儿童腺样体肥大并发分泌性中耳炎与变应性鼻炎发病的相关性分析

目的:分析儿童腺样体肥大群体中并发分泌性中耳炎(OME)与变应性鼻炎(AR)发病之间的相关性。方法:回顾性分析287例腺样体肥大患儿中并发OME的发病情况,有无AR病史,有无鼻类固醇激素使用病史等资料。结果:所有腺样体肥大患儿在不考虑鼻类固醇激素的作用下,伴AR组和不伴AR组中OME发生率分别为25.56%和32.47%,二者差异无统计学意义(χ2=1.643,P>0.05)。对未使用鼻类固醇激素治疗的患儿进行分组分析,伴AR组OME发病率为51.11%,明显高于对照组(32.26%)(χ2=5.019,P<0.05)。伴AR患儿中,使用鼻类固醇激素组中OME发生率为12.50%,明显低于不使用鼻类固醇激素组中OME的发生率(51.11%)(χ2=23.32,P<0.01)。结论:腺样体肥大患儿中OME的发病率较高,其中AR是影响OME发病的一个重要因素。鼻腔类固醇激素的使用可以减少OME的发病率,对中耳炎的治疗有一定效果,具体疗效评估及治疗机制尚需进一步研究。     

鼻咽部数字化摄影及ETDQ-7量表评分对腺样体肥大儿童的咽鼓管功能评价

目的:探讨鼻咽部数字化摄影及ETDQ-7量表评分在儿童腺样体肥大伴或不伴分泌性中耳炎(OME)的咽鼓管功能评估中的作用.方法:对2019年2月-2021年8月收治的60例伴或不伴OME的腺样体肥大患儿采用鼻咽部数字化摄影,对鼻咽腔有效气道宽度(PAS)、鼻咽腔宽度及腺样体指数(腺样体厚度/鼻咽腔宽度,A/N)进行测量,...     

IL-6表达与腺样体肥大伴分泌性中耳炎发病的关系

目的检测白细胞介素-6(IL-6)在单纯腺样体肥大及腺样体肥大伴分泌性中耳炎(otitis mediawith effusion,OME)患儿的腺样体组织及血清中的表达,探讨IL-6与OME发病的关系。方法单纯腺样体肥大组患儿20例(男12例,女8例),腺样体肥大伴OME组患儿20例(男11例,女9例),分别检测两组患儿腺样体组织及血清中IL-6的表达并进行比较。结果腺样体肥大伴分泌性中耳炎组腺样体组织中IL-6的表达明显高于单纯腺样体肥大组(P<0.05),两组患儿血清中IL-6的表达差异无统计学意义(P>0.05)。结论腺样体局部IL-6的高表达可能与分泌性中耳炎发病有关。     

腺样体肥大并分泌性中耳炎患儿的预后影响因素分析

目的：探讨腺样体肥大并分泌性中耳炎的患儿在腺样体切除术后其分泌性中耳炎预后的影响因素。方法以198例（252耳）腺样体肥大伴分泌性中耳炎患儿为研究对象,其中15例（23耳）行鼓膜置管术者不计入统计结果。对其余183例（229耳）住院行鼻内镜下腺样体切除术的患儿,随访3～12个月,比较不同性别、病程、腺样体肥大程度、咽鼓管功能及是否伴慢性鼻－鼻窦炎患儿的疗效。结果183例（229耳）并分泌性中耳炎患儿行腺样体切除术后分泌性中耳炎治愈143例（157耳）,好转20例（39耳）,无效20例（33耳）。病程长、腺样体Ⅲ度肥大、咽鼓管功能未恢复、伴慢性鼻－鼻窦炎的患儿分别较病程短、腺样体Ⅰ、Ⅱ度大、咽鼓管功能恢复及不伴慢性鼻－鼻窦炎患儿疗效差（P＜0．05）。结论病程较长、腺样体Ⅲ度肥大、咽鼓管功能障碍、伴慢性鼻－鼻窦炎可能影响腺样体肥大并分泌性中耳炎患儿在腺样体切除术后其分泌性中耳炎的预后。     

儿童腺样体肥大与中耳咽鼓管功能相关性分析

目的:探讨腺样体大小与中耳功能和咽鼓管功能的相关性。方法:回顾性分析2004年2月~2004年10月因腺样体肥大收入院手术患儿的中耳功能,并比较腺样体肥大患儿和正常同龄儿童的咽鼓管功能的差异。结果:①腺样体大小与中耳压力有明显的负相关性(r=-0.41,P<0.05);②腺样体肥大患儿咽鼓管功能(13.9±13.2)daPa,与正常儿童咽鼓管功能(22.5±10.4)daPa比较,差异有统计学意义(t=-3.1,P<0.01);③患儿腺样体的大小程度与咽鼓管功能无明显相关性(r=-0.19,P>0.05)。结论:腺样体病理性肥大可引起咽鼓管功能障碍,是分泌性中耳炎(SOM)的发病基础。     

儿童腺样体肥大与分泌性中耳炎的关系研究

目的探讨腺样体肥大儿童中分泌性中耳炎发病情况及其影响因素。方法258例住院手术治疗的腺样体肥大的儿童,均常规进行病史采集、鼻咽侧位片、声导抗检查;对部分患儿进行鼻内镜检查录像,单盲评估腺样体肥大程度及其与咽鼓管咽口的关系。统计分析分泌性中耳炎发生率及其影响因素。结果在258病例中经声导抗检查证实合并分泌性中耳炎者108例（41.9％）,而病史中有明确听力减退主诉者仅27例（10.5％）;对合并和未合并分泌性中耳炎病例的相关影响因素统计分析发现,患儿性别、病程长短、腭扁桃体大小等因素对分泌性中耳炎发病无明显影响,低龄患儿、腺样体过度肥大、腺样体与咽鼓管园枕或咽口关系密切者发生分泌性中耳炎可能性大,多元回归分析证明其中影响最显著的因素是腺样体与咽鼓管园枕或咽口关系密切程度。结论有必要对所有腺样体肥大患儿常规进行听力学检查,以确认或除外分泌性中耳炎诊断。低龄患儿、腺样体过度肥大或与咽鼓管园枕及咽口关系密切是分泌性中耳炎的促发因素。     

小儿分泌性中耳炎与腺样体肥大

目的探讨小儿分泌性中耳炎与腺样体肥大的关系.方法回顾性分析1988～2001年我院施行扁桃体及腺样体联合切除术患儿116例,其中患分泌性中耳炎37例(31.9%),共52侧.结果术后37例分泌性中耳炎均治愈,随访期间仅2例复发.结论分泌性中耳炎伴扁桃体及腺样体肥大者,应考虑联合切除术,以利咽鼓管功能恢复.     

腺样体肥大儿童伴变应性鼻炎与分泌性中耳炎的相关性

分泌性中耳炎影响患儿听力,甚至影响语言、交流能力发育[1],若不能进行合理治疗,可能会造成儿童听力障碍以及言语与治疗发育不良。近几年临床研究显示,该疾病与儿童腺样体肥大以及变应性鼻炎存在一定关系。本文选择我院曾接收的存在腺样体肥大病史的患儿500例,对其变应性鼻炎、咽鼓管功能不良以及分泌性中耳炎相关性进行分析。1.1资料来源。2012年1月~2012年12月我院住院的腺样体肥大患儿500例,腺样体肥大程度为3~4度阻塞。其中男     

分泌性中耳炎患儿腺样体与中耳积液中IgE相关性的研究

目的:探讨反复发作的分泌性中耳炎(OME)患儿腺样体和中耳积液中的IgE是否存在相关性.方法:选取35例OME患儿为实验组,31例腺样体肥大患儿为对照组,实验组取中耳积液和腺样体标本,对照组取腺样体标本,其中腺样体标本制成组织匀浆,用酶联免疫分析技术测定腺样体和中耳积液中IgE的含量.运用SPSS 18.0统计软件对所有相关数据进行处理分析.结果:实验组腺样体和中耳积液中IgE的含量比对照组明显增高(P<0.05).实验组中耳积液和腺样体中IgE的含量呈直线正相关(r=0.580,P<0.05).结论:OME的发生与免疫因素有关,肥大腺样体内的Ⅰ型免疫反应增强,可能与OME的反复发作、迁延不愈有关.     

172例儿童声导抗检测结果分析

分泌性中耳炎(OME)是一种影响儿童听力的常见疾病,常与儿童鼻窦炎、变应性鼻炎、腺样体肥大等并发,上述患儿的OME发病率远高于正常儿童,应引起重视.     

The role of allergic rhinitis in the development of otitis media with effusion: effect on eustachian tube function

PURPOSE: The pathogenesis of otitis media with effusion (OME) is considered multifactorial, with viral upper respiratory tract infection and eustachian tube dysfunction. Allergy may be related to the pathogenesis of OME or to another etiological factor. We investigated the role of allergic rhinitis (AR) in children with OME and evaluated eustachian tube function in patients with AR. MATERIALS AND METHODS: We prospectively analyzed the prevalence of AR, serum eosinophil count, and serum total IgE concentrations in 123 children with OME and in 141 controls. IgE concentration in middle ear effusion was compared in children with OME with and without AR, and eustachian tube function after a nasal provocation test was compared between patients with AR and controls. RESULTS: The prevalence of AR in children with OME (28.4%) and control subjects (24.1%) did not differ significantly. These 2 groups also showed no differences in total eosinophil count and serum and middle ear effusion IgE concentration. Abnormalities in eustachian tube function were the same in patients with AR and controls. CONCLUSIONS: Allergic rhinitis may not be related to the development of OME in children.     

Update on eustachian tube dysfunction and the patulous eustachian tube

PURPOSE OF REVIEW: The purpose of this review is to summarize the recent knowledge on eustachian tube dysfunction and the patulous eustachian tube. RECENT FINDINGS: A clinically useful test for eustachian tube function is still lacking. Narrowing of the isthmus alone was demonstrated to be an insufficient cause of otitis media. Inflammatory mediators identified within the eustachian tube and middle ear cells were causally linked with otitis media with effusion. Increasing evidence was found that allergic disease and reflux may be two of the most important contributors of tubal inflammation causing otitis media with effusion. The adenoid size and proximity to the torus tubaris may also be important in considering which patients with persistent otitis media with effusion may benefit from adenoidectomy. Computed tomography scan has documented loss of soft tissue within the cartilaginous eustachian tube in patients with patulous eustachian tubes. An endoscopic approach to seal the tubal lumen has been found to be effective in relieving patulous symptoms. SUMMARY: These studies suggest that allergic rhinitis and gastroesophageal reflux should be investigated in patients with eustachian tube dysfunction. Adenoidectomy should also be considered in patients who have adenoids that obstruct the torus tubaris. Patients with a patulous eustachian tube may benefit from an endoscopic closure. Further research is needed to identify a clinically useful test for eustachian tube dysfunction.     

Laser eustachian tuboplasty: two-year results

OBJECTIVE/HYPOTHESIS: Laser eustachian tuboplasty (LETP) combined with appropriate medical management will eliminate the chronic presence of middle ear effusions in selected patients. METHODS: The study population consisted of 13 adults with otitis media with effusion (OME). Patients underwent slow-motion video endoscopy to identify the location and extent of surgical resection. A diode or argon laser was used to vaporize areas of hypertrophic mucosa and submucosa along the cartilaginous eustachian tube. Patients were evaluated at 6, 12, and 24 months. Successful outcome was defined as absence of OME. Patients with evidence of reflux disease or allergic rhinitis were treated with medical therapy before surgery and throughout the follow-up period as indicated. RESULTS: LETP combined with medical management eliminated OME in 36% (4 of 11) of patients at 6 months, 40% (4 of 10) at 1 year, and 38% (3 of 8) at 2 years. Failure of LETP correlated with presence of laryngopharyngeal reflux (P = .01) or allergic disease (P = .05) for the results at 1 year but not at 2 years. CONCLUSIONS: LETP combined with appropriate medical management may be an effective treatment in select patients with chronic persistent eustachian tube dysfunction. A controlled trial with a larger number of subjects will be necessary to determine the efficacy of LETP and identify those factors predictive of successful outcome.     

Otitis media with effusion and histopathologic properties of adenoid tissue

OBJECTIVE: Adenoidectomy is being generally used for the treatment of otitis media with effusion (OME). The purpose of current study was to determine objectively the significance of the histopathology of adenoid tissue on the development of otitis media with effusion. METHODS: The records of all the patients operated on with the diagnosis of adenoid enlargement with or without OME were reviewed and pathologic specimen were re-evaluated regarding histopathological properties by one pathologist unfamiliar with the diagnosis. Sixty-one patients with adenoid hyperplasia were enrolled in the study group, 38 males and 23 females. Age ranged between 3 and 13 years (mean age was 7.03+/-3.26 years). All the patients of study group were those operated on due to the adenoid hyperplasia and uni- or bilateral OME. Control group was composed of 39 male and 26 female patients (age range was between 3 and 13 years, and mean age was 7.06+/-3.04 years) with solely adenoid hyperplasia. RESULTS: The squamous metaplasia was present in 47 (77%) and 14 (22%) patients of study and control groups, respectively. The fibrosis of connective tissue interspersed follicles of adenoid was present in 29 (48%) and 6 (9%) patients of study and control groups, respectively. The statistical analysis revealed a significant prevalence of squamous metaplasia (P<0.001) and fibrosis of connective tissue interspersed follicles of adenoid (P<0.001) for a surgical indication of adenoid hyperplasia with OME than for without OME. The prevalence of other parameters was not significantly different between two groups. CONCLUSIONS: Adenoid tissue not only exerts an obstructive influence on the eustachian tube lumen when enlarged, but also impedes (hinders) mucociliary drainage of the middle ear by the way of non-ciliated metaplastic epithelium and fibrosis of connective tissue.     

A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy

Objective

The aim of the present study was to evaluate the role of the different forms of chronic rhinitis in the pathogenesis of otitis media with effusion in children affected by obstructive adenoid hypertrophy.

Methods

81 patients, aged between 4 and 15 years (mean age of 6.9 years), affected by obstructive adenoid hypertrophy were evaluated. All patients underwent accurate history taking, physical examination with endoscopy of the nasopharynx, skin prick test, nasal cytology and hearing evaluation.

Results

Nasal citology showed that 21% of patients had a non-allergic rhinitis (NAR) subtype, 17.4% NAR overlapping with infectious rhinitis (IR), 29.6% IR, 4.9% allergic rhinitis (AR), 2.5% AR overlapping with IR and the remaining 24.6% a negative cytology. The presence of OME was positively correlated with neutrophils (p = 0.01) and mast cells (p = 0.022), while it was negatively correlated with the presence of eosinophils (p = 0.02) and bacteria (p = 0.02).

Conclusions

A chronic rhinitis was present in more than 70% of children with AH and 60% of them showed OME. Nasal cytology together with SPT showed that AR was rarely present in this group of children, while the mast-cells and neutrophils positively correlated with OME.     

Is facial pattern a predisposing factor for otitis media with effusion in children?

Abnormalities in craniofacial morphology are associated with Eustachian tube dysfunction and otitis media with effusion (OME).Aim: to evaluate the relationship between facial pattern and craniofacial growth direction, and OME in children with enlarged tonsils and adenoids (ETA).Methods: Clinical prospective survey in 79 children (41 male and 38 female), ranging from 4 to 10 years of age, with tonsil and adenoid enlargement (Brodsky's grades III and IV). Forty children presented with OME (study group) and 39 did not (control group). Cephalometric analysis was used to determine the facial pattern.Results: There was no correlation observed between facial pattern and OME (c 2 = 0.25 p = 0.88). Facial Axis was larger in the OME group (F(1.75) = 3.68 p = 0.05) and the Lower Anterior Facial height was smaller (F(1. 75) = 3.99 p = 0.05) in children with otitis media with effusion.Conclusions: There was no correlation between OME and facial pattern in children with ETA although a more horizontal facial growth direction, and a smaller lower anterior facial height was observed consistently among subjects in this group. This suggests that abnormal positioning of the eustachian tube influences the development of OME in children with ETA.     

分泌性中耳炎复发的相关因素分析

目的：探讨分泌性中耳炎（otitis media with effusion,OME）复发相关的影响因素。方法分析经鼓膜切开置管术治疗的255例慢性分泌性中耳炎患者的临床资料,其中取出通气管后一年内复发者85例,未复发者170例。对与分泌性中耳炎复发相关的可能因素包括年龄、性别、病程、吸烟环境、反复呼吸道感染、慢性鼻－鼻窦炎、鼻腔结构异常、腺样体肥大或鼻咽淋巴组织增生、乳突气化情况、既往置管手术史、中耳通气管留置时间等进行单因素分析及多因素 Logistic 回归分析。结果单因素分析发现,年龄、反复呼吸道感染（χ2＝22．546,P＝0．000）、慢性鼻－鼻窦炎（χ2＝5．211,P＝0．023）、腺样体肥大或鼻咽淋巴组织增生（χ2＝10．338,P＝0．002）、乳突气化不良（χ2＝15．196,P＝0．000）、通气管留置时间（3～6月）（χ2＝11．347,P＝0．001）对分泌性中耳炎复发的影响有统计学意义。Logistic回归分析显示,小龄、反复呼吸道感染（P＝0．001,OR＝2．992）、腺样体肥大或鼻咽淋巴组织增生（P＝0．021,OR＝2．198）、乳突气化不良（P＝0．000,OR＝3．433）、通气管留置时间（3～6 m）（P＝0．010,OR＝2．237）5个因素对分泌性中耳炎复发的影响有统计学意义。反复呼吸道感染对学龄前、学龄期儿童和青少年复发性分泌性中耳炎影响有显著意义,腺样体肥大或鼻咽淋巴组织增生对学龄前儿童O ME复发的影响有显著意义（P＜0．05）。结论小龄、反复呼吸道感染、慢性鼻－鼻窦炎、腺样体肥大或鼻咽淋巴组织增生、乳突气化不良、通气管留置时间较短可能是导致分泌性中耳炎复发的主要因素。反复呼吸道感染对学龄前、学龄期儿童和青少年的影响较成人更为显著,腺样体肥大对学龄前儿童的影响最为明显。     

Prevalence and associated risk factors of recurrent otitis media with effusion in children in Upper Egypt

ObjectiveWe conducted this study to determine the associations of possible risk factors and prevalence of recurrent otitis media with effusion (OME) in a cohort of children in Upper Egypt.MethodsThis was a cross-sectional study undertaken in two tertiary referral centers in Upper Egypt. Associations of possible risk factors with prevalence of recurrent OME were studied. Multi-factor logistic regression analysis was done to recognize the statistically significant risk factors associated with recurrent OME.ResultsWe collected the data of 2003 pediatric patients, of which 1016 were males (50.7%). A total number of 310 children have OME, including 159 males (51.3%). The prevalence rate of OME in our cohort was 15.5%. Multi-factor logistic regression analysis of the risk factors related to recurrent OME showed it was strongly associated with adenoid hypertrophy (P < 0.0001), tonsil hypertrophy (P < 0.0001), sinusitis (P < 0.0001), posterior nostril polyps (P = 0.009), allergic rhinitis (P < 0.0001), recurrent URTIs (P = 0.029) and gastroesophageal reflux (P = 0.031).ConclusionsOur study showed that recurrent OME in children in Upper Egypt is a common multifactorial problem, especially in young age. In our locality, allergic rhinitis, recurrent upper respiratory tract infections, gastroesophageal reflux, adenoid and tonsil hypertrophy were the most important associated factors related to the etiopathogenesis of OME.     

Site of eustachian tube dysfunction in patients with otitis media with effusion

This study was conducted to identify an exact site of ventilatory dysfunction within the eustachian tube among patients with otitis media with effusion (OME). Using 10 adults with OME, a fine polyethylene tube with a small pore at its tip was inserted into the eustachian tube via its pharyngeal orifice. Negative middle ear pressure was applied through a ventilation tube in the eardrum, and the patients were asked to swallow repeatedly at every 5-mm depth of insertion of the polyethylene tube toward the middle ear. Negative middle ear pressure could be equilibrated by swallowing within 10 mm of tube advancement from the pharyngeal orifice of the eustachian tube in seven of ten patients. It was concluded that the site of tubal ventilatory dysfunction is in the distal part of the cartilaginous portion of the eustachian tube in most adult patients with OME.