气道正压对中耳的影响：系统综述与荟萃分析
The Effects of Positive Airway Pressure on the Middle Ear: Systematic Review and Meta-Analysis.
文献信息
| PMID | 42865084 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Joseph Krivda |
| 作者单位 | Department of Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA. |
| 期刊 | The Laryngoscope |
| SCI 分区 | Q2 |
| IF | 2.3 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 系统综述评估气道正压（PAP）对中耳影响的文献，并对其对中耳压力（MEP）、鼓膜（TM）形态及听力结局的影响进行荟萃分析。
数据来源： PubMed、MEDLINE、OVID、Scopus、Web of Science 和 Cochrane Library。
方法： 按照 PRISMA 指南，从数据库建库至 2025 年 11 月 1 日进行系统检索。纳入报告 PAP 后中耳定量结局的研究。采用随机效应模型对 MEP、鼓膜内陷分级和纯音平均听阈（PTA）进行荟萃分析。
结果： 九项研究符合纳入标准。PAP 治疗显示 MEP 呈显著剂量依赖性增加（R2 = 0.9516，p < 0.0001）。在 10 cm H20 设置下对 MEP 的荟萃分析显示合并平均增加 51.4 daPa（p < 0.00001）。吞咽被发现是显著压力传递至中耳的先决条件。在咽鼓管功能障碍和鼓膜内陷患者中，持续使用 PAP 与鼓膜内陷的显著形态学改善（p = 0.002）及 PTA 平均改善 7.3 dB HL（95% CI 3.45, 11.17，p = 0.0002）相关。
结论： PAP 以剂量依赖性方式增加 MEP，这一发现对耳科手术医生具有意义。除在睡眠医学中的作用外，PAP 治疗可能作为慢性咽鼓管功能障碍和鼓膜内陷的无创治疗方法。需要进一步的前瞻性研究来指导使用 PAP 的耳科患者的管理结论，尤其是在术后情况下。
英文摘要
OBJECTIVES: To systematically review the literature evaluating the effects of positive airway pressure (PAP) on the middle ear and to perform a meta-analysis of its impact on middle ear pressure (MEP), tympanic membrane (TM) morphology, and hearing outcomes.
DATA SOURCES: Pubmed, MEDLINE, OVID, Scopus, Web of Science, and the Cochrane Library.
METHODS: A systematic search was performed from database inception through November 1, 2025, following PRISMA guidelines. Studies reporting quantitative middle ear outcomes following PAP were included. Meta-analyses were performed using a random-effects model of MEP, TM retraction grade, and pure tone average (PTA).
RESULTS: Nine studies met inclusion criteria. PAP therapy demonstrated a significant dose-dependent increase in MEP (R2 = 0.9516, p < 0.0001). Meta-analysis of MEP at a setting of 10 cm H20 showed a pooled mean increase of 51.4 daPa (p < 0.00001). Swallowing was found to be a prerequisite for significant pressure transfer to the middle ear. In patients with Eustachian tube dysfunction and TM retraction, continuous PAP use was associated with significant morphological improvement in TM retractions (p = 0.002) and a mean improvement in PTA of 7.3 dB HL (95% CI 3.45, 11.17, p = 0.0002).
CONCLUSION: PAP increases MEP in a dose-dependent manner, a finding of interest to otologic surgeons. In addition to its role in sleep medicine, PAP therapy may serve as a noninvasive treatment for chronic Eustachian tube dysfunction and TM retraction. Further prospective studies are needed to guide management conclusions for otologic patients utilizing PAP, particularly in the postoperative setting.