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。     

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.     

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.     

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.     

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。     

Middle ear fluid bacteriology of acute otitis media in neonates and very young infants

The middle ear fluid (MEF) bacteriology of 107 attacks of acute otitis media (AOM) in 101 infants less than 3 months old was analyzed. A total of 108 bacteria were isolated from 85 attacks. Major AOM-pathogens, S. pneumoniae (19%), H. influenzae (9%) or B. catarrhalis (7%) were cultured in approximately one-third of all the attacks. S. aureus (17%) and coagulase-negative staphylococci (22%) without the above pathogens were commonly found, whereas gram-negative enteric bacteria were culturable from only 5 attacks. Only 8% of the MEFs were polymicrobial. More than half of all the bacterial strains produced beta-lactamase. The bacteriology of those younger than one month was not different from that of the others. The same was true with attacks of out-patients and in-patients, except for a larger proportion of beta-lactamase producing strains in in-patients. Nasal-nasopharyngeal and MEF samples showed the same bacteriology in only 20% of cases. Two-thirds of AOM attacks were present in infants with perinatal or other concomitant morbidity, but their bacteriology was not different from those without other morbidity. In addition to the examination of ears in infants presenting with any illness before the age of 3 months, the study stresses the importance of bacteriological analysis of MEF in all cases of AOM at this age.     

Nasopharyngeal and middle ear flora in children with acute otitis media

Nasopharyngeal flora can be a reservoir of bacteria caused acute otitis media in children. The aim of the study was to identify microorganisms and antimicrobial susceptibilities of pathogens from the nasopharynx and middle ear of children with acute otitis media. The study comprised 128 children ages 1 year to 14 years with diagnosed of acute otitis media with purulent discharge. The nasopharyngeal and middle ear samples were collected at the same time. Agar, chocolate, blood and Chapman plates were inoculated for isolation of bacteria. The plates were incubated at 37 degrees C and examined at 24 hours. The susceptibility of bacteria was determined by disk diffusion technique containing concentration gradients for following antibiotics: penicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefaclor, cefprozil, cefuroxime, erythromycin, azithromycin, clindamycin and trimethoprim/sulfamethoxazole. 196 organisms from nasopharynx and 325 organisms from middle ear were isolated. Most frequent cultured bacteria were: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis--75.6% in nasopharynx and 77.8% in middle ear. We observed statistically significant (p < 0.01) increased of Moraxella catarrhalis in specimens from the middle ear than from nasopharynx. Most of the organisms were susceptible to amoxicillin/clavulanate--83.2% of bacteria from nasopharynx and 81.8% of bacteria from middle ear. Most organisms were resistant to trimethoprim/sulfamethoxazole--60.7% of bacteria from nasopharynx and 62.6% of bacteria from middle ear. Penicillin resistance was observed in 25.0% of bacteria from nasopharynx and 25.6% of bacteria from middle ear. The correlation in resistance of bacteria between trimethoprim/sulfamethoxazole and erythromycin (r = 0.4886) and between trimethoprim/sulfamethoxazole and penicillin (r = 0.5027) was observed. Nasopharyngeal and middle ear flora in children with acute otitis media is similar. In that case susceptibility of bacteria from the nasopharynx can be useful for empirical treatment of acute otitis media in children.     

Nasopharyngeal bacterial flora and secretory otitis in adults

The AA. have realized a prospective study of the links between the bacterial flora of the nasopharynx and the secretory otitis media in grown-up people. For achieving this purpose nasopharyngeal smears of rhinopharyngeal samples belonging to 85 otitic patients and other 85 healthy adults were cultivated. Statistical analysis showed that the otitis cases presented with 63.6% of microorganisms potentially pathogenic, being the 17.6% the percentage among healthy individuals (p < 0.001). Microorganisms more frequently encountered were: Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. After the medical treatment those patients recovered showed an increase of saprophyte flora from early 36.4% till 86% (p < 0.001). It could be appreciate a seasonal influence in the debut of this malady specially in winter.     

Aerobic bacteriology of chronic suppurative otitis media without cholesteatoma in children.

Medical management of chronic suppurative otitis media without cholesteatoma in children was shown recently to be efficacious. We undertook a prospective study in order to determine 1) the organisms associated with the disease and their sensitivity to various antibiotics and 2) their association with clinical variables. Pseudomonas was isolated from 84% of the patients, enteric gram-negative bacilli from 32%, Staphylococcus aureus from 20%, streptococci from 14%, and Hemophilus influenzae from 15%. Pseudomonas aeruginosa was the sole isolate in 48 of the 128 patients (38%). The sensitivity of P aeruginosa (78 isolates) was 100% (of isolates) to mezlocillin and ciprofloxacin, 99% to tobramycin and ceftazidime, 97% to piperacillin, 94% to gentamicin, and 78% to ceftriaxone. The isolated organisms and their sensitivity to antibiotics were not associated with age, sex, duration of otorrhea, or the presence of granulation tissue or polyps. We believe that our data may contribute to the appropriate choice of antibiotics when nonsurgical management of chronic suppurative otitis media without cholesteatoma is considered.     

Chronic secretory otitis media

Of 242 children and teenagers treated surgically for chronic secretory otitis media in 1972, 212 presented for evaluation 5 years later. Although the pure-tone audiometric threshold was 20 dB HL or better in 87.7% of the ears, only 40.6% were judged to be otoscopically normal. The findings at the first myringotomy for insertion of tympanostomy tubes were of no prognostic value for the course of the disease, and the presence of characteristics of middle ear fluid at subsequent myringotomies varied unpredictably. Adenoidectomy performed at an early stage, and in the presence of nasal obstruction, resulted in a significant reduction in the need for re-insertion of tympanostomy tubes.     

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.     

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.     

A prospective epidemiological study of secretory otitis media in young children related to the indoor environment

To assess the influence of housing upon the middle ear status in young children in the form of secretory otitis media (SOM), 210 children not looked after in kindergarten or municipal day-care were investigated. Tympanometry was performed 6 times at 2-week intervals, and the parents filled in a questionnaire concerning housing conditions. In addition to the number of times the children had suffered from SOM, we evaluated long-lasting cases, and the frequency of common colds. Age affected all 3 parameters and sex 1, the boys having a larger number of long-lasting episodes. As to housing factors, the type of housing was of importance, children living in flats being most apt to get SOM, and children on farms least, but this difference disappeared after a regression analysis. Both major and minor airing resulted in fewer cases of SOM than did average airing. Children with a history of allergy (but not of allergic rhinitis) caught colds more often than others.     

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。     

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.