| BackgroundOpen radical mastoidectomy for the treatment of otitis media mastoiditis and cholesteatoma caused by suppurative otitis media is recognized as a feasible and effective treatment program,which brings benefits to the majority of patients with clinical ear diseases.The reason is that it enlarges the middle ear drainage channel,maximizes exposure of the middle ear structure,is conducive to removing lesions,smooth drainage of the middle ear,and achieves the goal of "self-cleaning".However,after open radical mastoidectomy,the occurrence of mastoid cavity infection and the delay of mastoid epithelialization time after mastoidectomy bring inconvenience to patients' lives,and are not conducive to the selection of hearing aids after operation.Eustachian tube balloon dilation is a new and effective operation in recent years.It is mainly used in the clinical patients with secretory otitis media,ear tightness,ear distension but no middle ear effusion.The cause of its occurrence is the dysfunction of the eustachian tube.At present,the eustachian tube is mainly used to dilate the eustachian tube through the eustachian tube oropharynx.The length of the balloon is limited,so it mainly acts on the cartilage of the eustachian tube,isthmus,bone and tympanic orifice.Therefore,it can not be reached in the open brea Eustachian tube was dredged by balloon dilatation device through tympanic orifice during radical resection of protrusion,which provided a good method for the recovery of patients after operation.ObjectiveTo summarize the clinical data of patients undergoing open radical mastoidectomy and using balloon dilatation equipment of eustachian tube,collect and compare the data of patients with balloon dilatation through tympanic orifice,pharyngeal orifice and only through pharyngeal orifice,explore the relationship between balloon dilatation and postoperative recovery outcomes,promote the understanding of balloon dilatation,help to better grasp the scope of application of this new technology,and guide the clinical comprehensive treatment of ears.Illness.MethodsAccording to the inclusion criteria,33 patients(12 left ears and 21 right ears)who underwent open radical mastoidectomy in otorhinolaryngology head and neck surgery of 988 Hospital of PLA from September 2016 to December 2017 were selected.After comprehensive examination,they met the indications for radical mastoidectomy.According to the way of balloon dilatation,they were divided into pharyngo-oropharyngeal dilatation group(control group)and transpharyngeal dilatation group(control group).In the tympanostomy and pharyngostasis dilation group(experimental group),the pure tone hearing threshold,acoustic impedance maps and local infection were recorded,and the pure tone hearing threshold,acoustic impedance,the probability of infection and the time of mastoid cavity epithelialization were recorded.The eustachian tube was dredged by balloon dilation during mastoid open surgery.The difference between experimental group and control group was compared,and the effect of balloon dilation on postoperative recovery was evaluated.ResultsFollow-up was carried out at 3 days before operation,1 month after operation,3 months after operation and 6 months after operation.The cavity condition was reexamined to 10 months after operation.One case of all 33 patients lost connection due to its own reasons and could not be followed up.The other 32 patients cooperated actively and came to the hospital regularly for reexamination.PTA and ABG were significantly improved at 6 months after operation compared with 3 days before operation.The proportion of type A curve was significantly improved at 6 months after operation compared with 3 days before operation.The ratio of B-shaped curve to As-shaped curve was significantly lower than that of 3 days before operation.The hearing of 30 cases was well preserved and the symptoms of tinnitus were significantly alleviated.One month after operation,5 cases of mastoid secretion were found by otoendoscopy,the incidence of infection was 15.62%(5/32);3 cases of facial recess and tympanic orifice showed a small amount of soft tissue shadow 3 months after operation,considering infection,the incidence was 9.37%(3/32),and the other patients had good epithelialization of mastoid cavity;6 months after operation,2 cases showed purulent secretion accumulation,the incidence was 6.25%(2/32),giving local treatment.After washing and antibiotic treatment,the epithelialization of mastoid cavity was good in the other patients;8 months after operation,1 case had infection,the incidence was 3.12%(1/32).The epithelialization of mastoid cavity was good in the other patients,and 10 months after operation,the follow-up showed that the epithelialization was good and no new infection cases were found.ConclusionAt the same time,balloon dilatation through pharynx and tympanic orifice is conducive to rapid epithelialization of mastoid cavity,rapid recovery of eustachian tube function,preservation of hearing and reduction of tinnitus.It is worthy of clinical application.Restoration of eustachian tube anatomical structure,that is,unobstructed eustachian tube is an important basis to play its physiological function.Dysfunction of eustachian tube can lead to the occurrence of otitis media.At the same time,recovery of eustachian tube function can promote the good prognosis of the disease.The two complement each other. |
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