摘要
目的探讨咽鼓管测压(Tubomanometry,TMM)联合主观评分在慢性化脓性中耳炎和慢性分泌性中耳炎的咽鼓管功能评估中的价值。方法对180例慢性化脓性中耳炎患者的229患耳,对侧正常耳131耳,68例慢性分泌性中耳炎的98患耳,对侧正常耳38耳,以及作为正常对照的24例耳鸣患者48耳,采用TMM检测获得客观咽鼓管(ET)功能评分。其次,另选择Valsalva动作能否完成和吞咽是否可听到click声作为主观评分。而客观ET评分加上主观评分获得总分。分析比较慢性化脓中耳炎和正常耳,分泌性中耳炎与正常耳在ET评分、主观评分、总分间的差异。结果1、慢性化脓性中耳炎中患耳ET评分、主观评分、总分分别为2.86±2.41、2.01±1.42、4.87±3.24,正常耳分别为4.96±1.73、3.21±1.13、8.17±2.27,结果显示患耳ET评分、主观评分及总分显著低于正常耳(P=0.000,P=0.000,P=0.000)。2、5例外耳道或鼓室内有肉芽形成的慢性化脓性中耳炎患耳,ET评分低,但主观评分却较高,结果互相矛盾。3、10例单侧慢性化脓性中耳炎穿孔耳ET评分为5.80±0.42(满分6分)、主观评分3.50±0.53(满分4分),而对侧未穿孔耳ET评分为5.60±0.52(满分6分),主观评分1.50±0.53(满分4分),结果显示未穿孔耳ET评分与主观评分互相矛盾。4、慢性分泌性中耳炎中患耳ET评分、主观评分、总分分别为2.17±2.13、1.58±1.38、3.76±2.78,正常耳分别为4.96±1.73、3.21±1.13、8.17±2.27,结果显示ET评分、主观评分及总分显著低于正常耳(P=0.000,P=0.000,P=0.000)。5、7例慢性分泌性中耳炎患者症状耳ET评分和主观评分高,而无症状耳ET评分和主观评分却低,两组间差异均具有显著性(P=0.017,P=0.026)。结论1、评估慢性化脓性中耳炎咽鼓管功能,ET评分、主观评分、总分三者具同等价值。2、当外耳道或鼓室有肉芽阻塞,可出现ET评分与主观评分矛盾,评判功能时需结合耳镜或颞骨CT了解患耳外耳道及中耳鼓室情况,这样可更客观地分析患耳的咽鼓管开放功能。3、对单侧慢性化脓性中耳炎的鼓膜大穿孔患者,当穿孔耳ET、主观评分高时,无穿孔耳可出现ET评分高,而主观评分低的矛盾现象。4、评估慢性分泌性中耳炎咽鼓管功能,ET评分、主观评分、总分三者具同等价值。5、部分分泌性中耳炎患者可出现症状耳与无症状耳评分结果相反,需结合纯音测听和声阻抗综合判断。
Objective To report the use of eustachian tube manometry(TMM)combined with subjective scores in evaluating eustachian tube function in patients with chronic suppurative otitis media or chronic secretory otitis media.Methods TMM was used in 180 patients with chronic suppurative otitis media(229 diseased ears and 131 contralateral normal ears),68 patients with secretory otitis media(98 diseased ears and 38 contralateral normal ears)and 24patients with tinnitus(48 ears as controls)to generate a eustachian tube(ET)function score.Successful Valsalva maneuver or a clicking sound upon swallowing was used as the subjective assessment score.The combination of both the ET function and subjective assessment scores was a total score.The three scores were compared between ears with chronic suppurative otitis media,secretory otitis media and controls.Results The ET function,subjective assessment score and total scores in chronic suppurative otitis media(2.86±2.41,2.01±1.42 and 4.87±3.24,respectively)were lower than in normal ears(4.96±1.73,3.21±1.13 and 8.17±2.27,respectively)(P=0.000,P=0.000,P=0.000).The ET function score was low in 5 cases of chronic suppurative otitis media with granulation in the ear canal or tympanic chamber,although with contradictory high subjective assessment scores(3.80±0.45 out of maximum score of 4).The objective ET function score was 5.80±0.42(maximum score=6)and subjective assessment score was 3.50±0.53 in 10 patients with large tympanic membrane perforation,and 5.60±0.52 and 1.50±0.53,respectively,in the contralateral non-perforated ear.The ET function score,subjective assessment score and total score in ears with secretory otitis media(2.17±2.13,1.58±1.38 and 3.76±2.78,respectively)were significantly lower than those in normal ears(4.96±1.73,3.21±1.13 and 8.17±2.27,respectively)(P=0.000,P=0.000,P=0.000).The ET function score and subjective assessment score in symptomatic ears were higher than in contralateral asymptomatic ears in 7 patients with secretory otitis media(P=0.017 and P=0.026,respectively).Conclusion The ET function score,subjective assessment score and total score are of equal value in evaluating eustachian tube function in chronic suppurative otitis media and in chronic secretory otitis media.With granulation obstruction in the external auditory canal or tympanic chamber,the ET function score and subjective assessment score may contradict each other,suggesting the need for otoscopy and/or temporal bone CT assessment of the external auditory canal and tympanic chamber for more accurate evaluation of eustachian tube function of the affected ear.In patients with large tympanic membrane perforation,the ET function score may contradict the subjective score in the contralateral non-perforated ear.In some patients with secretory otitis media,the scores may not be consistent in symptomatic and asymptomatic ears,demanding further combined pure tone audiometry and acoustic impedance evaluation.
作者
江黎珠
钟时勋
胡国华
宗小芳
康厚墉
JIANG LiZhu;ZHONG ShiXun;HU GuoHua;ZONG XiaoFang;KANG HouYong(Department of Otorhinolaryngology,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016)
出处
《中华耳科学杂志》
CSCD
北大核心
2020年第2期305-309,共5页
Chinese Journal of Otology
关键词
咽鼓管测压
慢性化脓性中耳炎
慢性分泌性中耳炎
评分
Eustachian tube manometry
Chronic suppurative otitis media
Chronic secretory otitis media
Score
