Endoscopic transnasal shim technique for treatment of patulous eustachian tube
Endoscopic transnasal shim technique for treatment of patulous eustachian tube
复制标题
内镜下经鼻垫片技术治疗咽鼓管扩张
DOI：
10.1002/lary.24751
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
B. Davidson
中科院分区：
文献类型：
--
作者：
B. Rotenberg;B. Davidson
一个异常开放的咽鼓管，称为咽鼓管扩张（pET），可以导致禁用autophony以及恼人的呼吸和吞咽传输的声音。Poe等人的研究表明，咽鼓管（ET）鼻咽端的前外侧输卵管瓣存在解剖学缺陷。令患者及其护理人员沮丧的是，目前的医疗和手术治疗在消除pET症状的能力方面相对不一致。已经提出了许多治疗方法，包括硅胶塞、卷导管、鼓膜上的质量负载材料、银烧灼、结合雌激素滴、电烙、特氟隆/脂肪注射和软骨腔重建。2012年，我们来自西方大学的小组发表了输卵管隆凸缝合结扎治疗pET的结果。然而，随着时间的推移，我们发现在一些情况下，缝线最终会自行错位，可能是由于吞咽过程中作用在ET上的强大肌肉力量。在这些病例中，翻修手术通过放置填充骨蜡的缝线固定垫片来阻塞处于静止位置的ET管腔，从而恢复闭合机制的能力，立即改善了pET的功能-并且持续和长期地这样做。在这里，我们描述了我们的垫片技术和它的有效性，在消除autophony。
INTRODUCTION An abnormally patent Eustachian tube, known as a patulous Eustachian tube (pET), can cause disabling autophony as well as annoying transmitted sounds of breathing and swallowing. The elegant work of Poe’s group has shown that the anatomical defect is found in the anterolateral tubal valve of the nasopharyngeal end of the Eustachian tube (ET). To the frustration of both patients and their caregivers, current medical and surgical treatments are relatively inconsistent in their ability to eliminate the symptoms of pET. Numerous treatments have been proposed, including silicone plugs, rolled catheters, mass loading material on the tympanic membrane, silver nitrate cautery, conjugated estrogen drops, electrocauterization, Teflon/fat injection, and cartilaginous luminal reconstruction. In 2012, our group from Western University published the results of suture ligation of the torus tubaris for treatment of pET. Over time, however, we found that the sutures eventually worked themselves out of place in several cases, presumably due to the strong muscular forces acting on the ET during swallow. In these cases, revision surgery via placement of a suturefixated shim filled with bone wax to block the ET lumen in the resting position, thereby restoring the competency of the closing mechanism, immediately improved the pET symptoms—and did so both consistently and for the long term. Herein we describe our shim technique and its effectiveness in eliminating autophony.