儿童分泌性中耳炎的临床经验介绍

分泌性中耳炎是耳鼻喉科常见疾病之一,也是儿童的常见病及多发病之一,且儿童发病率明显高于成人,是引起儿童听力下降的重要原因之一,多有感冒病史,早期症状不明显,很容易延误病情。孙海波教授善于从中医角度治疗一些疑难病症,临床经验丰富,治疗儿童分泌性中耳炎更是有其独到见解,孙教授从"疏风宣肺,健脾利湿通窍"论治,随证加减,综合疗法治疗儿童分泌性中耳炎,疗效显著。     

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。     

小儿腺样体肥大与分泌性中耳炎

目的探讨腺样体肥大患儿的不同鼓室图与分泌性中耳炎的关系及分泌性中耳炎的诊断。方法对2009年1月—2011年6月期间本院收治的328例腺样体肥大患儿(包括单纯腺样体肥大及合并有慢性扁桃体炎及扁桃体肥大者)的病例资料进行回顾性分析。分析统计分泌性中耳炎的发病率及声导抗测试诊断分泌性中耳炎的阳性率。结果 328例腺样体肥大患儿中有105例最终经鼓膜穿刺或鼓膜置管确诊为分泌性中耳炎(32.31%);声导抗测试鼓室导抗图表现为B型者89例152耳,其中最终确诊为分泌性中耳炎者为86例147耳,阳性率为96.63%;C导抗图(负压在-150dapa以上)者33例49耳,其中最终确诊为分泌性中耳炎者为16例20耳,阳性率为40.82%;As导抗图2例2耳亦最终确诊为分泌性中耳炎。结论对于腺样体肥大患儿不论主诉有无听力下降,常规进行声导抗测试,同时结合认真的体格检查及电耳镜或耳内镜检查,可大大降低小儿分泌性中耳炎的误诊率。     

儿童与成人分泌性中耳炎临床特征比较

目的 探讨儿童与成人分泌性中耳炎的临床特征的异同.方法 回顾性分析我科2004年3月～2006年3月诊治的84例(104耳)儿童和41例(53耳)成人分泌性中耳炎患者的临床资料,比较其病因、病程、首发症状和听力受损特征的异同.结果 儿童分泌性中耳炎患者平均病程较成人短,病因以腺样体肥大和上呼吸道感染为主,首诊原因多为耳痛,其次为听力下降;成人患者病程较长,病因以慢性鼻窦炎鼻息肉和鼻咽部新生物为主,首诊原因多为听力下降,其次为耳闷.儿童与成人患者都可出现骨导听阈提高,以2、4、8 kHz为主.结论 儿童与成人分泌性中耳炎患者在病因、病程及首发症状等方面有所不同,且儿童患者可造成言语语言发育迟缓,应及早诊治.     

The occurrence of secretory otitis media in allergic children

One hundred and forty-four ears (72 patients), forming part of the computer controlled respiratory allergy group of the University of Turku, were analyzed with tympanometry and audiometry to diagnose secretory otitis media. Effusion was found in 3 ears (2 patients) and a pathological tympanogram in a total of 15 ears (io patients). The incidence of secretory otitis media was 3% and of pathological tympanograms 14%. This study supports the opinion that immediate allergy is not an aetiological factor in secretory otitis media.     

Tubal function in chronic secretory otitis media in children

In 100 children (150 ears) with chronic secretory otitis media the function of the Eustachian tube during treatment with grommet was investigated by air equalisation methods. Tubal function proved poor in the great majority at the beginning of the treatment, but towards its completion there was some improvement. After extrusion of the grommet, tubal function was investigated on the same material by tympanometry. 34% had normal middle-ear pressure initially, and 43% 12-18 months after closure of the perforation. There was no relation between tubal function shown by air equalisation methods and by tympanometry, and the air equalisation methods proved of less value than tympanometry in assessing the course and prognosis of secretory otitis. The pathogenetic theories - the ex vacuo and the secretory theory - are discussed in relation to the chronic tubal dysfunction found to be the most common direct cause of the disease.     

Nasopharyngeal bacteriology and secretory otitis media in young children

A prevalence study was performed on the nasopharyngeal bacteriology of 112 young children, aged 4-6 years. During the preceding 2 years, 74 of these children had suffered from secretory otitis media (SOM) and 40 had had normal middle ear ventilation. At the examination, one-third of the children with SOM had improved their middle ear status (previous SOM group), whereas otomicroscopy and tympanometry remained unchanged in the healthy group. The nasopharyngeal swab sample was obtained from behind the soft palate by the oral route. The isolation rate of Streptococcus pneumoniae was significantly higher in the SOM group than in the two other groups of children (p less than 0.006). The most commonly isolated capsular types of pneumococci were 6, 19, and 23, corresponding to the types involved in acute otitis media. The isolation rate of Haemophilus influenzae was 50% and an even distribution was found among the three groups of children examined. Biotypes I, II, III and IV accounted for 75% of the isolated cases of H. influenzae. As in acute otitis media, S. pneumoniae also seemed to play an important role in the pathogenesis of tubal dysfunction and SOM, and the difference is probably caused by variations in the quantitative colonization of pneumococci in the nasopharynx.     

儿童分泌性中耳炎误诊漏诊分析

分泌性中耳炎（secretoryotitismedia,SOM）是儿童常见多发病之一,有资料表明,该病占学龄儿童体检人数的10％,占儿童耳鼻咽喉科患病数的3．6％,是儿童听力下降的常见原因[1];如不合理诊治,可能导致儿童听力障碍及言语、智力发育不良等。2009—01—2012—09期间在我科门诊和住院治疗的资料完整的236例（260耳）SOM患儿,发生误诊漏诊的22例（30耳）进行回顾性分析,现报告如下。     

分泌性中耳炎患儿腺样体组织中T淋巴细胞亚群分布

目的 探讨儿童肥大腺样体T淋巴细胞亚群免疫失衡与反复发作性分泌性中耳炎的关系.方法 106例分泌性中耳炎患儿腺样体组织(72例中耳炎发作次数大于3次,34例中耳炎发作次数少于等于3次)及30例单纯腺样体肥大患儿腺样体组织.采用免疫组化方法检测上述各组T淋巴细胞CD4 、CD8 的表达及CD4 /CD8 值,统计分析三组之间是否有差别.结果 反复发作性分泌性中耳炎(中耳炎发作次数大于3次)患儿腺样体组织中CD4 、CD8 细胞数及CD4 /CD8 分别为41.9±9.07,20.45±7.08,2.10±0.17;较非反复发作性分泌性中耳炎组(中耳炎发作次数少于等于3次)17.4±6.85,13.02±5.88,1.33±0.11及单纯腺样体肥大组(无中耳炎病史)16.3±8.21,11.15±5.71,1.39±0.1 5均有显著性差异(P＜0.05);其中CD4 细胞数明显多于CD8 细胞数;非反复发作性分泌性中耳炎组患儿腺样体组织中CD4 、CD8 的表达及CD4 /CD8 与单纯腺样体肥大组比较无明显差异(P＞0.05).结论 反复发作性分泌性中耳炎的形成与T淋巴细胞亚群免疫失衡有关.     

The occurrence of secretory otitis media in allergic children.

One hundred and forty-four ears (72 patients), forming part of the computer controlled respiratory allergy group of the University of Turku, were analyzed with tympanometry and audiometry to diagnose secretory otitis media. Effusion was found in 3 ears (2 patients) and a pathological tympanogram in a total of 15 ears (10 patients). The incidence of secretory otitis media was 3% and of pathological tympanograms 14%. This study supports the opinion that immediate allergy is not an aetiological factor in secretory otitis media.     

Prevalence of secretory otitis media among school children in Kuwait

Tympanometry and otoscopy were performed by the authors on 893 school-children in Kuwait during early 1983. Based on tympanometry 31.3 per cent were found to have tympanograms indicating secretory otitis media. The otoscopic findings confirmed this high prevalence (30.0 per cent). At re-examination three months later, the point prevalence had decreased by almost 5 per cent which is well in accordance with the seasonal variation of this disease.     

The surgical treatment of secretory otitis media in children.

Two groups of children with secretory otitis media, 100 in each group, were followed after treatment. The first group was treated with adenoidectomy only, the second group was treated with adenoidectomy and bilateral myringotomies with insertion of grommets. The difference in results between the two treatments was found to be statistically not significant.     

Bacteriologic evaluation of middle ear fluid during the course of secretory otitis media in children

Fluid collected from tympanic cavity during operation from 43 children with O.M.S. was subjected to bacteriological examination. After the collection, each sample was immediately applied to Bactec Peds Plus/F liquid medium from Becton Dickinson. The number of samples, where each genus and species of bacteria were found, was determined, as well as the number of samples where every two genus coexisted; also the pH genes, in which each genus was found were calculated. Obtained results showed that 22 species of bacteria, belonging to 6 genus lived in the samples. The most commonly occurring genus were Staphylococcus, Streptococcus and Haemophilus; the most rare genus were Moraxella and Bacillus. The most common species were: Haemophilus influenzae (18.6% of samples), Staphylococcus aureus (14.0%), Staphylococcus epidermidis (11.6%), Staphylococcus warneri (9.3%) and Streptococcus oralis (7.0%). Streptococcus coexisted most frequently with Staphylococcus and Haemophilus; Staphylococcus--with Haemophilus and Bacillus; Haemophilus--with Streptococcus and Staphylococcus. The pH ranges for the three most often found genus were: for Staphylococcus--7.7-9, for Streptococcus--7.7-9.3 and for Haemophilus--8.2-8.8.     

Impedance screening for otitis media with effusion in Nigerian children

Tympanometry and acoustic reflex tests performed on 431 school children aged five to six years showed that eight per cent of the ears screened had type B or type C tympanograms suggestive of otitis media with effusion (1.2 per cent type B, and 6.8 per cent type C). Preliminary otoscopy revealed tympanic membrane appearances consistent with middle ear effusion in a correspondingly low proportion of ears (7.6 per cent), whilst acoustic reflex screening at 105 dB for three frequencies (0.5, 1 and 2 kHz) showed absent reflexes at one or more frequencies in 8.1 per cent of the ears. The findings indicate a relatively low prevalence of otitis media with effusion in children in Nigeria. Possible contributory factors are discussed.     

儿童腺样体肥大与分泌性中耳炎的相关性研究

目的分析儿童腺样体肥大伴分泌性中耳炎的发病情况及腺样体切除术后分泌性中耳炎的转归。方法1382例腺样体肥大的儿童行腺样体切除手术前后经鼻咽侧位片、声导抗检测及电测听检查,统计分析伴分泌性中耳炎发生率及其与腺样体肥大的关系。结果1382例中腺样体肥大合并分泌性中耳炎患者892耳,腺样体切除术后3个月复查,合并分泌性中耳炎患儿中治愈528耳（59.19%）,好转298耳（33.41%）,总有效率达92.60%。结论腺样体过度肥大是儿童分泌性中耳炎的一大诱因,鼻内镜下切除肥大腺样体治疗分泌性中耳炎,疗效明确,具有重要的临床意义。     

儿童鼻窦炎与分泌性中耳炎相关性的研究

目的探讨儿童鼻窦炎与分泌性中耳炎(SOM)的关系,以便有效地预防与治疗儿童鼻窦炎与分泌性中耳炎.方法为儿童鼻窦炎96例与正常儿童73例进行声阻抗检查,分析SOM的发病情况.结果两组之间分泌性中耳炎发生率差异有高度显著性(P＜0.01).结论儿童鼻窦炎与分泌性中耳炎密切相关,防治SOM中,须重视儿童鼻窦炎的防治.     

儿童分泌性中耳炎的疗效观察与分析

目的 探讨借鉴美国儿科学会、家庭医生学会和美国耳鼻咽喉-头颈外科学会<分泌性中耳炎的临床诊断与处理指南>治疗儿童分泌性中耳炎的疗效.方法 通过2006年12月至2007年1月对山东省滨州市1 536例2～7岁儿童进行分泌性中耳炎横断面流行病学调查,对确诊的96例患儿借鉴该指南进行治疗,即保守治疗随诊3个月,保守治疗3个月无效者选择手术治疗.将拟进行手术的患儿随机分成腺样体切除组及腺样体切除+鼓膜置管组.对2组的疗效进行系统的观察与分析.结果经过系统、规范的随诊、治疗,96例分泌性中耳炎患儿,治愈89例,好转5例,无效2例,有效率97.91%.其中保守治疗有效74例,有效率77.08%;2～3岁、4～5岁、6～7岁三个年龄组经保守治疗有效率差异有统计学意义,年龄越小,保守治疗效果越好.手术治疗22例:腺样体切除术组11例,治愈9例,好转2例,有效率100%;腺样体切除+鼓膜置管组11例,治愈3例,好转6例,无效2例,有效率81.81%;两组有效率差异有统计学意义.结论 经过借鉴该指南治疗儿童分泌性中耳炎,有效率高,值得广大耳鼻咽喉科医师参照进行规范治疗.在手术方式选择上推荐腺样体切除术.     

Adenoidectomy for otitis media with effusion in 2-3-year-old children

Objective

To compare the efficacy of three surgical treatment combinations - myringotomy and tympanostomy tube insertion (M&T), adenoidectomy with M&T (A-M&T), and adenoidectomy with myringotomy (A-M) - in reducing middle-ear disease in young children with chronic OME.

Methods

Children 24-47 months of age, with a history of bilateral middle-ear effusion (MEE) for at least 3 months, unilateral for 6 months or longer or unilateral for 3 months after extrusion of a tympanostomy tube, unresponsive to recent antibiotic, were randomly assigned to either M&T, A-M&T, or A-M. Treatment assignment was stratified by age (24-35 months, 36-47 months), nasal obstruction (no, yes) and previous history of M&T (no, yes). Subjects were followed monthly and with any signs or symptoms of ear disease for up to 36 months.

Results

Ninety-eight subjects were randomly assigned to the three treatment groups. Fifty-six subjects (57%) were 24-35 months of age; 63% had nasal obstruction, and 36% had previously undergone M&T. During the 36 months after entry, subjects were noted to have MEE for the following percentages of time: 18.6% in the M&T group, 20.6% in the A-M&T group, and 31.1% in the A-M group (M&T vs. A-M&T, p = 0.87; M&T vs. A-M, p = 0.01). By 36 months, there were no differences in the number of further surgical procedures for ear disease needed among the groups.

Conclusions

Adenoidectomy with or without tube insertion provided no advantage to young children with chronic OME in regard to time with effusion compared to tube insertion alone. Fewer tympanostomy tubes were placed in children undergoing A-M as their initial procedure, but this should be balanced by the performance of the more invasive surgical procedure and their increased time with effusion.     

Evaluation of adenoid mast cells in children with secretory otitis media

Mast cells may play a role in pathogenesis of the otitis media with effusion (OME) in children. The study involved 72 children with no history of allergic diseases. The analysed material were adenoids removed on the grounds of hypertrophy. Immunohistochemical analyses were carried out using antibodies (Dako, M 7052) directed against mast cell tryptase. The slides evaluation was performed by means of optic microscope. The presence of mast cells within adenoidal tissue were scored. There were no statistically significant difference between the numbers of mast cells in each examined adenoid as well as age groups. Our results correspond with those obtained by other authors according to mast cells distribution in adenoid tissue and do not indicate any particular role of mast cells in pathogenesis of OME in children.