| Objective: To investigate the postoperative effect of different diameters of CO2 laser tympanostomy in the treatment of secretory otitis media caused by radiotherapy in patients with head and neck tumor,and to find out the best diameter range of tympanostomy according to the curative effect.Methods:40 ears(23 cases,including 6 single ear perforation and 17 double ear perforation)were collected from January 2019 to January 2020(1 year in total)after radiotherapy in otorhinolaryngology department,Affiliated Hospital of Dalian Medical University.The average 40 ears were divided into two groups: the diameter of perforation ≤ 3mm and the diameter of perforation > 3mm,and the results were recorded as A and B groups,Each group was 20 ears.A.B both groups were compared with tympanum and pure tone threshold after perforation,and then performed pure tone threshold measurement,tympanoplasty and otoendoscopy 1,3,6 months after operation respectively.Meanwhile,patients were asked to assist in filling in the score scale of eustachian tube dysfunction,to understand the difference of clinical symptoms and to count the complications after operation.The changes of the size of the holes were compared with the corresponding attractors during the follow-up.The number of the healing and non union of the tympanic membrane was recorded at the same time at the first,third and sixth months after the operation,and the tympanum diagram was performed for each patient.The results were based on the results of 6 months after operation and evaluated according to the following criteria:(1)the effect was obvious:the original symptoms were improved obviously,the difference between the gas bone conduction and the control was less than 10 d B compared with that of the day after operation.No effusion was found in the drum room under the endoscope,the drainage was smooth,and the edge of the hole was clean and smooth(2)Effective: the original clinical symptoms were improved in the history,the difference between the gas and bone conduction was less than 10 d B compared with the control on the day after operation.A little fluid was collected in the drum room under the endoscope,and the drainage was smooth,and the edge of the hole was clean and smooth(3)Invalid: the original clinical symptoms in the history did not improve or worsen,and there were corresponding complications such as middle ear infection.The difference between gas and bone conduction was not changed or aggravated than that of the day after operation.Under the endoscope,the effusion in the drum chamber was seen,the liquid level was visible,and the edge of the hole was polluted.Total effective =(significant +effective)/ total ears × 100%。 A.The age and gender of the two groups were tested by the balance test,and there was no significant difference.SPSS 24.0 statistical software was used to process the data,and Fisher was used to evaluate the difference of the preoperative and postoperative air bone conduction difference between patients and evaluate whether the different diameter of the perforation had difference in the treatment of secretory otitis media after radiotherapy for head and neck tumor,P < 0.05 was statistically significant;The results of Fisher accurate test were used to evaluate the effectiveness of different diameter of perforation on the treatment of secretory otitis media after radiotherapy for head and neck tumor,P < 0.05 was statistically significant.Result:(1)After operation,the mean value of pure tone hearing threshold air bone conduction difference in group A was significantly lower than that in group B(P< 0.05),indicating that the postoperative hearing recovery in group A was better than that in group B;compared with group A and group B,the mean value of air bone conduction difference in group A was less than that before operation(P < 0.05),indicating that under the set perforation area in group A,the postoperative effect was significant;there was no statistical difference in the mean value of air bone conduction difference before and after operation in group B The difference was statistically significant(P > 0.05),indicating that the operation had no obvious effect under the set perforation area in group B(see Table 4).(2)Within six months after operation,the tympanic membrane in group a healed more than that in group B(P < 0.001,see Table5);in patients with unclosed tympanic membrane in group A and B,the number of smaller tympanic membrane diameter in group A was more than that in group B(P <0.001).(3)The effective rates of group A(11 people,20 ears)and group B(12 people,20 ears)were 75% and 35%,respectively.The postoperative effect of group A was significant(see Table 6,P < 0.05).(4)The incidence of postoperative complications such as middle ear infection and tympanic membrane nonunion in group A and group B were 25% and 45%,respectively.The incidence of postoperative complications in group A was significantly lower than that in group B(P < 0.05,see Table 7).(5)the subjective feelings of patients in group A were significantly improved after operation(P < 0.001).Compared with the postoperative questionnaire,the patients in group B had no significant improvement in subjective feeling after operation,and the scores of eustachian tube dysfunction score in the two groups of A and B after treatment were significantly better than those in the A group(P < 0.001)compared with those in the B group(B < 0.001).Conclusion: According to this experimental study,in the range of 2 mm ～ 4 mm,2.5 mm ≤ D(diameter)≤ 3 mm,the postoperative effect is better. |
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