Balloon Dilation Eustachian Tuboplasty Combined With Tympanotomy Tube Insertion In The Treatment Of Atelectasis Otitis Media Of Type Ⅱ And Ⅲ

Objective:To report outcomes of balloon dilation eustachian tuboplasty（BET）combined with tympanotomy tube insertion in the treatment of atelectasis otitis media of type Ⅱ and Ⅲ.Methods:In this study,dating from February 2016 to February 2017,13 patients（17 ears）were diagnosed with atelectasis otitis media of type Ⅱ and Ⅲand underwent tympanotomy tube insertion andBET.Endotoscopy examination,tympanometry test,pure tone audiometry（PTA）,and the 7-item eustachian tube dysfunction questionnaire（ETDQ-7）were followed up at 1,3,6 and 12 months after operation.At 12 months,the temporal bone CT was reviewed and the dynamic displacement of the peak pressure point in the tympanogram was checked after the eardrum was healed.The above results compared with preoperative data for statistical analysis.Results:1、Comparison of ETDQ-7 scores before and after surgery.The preoperative ETDQ-7 score was 4.26±0.68 and dropped to 2.15±0.89 one month after surgery.The data of two groups were statistically significant at t=7.69 and P=1.38*10^-8.Similarly,ETDQ-7 at 3,6,and 12 months after operation were 2.31±0.88,2.54±1.07 and 2.36±0.91,and there were statistically difference from the preoperative.There was no significant difference between 1,3,6 and 12 months after operation.On the general trend,the ETDQ-7 score was lowest at 1 and 3 months after surgery and slightly increased thereafter but stabilized.2、Comparison of PTA and tympanogram before and after surgery.The preoperative PTA was 41.47 ± 12.08 dB HL and decreased to 23.64 ± 8.97 dB HL at 1 month after operation.The data of two groups were statistically significant at t = 4.88 and P=3.36*10^-5.PTA at 3,6,and 12 months after operation were 26.88 ± 8.24 dB HL,27.12 ± 7.79 dB HL and 25.76 ± 7.64 dB HL,and there were statistically difference from the preoperative.There was no significant difference between 1,3,6 and 12 months after operation.On the overall trend,PTA was the lowest at 1 month after surgery,and it increased slightly but stabilized afterwards.The rate of types A,B,and C tympanograms preoperatively was 0.0%,94.1%,and 5.9%.1 to 6 months after after operation,tympanogram were B and C type.12 months after operation,the rate of types A,B,and C tympanograms was 29.4%,52.9%,and 17.7%.3、Comparison of the dynamic displacement of the peak pressure point in the tympanogram before and after surgery.All patients before surgery,the dynamic displacement of the peak pressure point in the tympanogram showed ET dysfunction.Postoperative 6-12 months,after extubation and tympanic membrane healing,the dynamic displacement of tympanogram peak pressure point was reviewed.The ET function was normal 64.7%.4、The impact on the efficacy of the lack of ventilation in attic.In Case 1,tympanic membrane showed atelectasis otitis media of type Ⅱ with the tympanic cavity slightly retracted.The temporal bone CT showed that it was hardened mastoid,the tympanic cavity filled with soft tissues,and the morphology of ossicular chain was intact.Postoperative subjective and objective assessments show better results.In Case 2,tympanic membrane showed atelectasis otitis media of type Ⅱ with attic retraction pocket,but there is no signs of cholesteatoma.The temporal bone CT shows the diplotic mastoid with soft-tissue in atticus,tympanic cavity and antrum and without bone erosion.The morphology of ossicular chain was intact,though it can be seen some sclerosis around ossicular chain.At 12 months after operation,eustachian tube function improved,but subjective feeling was poor.The temporal bone CT showed there was no significant improvement with preoperative.Conclusion:1、BET is a simple,safe and effective treatment for atelectasis otitis media of type Ⅱ and Ⅲwith a effective rate of 64.7%.2、The symptom significantly improvement at 1 month after operation.The overall curative effect of operation tended to be stable 6 to 12 months post-operatively.3、Atelectasis otitis media can be accompanied by eustachian tube dysfunction and the lack of ventilation in attic.BET can not solve the problem of ventilation in attic.So in these cases,BET simply combined with tympanotomy tube insertion lead to invalid.