腺样体肥大致分泌性中耳炎手术切除后复发的临床分析及防治

目的探讨腺样体肥大所致分泌性中耳炎手术切除后复发的原因及防治措施.方法对18例、35耳腺样体肥大所致分泌性中耳炎手术切除后复发的患者行常规声阻抗、纯音测听及鼻咽镜检查.在鼻内窥镜下切除增生组织,咽鼓管置管,并结合药物治疗.结果复发18例、35耳中10例腺样体有不同程度的增生,6例咽鼓管扁桃体增生,2例咽鼓管咽口形成瘢痕.经治疗,16例、32耳治愈,1例、2耳好转,有效率97.1%.结论传统腺样体手术由于不能在直视下进行,故手术切除增生组织的范围、深度不能确切保证,是术后复发的主要原因,周围淋巴组织代偿性增生也是重要因素.内镜下直视手术及咽鼓管置管,操作简便,疗效确切.     

分泌性中耳炎咽鼓管咽口的内窥镜观察

咽鼓管功能失调是分泌性中耳炎发病的重要原因之一，但引起咽鼓管功能失调的原因尚未完全阐明。对鼻咽部病理改变的观察有助于对咽鼓管功能失调原因的认识。文中应用鼻内窥镜技术对155耳分泌性中耳炎患者咽鼓管咽口的病理改变进行了观察。材料与方法：分泌性中耳炎病人，儿童45例（77耳），年龄5～12岁，成人60例（78耳），年龄25～73岁，以4％利多卡因行鼻腔表面麻醉，应用纤维内窥镜观察鼻咽部。结果，儿童56耳（727％）咽鼓管咽口被粘脓性鼻分泌物阻塞；40耳（52．0％）咽口被腺样体挤压；13耳（119％）咽鼓管咽口腺样体肥大；8耳（10．4…     

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。     

鼻内镜下电动钻切除腺样体治疗小儿分泌性中耳炎

分泌性中耳炎与咽鼓管功能有关,腺样体肥大导致咽鼓管咽口机械性阻塞,引起咽鼓管功能障碍。我科1998年2月-2004年2月在鼻内镜下使用电动钻切除肥大腺样体治疗小儿分泌性中耳炎70例,取得良好效果。报告如下。     

传统方法与鼻内窥镜联合行腺样体切除术21例

应用鼻内窥镜行腺样体切除术21例,男13例,女8例,4～13岁,平均5.6岁.临床诊断为腺样体肥大4例,腺样体肥大加扁桃体肥大6例,腺样体肥大加渗出性中耳炎11例.症状主要为鼻阻塞、张口呼吸、打鼾和听力下降.检查示腺样体面容5例,轻度鸡胸1例,双侧扁桃体Ⅱ～Ⅲ度肥大5例,扁桃体已摘除1例,单侧鼓室积液7例,双侧鼓室积液4例.纯音测听结果示传导性聋曲线11例,声导抗测试鼓室功能曲线呈B型或C型,镫骨肌反射消失.患者术前X线侧位片,CT或核磁共振均显示腺样体团块阻塞鼻咽腔内.手术所用内窥镜为Storz公司生产的硬性鼻内窥镜,直径2.7mm和4mm,视野为0°～30°,国产鼻内窥镜手术器械和腺样体刮匙.气管插管全麻成功后患儿取平卧仰头位,常规消毒面部和口腔,并以2%丁卡因肾上腺素棉片收缩鼻腔和咽部黏膜约10min.全麻后伴扁桃体肥大者先行扁桃体切除术,伴渗出性中耳炎者行鼓膜穿刺或置管术,然后行腺样体手术.用细导尿管一根自一侧鼻腔插入,前端从口内拉出,两端打结牵拉软腭,内窥镜可从鼻腔或口腔置入,腺样体刮匙从口腔置入,在内窥镜直视下先用腺样体刮匙刮除腺样体大部分,迅速用大棉球压迫鼻咽部止血,取出纱球,再次置入内窥镜,用鼻息肉钳或电动切割吸引器摘除残余组织和残存于鼻咽顶部、后鼻孔及咽鼓管圆枕周围的淋巴组织直至手术满意,并彻底止血.21例随访半年以上,除12例因结痂或鼻黏膜肿胀引起一过性鼻阻塞外,无鼻咽出血、瘢痕狭窄等并发症,未见复发者,无1例需再次手术.1例渗出性中耳炎听力未完全恢复正常,余者临床症状均消失.     

内镜下腺样体肥大分型的临床意义

目的 探讨内镜下对腺样体肥大的分型与临床症状的关系.方法 对306例因为打鼾憋气(163例)、鼻塞流涕(80例)、分泌性中耳炎(63例)患儿术前施行了鼻咽侧位X线片、内镜检查及耳部的检查,所有患者均行腺样体切除,其中合并分泌性中耳炎的患儿同时行鼓室置管或鼓膜造孔,术后经过6个月～4年随访.结果 根据内镜的检查结果,将腺样体肥大分为3种类型.1型为整体肥大型,腺样体整体向前突出堵塞鼻中隔后缘、后鼻孔、鼻咽侧壁(106例,占34.6%).2型为中央肥大型,腺样体中央向前突出,突至鼻中隔后缘,只堵塞部分后鼻孔(79例,占25.8%).3型为侧方肥大型,腺样体主要在两侧突出,突向后鼻孔,堵塞鼻咽侧壁(73例,占23.9%).其余48例(15.7%)多为腺样体炎或肥大突出较轻者,各种症状的程度均较轻,故未进行分型.各型中不同症状的患者所占比例明显不同,差异有统计学意义(x2=73.48,P<0.01).以打鼾憋气和鼻塞流涕为主症的患者术后均恢复正常,其中6例症状复发,2例药物治疗和4例再次手术后症状消失.分泌性中耳炎为主的患儿中14例术前听力基本正常,43例术后恢复正常,6例遗留轻度的气导听力下降.结论 腺样体肥大的类型不同所产生的症状不尽相同,1型可以发生全部症状,2型以打鼾憋气为主,3型压迫或接近咽鼓管咽口是分泌性中耳炎的主要原因.内镜检查是确定腺样体肥大类型的有效方法,可以避免X线检查,有效指导临床诊断和治疗工作.     

分泌性中耳炎行纤维鼻咽镜检查的意义

分泌性中耳炎的病因不是单一的 ,咽鼓管功能障碍是重要原因之一。我科自 1 996年 6月～ 1 997年 6月对 63例 (81耳 )分泌性中耳炎患者应用Olympus纤维鼻咽镜进行鼻腔 -鼻咽部检查 ,为确定治疗方案提供依据。1　临床资料分泌性中耳炎患者 63例 (81耳 ) ,男 40例 ,女2 3例。 8～ 1 7岁 2 2例 (37耳 ) ,其中鼻腔或鼻咽部脓性分泌物 8例 ,腺样体红肿 8例 ,咽鼓管咽口肿胀 3例 ,腺样体肿大伴咽鼓管咽口淋巴滤泡增生 3例 ;>1 7～ 69岁 41例 (44耳 ) ,其中鼻腔或鼻咽部脓性分泌物 1 2例 ,鼻腔息肉 8例 ,下鼻甲后端肥大 2例 ,鼻咽部充血 5例 ,鼻咽…     

鼻内镜下腺样体吸切术对咽鼓管周围组织的处理

目的总结鼻内镜下腺样体吸切术在处理咽鼓管咽口周围结构的临床经验。方法回顾分析26例腺样体肥大伴分泌性中耳炎的临床疗效。着重探讨对咽鼓管扁桃体和咽鼓管圆枕后方肥大淋巴组织的处理方法。结果鼻内镜下腺样体吸切术术后治愈率和好转率较常规腺样体刮除术高(P<0.05)。结论鼻内镜直视下用弯头外侧开口吸切头经口腔入路切除腺样体对于清除咽鼓管周围淋巴组织具有明显优势,对于改善咽鼓管通气功能甚为重要,而且降低了咽鼓管咽口损伤的可能。     

鼻内窥镜下腺样体切除治疗儿童分泌性中耳炎

目的 探讨鼻内窥镜下腺样体切除治疗儿童分泌性中耳炎的疗效。方法 对32例(46耳)腺样体肥大合并分泌性中耳炎的儿童，在全麻鼻内窥镜下行腺样体切除。结果腺样体切除顺利，术后随访3～12个月，28耳(60．9％)痊愈，听力恢复正常；听力提高，体征改变属有效者13耳(28．3％)，总有效率为89．1％；术后复发3耳。同时鼻塞打鼾消失，合并鼻窦炎者获得治愈或改善，未见明显并发症。结论 鼻内窥镜下腺样体切除是治疗儿童分泌性中耳炎的有效方法。     

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。     

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.     

Treatment of otitis media with effusion in children with mucopolysaccharidoses

Otitis media with effusion (OME) is a constant finding in children with mucopolysaccharidoses (MPS). Affected children may also present the anaesthetist with a difficult airway. A 7-year retrospective review of the management of OME in individuals with MPS was carried out. Nine patients were identified. All had a number of short-term ventilation tube insertions (one to four, mean two) before a diagnosis of MPS was made. Following diagnosis three required repeated short-term ventilation tubes insertions (two to four, mean three), four had long-term ventilation tube insertions once only. Five children who had residual hearing loss were provided with hearing aids but compliance was poor in two. Once a diagnosis of MPS has been made, a hearing aid, if compliant, or a long-term ventilation tube would be a better option than a short term one in order to minimise the anaesthetic risk. A 'watch and wait' policy is not recommended.     

Middle ear pressures of children with otitis media with effusion

Middle ear (ME) pressures were measured in 30 children with chronic otitis media with effusion (OME) transtubally with the use of a catheter pressure transducer (Mikro-tip, PC-330F). They were found to range from 40 to -185 mm H2O, the average being mildly negative (-54.33 +/- 59.04 mm H2O). About two thirds of these children had pulsating changes of ME pressure; the range of the pressure change was between 10 and 50 mm H2O. The ME pressure tended to be lower in ears with serous effusion than in those with mucoid effusion, but there was no significant difference between them.     

Predictors of outcome in children with otitis media with effusion

Otitis media with effusion (OME) is the commonest cause of hearing impairment in young children. The fluctuating nature of the condition makes identification of those with persistent disease difficult without subjecting each child to a period of ‘watchful waiting’. The aim of this study was to determine if the outcome of this observation period could in any way be predicted. The study involved the retrospective analysis of 517 children, aged 3–15 years (mean 5 years and 4 months) in whom the diagnosis of OME had been established. All children had been subjected to an observation period before a decision on surgery was taken. There was a significant correlation between the degree of hearing loss at presentation and after the period of observation. Sex was not a reliable predictor of outcome, but age less than 4 years and presentation in autumn or winter were associated with a poor audiometric outcome. This study identifies a predictive influence on the resolution of OME for these three factors and points the way for future research aimed at identifying the subgroup of children with OME who would benefit from early surgical intervention.     

婴幼儿中耳炎的听力学特征分析

目的 分析婴幼儿中耳炎的听力学特征,探讨多种听力学测试方法在婴幼儿中耳炎的诊断和干预中的作用.方法 收集2004年12月至2007年6月由外院转入本院进行听力学诊断性检查后确诊或高度怀疑中耳炎的56例婴幼儿患者(男加例,女16例).初诊年龄为42 d至3岁,平均为5个月.患儿在完成耳鼻咽喉科常规检查后,进行了多种听力学测试方法联合诊断,包括听性脑干反应(ABR)、耳声发射(OAE)、鼓室声导抗测试(226和1000 Hz探测音),4例患儿完成了小儿行为测听.结果 56例(112耳)中有87耳诊断为中耳炎,31例为双侧,25例为单侧.56例中有49例在出生后3 d内进行了新生儿听力筛查,其中36例初筛未通过;42 d时行进一步筛查的有52例(其中有3例未行初筛直接进行了复筛),显示均为未通过.4例患儿未经过听力筛查,为家长发现听力不佳来诊.52例(104耳)进行了226 Hz鼓室声导抗测试,其中20例(28耳)鼓室图B型或c型;39例(78耳)进行了1000 Hz鼓室声导抗测试,其中38例(55耳)出现异常;56例(112耳)进行了ABR检查,其中49例(74耳)出现ABR的波I潜伏期延长;56例(112耳)进行了OAE测试,其中55例(81耳)未通过;4例(8耳)完成了小儿行为测听,均出现骨、气导差.结论 联合应用226 Hz及1000 Hz鼓室声导抗测试、ABR潜伏期及阈值测试、小儿行为测听、OAE测试多种方法能够发现婴幼儿中耳炎的特征性表现,在早期诊断中具有帮助.