鼓室置管治疗儿童分泌性中耳炎的预后因素分析

目的总结鼓室置管治疗儿童分泌性中耳炎的经验与疗效,探讨影响其预后的因素。方法以鼓室置管治疗儿童分泌性中耳炎68例（99耳）,对其治疗效果及预后影响因素进行研究。结果病程、留管时间、咽鼓管功能、乳突气房面积对预后均有影响,年龄、积液性质等对预后无明显影响。结论留管半年以上,积极改善咽鼓管功能对提高鼓室置管治疗儿童分泌性中耳炎的疗效有积极意义。     

儿童分泌性中耳炎耳内镜下鼓室置管术后复发因素分析

目的 探讨儿童分泌性中耳炎耳内镜下鼓室置管术后复发的相关因素.方法 回顾性分析2017年3月至2018年3月于湖南省儿童医院实施儿童分泌性中耳炎耳内镜下鼓室置管手术的93例患者资料,随访1年,根据复发情况分为复发组(n=23)和未复发组(n=70).收集患者病程、性别、年龄、吸烟环境、扁桃体炎症、反复呼吸道感染、变应性...     

腺样体切除对治疗儿童分泌性中耳炎的疗效分析

目的探讨腺样体切除对儿童分泌性中耳炎的疗效：方法1998年6月-2004年4月诊治分泌性中耳炎伴腺样体肥大学龄儿童117例(196耳)，随机分为手术组(治疗组)和非手术组(对照组)。手术组常规行腺样体刮除术，术后予以0．5％麻黄素液滴鼻，阿莫西林防治感染1周。对照组予0．5％麻黄素液滴鼻，阿莫西林、强的松、开瑞坦口服及波氏耳咽管吹张术，疗程2-3周。两组治疗结束后10周复查声导抗及纯音测听，结果手术组鼓室导抗图“A”型，声反射正常84(81．6％)耳，纯音测听正常82(79．6％)耳；对照组鼓室导抗图“A”型，声反射正常49(52．7％)耳，纯音测听正常51(54．8％)耳。经x^2检验，两组之间有显著性差异。结论腺样体切除有利于儿童分泌性中耳炎的康复。     

儿童急性鼻鼻窦炎纯音测听和声导抗异常的临床分析

目的通过观察分析儿童急性鼻—鼻窦炎纯音测听和声导抗异常,初步探讨急性鼻—鼻窦炎导致分泌性中耳炎的因素。方法通过观察61例（122耳）急性鼻—鼻窦炎患儿的纯音测听和声导抗检查判定是否合并分泌性中耳炎,并分析治疗前后检查结果的变化。结果61例患儿中,纯音测听和声导抗异常者15例（26耳）,其中变应性鼻炎组7例（12耳）,急性鼻—鼻窦炎组8例（14耳）,治疗2周后26耳全部听力恢复正常,声导抗由 B 型转为 A 型。随访3个月,未见复发。结论部分儿童急性鼻—鼻窦炎患儿纯音测听和声导抗结果存在异常,有分泌性中耳炎的可能,早期治疗可阻断分泌性中耳炎发展。     

腭裂患儿手术年龄与分泌性中耳炎恢复的相关性分析

目的从腭裂患儿分泌性中耳炎恢复的角度探讨适宜手术年龄。方法对不同年龄段腭裂患儿于术前和术后半年进行鼓膜检查，声导抗测试，脑干听性诱发电位测试（ABR）。并对年龄构成相儿配的正常儿童进行同样测试。结果腭裂患儿分泌性中耳炎的指标与正常儿童比较有显著差异；各年龄段腭裂患儿分泌性中耳炎的指标比较，差异无统计学意义（P〉0．05）。患儿术前术后指标比较，差异有统计学意义（P〈0．05）。6～18个月组与18个月至3岁组、3～7岁组比较，差异有统计学意义（P〈0．05），而18个月至3岁组和3～7岁组比较，差异无统计学意义（P〉0．05）。结论腭裂手术对中耳功能的恢复、听力损失的改善起着积极的作用，于术时年龄越小，分泌忡中耳炎的恢复越好，6～18个月是较为适宜的手术年龄。     

儿童分泌性中耳炎序列治疗的疗效分析

目的探讨儿童分泌性中耳炎从保守治疗到手术干预序列治疗的疗效。方法回顾性分析78例儿童分泌性中耳炎的临床资料，78例均先接受药物保守治疗和临床观察3个月，对无效或效果不佳者予进一步的手术治疗。结果患儿经保守治疗和临床观察3个月后，治愈率为41．0％；对保守治疗和临床观察3个月后无效或疗效不佳者进行手术治疗，其治愈率为91．3％。结论采取保守治疗到手术干预的序列治疗方法可有效治疗儿童分泌性中耳炎，并避免部分儿童接受不必要的手术。     

儿童腺样体肥大52例的临床分析

目的对52例儿童腺样体肥大患儿进行临床分析，探讨诊治方法，以进一步加深对儿重腺样体肥大的认识。方法根据临床症状，结合鼻咽侧位片、鼻咽纤维喉镜检查等确定诊断，15例鼻咽区手指触诊，37例行鼻咽纤维喉镜检查。其中3例在全麻下行纤维喉镜刮除，余49例在表麻下刮除。11例同时行扁桃体摘除术(其中3例行单侧挤切术)，22例行鼓膜穿刺等治疗。结果手术均较顺利，术中出血不超过80ml，均未行鼻腔及鼻咽区堵塞止血。随诊6个月～2年，未复发，症状改善满意35例；17例术后仍有睡眠打鼾、开口呼吸现象，但较术前明显好转。伴分泌性中耳炎痊愈12例，仍反复发作8例，遗留中耳粘连，听力下降6例。所有病例未发生鼻咽腔粘连或发音异常等。结论儿童腺样体肥大可影响邻近器官及儿童健康发育，早期诊断是关键，手术治疗是安全有效的。     

伴有并发症的儿童胆总管囊肿的临床处理

目的 讨论合伴有各类并发症的儿童胆总管囊肿的临床处理及手术时机和方法.方法 回顾性分析2013年1月至2015年12月上海新华医院小儿外科收治的45例合伴有各类并发症的儿童胆总管囊肿患儿的临床资料.其中,胆道穿孔7例,胆源性胰腺炎9例,胆管炎、阻塞性黄疸、肝功能受损29例,保守治疗效果不佳.7例胆道穿孔中,5例胆汁性腹膜炎行囊肿外引流和二期根治术;2例隐匿性胆道穿孔一期行根治术.9例胆源性胰腺炎给予内镜下鼻胆管引流,待淀粉酶正常后一期行根治术.29例阻塞性黄疸伴肝功能受损的患儿中,17例发病年龄小于3个月行一期根治手术;12例发病年龄大于6个月患儿先行ERCP置鼻胆管引流,待黄疸消退、转氨酶正常后一期行根治性手术.结果 伴胆道穿孔的7例胆总管囊肿患儿中,2例在外引流期间出现水电解质紊乱,1例T管脱落,1例隐匿性穿孔在根治术后出血再次手术,余者术后均痊愈出院.9例胆源性胰腺炎患儿置鼻胆管引流后淀粉酶均恢复正常,根治术后均痊愈出院.并发急性胆管炎、伴有梗阻性黄疸、肝功能受损29例中,12例发病年龄大于6个月,其中11例行内镜下置鼻胆管引流后并发症改善行根治手术,1例ERCP失败后改行外引流和二期根治术;小于3月龄婴儿直接行一期根治性手术,术后均痊愈出院.所有患儿保持随访,术后随访时间1～3年.1例术后慢性胰腺炎史,1例胆管炎史,均通过药物治疗缓解症状.结论 对合伴有各类并发症的儿童胆总管囊肿选择合理的处理手段和合适的手术方式将有效减少并发症所造成的危害.     

鼻内镜下电动切吸器治疗儿童腺样体肥大37例临床分析

目的 探讨鼻内镜下电动切吸器经鼻行腺样体切除的可行性及优点。方法 对37例腺样体肥大患儿施行经鼻腺样体切除术，治疗因腺样体肥大所致的鼻窦炎、鼻炎和分泌性中耳炎等。结果 术后腺样体切除干净，无残留，鼻咽部结构显示良好，无咽鼓管损伤等并发症。随访6个月，无复发。结论 鼻内镜下电动切吸器治疗儿童腺样体肥大病变切除彻底，手术疗效明显，并发症少。     

小肠内置管肠排列术治疗婴幼儿粘连性小肠梗阻的远期临床效果

目的:探讨小肠内置管肠排列术在婴幼儿粘连性小肠梗阻中的远期临床效果。方法:回顾性分析2012年1月到2015年12月间郑州大学第三附属医院收治的67例粘连性小肠梗阻患儿行小肠内置管肠排列术治疗的临床资料。其中,男46例,女21例;年龄(343.3±279.7)d;既往腹部手术次数(1.1±0.6)次。术中顺行置管51例...     

Anatomic and audiologic sequelae after tympanostomy tube insertion or prolonged antibiotic therapy for otitis media

In this study the anatomic and hearing sequelae are characterized for 43 children (86 ears) with recurrent acute otitis media and/or persistent otitis media with effusion who had received three or more tympanostomy tube placements and 46 children (92 ears) managed medically with repeated courses of therapeutic and/or or prophylactic antibiotics. In the surgical group 311 tympanostomy tube surgeries had been performed and in the medical group 1334 episodes of acute otitis media and/or 186 episodes of otitis media with effusion occurred. Tympanosclerosis was found in 6.5% of the medical group ears and 52.3% of the surgical group ears. Tympanic atrophy occurred in 4.3% of the medical group ears and 40.7% of the surgical group ears. The duration of the presence of the tympanostomy tube significantly influenced the tympanic membrane. The presence of middle ear fluid at the time of tube insertion, particularly high viscosity ("glue") fluid, correlated with persisting sclerosis (P less than 0.00001) and reduced tympanic membrane mobility (P less than 0.00001) but not tympanic membrane atrophy (P = 0.94) later. Abnormal hearing, defined as a hearing threshold greater than 20 dB occurred in 9.3 to 18.7% of the surgical ears and in 3.7 to 9.0% of the medical ears depending on the hearing frequency tested. Medical management consisting of recurrent use of therapeutic and/or prophylactic antibiotics was associated with infrequent anatomic and audiologic sequelae. Repeated placement of tympanostomy tubes may be associated with the frequent occurrence of both anatomic and audiologic sequelae.     

Why and how should serous otitis media be treated?]

Serous otitis media is an extremely commonplace condition in pediatric patients and tends to resolve spontaneously. Only some forms warrant treatment. Indications for treatment include frequent superinfections, lasting hearing impairment with adverse consequences on socialization, or debilitation of the tympanic membrane carrying a risk for the ear. Tympanostomy tubes are a palliative treatment for serous otitis which restores hearing within a few hours and eliminates unfixated retractions of the tympanic membrane within a few weeks. Tympanostomy tubes may lead to complications including otorrhea and perforation of the tympanic membrane and should therefore be used only in patients with severe otitis media. Etiologic treatment of serous otitis rests on restoration of satisfactory nasal ventilation (education to improve nose-blowing, adenoidectomy), improvement of eustachian tube patency (corticosteroids), and modification of the characteristics of middle ear secretions (mucolytic agents and mucomodifying agents).     

Hearing thresholds and tympanic membrane sequelae in children managed medically or surgically for otitis media with effusion

OBJECTIVE: To determine the long-term effects of ventilation tube insertion on hearing thresholds and tympanic membrane pathologic abnormalities in children with otitis media with effusion. DESIGN: Prospective cohort study. SETTING: Tertiary care children's hospital, otorhinolaryngology and audiology service. PARTICIPANTS: Patients aged 8 to 16 years who participated in a randomized controlled trial of medical vs surgical (ventilation tube [VT]) treatment for recurrent otitis media with effusion at ages 2.5 to 7 years. MAIN OUTCOME MEASURES: Hearing thresholds and tympanic membrane sequelae. METHODS: One hundred thirteen of 125 children who had participated in the trial underwent blinded audiometric, tympanometric, otomicroscopic, and parental questionnaire evaluation 6 to 10 years following the trial. Thirty of 57 [corrected] medical subjects received ventilation tubes and 18 of 56 [corrected] VT subjects received more than 1 set of tubes. To evaluate sequelae risk associated with ventilation tubes independent of disease severity, we compared 27 medical subjects who never received ventilation tubes and 38 subjects randomized to VT who only received 1 set of tubes. RESULTS: Tympanic membrane pathologic abnormalities were present in 81% of VT subjects and 19% of medical subjects (relative risk, 4.4; 95% confidence interval, 2.2-9.9). Hearing thresholds were 2.1 to 8.1 dB higher in subjects treated with tubes (P = .005). CONCLUSIONS: In children who were candidates for ventilation tube insertion randomly assigned to receive medical or VT treatment for otitis media with effusion, elevated hearing thresholds and tympanic membrane pathologic abnormalities were more common in VT subjects 6 to 10 years after insertion.     

Evaluation of ventilating tubes and myringotomy in the treatment of recurrent or persistent otitis media

In a prospective controlled study of the efficacy and sequelae of ventilating tubes, 44 children with bilateral recurrent acute otitis media (greater than 6 episodes/year) and 13 children with bilateral persistent middle ear effusion (greater than 3 months) received unilateral ventilating tube insertion in a randomly selected ear. The contralateral ears were randomized to receive either myringotomy alone or no surgery. Clinical, otoscopic, tympanometric and audiologic examinations were performed before the study and 2 to 4 weeks later, then at 3-month intervals for up to 2 years and at 36 months after surgical randomization. Medical therapy and antibiotic prophylaxis were used whenever indicated. While the ventilating tubes remained functional (mean duration, 10 months) the ears with a tube had significantly fewer episodes of otitis media than their contralateral ear (P less than 0.001; 95% confidence intervals -0.7, -1.7) and had more hearing improvement (P = 0.005; 95% confidence intervals, -5.9, -1.2). After tube extrusion there was a tendency for surgically treated ears to have more otitis and worse hearing, but not at a significant level. Tympanosclerosis, retraction and atrophy were more common in ears that received tubes. The majority of ears treated medically also improved. There is need for a more cautious and selective use of ventilating tubes.     

Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion.

In a previous trial involving 109 children with chronic otitis media with effusion of at least a 2 months' duration that had been unresponsive to medical treatment, we compared the efficacy of myringotomy with tube insertion, myringotomy alone and no surgical intervention with regard to time with middle ear effusion, hearing status and other indices over a 3-year period. Because interpretation of the results was rendered difficult by certain complexities of study design, the present trial with a revised protocol was carried out in an additional group of 111 children. As in the previous trial, myringotomy with tube insertion resulted in less time with effusion and better hearing than did either myringotomy alone or no surgery. However, acute and chronic otorrhea and tympanic membrane perforation developed not uncommonly after tube insertion. Myringotomy alone offered no advantage over no surgery regarding the percent of time with effusion or the number of episodes of acute otitis media. Currently for children with long-standing middle ear effusion, we recommend either watchful waiting with periodic hearing assessment or myringotomy with tube insertion, individualizing the recommendation for each child.     

Turicella otitidis and Corynebacterium auris do not cause otitis media with effusion in children

BACKGROUND: The recently described coryneform bacteria and were first detected in the middle ear of patients with acute otitis media and chronic otitis media. Whether these bacteria play an essential role in the pathogenesis of otitis media with effusion (OME) is unclear. METHODS: In a prospective study 60 children with OME and 205 controls were evaluated to determine the incidence of and. Swabs from the external auditory canal (EAC) and the middle ear effusion (MEE) of OME children undergoing tympanotomy, ventilation tube insertion or both were cultured. Swabs from the EAC from healthy children served as controls. RESULTS: In control children was found in EAC swabs from 23 of 205 (11.2%) and in 32 of 205 (15.6%). was isolated from 14 of 60 (23.3%) OME patients from the EAC only and in 6 of 60 (10.0%) OME patients from both EAC and MEE. was isolated in 2 of 60 (3.3%) from the EAC only and in 1 of 60 (1.7%) from both EAC and MEE. In no patient did or grow exclusively from MEE. CONCLUSION: and may be part of the normal bacterial flora of the EAC in some children. Neither organism seems to cause OME in children.     

Diagnosis and treatment of the child with a draining ear.

Treating a child with a draining ear is a common occurrence in the pediatric primary office. The symptoms of otorrhea are broad, and a multitude of factors must be considered in arriving at a diagnosis. The assessment begins with a thorough history of the frequency, duration, and characteristics of the drainage. Physical examination of the affected ear requires cleansing of the external auditory canal before the tympanic membrane can be accurately assessed. The ear must be adequately visualized for accurate diagnosis and treatment. Differential diagnoses include acute suppurative otitis media, otitis externa, granuloma, and bullous myringitis. The acutely draining ear is frequently an uncomplicated suppurative event that will respond well to a regimen of aural hygiene and topical therapy. Patients with a chronically draining ear should be referred to an otolaryngologist for further diagnostics and aggressive therapy. Children with tympanostomy tubes are especially at high risk for suppurative complications. Avoiding the introduction of water into the ear, protecting the ear from water, and prophylactic topical treatment are options that have been suggested for prevention of otorrhea.     

Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial.

To determine the efficacy of amoxicillin prophylaxis and of tympanostomy tube insertion in preventing recurrences of acute otitis media, we randomized 264 children 7 to 35 months of age who had a history of recurrent otitis media but were free of middle ear effusion to receive either amoxicillin prophylaxis, bilateral tympanostomy tube insertion or placebo. The average rate of new episodes per child year of either acute otitis media or otorrhea was 0.60 in the amoxicillin group, 1.08 in the placebo group and 1.02 in the tympanostomy tube group (amoxicillin vs. placebo, P less than 0.001; tubes vs. placebo, P = 0.25). The average proportion of time with otitis media of any type was 10.0% in the amoxicillin group, 15.0% in the placebo group and 6.6% in the tympanostomy tube group (amoxicillin vs. placebo, P = 0.03; tubes vs. placebo, P less than 0.001). At the 2-year end point, the rate of attrition was 42.2% in the amoxicillin group, 45.5% in the placebo group and 26.7% in the tympanostomy tube group. Adverse drug reactions occurred in 7.0% of the amoxicillin group and persistent tympanic membrane perforations developed in 3.9% of the tympanostomy tube group. The observed degree of efficacy of amoxicillin prophylaxis and of tympanostomy tube insertion must be viewed in light of the fact that study subjects proved not to have been at as high risk for acute otitis media as had been anticipated and in view of the differential attrition rates.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bacterial etiology of acute myringitis in children less than two years of age.

BACKGROUND: Acute myringitis is an inflammation of the tympanic membrane that occurs alone or in association with external otitis or otitis media. The two clinical entities, based on physical examination, are bullous myringitis and hemorrhagic myringitis. OBJECTIVES: To investigate the association of concomitant middle ear disease with acute myringitis and to analyze the bacteriologic findings of the middle ear fluid in children with acute myringitis. METHODS: A prospective longitudinal cohort study of 2028 children age 7 to 24 months at primary care level in the Finnish Otitis Media Vaccine Trial. Matched case-control design for analysis of bacterial pathogen distribution. RESULTS: There were 82 children in whom 92 ears were diagnosed with acute bullous myringitis and 37 children in whom 40 ears were diagnosed with hemorrhagic myringitis during the follow-up. Middle ear disease was associated with bullous myringitis in 97% of ears and with hemorrhagic myringitis in 82% of ears. Bacterial pathogen distribution was similar to that of acute otitis media, although a higher proportion of Streptococcus pneumoniae was detected in both bullous and hemorrhagic acute myringitis. CONCLUSIONS: Middle ear fluid was present in vast majority of ears with acute myringitis in young children. The same etiologic bacteria were found in acute myringitis as in acute otitis media, but S. pneumoniae was the major pathogen. Acute bullous myringitis should be treated as acute otitis media in children <2 years of age.     

Pneumatic otoscopy in pediatrics]

Pneumatic otoscopy is based upon the reaction of the tympanic membrane after sending a small air volume. A normal mobility means that air is present in the middle ear. Instead absent or reduced mobility means that effusion is present. This technique improves the quality of ears clinical examination and is particularly useful for the diagnosis of suppurative and serous otitis media.