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目的:分析鼻咽癌(NPC)放疗后分泌性中耳炎(SOM)的发生机制,依据循证医学(EBM)的原则,探索一种有效的、针对其发病机制各个环节的治疗方法。方法:对106例(112耳)NPC放疗后SOM患者,采用全身和局部抗炎、神经营养、扩张血管及激素治疗;加强鼻腔、鼻咽局部清理,治疗鼻腔鼻窦疾病;采用咽鼓管置管、冲洗及注药等综合治疗措施。结果:所有患者治疗前均有耳鸣、耳闷塞感及听力下降等症状,鼓室导抗图均为B型。经综合治疗后,耳鸣:消失81耳(72.32%),好转25耳(22.32%),无效6耳(5.36%),总有效率为94.64%耳闷塞感:消失92耳(82.14%),好转18耳(16.07%),无效2耳(1.79%),总有效率为98.21%。声阻抗检查:鼓室曲线A型56耳(50.00%),As型42耳(37.50%),B型2耳(1.79%),C型12耳(10.71%)。治疗后0.5、1.02.0kHz气导听阈均值为(28.5±3.0)dBHL,而治疗前为(47.0±5.0)dBHL,其差异有统计学意义(P<0.01)结论:依据EBM的原则,有针对性地对NPC放疗后SOM的发病机制的各个环节采取对因治疗,是非常有效和切实可行的,对提高NPC患者的生存质量具有重要意义。
OBJECTIVE: To analyze the mechanism of secretory otitis media (SOM) after radiotherapy for nasopharyngeal carcinoma (NPC) and to explore an effective treatment for all aspects of its pathogenesis according to the principles of evidence-based medicine (EBM). Methods: 106 patients (112 ears) NPC after radiotherapy SOM patients with systemic and local anti-inflammatory, neurotrophic, dilated blood vessels and hormone therapy; strengthen nasal and nasopharyngeal local cleaning, the treatment of nasal sinus disease; Eustachian tube catheter , Flushing and injection and other comprehensive treatment measures. Results: All patients had tinnitus, stuffy stuffy feeling and hearing loss and other symptoms before treatment. Tympanogram was type B. After the comprehensive treatment, tinnitus: 82 ears disappeared (72.32%), 25 ears improved (22.32%), 6 ears ineffective (5.36%), the total effective rate was 94.64% The improvement of 18 ears (16.07%), 2 ears (1.79%), the total effective rate was 98.21%. Acoustic impedance test: tympanogram 56 cases (50.00%) of A type, 42 cases of As type (37.50%), 2 cases of B type (1.79%) and 12.76% of C type (10.71%). The mean value of airway hearing threshold at 0.5 and 1.02.0 kHz after treatment was (28.5 ± 3.0) dBHL, while it was (47.0 ± 5.0) dBHL before treatment, the difference was statistically significant (P0.01) .Conclusion: According to the principle of EBM, It is very effective and practicable to take all the steps of SOM pathogenesis after radiotherapy for NPC, which is of great significance to improve the quality of life of NPC patients.