The function of tubomanometry in forcasting the progonosis of acute otitis media with effusion
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摘要: 目的: 探讨咽鼓管测压(TMM)在判断急性分泌性中耳炎(OME)预后中的作用。方法: 对65例(84耳)OME患者的双耳均进行TMM检测,以量化评估咽鼓管(ET)功能。测试时在患者吞咽水的同时鼻咽部分别给予30、40及50 mbar的压力,记录各压力下鼻咽部压力和外耳道内压力随时间变化的曲线。根据曲线计算咽鼓管开放潜伏期指数R。R<1时表示ET开放正常,记为2分;R>1时表示ET延迟开放,记为1分;当外耳道没有记录到压力变化时表示ET没有开放,记为0分。将3个压力下测到的得分相加即为检测耳的ET评分(ETS),最差为0分,最好为6分。根据初次检测TMM时的病史情况将患者分为2组,慢性OME组[阳性对照组,30例(38耳)]及急性OME组[35例(46耳)]。患者的正常耳设为正常对照组,共计46例(46耳)。急性OME组患者在就诊后的1~2个月均采用统一、严格正规的治疗措施,根据疗效将急性OME组进一步分为有效组[26例(33耳)]和无效组[9例(13耳)]。结果: 正常对照组ETS为5.11±1.32,阳性对照组ETS为1.08±1.32,二者差异有统计学意义(P<0.01);急性OME治疗有效组和无效组在治疗前ETS均显著低于正常对照组(P<0.01),但有效组ETS显著高于阳性对照组(P<0.01),无效组ETS与阳性对照组比较差异无统计学意义;有效组和无效组在治疗后ETS均有显著提高(P<0.05),有效组治疗后ETS与正常对照组之间比较差异无统计学意义,无效组治疗后ETS仍显著低于正常对照组(P<0.01),与阳性对照组比较差异无统计学意义。结论: TMM可以判断急性OME的预后。急性OME患者的ET功能都存在不同程度的障碍,ETS较高的患者经过规范的药物、穿刺注药等治疗,ET功能可以恢复,OME可以治愈;ETS较低的患者则短期内难以治愈,可以考虑置管。若置管后ETS无明显好转,则应在发病3个月之内考虑更为积极的治疗措施,如咽鼓管球囊扩张术,旨在尽快恢复ET功能,避免发展为慢性OME。Abstract: Objective: To evaluate the function of tubomanometry (TMM) in forcasting the progonosis of acute otitis media with effusion (OME).Method: We used the technique of TMM to quantify the degree of eustachian tube (ET) dysfunction in 65 patients with OME. The opening of the ET and the transportation of gas into the middle ear were registered by a pressure sensor in the occluded outer ear after applying the stimulus of a controlled gas bolus into the nasopharynx during swallowing. Three excess pressure values were tested subsequently (30, 40, and 50 mbar). If tube opening was registered, the time of opening in relation to pressure applied was meas-ured. The TMM calculated the opening latency index or index R. An R value of <1 indicated early opening of the tube at the start of application of the stimulus, which was considered optimal. A value >1 indicated late opening of the tube occurring after the initial stimulus and was interpreted as suboptimal. Inability to calculate the index R value indicated that the tube was unable to actively open at all. The TMM results, were weighted as follows:no R with 0 points, R>1 with 1 point and R<1 with 2 points for the measurements at 30, 40, and 50 mbar, respectively. The points of these three tests were added so the ET score (ETS) ranges from 0 (worst value) to 6 (best value). According to the medical history, the patients were divided into two groups, chronic OME group (defined as positive control group), 30 cases with 38 ears; and acute OME group, 35 cases with 46 ears. The healthy ears of all patients were defined as normal control group, 46 cases with 46 ears. The same regular treatments, including classic medical treatments and intratympanic dexamethasone injections, were used to acute OME group in the following 1-2 months. On the basis of therapeutic effect, acute OME group was subdivided into valid group (26 cases with 33 ears) and invalid group (9 cases with 13 ears).Result: The ETS of normal control group was 5.11±1.32 while it was 1.08±1.32 in positive control group. It was found marked differences between the two groups (P<0.01). The ETS of both valid and invalid subgroup of actue OME group were significantly lower than normal control group (P<0.01), but in valid subgroup it was significantly higher than positive control group (P<0.01),and no marked difference was found between the invalid subgroup and positive control group. After treatments, a significant improvement of the ETS was found in both valid and invalid subgroup(P<0.05),there was no marked difference between valid subgroup and normal control group. But in invalid subgroup it was still significantly lower than normal control group (P<0.01).Conclusion: TMM could forecast the prognosis of acute OME. Patients with acute OME suffered from ET dysfunction of varied degrees. Those with high ETS could be cured by classic medical treatments and intratympanic dexamethasone injections. But those with poor ETS could not be cured in short period, tube insertion should be considered. If ETS could not be improved by ventilation tube placement, more active treatment, for example, balloon Eustachian tuboplasty (BET), should be used to prevent transforming into chronic OME.
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Key words:
- tubomanometry /
- otitis media /
- with effusion /
- prognosis /
- eustachian tube dysfunction /
- eustachian tube score
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