耳内镜下鼓膜穿刺治疗分泌性中耳炎临床观察.docVIP

耳内镜下鼓膜穿刺治疗分泌性中耳炎临床观察 　　【摘要】目的:探讨耳内镜下鼓膜穿刺治疗分泌性中耳炎效果。方法:分泌性中耳炎50例患者取平卧位,头偏向健侧,行外耳道及鼓膜表面麻醉,直接插入0号耳内镜,在耳内镜直视下,用鼓膜切开刀在鼓膜紧张部前下或后下象限弧形切开鼓膜2-3mm,充分吸净鼓室内积液,注入地塞米松针5mg和α-糜蛋白酶针4000U混合液进行冲洗,再行负压吸引。术毕用消毒棉球封堵住外耳道口预防感染;同时口服抗生素,强的松,呋麻液滴鼻1周。结果:50例病例均获随访,平均7.8月,外耳道、鼓膜反应轻微,术后均诉耳聋、耳闷塞感、耳鸣症状缓解,未发现中耳渗液。治愈33例,有效12例,无效5例,有效率90.0%(45/50)。结论:耳内镜下鼓膜置管治疗分泌性中耳炎效果良好,治疗过程中熟练掌握鼓膜穿刺技术,注意头位固定,病因治疗也是预防的关键。 　　【关键词】内窥镜;鼓膜穿刺;分泌性中耳炎;地塞米松针;α-糜蛋白酶 　　 　　【Abstract】Objective: To explore the effect of auripucture with otic endoscope in treating secretory otitis media.Method: 50 patients with secretory otitis media were included in this research. Patients were fixed with supine position, head to the healthy side. After external auditory canal and tympanic membrane topical anesthesia, tense part of tympanic membrane were cut arc shaped into the anterior or posterior inferior with otic endoscope. Effusion in the tympanic cavity was drained followed with dexamethasone 5mg and α-chymotrypsin 4000U washing. After the operation, external acoustic foramen was filled with sterilized cotton ball. Patients were asked to taken antibiotics and prednisone orally with compound furacilin nasal drops for a week.Results: All 50 patients were followed up for an average of 7.8 months. Symptoms of deafness stuffiness and tinnitus were released. No obvious external auditory canal and tympanic membrane response or middle ear exudates were found. 33 patients were cured, 12 cases effective and 5 case ineffective, with effective rate 90.0%(45/50).Conclusion: Auripucture with otic endoscope is effective in treating secretory otitis media. Skilled auripucture, head position fixation and etiological treatment are also important in prevention. 　　【Key words】 Otic endoscope; Auripucture; Secretory otitis media; Dexamethasone; α-chymotrypsin 　　【中图分类号】R764.21 【文献标识码】A 【文章编号】1006-1959(2009)08-0091-02 　　 　　分泌性中耳炎是耳鼻咽喉科常见病和多发病,主要症状为中耳积液(包括浆液、黏液或浆黏液)及听力下降。我院2006年1月-2008年6月采用内窥镜下鼓膜穿刺,鼓室注射地塞米松,α-糜蛋白酶治疗分泌性中耳炎50例,疗效满意,报告如下。 　　 　　1 临床资料