Masked Patulous Eustachian Tube: An Important Diagnostic Precaution Before Middle Ear Surgery
Masked Patulous Eustachian Tube: An Important Diagnostic Precaution Before Middle Ear Surgery
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DOI：
10.1620/tjem.218.317
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发表时间：
2009-08-01
影响因子：
2.2
通讯作者：
Kawase, Tetsuaki
中科院分区：
文献类型：
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作者：
Kobayashi, Toshimitsu;Hasegawa, Jun;Kawase, Tetsuaki
咽鼓管通常是关闭的，但它在吞咽时仅打开不到一秒，以使中耳压力与大气压力平衡，并立即再次关闭。咽鼓管（PET）扩张的患者患有令人烦恼的症状，例如耳胀（耳朵中的胀感）、自鸣症（异常大声地听自己的声音）、听呼吸声以及呼吸时鼓膜的波动感。当患者主诉此类典型症状时，PET的诊断并不困难。然而，有一个意想不到的陷阱，其中PET的症状被传导性听力损失和明显的中耳病变所掩盖。在这里，我们建议这种情况被称为“掩蔽性咽鼓管扩张”，以促进正确的诊断前计划中耳手术。四个有代表性的患者与“掩蔽的咽鼓管扩张”：两个表现出的症状后，修复慢性鼓膜穿孔，一个镫骨手术后的耳硬化症，和一个后中耳炎手术。在这些患者中，由于听力改善，PET症状仅在手术后才变得明显。听力改善程度在15 ~ 40 dB之间。因此，重要的是要检查存在的“掩盖性咽鼓管扩张”，除了中耳疾病的手术计划。外科医生应告知患者“I掩蔽型咽鼓管扩张”的可能性，以避免术后失望。
The Eustachian tube is normally closed, but it opens upon swallowing for only less than one second to equalize the middle ear pressure with the atmospheric pressure, and immediately closes again. Patients with patulous Eustachian tube (PET) suffer from annoying symptoms, such as aural fullness (sensation of fullness in the ear), autophonia (abnormally loud audition of own voice), audition of breathing sound, and fluctuating sensation of the tympanic membrane upon respiration. The diagnosis of PET is not difficult when patients complain of such typical symptoms. However, there is an unexpected pitfall, in which the symptoms of PET are masked by the presence of conductive hearing loss and obvious middle ear pathology. Here, we propose that this condition be termed 'masked patulous Eustachian tube' to promote correct diagnosis prior to planning the middle ear surgery. Four representative patients with 'masked patulous Eustachian tube' are presented: two exhibited symptoms after repair of chronic perforation of the tympanic membrane, one after stapes surgery for otosclerosis, and one after cholesteatoma surgery. In these patients, the symptoms of PET became evident only after surgery due to the improvement of hearing. The degree of hearing improvement varied among the patients from 15 to 40 dB in average hearing level. It is therefore important to examine the presence of 'masked patulous Eustachian tube', in addition to a middle ear disease for which surgery is planned. The surgeon should inform the patient of the possibility of I masked patulous Eustachian tube' to avoid the postoperative disappointment.