钟泗华

【摘要】 目的：探讨对分泌性中耳炎（secretory otitis media，SOM）患者使用鼻内镜下咽鼓管吹张治疗的临床效果。方法：对本院收治的中耳炎患者展开研究，参照分层抽样法将2018年2月-2020年1月200例分泌性中耳炎患者分为两组，每组100例。对照组予以传统导管吹张法治疗，治疗组予以鼻内镜下咽鼓管导管吹张注药治疗，比较两组治疗效果。结果：治疗组和对照组的治疗总有效率分别为94.00%和85.00%，治疗组总有效率较高，差异有统计学意义（P<0.05）;治疗前，两组纯音听阈的气导值相比差异无统计学意义（P>0.05）;治疗后，两组较本组治疗前纯音听阈的气导值均有明显下降，差异均有统计学意义（P<0.05），并且治疗组治疗后纯音听阈的气导值（20.61±9.34）dBHL，明显低于对照组的（27.01±9.52）dBHL，差异有统计学意义（P<0.05）。结论：对分泌性中耳炎患者使用鼻内镜下咽鼓吹张治疗，可以有效降低纯音听阈的气导值，改善患者听力障碍的现象，保障临床治疗的总有效率，临床应用价值显著。

【关键词】 鼻内镜 咽鼓管 吹张疗法 分泌性中耳炎 治疗效果

doi：10.14033/j.cnki.cfmr.2020.13.012 文献标识码 B 文章编号 1674-6805（2020）13-00-03

Efficacy Observation of Eustachian Tube Insufflation in Treating Secretory Otitis Media under the Guidance of Nasal Endoscope/ZHONG Sihua. //Chinese and Foreign Medical Research， 2020， 18（13）： -33

[Abstract] Objective： To discuss the clinical effect of eustachian tube insufflation in treating secretory otitis media （SOM） under the guidance of nasal endoscope. Method： Through stratified sampling method， 200 patients with SOM from February 2018 to January 2020 were investigated and assigned to two groups， 100 cases in each group. The control group took the conventional eustachian tube insufflation， the treatment group took the eustachian tube insufflation under the guidance of nasal endoscope. The therapeutic effects were probed. Result： The total effective rate in the treatment group and control group was 94.00% and 85.00%， the total effective rate in the treatment group was higher， the difference was statistically significant （P<0.05）. Before treatment， the pure tone threshold between groups showed no statistically significant difference （P>0.05）. After treatment， pure tone threshold for two groups was substantially reduced， the differences were statistically significant （P<0.05）. After treatment， the pure tone threshold in the treatment group was （20.61±9.34） dBHL and （27.01±9.52） dBHL in the control group， with statistically significant difference （P<0.05）. Conclusion： Under the guidance of nasal endoscope， eustachian tube insufflation can efficiently reduce the pure tone threshold， relieve the hearing disorder symptoms and increase the treatment effective rate. It is worthy of clinical application.

[Key words] Nasal endoscope Eustachian tube Insufflation Secretory otitis media Therapeutic effect

First-authors address： Wuhua County Peoples Hospital， Wuhua 514400， China

分泌性中耳炎（SOM）是临床耳科最常见、也是发病率最高的病症[1]。患者主要表现为中耳负压或积液，同时伴有不同程度的听力下降等症状，该病好发于冬春季节，儿童和成人均可发病[2]。经临床研究表明，对于中耳炎患者而言，咽鼓管出現狭窄、阻塞或功能障碍是引发SOM的主要原因[3]。正常情况下，中耳内部的压力和外部的压力基本相等，但当维持内外气压平稳的唯一途径的咽鼓管，当其发生堵塞或功能障碍时，中耳内的气体会被黏膜吸收，形成负压[4]。受负压的影响，患者中耳黏膜的静脉血管会随之扩张，通透性继而增加，大量的血清渗出形成中耳积液，对患者的听力造成一定的影响[5]。因此疏通咽鼓管是患者治疗的首要目的，而临床疏通咽鼓管的主要方式是咽鼓管吹张术，相较于传统的咽鼓管吹张术而言，鼻内镜下咽鼓管具有视野广阔、直观可视等特点[6]。……