Ear drum incision endoscopic tube of the treatment of chronic otitis media with effusion Clinical Analysis

[Abstract] Objective: To evaluate the tympanic membrane incision endoscopic ear tube treatment of chronic secretory otitis media treatment. Methods: 42 cases of hospital patients with chronic secretory otitis media for the treatment group to the same period treated 40 cases of chronic otitis media with effusion control group patients in the conventional anti-inflammatory treatment, based on the control group was given sheets eustachian tube blowing technique, the treatment group received ear drum incision endoscopic catheter, two groups were compared the efficacy results: improved rate of 2 groups the difference was not statistically significant, P> 0.05, treatment group, the cure rate was higher, no less efficient than the control group, the test, the difference was statistically significant, P <0.05. Conclusion: Endoscopic ear drum cut set tube in the treatment of chronic secretory otitis media, simple operation to do, a significant effect.

[Keywords] endoscopy, chronic otitis media with effusion, tympanic membrane tube cut
Chronic otitis media with effusion is middle ear effusion, hearing loss, middle ear disease as the main feature, the performance of the middle ear milk membrane, periosteum, or bone deep suppurative inflammation, and its secretions thick, compared with non-surgical treatment poor, can cause serious intracranial complications [1]. the treatment of many surgical microscope to cut down the tympanic membrane and middle ear ventilation tube placement, but there are still major shortcomings trauma With the extensive application of endoscopy in the ear endoscopic incision down the middle ear cavity tympanic membrane tube can be carried out under direct vision, trauma, good curative effect. in our hospital 42 cases of chronic secretory otitis media were treated with ear drum incision endoscopic catheter, satisfactory outcome , the analysis is as follows.

1 Clinical data and methods
1.1 General information: In my hospital January 2006 December 2008 admitted 42 patients with chronic ENT otitis media with effusion in patients for the treatment group, 25 males and 17 females, age 1564, an average of 39.34 + -12.35 months, duration 625 months, an average of 16.13 + -3.25 months. to the same period 40 patients were treated for the control group, including 26 males and 14 females, age 1366, an average of 37.89 + -13.28 months, the duration of 727 months, on average, 18.62 + -5.32 All patients mainly as hearing loss, tinnitus and other ear and a sense of obstruction, check tympanic membrane retraction, light-cone disappears, weakening or disappearance of the tympanic membrane activity, a clear middle ear fluid levels, audiometry showed conductive or mixed hearing loss, air-bone gap <30dBHL, tympanogram photo "B"-type curve, tympanic negative pressure, conventional drugs and physical therapy, the symptoms do not improve [2] .2 groups in the proportion of men and women, differences in age and duration not statistically significant, p> 0.05, comparable.

1.2 Treatment: (1 control group: eustachian tube blowing Zhang surgery, oral cephalexin capsules (2 treatment groups: to give ear drum incision endoscopic catheter, as follows, the patient was sitting, routine disinfection ear canal, the ear canal into the zero endoscopy, look straight down at the display operation, first carefully observed cases of tympanic membrane and middle ear effusion, tympanic membrane with a cotton pad line anesthetic topical anesthesia, in the anterior tympanic membrane tympanic membrane puncture or after the next quadrant, from which ear cavity suction out secretions, into the pine needles dexamethasone 5mg and @ - chymotrypsin mixture needle 4000U Rinse, promote secretion of reduced residual viscosity, while reducing local edema, promote fluid excretion and absorption, smooth throat drum nozzle, followed with a knife in the tympanic membrane tympanic membrane before or after the lower quadrant for the next parallel to the external auditory canal wall with curved incision, about 12mm, damage to the tympanic mucous membrane only once, in order to avoid mucous membrane bleeding, endoscopic full suction drum interior effusion of cholesteatoma, cholesteatoma matrix clean-up and finally use special equipment to the middle ear tube silicone tube into the incision and accurate, surgery to block the ear canal with a sterile cotton mouth closed. postoperative intravenous antibiotics, oral prednisone, 1% nasal solution furosemide Ma 1 week after 14 weeks of weekly review 1, review 1 month later, there is still room if the drum can be administered by the oral fluid aspiration and injection of drugs wash, if 36 months or more without effusion, hearing a good recovery, given to take control.

1.3 Statistical Methods: Data analysis using statistical software SPSS14.0, count data by x2 test, with P <0.05 as the standard, the difference was significant.

2 Results
2 After treatment, the disease recovery schedule below shows two groups was not statistically significant difference in improvement rate, P> 0.05. Cure rate higher than the treatment group, no less efficient than the control group, the test, the difference was statistically significance, P <0.05.

After treatment, the condition in Schedule 2 Comparison of recovery
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Chronic secretory otitis media non-suppurative inflammatory disease, its etiology and pathogenesis remains unclear. Eustachian tube function is to balance the attic and outside air pressure, to maintain the normal tympanic membrane acoustic features, the surface of the cilia on the ciliated epithelium to the nasopharynx of campaign , the mucosal surface of the blanket layer of mucus, secretions help drum interior drainage to the nasopharynx. caused by many factors to consider lesions eustachian tube dysfunction, pathogen infection, allergy and other immune factors, the most important factors eustachian tube dysfunction caused by mechanical obstruction, if the Eustachian tube dysfunction occurs due to various causes will lead to the outside air can not enter the middle ear, the middle ear of the original gas will gradually be absorbed by mucous membranes, middle ear negative pressure, tympanic mastoid mucosal congestion and edema, serous exudation, the formation of middle ear effusion. long-term middle ear effusion, middle ear mucosa can be stimulated, leading to middle ear dysfunction, leading to many complications [3].

For the treatment of chronic otitis media with effusion, in addition to conventional anti-inflammatory treatment, available eustachian tube blowing tensioned, which will help discharge discharge, but the cumbersome process of repeatedly blowing sheets intubation, repeated intubation, pharyngeal opening of eustachian tube There is also damage to mucous membranes, inflammation and edema, increased obstruction [4], so it is more to surgery. tympanic membrane puncture the main surgical approach, myringotomy and tympanic membrane incision catheter three kinds. tympanic membrane tympanic membrane puncture and cut can not be complete drainage of the liquid drum room, attic and outside air pressure can not remain the same, the tympanic membrane incision catheter that allows continuous drainage of liquid drum interior, but also to maintain consistent air pressure inside and outside the drum, Eustachian tube patency and restore mucosal surface of the cilia motor function, but also can be administered through the ear canal repeated washing, the diluted liquid drum interior, and promote the outflow of liquid, promote the dissipation of the tympanic mucous membrane inflammation, so cut the catheter tympanic membrane is an ideal surgical approach. tympanic tube is usually cut in the mirror or headlight according to the amount as under, the more narrow field of vision, low light, exposure is poor, could easily lead to the size of the depth of incision discomfort, damage the middle ear structure, although the microscope can provide good lighting and high-quality magnified image, but only observed on the lens axis in front of the anatomy of the tympanic membrane of the cut tube, requires the use of otoscope and ear pulling, head position changes, exposure is not ideal. endoscopic Technology , with a clear operative field, simple operation, trauma, greatly reducing the operative time and postoperative recovery characteristics [5].

This study, the treatment group were treated with ear drum incision endoscopic catheter, the treatment group was higher cure rate, no less efficient than the control group, the test, the difference was statistically significant, P <0.05 We sum up, down the ear drum incision endoscopic catheter, has the following advantages: ① can choose exactly the tympanic membrane under direct vision incision, effectively control the size and depth of incision, avoiding the incision is too large, after the detached, catheter tube slide buried too deep to make the drum interior. ② can clearly understand the nature of middle ear effusion, middle ear and can be washed repeatedly medication drainage to prevent postoperative plugging or poor drainage. ③ fully look into the middle ear structures and prevent damage [6].

In summary, the ear drum incision endoscopic catheter line with the operative field clear, easy to operate accurately, trauma, etc., effectively avoiding the catheter to the external auditory canal, tympanic membrane and the promontory of the damage, reducing the incidence of complications.

References
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[3] Jiang Sichang, Rui Gu, Zheng-Min Wang. Ear science [M]. Shanghai: Shanghai Science and Technology Press, 2002,9:66.

[4] Xia, Liu Zhiying, Mo Yan-ling, et al. Eustachian tube dilation of 52 cases of secretory otitis media [J]. Clinical Otorhinolaryngology, 2007,11 (4): 170.

[5] Bassim MK, Drake AF. Tympanostomy tube obstruction related toototopicaldrugtherapy [J]. EarNoseThroatJ, 2005,84 (7): 416.

[6] Zhang Xin, Tianxiang E. Ear endoscopy in the middle ear surgery [J]. China Endoscopy, 1999,5 (1): 34 Links to free download http://www.hi138.com