分泌性中耳炎治疗的分析现状-耳鼻咽喉科学专业论文.docxVIP

1 PAGE 1 PAGE 1 分泌性中耳炎治疗的研究现状 中文摘要 分泌性中耳炎是耳鼻咽喉头颈外科常见病和多发病，成人及儿童均可发生， 是听力下降的重要原因之一。以传导性耳聋及鼓室积液为主要特征，鼓室积液多 为浆液性或粘液性，无脓液形成。病因较复杂，其中咽鼓管功能障碍是最主要致 病因素，另外还有中耳局部感染、变态反应、遗传因素等。伴有耳闷、耳鸣及耳 痛的听力下降是其突出临床表现，检查可见鼓膜充血内陷。鼓室积液时鼓膜失去 正常光泽，并可透见状如弧形发丝的液平面及气泡。鼓膜活动受限。听力检查结 果提示程度不一的传导性聋。听力损失主要表现在低频，高频亦可有所下降。声 导抗检查示：平坦型曲线（即 B 型曲线）为分泌性中耳炎典型曲线。少数患者 可表现为 C 型曲线，提示咽鼓管功能障碍。CT 扫描提示中耳气腔有不同程度密 度增高。关于其治疗手段国内外尚存在较大争议。保守治疗是重要治疗方式，包 括规律药物治疗及物理治疗等，在保守治疗无效的基础上施行手术治疗。手术治 疗包括鼓膜治疗、咽鼓管治疗、针对病因的治疗、内镜治疗及乳突手术治疗等多 种方法，均各有利弊。传统疗法着重于鼓膜治疗，但创伤相对较大。近几年新兴 的咽鼓管治疗及内镜治疗减少了手术创伤，安全性及准确性均有较大提高。但仍 有许多不足之处是不容被忽视的。探寻安全有效且无创的治疗方法，为广大分泌 性中耳炎患者解除病痛是摆在许多研究者面前的重要任务，也是临床医师应肩负 起来的神圣使命。现本文就国内外关于分泌性中耳炎的治疗现状进行综述。 关键词：分泌性中耳炎；手术治疗；咽鼓管 Research status of treatments for secretory otitis media Abstract Secretory otitis media is a common disease in ear-nose-throat department,and has a high disease incidence.Both adults and children are possibly suffer from it,which is an important reason of hearing loss.It is characterized in conductive hearing loss and ear effusion .The ear effusion is serous or mucinous,without pus.The etiology is complex,and the disfunction of esucation tube is the most important reason in all of the factors,which include limited infection of middle ear,allergy and genetic factors as well.Hearing loss with ear fullness,tinnitus and earache is the outstanding clinical manifestation.Clinical examination shows that the tympanic membrane is congested and indented.The tympanic membrane loses its luster when ear effusion assists,and arcuated liquid surface or bubbles could be observed at the same time.Actitivity of the tympanic membrane could be restricted.Hearing examination shows varying degrees of conductive hearing loss.Low frequency hearing loss is significant while high frequency hearing loss exists ,too.Acoustic impedance shows,the flat curve(B type curve) is typical curve of secretory otitis media,but minority of patients show C type curve,which means disfunction of esucation tube.CT shows varying degrees of high density.T