鼓室軟骨片置入術治療頑固性耳咽管開放症－病例報告

Trans-Tympanic Cartilage Chip Insertion in a Patient with Intractable Patulous Eustachian Tube-Case Report

余瑞彬(Rui-Bin Yu) ； 林凱南(Kai-Nan Lin) ； 張淳翔(Chun-Hsiang Chang) ； 陳一嘉(Yi-Jia Chen) ； 陳正文(Jeng-Wen Chen)

《台灣耳鼻喉頭頸外科雜誌》 55卷1期 (2020/03) Pp. 32-36

https://doi.org/10.6286/jtohns.202003_55(1).032

摘要

耳咽管開放症之病因為耳咽管功能異常，無法順利關閉，患者有耳悶、自聽增強等症狀，當患者彎腰低頭或平躺時症狀有所改善。目前常見的治療方法包括保守觀察、增加體重、使用鼻滴劑、中耳通氣管置放、耳咽管填塞及耳咽管重建等。本文報告1名64歲女性，因耳悶及自聽增強無法緩解，經診斷後為耳咽管開放症。病患曾接受中耳通氣管置放、鼻滴劑及兩次經鼻耳咽管填塞，治療後主觀症狀仍持續存在。我們將病人的耳珠軟骨裁切後，經鼓膜切開處置入耳咽管峽部，病患術後恢復良好，耳悶及自聽增強主觀症狀均有明顯改善，無耳部不適。

關鍵字

patulous eustachian tube ； surgery ； tragal cartilage ； trans-tympanic（耳咽管開放症 ； 手術 ； 耳珠軟骨 ； 經鼓室）

並列摘要

Patulous eustachian tube is caused by inadequate closure of the eustachian tube (ET). Most patients have symptoms of aural fullness and autophony. These symptoms can be improved by posture change to the lordotic or supine position. Currently, treatments of the patulous eustachian tube include conservative observation, weight gain, nasal drops, tympanostomy tube, occlusion of ET, and reconstruction of the ET. We report a 64-yearold female, who was diagnosed as patulous eustachian tube due to aural fullness and autophony. The patient had received tympanostomy tube, nasal drops, and transnasal ET occlusion twice, but all are ineffective. We performed a trans-tympanic autologous tragal cartilage chip insertion for this patient. The tragal cartilages were trimmed and inserted into the isthmus of the eustachian tube through the tympanic membrane and the middle ear. The patient showed a significant reduction in symptoms of aural fullness and autophony. No ear discomfort was noted after the surgery. We demonstrated that the trans-tympanic autologous tragal cartilage chip insertion might be a feasible technique to treat intractable patulous eustachian tube.

並列關鍵字

patulous eustachian tube ； surgery ； tragal cartilage ； trans-tympanic