The discussion on the application of simultaneous balloon Eustachian tuboplasty in the hearing reconstruction in patients with chronic suppurative otitis media
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摘要: 目的 探讨同期咽鼓管球囊扩张术(BET)在慢性化脓性中耳炎患者听力重建中应用的意义。方法 回顾性纳入23例(23耳)诊断为慢性化脓性中耳炎合并咽鼓管功能障碍并接受听力重建手术的患者, 其中病例组12例(12耳)同期行BET和听力重建手术, 对照组11例(11耳)单纯行听力重建手术。所有患者均在术前以及术后1年内进行咽鼓管功能评分(ETS)、纯音听阈测试, 并就耳闷胀感、听物朦胧感、耳鸣、听力下降等症状的主观改善程度对患者进行随访问卷调查, 对比分析两组患者以上结果的差异。结果 两组患者术前的ETS和纯音听阈测试结果差异无统计学意义(P>0.05)。病例组患者术前及术后的ETS分别为(3.75±2.42)分、(6.58±2.19)分, 对照组患者分别为(3.18±1.99)分、(4.27±1.79)分, 术后均较术前改善(P < 0.01), 病例组改善程度优于对照组(P < 0.05)。病例组术前的气导听阈、骨导听阈及气骨导差分别为(65.17±11.56) dB、(24.25±12.96) dB、(40.92±12.17) dB, 术后降低至(30.58±6.40) dB、(23.67±9.74) dB、(6.92±12.00) dB; 对照组术前的气导听阈、骨导听阈及气骨导差分别为(63.55±9.74) dB、(22.64±8.61) dB、(40.91±9.83) dB, 术后降低至(41.45±15.50) dB、(25.73±8.52) dB、(15.73±11.20) dB。两组患者术后的气导听阈和气骨导差较术前改善(P < 0.01), 病例组术后气导听阈显著低于对照组(P < 0.05)。随访问卷调查显示, 病例组患者耳闷胀感、听物朦胧感、听力下降的主观改善程度评分高于对照组(P < 0.05)。结论 慢性化脓性中耳炎合并咽鼓管功能障碍的患者行听力重建手术时同期行BET能有效提高听力改善程度, 并能改善咽鼓管功能和主观症状。Abstract: Objective To explore the application of simultaneous balloon Eustachian tuboplasty(BET) in hearing reconstruction in patients with chronic suppurative otitis media.Method Twenty-three patients(23ears) who diagnosesd as chronic suppurative otitis media and Eustachian tube dysfunction and underwent hearing reconstruction surgery were retrospectively enrolled, including 12 patients(12 ears) received BET + hearing reconstruction surgery as the case group, 11 patients(11 ears) received hearing reconstruction surgery as the control group. All patients underwent Eustachian tube function score(ETS) and pure tone audiometry before the surgery and one year after the surgery. The subjective improvement degree of symptoms such as ear fullness, muffled hearing, tinnitus and hearing loss were investigated. The differences in test results between the two groups were analyzed.Result There was no statistically significant difference in ETS and pure tone audiometry between the two groups before the surgery(P>0.05). The preoperative ETS and postoperative ETS of the case group were 3.75±2.42 and 6.58±2.19, compared to 3.18±1.99 and 4.27±1.79 of the control group. ETS of two groups were improved after surgery(P < 0.01), and the improvement degree of the case group was better than that of the control group(P < 0.05). The preoperative air conduction hearing threshold, bone conduction hearing threshold and air bone gap of the case group were(65.17±11.56) dB, (24.25±12.96) dB, (40.92±12.17) dB, and decreased to(30.58±6.40) dB, (23.67±9.74) dB, and(6.92±12.00) dB after surgery. The preoperative air conduction hearing threshold, bone conduction hearing threshold and air bone gap of the control group were(63.55±9.74) dB, (22.64±8.61) dB, (40.91±9.83) dB, and decreased to (41.45±15.50) dB, (25.73±8.52) dB, (15.73±11.20) dB after surgery. The air conduction hearing threshold and air bone gap of the two groups were improved after surgery(P < 0.01), and the postoperative air conduction threshold of the case group was significantly lower than that of the control group(P < 0.05). In the follow-up questionnaire results, the subjective improvement degree of ear fullness, muffled hearing and hearing loss in the case group was higher than that of the control group(P < 0.05).Conclusion In patients with chronic suppurative otitis media and Eustachian tube dysfunction, simultaneous BET and hearing reconstruction surgery can effectively increase the patients' hearing improvement degree, and can improve the Eustachian tube function and subjective symptoms.
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表 1 ETS评分方法
症状 2分 1分 0分 TMM 30 mbar R < 1 R≥1 没有记录到压力变化 TMM 40 mbar R < 1 R≥1 没有记录到压力变化 TMM 50 mbar R < 1 R≥1 没有记录到压力变化 吞咽时的click声 经常有 偶尔有 没有 Valsalva时的click声 经常有 偶尔有 没有 
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表 2 两组患者术前与术后的纯音听阈测试结果
dB 组别 气导听阈 骨导听阈 气骨导差 术前 术后 术前 术后 术前 术后 病例组 65.17±11.56 30.58±6.401)2) 24.25±12.96 23.67±9.74 40.92±12.17 6.92±12.001) 对照组 63.55±9.74 41.45±15.501) 22.64±8.61 25.73±8.52 40.91±9.83 15.73±11.201) 与术前比较，1)P < 0.01；与对照组比较，2)P < 0.05。
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表 3 患者症状的主观改善程度
分 组别 耳闷胀感 听物朦胧感 耳鸣 听力下降 病例组 7.92±1.441) 7.17±1.751) 6.17±1.34 8.25±1.141) 对照组 5.45±1.75 5.36±2.06 5.36±1.86 6.27±2.05 与对照组比较，1)P < 0.05。
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