| Purpose:To analyze the effect of grommet insertion under endoscope for the patients with complicating otitis media with effusion(OME) after Nasopharyngeal carcinoma(NPC) radiotherapy,the preventions and treatments for otorrhea after grommet insertion with endoscope for the patients with complicating OME after NPC radiotherapy,the prognostic influential factors of grommet insertion with endoscope for the patients with complicating OME after NPC radiotherapy,and to research the standard therapy for the patients with complicating OME after NPC radiotherapy.Method:From October 2006 to November 2007,39 patients who were diagnosed as complicating OME following the radiotherapy(or plus chemotherapy) with nasopharyngeal carcinoma and received grommet insertions in our department were NPC group.And in the corresponding period,32 patients(38 ears) were non-NPC group that had been diagnosed as OME by non-tumorous factors and also received grommet insertions in our department The grommet insertions were taken under the endoscope for both groups separately.Observe and compare the effects of the 2 groups(cure,recurrence and chronic otitis media) and the otorrhea pro-operations Analyze NPC group's prognostic influential factors.Results:39 patients(50 ears) in NPC group had their tympanostomy tubes maintained in place for 6-12 months;3 months after the tympanostomy tubes' falling or removal,27 ears (54.0%) were cured,10 ears(20.0%) had recurred symptoms and 13 ears(26.0%) were suffered from chronic otitis media;the symptoms of tinnitus and ear depression disappeared in 31 ears (62.0%),were reduced in 12 ears(24.0%) and weren't effectively improved in 7 ears(14.0%); there were 27 ears in A type in tympanogram,9 ears in B type and 1 ear in C type;and 34 patients(87.2%) reported their improved quality of life.32 patients(38 ears) in NPC group had their tympanostomy tubes maintained in place for 6-12 months;3 months after the tympanostomy tubes' falling or removal,26 ears(68.4%) were cured,8 ears(21.1%) had recurred symptoms and 4 ears(10.5%) were suffered from chronic otitis media;the symptoms of tinnitus and ear depression disappeared in 29 ears(76.3%),were reduced in 4 ears(10.5%) and weren't effectively improved in 5 ears(13.2%);there were 26 ears in A type and 8 ears in B type in tympanogram;and 29 patients(90.6%) reported their improved quality of life.The chi square test for the comparison of the effects(of cure,recurrence and chronic otitis media) between NPC group and non-NPC group stated that the difference was not statistically significant(P＞0.05).In NPC group,there were 13 ears(26%) developed to chronic otitis media,5 ears(10.0%) just with perforation of tympanic membranes but without secretions,and 8 ears(16.0%) with perforation of tympanic membranes and secretions in which 5 ears(10.%) had purulent secretions.In non-NPC group,there were 4 ears(10.5%) developed to chronic otitis media,3 ears(7.9%) just with perforation of tympanic membranes but without secretions and 1 ears(2.6%) with perforation of tympanic membrane and non-purulent secretion.The chi square test for the comparison of 2 types of chronic otitis media developed from NPC group and non-NPC group declared the difference was not statistically significant(P＞0.05).There were 21 ears(42.0%) with complicating otorrhea after the surgeries,in which 9 ears(18.0%) had the chronic drainage in≥8 weeks;and there were 8 ears(42.0%) with complicating otorrhea after the surgeries,in which 1 ears(2.6%) had chronic drainage in≥8 weeks.The chi square test for the comparison of otorrhea after surgeries between NPC group and non-NPC group indicated the difference was statistically significant,as P＜0.05;however,the chi square test for the comparison of chronic drainage in≥8 weeks after surgeries between NPC group and non-NPC group indicated the difference was not statistically significant,as P＞0.05.21 ears in NPC group had complicating otorrhea after surgeries,in which 13 ears formed the dry ears with the tympanostomy tubes in place.Among 13 ill ears with chronic otitis media in NPC group,8 had complicating otorrhea after the surgeries,but the other 5 didn't;that's,8 out of those ill ears with otorrhea developed to chronic otitis media,and 5 out of those ill ears without otorrhea after surgeries developed to chronic otitis media.Through the comparison of the patients with chronic otitis media out of those with and without otorrhea after surgeries,the chi square test showed the difference was not statistically significant,as P＞0.05.After the analyses of NPC group's prognostic influential factors(sex,ages,tumors' sizes and staging),the chi square tests of sex and ages showed the difference was not statistically significant,as P＞0.05;and the tests of tumors' sizes and staging showed the difference was also not statistically significant,as P＜0.05.Conclusion:For the patients with complicating OME after NPC radiotherapy who still have the uncomfortable symptoms of ears and the hydromyringa after the regular medication and the tympanotomy,the grommet insertion should be carried out without delay;and the grommet insertion under endoscope should be implemented for the patients with complicating OME after NPC radiotherapy and the ones with general OME,and the differences of its curative effects(of cure,recurrence and chronic otitis media) were not statistically significant,but the NPC treated patient has higher risk of otorrhea complication after the surgery;the grommet insertion with endoscope for the patient with complicating OME after NPC radiotherapy can effectively alleviate the uncomfortable symptoms of ears such as the ears' depression and the hearing loss, so as to improve the patients' quality of life;after the grommet insertion under endoscope, special attention should be paid to the treatments for the inflammation and the secretions at nasal cavity,paranasal sinus and nasopharynx,in order to maintain the tympanostomy tube's effective and regular drainage,which can effectively prevent and cure the complicating otorrhea after the grommet insertion under endoscope.
|
PDF Full Text Request