Clinical observation of chronic recurrent secretory otitis media in adults treated by balloon dilatation of Eustachian tube combined with myringotomy and catheterization
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摘要: 目的 探讨成人慢性复发性分泌性中耳炎采用咽鼓管球囊扩张术联合鼓膜切开置管术治疗的临床疗效。方法 按照随机数字表法，将2018年1月—2020年5月秦皇岛市第一医院耳科收治的100例(135耳)成人慢性复发性分泌性中耳炎患者随机分为对照组50例(68耳)和观察组50例(67耳)。对照组采取鼓膜切开置管术，观察组采取鼓膜切开置管术联合咽鼓管球囊扩张术，比较2组患者的总有效率、咽鼓管功能障碍症状评分量表(ETDQ-7)、咽鼓管测压R值计分、纯音听阈值、并发症发生率、生活质量评分、术后1年复发率。结果 观察组的总有效率高于对照组(P < 0.05)。与术前比较，2组患者术后3、6、12个月的ETDQ-7评分、各频率纯音听阈值均降低(P < 0.05)，咽鼓管测压R值计分升高(P < 0.05)；术后3、6、12个月，观察组的ETDQ-7评分、各频率纯音听阈值均低于对照组(P < 0.05)，咽鼓管测压R值计分高于对照组(P < 0.05)。与对照组相比，观察组的并发症发生率、术后1年病情复发率均更低(P < 0.05)。与术前比较，2组患者术后3、6、12个月的生活质量评分均增高(P < 0.05)；术后3、6、12个月，观察组的生活质量评分高于对照组(P < 0.05)。结论 咽鼓管球囊扩张术联合鼓膜切开置管术可有效改善成人慢性复发性分泌性中耳炎患者的咽鼓管功能，更好地促进患者听力的恢复，提高患者的临床治愈率，同时大大减少了并发症的发生率以及病情的复发率，明显提升了患者的生活质量水平，具有良好的临床疗效。Abstract: Objective To explore the clinical effect of balloon dilatation of the Eustachian tube combined with myringotomy and catheterization in treating chronic recurrent secretory otitis media in adults.Methods 100 cases(135 ears) of chronic recurrent secretory otitis media in our hospital from January 2018 to May 2020 were selected as the research objects, and were divided into two groups according to the random number table method, 50 cases(68 ears) in the control group and 50 cases(67ears) in the observation group. The control group received tympanostomy and catheterization, while the observation group received tympanostomy with catheterization and balloon dilatation of the Eustachian tube. The total effective rates, Eustachian tube dysfunction scores, Eustachian tube pressure R scores, pure tone thresholds, complication rates, scores of life quality and recurrence rates 1 year after operation were compared between the two groups.Results The total effective rate was higher in the observation group than the control group(P < 0.05). Compared with pre-operation, the score of Eustachian tube dysfunction, the pure tone listening threshold of each frequency were lower and the Eustachian tube pressure R scores were higher in the two groups at 3 months, 6 months and 12 months after operation(P < 0.05); 3 months, 6 months and 12 months after operation, the scores of Eustachian tube dysfunction, the pure tone listening threshold of each frequency in the observation group were lower than those in the control group(P < 0.05), and Eustachian tube pressure R scores were higher than those in the control group(P < 0.05). Compared with the control group, the incidence of complications and recurrence rate 1 year after operation were lower in the observation group(P < 0.05). Compared with before operation, the scores of life quality in the two groups were higher at 3 months, 6 months and 12 months after operation(P < 0.05); 3 months, 6 months and 12 months after operation, the scores of life quality were higher in the observation group than the control group(P < 0.05).Conclusion Tympanotomy combined with balloon dilatation of Eustachian tube can effectively improve the Eustachian tube function of adult patients with chronic recurrent secretory otitis media, it has impressiveclinical effects. On the one hand, it can be better to promote the recovery of patients' hearing and improve the clinical cure rate of patients; On the other hand, it reduce the occurrence of complications and disease recurrence greatly, so the quality of the patients' life were improved significantly.
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表 1 2组患者的总有效率比较
例(%) 组别 例数 痊愈 好转 无效 总有效率 对照组 50 20(40.00) 20(40.00) 10(20.00) 40(80.00) 观察组 50 26(52.00) 21(42.00) 3(6.00) 47(94.00)1) 与对照组比较，1)P < 0.05。 
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表 2 2组患者ETDQ-7评分、咽鼓管测压R值计分比较
分，x±s 组别 ETDQ-7评分 咽鼓管测压R值计分 30 mbar 40 mbar 50 mbar 对照组 术前 3.49±1.02 0.97±0.22 0.93±0.21 0.84±0.20 术后3个月 2.38±0.651) 1.04±0.231) 1.02±0.221) 0.91±0.231) 术后6个月 2.03±0.521) 1.09±0.251) 1.05±0.251) 0.98±0.221) 术后12个月 1.69±0.441) 1.15±0.261) 1.09±0.231) 1.04±0.241) 观察组 术前 3.45±1.04 0.96±0.23 0.94±0.22 0.85±0.21 术后3个月 1.72±0.491)2) 1.28±0.241)2) 1.25±0.231)2) 1.16±0.241)2) 术后6个月 1.51±0.431)2) 1.35±0.261)2) 1.30±0.241)2) 1.23±0.251)2) 术后12个月 1.24±0.401)2) 1.41±0.251)2) 1.34±0.251)2) 1.31±0.271)2) 与本组术前比较，1)P < 0.05；与对照组同期比较，2)P < 0.05。
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表 3 2组患者的纯音听阈值比较
dB，x±s 组别 250 Hz 500 Hz 1 kHz 2 kHz 4 kHz 8 kHz 对照组 术前 21.35±2.69 22.97±2.81 23.40±2.57 24.13±3.02 25.72±3.49 25.89±2.50 术后3个月 18.58±2.171) 19.84±2.431) 20.05±2.171) 21.06±2.151) 21.97±2.341) 22.40±2.371) 术后6个月 17.41±2.201) 18.65±2.361) 19.17±2.091) 19.97±1.811) 20.45±2.321) 21.73±2.241) 术后12个月 16.86±2.131) 17.78±2.521) 17.96±1.831) 18.64±1.731) 19.16±2.101) 20.56±2.191) 观察组 术前 21.22±2.73 22.86±2.85 23.29±2.52 24.82±3.06 25.59±3.40 25.72±2.63 术后3个月 16.32±1.941)2) 17.21±2.101)2) 17.94±1.861)2) 18.73±1.871)2) 19.28±2.091)2) 19.84±2.051)2) 术后6个月 15.17±1.951)2) 16.19±2.081)2) 17.05±1.801)2) 17.98±1.591)2) 18.07±1.961)2) 19.27±2.101)2) 术后12个月 14.59±1.871)2) 15.04±2.171)2) 16.10±1.741)2) 16.85±1.681)2) 16.93±1.851)2) 18.05±2.021)2) 与本组术前比较，1)P < 0.05；与对照组同期比较，2)P < 0.05。
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表 4 2组患者的并发症发生率、术后1年复发率比较
例(%) 组别 例数 鼓膜穿孔不愈合 咽鼓管口粘连 中耳出血 总发生率 术后1年复发率 对照组 50 3(6.00) 4(8.00) 1(2.00) 8(16.00) 9(18.00) 观察组 50 1(2.00) 0(0) 0(0) 1(2.00)1) 2(4.00)1) 与对照组比较，1)P < 0.05。
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表 5 2组患者的生活质量评分比较
分，x±s 组别 生理 心理 环境 社会关系 对照组 术前 70.81±5.20 70.23±5.14 70.34±4.91 70.55±5.09 术后3个月 77.34±5.421) 77.80±5.271) 76.46±5.231) 76.33±5.401) 术后6个月 80.96±5.171) 80.45±5.331) 79.58±5.091) 79.80±5.161) 术后12个月 83.42±5.231) 83.89±5.171) 82.67±5.121) 82.91±5.341) 观察组 术前 70.67±5.14 70.34±5.02 70.25±4.94 70.67±5.13 术后3个月 83.05±5.691)2) 83.49±5.381)2) 82.47±5.381)2) 82.56±5.711)2) 术后6个月 86.47±5.301)2) 85.97±5.211)2) 84.92±5.431)2) 85.23±5.201)2) 术后12个月 89.24±5.511)2) 89.50±5.491)2) 88.15±5.301)2) 88.43±5.261)2) 与本组术前比较，1)P < 0.05；与对照组同期比较，2)P < 0.05。
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