手术治疗儿童分泌性中耳炎疗效观察

目的比较鼓膜置管术和腺样体切除同时鼓膜骨管术治疗儿童分泌性中耳炎的疗效。方法将83例（142耳）经保守治疗无效的儿童分泌性中耳炎患者，随机分为鼓膜置管组和腺样体切除同时鼓膜置管组，评价术后疗效。结果腺样体切除同时鼓膜置管术组有效率为96．43％，鼓膜置管术组有效率为84．48％，二组有效率比较有显著性差异（x^2=4．88，P〈0．05）.结论经保守治疗无效的儿童分泌性中耳炎，腺样体切除同时鼓膜置管术是较理想的治疗方法.     

耳内镜下鼓膜置管联合腺样体切除术治疗儿童分泌性中耳炎

目的 探讨同期耳内镜下鼓膜置管联合腺样体切除术治疗儿童分泌性中耳炎的疗效、听力变化、复发率及并发症等.方法 对80例(132耳)病史超过3个月,保守治疗无效的4～12岁儿童分泌性中耳炎患者分为两组,A组42例(72耳)采用在耳内镜下同期行鼓膜置管联合腺样体切除术治疗,B组38例(60耳)则仅在耳内镜下行鼓膜置管而不行腺样体切除术.结果 A、B组术后纯音听力均提高.A组术后中耳积液平均时间为(8.5±1.2)天,通气管脱落或取出后3个月分泌性中耳炎复发率为8.3%,并发中耳感染率为2.7%;B组积液时间为(10.3±1.4)天,分泌性中耳炎复发率为21.7%,中耳感染率为11,7%.结论 耳内镜下鼓膜置管术联合腺样体切除治疗儿童分泌性中耳炎可改善听力,能缩短中耳积液时间,减少复发率及继发中耳感染的发生率.对儿童分泌性中耳炎伴有腺样体肥大的患者施行鼓膜置管联合腺样体切除术是最合理的治疗方法.     

腺样体切除术同时行鼓膜置管或鼓膜切开对分泌性中耳炎的疗效分析

目的探讨低温等离子刀行腺样体消融并单纯鼓膜切开不行鼓膜置管和行鼓膜置管2种方法对治疗儿童分泌性中耳炎伴腺样体肥大的疗效。方法分析56例分泌性中耳炎伴腺样体肥大患儿的临床资料,术前均常规行鼻内镜及声导抗检查明确诊断;分别行低温等离子刀手术切除腺样体并行鼓膜切开不置管(A组)与并行鼓膜切开加置管(B组),术后观察统计2种方法治疗分泌性中耳炎的疗效。结果 A组28例,治愈18例,有效7例,无效3例,有效率89.3%。B组28例,治愈20例,有效6例,无效2例,有效率92.9%。2组疗效相比无统计学差异。A组发生并发症12例,B组发生5例,两组比较有统计学差异。结论对于分泌性中耳炎伴腺样体肥大,腺样体切除术同时行鼓膜切开或鼓膜置管术均是有效的治疗方法,但鼓膜置管术术后并发症少,值得推广。     

耳内镜下鼓膜穿刺与鼓膜置管及盐酸氨溴索冲洗中耳腔治疗鼻咽癌放疗后分泌性中耳炎的临床观察

目的观察耳内镜下鼓膜穿刺与鼓膜置管及局部应用氨溴索治疗鼻咽癌放疗后分泌性中耳炎的疗效。方法对112例、145耳鼻咽癌放疗后分泌性中耳炎患者分别行耳内镜下鼓膜穿刺与鼓膜置管及盐酸氨溴索冲洗中耳腔的治疗对照观察。结果A组（鼓膜置管＋盐酸氨溴索冲洗中耳腔）52耳,治愈45耳（86.5％）,好转5耳（9.6％）,无效2耳,有效率为96.1％;B组（鼓膜置管）53耳,治愈32耳（60.3％）,好转14耳（26.4％）,无效7耳,有效率为86.7％;C组（鼓膜穿刺＋盐酸氨溴索冲洗中耳腔）40耳,治愈20耳（50％）,好转12耳（30％）,无效8耳,有效率为80％。经Ridit分析,P〈0.05,有显著性差异,A、B两组疗程经t检验,亦有显著性差异。结论应用盐酸氨溴索冲洗中耳腔结合鼓膜置管治疗放疗后分泌性中耳炎有较好的疗效。     

鼓膜穿刺和置管治疗儿童OSAHS合并分泌性中耳炎疗效分析

目的探讨鼓膜穿刺抽液和置管对于儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并分泌性中耳炎的疗效。方法将OSAHS合并分泌性中耳炎患儿202例(267耳)随机分为腺样体切除伴鼓膜穿刺组96例(145耳)和腺样体切除伴鼓膜置管组106例(122耳)。鼓膜穿刺组于术后1月和3月、鼓膜置管组通气管取出后1月复查声导抗,并对两组治疗后分泌性中耳炎的有效率、复发率进行比较。结果鼓膜穿刺组术后1个月及3个月分泌性中耳炎的治疗有效率分别为90.34%和93.10%;鼓膜置管组取管1月后分泌性中耳炎的治疗有效率为95.08%,两组间差异无显著统计学意义(P>0.05)。术后随访6个月,两组的复发率分别为2.0%和0.8%,再手术率均为0。结论对于OSAHS合并分泌性中耳炎的患儿,在腺样体切除的前提下行鼓膜穿刺与鼓膜置管治疗分泌性中耳炎的疗效相当。     

小儿分泌性中耳炎置管治疗探讨

目的：探讨小儿分泌性中耳炎行鼓膜置管的最佳时机。方法：回顾性分析小儿分泌性中耳炎117例，均行鼓膜置管术治疗，同时治疗伴发疾病，置管一般保留6～8个月。结果：听力均有明显改善。结论：保守治疗4周无效，伴有腺样体肥大或(和)扁桃体肥大，纯音测听提示骨导听阈改变者均应尽早行置管手术。     

鼓膜置管治疗腭裂合并分泌性中耳炎疗效观察

目的探讨鼓膜置管术对腭裂合并分泌性中耳炎的疗效. 方法对45例(72耳)患有腭裂合并分泌性中耳炎经鼓膜穿刺抽液无效的患者行鼓膜置管术和随访. 结果随访1～4年,治愈36耳;好转24耳;无效和复发 8耳;并发症 4耳.腭裂修补组有效率93.3%;非腭裂修补组有效率 66.7%,总有效率 83.3%. 结论鼓膜置管治疗腭裂合并分泌性中耳炎有利于改善听力,但不能改善咽鼓管阻塞状况,已行腭裂修补术后置管的疗效明显优于非修补组.早期行腭裂修补术后置管对咽鼓管功能恢复,听力改善,提高生活质量至关重要.     

鼓膜置管治疗小儿分泌性中耳炎108例分析

目的了解鼓膜置管加鼓室注药对小儿分泌性中耳炎的治疗效果.方法回顾性调查小儿分泌性中耳炎108例鼓膜置管及鼓室注药后的疗效.结果鼓膜置管术有效率为92.1%(152/165).结论鼓膜置管加鼓室注药较适合小儿分泌性中耳炎的治疗.     

鼓膜置管术治疗分泌性中耳炎20例

目的探讨鼓膜置管术及鼓室药物灌洗治疗分泌性中耳炎的疗效。方法分泌性中耳炎20例均为经门诊行药物治疗、鼓膜穿刺、鼓室注药保守治疗2~3个月后无效,考虑主要为咽鼓管功能障碍所致。收入院行鼓膜置管术,并定期局部灌注药物冲洗,置管时间1~3个月后拔管。结果术后随访6~12个月,获得良好效果,总有效率100%,治愈率75%(15/20)。全部患者听力明显改善,纯音测听术后平均提高20~30dBHL。声导抗检查恢复为"A"型曲线15例,"A s"型曲线5例。拔管后鼓膜均自然愈合,无遗留鼓膜永久性穿孔、鼓膜萎缩、化脓性中耳炎等并发症。结论鼓膜置管术是治疗顽固性分泌性中耳炎的主要方法,其中术后的鼓室药物灌注冲洗尤其重要,同时要预防脱管、感染、鼓膜不愈合等并发症。     

CF鼓膜置管器械在分泌性中耳炎治疗中的应用

ＣＦ鼓膜置管器械在分泌性中耳炎治疗中的应用吴文璎，姚齐，肖根生，唐云青我们应用无锡市程冯新科技开发实验厂研制，包括鼓膜切开刀、安装器、三调吸引管、通气管（硅胶管、塑料管）等在内的鼓膜置管器械（下称ＣＦ鼓膜置管器械）治疗分泌性中耳炎，取得较好疗效。报告...     

以耳部症状首发、合并鼻咽占位的肉芽肿性多血管炎1例并文献复习

目的 探讨1例临床少见的以耳部症状首发、合并鼻咽部占位的肉芽肿性多血管炎(GPA)的临床特征、实验室检查、病理表现及诊疗过程。 方法 回顾性分析患者的病例资料,总结病例特点并回顾国内外GPA相关文献。 结果 患者以中耳炎、迷路炎症状为首发表现,合并鼻咽部占位,病程中逐渐出现面瘫,三叉神经刺激症状加重。多次留取耳及鼻咽部活检示急慢性炎症细胞浸润。升级抗生素,同时为避免中耳炎侵犯岩骨及颅内行乳突开放术。中耳局部炎症改善后其耳痛、面瘫等仍不缓解,但激素治疗有效,遂进一步完善自免病相关检查并再次行鼻咽部活检,最终确诊为GPA,予激素及免疫抑制剂治疗得以控制症状。术后3个月暂无显著肺部及肾脏受累表现。 结论 临床上发现不典型的中耳炎或常规治疗反复不愈,且逐渐进展出现内耳、颅神经侵犯表现如眩晕发作、面神经麻痹等,同时激素治疗有效,且合并鼻咽部占位、鼻窦炎影像学表现,或累及其他器官如肺、肾脏时,均应考虑到GPA的可能。当反复留取病理活检未能取得特异性确诊依据时,动态监测抗中性粒细胞胞浆抗体、红细胞沉降率、尿潜血、胸部CT、血肌酐等也具有重要的提示意义。     

Decreased miRNA-320e correlates with allergy in children with otitis media with effusion

ObjectiveOtitis media with effusion (OME) is a common childhood disease and the main cause of conductive hearing loss in this age group. Many factors predispose to OME but allergy is still widely disputed. The answer may lay in the molecular mechanisms of ear exudate formation and the recent studies showed miRNAs might take part in it. MiRNAs are also potent regulators of allergic response. As miRNAs are present in the middle ear, we hypothesized their expression differs between allergic and non-allergic patients and reflects the difference in pathomechanism of effusion formation between these two groups.Materials and methodsThis study aimed to establish the expression of 5 different miRNAs (miR-223-3p, miR-451a, miR-16-5p, miR-320e, miR-25-3p) in ear exudates in children diagnosed with OME. The allergy group consisted of 18 patients whereas the non-allergic group had 36 patients. MicroRNA was isolated from the middle ear fluid collected during myringotomy and transcribed into cDNA. MiRNA expression was measured with TaqMan™ MicroRNA Assays and analyzed with DataAssist software. The comparative CT method was used for calculating the relative quantification of gene expression based on the endogenous control gene expression (U6 snRNA-001973).ResultsMiR-320e expression was significantly decreased in allergic children with OME. Other studied miRNAs also showed reduced expression in allergic children, but the decrease was not significant.ConclusionsMiRNA expression differs between children with and without allergy in the course of OME, but further studies are needed to explain the exact role of miR-320e and its target genes in OME pathology in allergic patients.     

Experience with vertical partial laryngectomy with special reference to laryngeal reconstruction with cervical fascia

In this paper we report our experience of vertical partial laryngectomy using the superficial cervical fascia; we describe the technique and present the functional and oncological results of this method of treatment. A total of 42 patients with squamous cell carcinoma of the true vocal folds, in stage T(1) (n = 28) or T(2) (n = 14), were treated in our department using vertical partial laryngectomy during the decade 1987-1997. Nine patients had post-operative radiotherapy. The shortest follow-up time was three years. There were six recurrences in all, four in the larynx and two in the neck. All four of the laryngeal recurrences were treated with total laryngectomy and are doing well. Both the patients with neck metastases, who were treated with neck dissection, died. Permanent tracheotomy was necessary in one patient. There were no problems with aspiration. The recurrence rate was 14 per cent, the three-year survival index was 95.2 per cent and the three-year larynx preservation index was 90 per cent. According to our experience, vertical partial laryngectomy, using the method we describe, has a good functional and oncological result for stage T(1) and T(2) tumours.     

Cytokines in children with otitis media with effusion

We assayed 38 middle ear effusions from 23 children aged 4–13 years (mean 7) undergoing tympanostomy tube placements. All fluid was assayed for tumor necrosis factor (TNF) α, interleukin (IL) 1β, IL-8, and IL-10. Cytokine concentrations were measured by means of an enzyme-linked immunosorbent assay. Detectable levels of IL-1β, IL-8, and IL-10 were found in all of the effusions. TNF-α was detected in 18 of the middle ear effusions (47.4%). The mean concentration of TNF-α, IL-1β, IL-8, and IL-10 was, respectively, 0.423 ± 1.39, 30.58 ± 68.7, 7001.9 ± 6743, and 56 ± 58.7 pg/ml. There was a strong, statistically significant correlation between the concentrations of TNF-α and IL-1β (r = 0.87, P = 0.001) and between IL-1β and IL-8 (r = 0.53, P = 0.001). There was no correlation between the concentrations of IL-10 and other cytokines examined or between tympanic membrane pathology and the concentrations of TNF-α, IL-1β, IL-8, or IL-10. The presence of IL-10 in middle ear effusions may be one of the causes of a lack of clinical features of acute inflammation and may lead to a chronic inflammatory state. Received: 25 August 1999 / Accepted: 5 January 2000     

Polymyositis with dysphagia treated with endoscopic balloon dilatation

Polymyositis is characterized by non-specific inflammatory disease associated with an autoimmune disorder involving muscles of the limbs and neck. We report a case of an 80-year-old man who was referred to our clinic with a chief complaint of dysphagia and muscle weakness in all four limbs. The patient was diagnosed with polymyositis based on pathological findings, muscle weakness, electromyogram findings, and an elevated creatine phosphokinase level. The patient was also positive for HLA-DR3. Intravenous predonine administration was initiated, but dysphagia was not improved. We considered a cricopharyngeal myotomy, but this could not be performed because of heart failure. Endoscopic balloon dilation was performed and dysphagia improved on the same day. Therefore, we suggest that this method is a safe and effective approach for polymyositis with dysphagia.     

Hearing acuity of children with otitis media with effusion

Hearing levels are reported for a cohort of 222 infants (aged 7 to 24 months) and 540 older children (aged 2 to 12 years) with otitis media with effusion (OME). The infants had an average speech awareness threshold of 24.6 dB hearing level (HL). The older group had mean bone conduction thresholds less than 10 dB HL, and air conduction thresholds averaged 27 dB HL; however, acuity was 7 dB less impaired at 2,000 Hz. The mean three-frequency pure tone average and speech reception threshold were 24.5 and 22.7 dB, respectively. Hearing acuity was not significantly related to age or previous duration of OME. The otoscopic observation of an air-fluid level or bubbles was associated with less hearing impairment; however, a predictive relationship between hearing levels and tympanogram characteristics could not be demonstrated.