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析

目的 分析腺样体肥大儿童伴分泌性中耳炎(ＯＭＥ)与变应性鼻炎(ＡＲ)发病的相关性。方法 回顾性分析12岁以下870例腺样体肥大患儿的病史,分析AR、咽鼓管功能不良及OME的相关性。结果 本组腺样体肥大患儿中AR发病率为30.11%,AR在不同年龄组中的发病率差异有统计学意义,随着年龄增加,发病率逐渐升高(P<0.01)。6岁以内发生咽鼓管功能障碍及OME的概率高,其中1~3岁组发生分泌性中耳炎的概率最大(P<0.01)。春季OME发病率高(P<0.001)。与不伴AR患者相比,伴有AR患儿患咽鼓管功能不良的概率增加了0.4倍(P=0.042);但患有OME的检出率减少了32%(P=0.0472)。结论 在腺样体肥大患儿中,多种因素使咽鼓管功能不良乃至OME高发。其中咽鼓管及其周围结构生理、病理、发育特点是最主要的因素,变态反应是次要影响因素。随着年龄增长,前者因逐渐发育完善,致病性降低,后者致病性增高,但总的发病率是逐渐降低的。     

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.     

应用声反射鼻腔测量腺样体肥大患儿的鼻及鼻咽气道

目的:研究声反射鼻腔测量对腺样体肥大患儿的诊断与手术疗效评价方面的临床应用价值。方法:对23例正常儿童(正常儿童组)及27例腺样体肥大患儿(腺样体肥大组)进行坐位声反射鼻腔测量。结果:腺样体肥大组术前总鼻气道阻力(NAR)为[(0.44±0.17)kPa.L-1.min-1],较正常儿童组[(0.33±0.17)kPa.L-1.min-1]增大,差异有统计学意义(P<0.05),双侧鼻咽部容积(NPV)为[(14.74±5.01)cm3],较正常儿童组[(19.77±5.77)cm3]减小,差异有统计学意义(P<0.01);腺样体肥大组术后总NAR为[(0.36±0.21)kPa.L-1.min-1],较术前减小,差异有统计学意义(P<0.05),双侧NPV为[(17.93±4.56)cm3],较术前增大,差异有统计学意义(P<0.05)。结论:声反射鼻腔测量在腺样体肥大的诊断和疗效判定方面具有重要意义。     

血清中炎症介质和细胞因子与儿童腺样体肥大相关性研究

目的 探讨儿童腺样体肥大(adenoid vegetation)患者血清中肿瘤坏死因子-α(TNF-α) 、白介素-4(IL-4)、嗜酸细胞阳离子蛋白(ECP)水平变化及与其肥大程度、体质量指数之间的关系。方法 经鼻咽部X线侧位片及查体确诊的87例单纯腺样体肥大患者(实验组)及49例体检正常儿童(对照组),测定其身高、体质量,计算体质量指数(BMI)即体质量/身高2,用腺样体与鼻咽部口径的比值(A/N )来代表腺样体的相对大小;清晨抽取空腹静脉血,应用酶联免疫法(ELISA)测定血清中TNF-α、IL-4水平及Pharmacia CAP System ECP FEIA荧光酶标法测定血清中ECP水平,分析腺样体肥大程度、BMI与血清中TNF-α 、IL-4、ECP水平之间的关系,采用SPASS 17.0软件进行统计学分析。结果 实验组的血清TNF-α水平为(492.50±13.24)mg/L,与对照组(310.25±10.32)mg/L相比,差异具有统计学意义(P<0.05);实验组与对照组血清IL-4水平分别为(252.91±14.31)pg/mL、(174.37±11.23)pg/mL,差异有统计学意义(P<0.05);ECP水平分别为(6.12±1.18)μg/L、(5.56±0.87)μg/L,差异无统计学意义(P>0.05)。TNF-α水平与腺样体肥大程度分别呈正相关(轻度：r=0.98, P<0.05;中度：r=0.92, P<0.05;重度：r=0.94, P<0.05); IL-4水平与其肥大程度亦分别呈正相关(轻度：r=0.95, P<0.05;中度：r=0.94, P<0.05;重度：r=0.99, P<0.05),且均与BMI无关;ECP水平在两组检测结果中无明显差别(P>0.05)。 结论 腺样体肥大患者血清中TNF-α 、IL-4水平存在不同程度的升高且其水平与腺样体肥大程度呈正相关,与BMI无关;而ECP与腺样体肥大与否及其肥大程度无明显相关性。     

学龄前儿童腺样体肥大的声导抗和DPOAE探测结果分析

目的探讨与研究学龄前儿童腺样体肥大的声导抗和耳声发射。方法选取75例3~7岁不同程度腺样体肥大儿童,依次进行声导抗和耳声发射测试,并记录结果和参数。结果腺样体Ⅲ度肥大患儿出现A型鼓室图的概率、声反射引出率、平均峰压值均明显低于I度及II度肥大患儿,差异有统计学意义(P<0.05);腺样体III度肥大患儿的DPOAE较I度肥大患儿(1~8k Hz),较II度肥大患儿(1.5~8k Hz)引出率低,差异有统计学意义(P<0.05);声导抗为A型的患儿中,声反射未引出者的DPOAE在0.5~2k Hz区域引出率低于声反射引出者,差异有统计学意义(P<0.05)。结论对腺样体肥大的学龄前儿童应常规行声导抗和/或耳声发射检查,有助于早期诊断该人群是否伴有分泌性中耳炎;不同程度的腺样体肥大对儿童的中耳影响不同,III度腺样体肥大引起儿童分泌性中耳炎的概率大,程度重。     

腺样体肥大程度与分泌性中耳炎的相关性研究

目的：探讨腺样体大小与分泌性中耳炎(SOM)的相关性。方法：根据腺样体肥大的程度．将140例患儿分为腺样体中度肥大组和病理性肥大组。分析腺样体肥大程度对中耳功能的影响及两组间SOM发病率的差异。结果：两组之间SOM发生率差异有统计学意义；两组之间声导抗图的类型分布差异具有统计学意义。结论：腺样体肥大程度与SOM发病率呈正相关。     

儿童腺样体肥大和变应性鼻炎关系的临床研究

目的探讨儿童腺样体肥大与合并变应性鼻炎的相关性。方法抽选2017年10月至2018年10月间收治的60例儿童腺样体肥大患者,均对患儿进行鼻咽侧位像DR扫描,测定腺样体/鼻咽腔比率(A/N比值)来评定腺样体的大小,采用视觉模拟量表(VAS)供患者对疾病程度和生活质量所受的影响程度进行自我评估,依据症状发作的频度,持续时间,对睡眠、学习及工作的影响程度评分。应用Spearman秩相关对二者相关性进行分析。结果60例腺样体肥大患儿中,合并变应性鼻炎20例,占33.3%。腺样体肥大1级患儿4例,视觉模拟量表(VAS)评分为1-4分;2级6例,视觉模拟量表(VAS)评分2-7分;3级10例,视觉模拟量表(VAS)评分4-10分。腺样体肥大等级越高,视觉模拟量表(VAS)评分也越高。腺样体肥大与合并变应性鼻炎呈正相关。结论儿童腺样体肥大和变应性鼻炎具有显著相关性,腺样体肥大也是造成变应性鼻炎患病的因素之一。儿童变应性鼻炎的临床治疗,明确主要病因与腺样体肥大有关时,可采用对腺样体肥大的专业治疗,可有效消除变应性鼻炎的病源,改善患儿变应性鼻炎的症状,提升患儿的生活质量。     

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,...     

手术治疗腺样体肥大对儿童睡眠结构的影响

目的 观察腺样体肥大儿童在行腺样体切除术后睡眠结构的改变。方法 对120例行腺样体肥大切除术的儿童,分别于术前及术后1个月行夜间睡眠多导监测,比较手术前后宏观、微观睡眠结构的变化。结果 腺样体肥大儿童术后S1期和S2期所占比例与术前比较无统计学意义(P>0.05);SWS期和REM期所占比例增加(P>0.05)。腺样体肥大儿童术后觉醒指数AI(2.8±0.3)较术前(6.3±0.4)明显减小(P<0.01);术后最低SaO2（93.4±1.4）较术前(70.3±1.3) 明显提高(P<0.01)。 结论 腺样体肥大儿童术后宏观睡眠结构无明显改善,微观睡眠结构的改善可能是腺样体肥大儿童术后症状改善的病理生理学基础。     

儿童腺样体肥大所致鼻气道阻塞的客观评估

目的:研究鼻声反射技术在儿童腺样体肥大所致鼻气道阻塞客观评估中的临床应用价值.方法:30例腺样体肥大患儿分别于术前及术后8周接受声反射鼻腔测量和症状计分表调查,与27例正常儿童的声反射鼻腔测量各指标进行对照.结果:腺样体肥大组患儿手术前鼻气道阻力(NAR)和鼻咽腔容积(NPV)与手术后8周比较差异均有统计学意义(均P＜0.01),手术前鼻腔最小横截面积(MCSA)与手术后比较差异无统计学意义(P＞0.05);腺样体肥大组患儿NAR、NPV与MCSA与对照组比较差异均有统计学意义(P＜0.01);术后NAR与对照组比较差异无统计学意义(P＞0.05),NPV和MCSA与对照组比较差异有统计学意义(P＜0.01);NAR与NPV症状计分无明显相关(P＞0.05),MCSA与症状严重程度呈负相关(r=-0.519,P＜0.05).结论:鼻声反射测量可用于腺样体肥大所致儿童鼻气道阻塞的客观定量评估,在解释鼻声反射测量结果与主观症状关系时MCSA应作为主要参考指标.     

Measuring the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children

OBJECTIVE: To evaluate the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children. STUDY DESIGN: A prospective clinical study from June 2002 to May 2003. METHOD: A total of 64 children, aged 6-9 years who presented with nasal obstruction, snoring, mouth breathing, and hyponasal speech were examined and AN ratio was calculated by using the lateral neck radiograms and compared with the tympanometric values. The relationship between AN ratio and middle-ear pressure was evaluated, regarding the AN ratio of 0.71. The chi-square test was used to analyze the correlation between AN ratio and middle ear pressures and Wilcoxon test was used to compare the changes between the mean AN ratio values, and mean middle ear pressures (including A and C type tympanograms) before and after medical therapy. RESULTS: Middle-ear effusions and C type tympanograms in impedance audiometry were both related to eustachian tube dysfunction resulting from enlargement of the adenoids with AN ratios higher than 0.71. Middle ear pressures were found lower in children with AN ratio greater than 0.71 than in children AN ratio less than 0.71 and the difference was highly significant (p<0.001). Although medical treatment of large adenoids was rather effective to shrink the adenoid tissue (p<0.001), it did not cause a statistically significant change in tympanometric values (p>0.05). CONCLUSIONS: Antibiotherapy is effective in reducing adenoid size without signs and symptoms of infection. The reduction of the adenoids in size after 3 weeks of antibiotherapy has an positive effect on recovery of eustachian tube function but is not sufficient in patients with middle ear effusion. Early ventilation tube insertion may be an alternative therapy for the middle ear effusions not improving by 3 weeks medical therapy.     

腺样体铲除术对咽鼓管功能影响的研究

目的:观察鼻内镜下经口腔腺样体铲除术与传统腺样体铲除术对腺样体肥大患者咽鼓管功能的影响。方法:选取诊断为腺样体肥大且不伴中耳炎的住院患者为研究对象,分别采用鼻内镜下经口腔腺样体铲除术和传统腺样体铲除术,在治疗前及治疗3个月后分别检测咽鼓管功能。结果:2组患者治疗前咽鼓管功能检查无统计学差异,治疗后与术前相比,2组均有统计学差异;治疗后2组之间差异也有统计学意义。结论:鼻内镜下经口腔腺样体铲除术和传统腺样体铲除术均可改善腺样体肥大患者的咽鼓管功能,且鼻内镜下经口腔腺样体铲除术对咽鼓管功能的改善优于传统腺样体铲除术。     

儿童鼻窦炎对咽鼓管与中耳传音功能的影响

目的：探讨儿童鼻窦炎对咽鼓管与中耳传音功能的影响及程度,观察治疗鼻窦炎后,中耳传音功能障碍的恢复情况。方法：对儿童鼻窦炎100例和正常儿童50例行耳科检查、咽鼓管咽口观察、声阻抗检查、纯音测听,对比结果;对鼻窦炎合并耳病变的68例患者（128耳）行有针对性的治疗。结果：鼻窦炎患者中鼓膜异常率为64%、咽鼓管咽口异常率为62%、咽鼓管功能异常率为63.5%、鼓室导抗图异常率为62.5%,听力减退47.5%,与正常儿童组相比,差异有统计学意义（P＜0.01）。急性鼻窦炎、亚急性鼻窦炎与慢性鼻窦炎中耳病变的发生率和程度相比,差异有统计学意义（P＜0.05）。治疗鼻窦炎后,中耳传音功能障碍有明显改善。结论：儿童鼻窦炎引起咽鼓管功能的改变,中耳病变发生率较正常儿童显著增高;随病程的延长,发病率增高且程度加重。     

Tympanometric findings in patients with adenoid hyperplasia, chronic sinusitis and tonsillitis

Tympanograms were done on 120 patients with adenoid hyperplasia, chronic sinusitis and chronic tonsillitis to measure the middle-ear pressure as a parameter to eustachian tube function. The results were compared with those obtained in 50 normal subjects. The statistical significance of the mean values of middle-ear pressure is very highly significant in patients with adenoid hyperplasia, significant in chronic sinusitis group and insignificant in patients with chronic tonsillitis, as compared to the normal control group. Hence, eustachian tube dysfunction is maximum in patients with obstructing adenoids, less in chronic sinusitis and least in chronic tonsillitis.     

鼓室成形术后的咽鼓管功能检测及意义

目的探讨咽鼓管功能对慢性化脓性中耳炎鼓室成形术后疗效的影响。方法用咽鼓管鼓室-气流动态图(tube-tympanoaerodynamicgraphy,TTAG)法及音响法对53耳鼓室成形术后的咽鼓管功能进行检测,并分析鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况;并用鼻窦镜观察咽鼓管咽口,分析咽鼓管咽口与咽鼓管功能的关系。结果53耳鼓室成形术后咽鼓管功能正常37耳,其中29耳鼓膜生长良好;咽鼓管功能异常16耳中,有4耳鼓膜生长良好,比较咽鼓管功能正常耳与异常耳鼓膜生长良好耳数,两者有显著性差异(P<0.05);53耳术后有9耳咽鼓管咽口充血肿胀,其中2耳咽鼓管功能正常,7耳咽鼓管功能不良,提示术后咽鼓管功能障碍与咽鼓管咽口病变有关。结论慢性化脓性中耳炎鼓室成形术后咽鼓管功能与疗效关系密切,术后咽鼓管功能障碍可能是导致手术失败的原因之一。     

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.     

咽鼓管咽口及其周围形态学改变与分泌性中耳炎的相关性研究

目的:研究咽鼓管咽口及其周围形态学改变与分泌性中耳炎(SOM)的相关性。方法:72例(144耳)正常人为对照组,89例(151耳)SOM患者为SOM组。用纤维鼻咽镜观察对照组和SOM组咽鼓管咽口的形态及SOM组咽鼓管咽口周围形态改变。结果:①对照组和SOM组成人咽鼓管咽口形态中三角形及缝隙形的差异有统计学意义(均P<0.01);②对照组和SOM组儿童咽鼓管咽口形态差异无统计学意义;③成人SOM咽鼓管咽口周围形态改变与儿童不同。结论:①成人咽鼓管咽口形态改变在SOM的发生、发展中有着不可忽视的相关性,为探索成人SOM的治疗提供了一个新的思路。②在SOM组儿童中发现所有患儿咽鼓管咽口周围主要是鼻咽部炎症,次之是腺样体肥大和咽鼓管扁桃体肥大。③本研究采用纤维鼻咽镜直接观察咽鼓管咽口及鼻咽侧壁,对于明确SOM的病因和选择治疗方案具有重要意义。     

Adenoidectomy in otitis media. A review

For many years adenoids were thought to affect adversely middle ear (ME) aeration by obstructing the eustachian tube opening, leading to ME infections and effusions. Consequently, the adenoids have often been removed in children suffering from ME diseases; indeed, adenoidectomy is still performed around the globe on millions of children annually. Opinions vary, however, on the usefulness of the operation in various ME diseases. The purpose of this study is to review the available studies concerning the relationship of adenoids to the ME as well as the effect and benefit of adenoidectomy on ME effusions and ME infections.