【摘要】 目的 :研究咽鼓管功能与粘连性中耳炎的发生、发展及治疗效果的相关性。方法 :为 93例施行咽鼓管CT造影 ,咽口和鼓口内窥镜观察和相应的手术处理。结果 :CT造影 :2例咽鼓管全程显影 ,显影的咽鼓管呈弧形 ,在不同平面显示不同节段 ,提示咽鼓管有“S”形弯曲。 4例仅鼓口点状显影 ,提示咽鼓管鼓口狭窄 ,后在手术中经鼓口内窥镜检查证实。咽鼓管鼓口内窥镜检查和狭窄处理 :16例中 12耳鼓口狭窄 ,11耳为骨性增生 ,1耳为骨性和钙化混合增生 ,均剔除增生骨质 ,形成喇叭口状。咽鼓管咽口内窥镜检查和处理 :按咽口形态分为宽阔、狭窄、缝隙 3种类型 ,总数 71耳 ,粘连性中耳炎组的发生率依次为 2 3,5,3耳 ;渗出性中耳炎组为 6,11,3耳 ;鼻部疾病 (中耳正常 )组为 2 0 ,0 ,0耳。经统计学处理粘连型和渗出型狭窄的发生率差异有显著性 (P <0 0 5)。粘连型、渗出型及鼻部疾病组狭窄和缝隙的发生差异率有高度显著性 (P <0 0 1)。粘连型和渗出型缝隙的发生差异无显著性 (P >0 0 5)。 1耳咽口内置入钛镍合金支架后 ,咽口立刻扩张。粘连型术后咽鼓管通畅和听力情况 :鼓口狭窄经剔除处理后的 11例、12耳 ,术后鼓室气化良好 10耳 ,再次局部粘连 1耳 ,中耳积液 1耳 ,听力提高 10dB以上 11耳 ,其中 3耳提高 4 5dB ,5耳提高更多还原

【Abstract】 Objective:To explore the relationship between morphology and function of eustachian tube and the genesis,development and result of adhesive otitis media.Method:93 cases were performed eustachian CT contrast examination,endoscopy of ostium tympanicum tubae auditivae,of pharyngeal opening of auditory tube.Result:The authors performed CT scan on 6 ears.Among them,2 cases revealed arched eustachian tube,which were different on different flats and suggested be “S”models;4 cases revealed only ostium tympanicum tubate auditivae which suggested constrictions .The authors performed endoscopy in 16 cases,12 esrs were constrictive in ostium tympanicum tubae auditivae,11 ears were with osseous hyperplasia,1 ear was osseous and calcific hyperplasia,they were all removed the hyperplastic bony and made the ostium tympanicum tubae auditivae to be flared.10 ears revealed good ventilation of tympani cavity,1 ear had a little adhesion at epitympany,1 ear had effusion.11 ears had improvement over 10 dB,of them,3 ears over 45 dB,5 ears over 20 dB.Adhesion in tympani cavity was kept apart by placing a piece of polydiocxanone.71 ears were divided into three groups:31 cases had adhesive otitis media(AOM),20 cases had middle ear effusion (MEE),20 had no ear disease(NED).They showed three shapes:wide,narrow,fissure.The narrow and fissure in AOM and MEE were much more than that in NED (P<0.01).The narrow in AOM were more than that in MEE (P<0.05).The fissure in AOM were equal to that in MEE (P>0.05).1 ear with fissure was implanted a titanium nickel support in cartilaginous part of eustachian tube,the ostium pharynx of tube showed open at once.Conclusion:Eustachian tube must be observed in overall situation.CT scan can help know morphology and function of eustachian tube.The stenosis of ostium tympani or pharynx will affect the function.But the stenosis can be deal with proper interfere.Adhesion in tympani cavity can be kept apart by using a piece of polydiocxanone which will be absorbed after 3 months and is better than silicon rubber member.更多还原