.6?±?1.1 and 22.5?±?10.0 in the PET group (p?r?=?0.248, p?=?.09). The average total score of the ETDQ-7 in the mild or moderate PET group was 19.9?±?9.0 and 25.3?±?11.1 in the severe PET group and this was not statistically different (p?=?.08).

Conclusion: The highest ETDQ-7 score was also observed in PET patients and in ET dysfunction patients. These findings necessitate careful discrimination between ET dysfunction and PET in balloon dilation Eustachian tuboplasty (BET) based on ETDQ-7.     

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.     

Objective assessment of autophony in patients with patulous Eustachian tube

The objective of the present study is to evaluate the Eustachian tube (ET) acoustic patency during phonation. The sound level in the EAC during phonation of the “A” and ”N” sounds was measured by microphones in the bilateral EACs of nine normal subjects and 31 patients with patulous ET. The measured sound pressure differences between the right and left ears were correlated with the differences in severity of autophony between the bilateral ears assessed by a visual analogue scale (VAS). The patulous condition was often remarkable when the “N” sound was phonated. In some patients with patulous ET, the patulous condition was indicated only by the present method, and not by conventional ET function tests such as tubo-tympano-aerodynamic-graphy or sonotubometry.