Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials

We studied the efficacy of adenoidectomy in 213 children who had received tympanostomy-tube placement because of persistent and/or recurrent otitis media and had again developed otitis media after tubal extrusion. Ninety-nine of the children were assigned randomly to either an adenoidectomy group or a control group; in a separate trial, 114 children whose parents withheld consent for randomization were assigned according to parental preference. In both trials, control group outcomes appeared to have been biased favorably by the withdrawal of certain severely affected subjects from control status to receive adenoidectomy. Nonetheless, in both trials, adenoidectomy group outcomes were more favorable than control group outcomes during the first 2 follow-up years. Statistically significant differences were found mainly in the randomized trial, where during the first and second years, respectively, adenoidectomy subjects had 47% and 37% less time with otitis media than control subjects and 28% and 35% fewer suppurative (acute) episodes than control subjects. We conclude that adenoidectomy is warranted on an individualized basis for children who develop recurrent otitis media after extrusion of tympanostomy tubes.     

Chronic otitis media with effusion (glue ear) and adenotonsillectomy: prospective randomised controlled study

A prospective study was conducted of the effects of adenoidectomy and adenotonsillectomy on established otitis media with effusion unresponsive to medical treatment. The operations were performed at random with a controlled no surgery group on a cohort of 103 children with the condition and the results assessed six weeks, three months, six months, nine months, and one year later. After adenoidectomy the rate of resolution of the condition increased from 39% at six weeks to 72% at one year; and after adenotonsillectomy the rate increased from 59% at six weeks to 62% at one year. In the no surgery group the rate increased from 16% at six weeks to 26% at one year. Compared with the no surgery group the effect of adenoidectomy alone at one year was highly significant (p less than 0.001), and similarly the effect of adenotonsillectomy was significant (p less than 0.01). There was, however, no increased benefit from the addition of tonsillectomy compared with adenoidectomy alone. Thus there was resolution of 36-46% of chronic effusions as a result of adenoidectomy.     

鼓膜置管联合鼻内镜下腺样体切除治疗儿童分泌性中耳炎的临床疗效探讨

目的：探讨鼓膜置管联合鼻内镜下腺样体切除治疗儿童分泌性中耳炎的临床疗效。方法随机选取我院2011年1月～2012年10月收入的儿童分泌性中耳炎患者68例（120耳）为研究对象,按入院顺序分为观察组和对照组,各34例。将单纯行显微镜下骨膜置管治疗的34例（56耳）作为对照组;实施显微镜下鼓膜置管联合鼻内镜下腺样体切除治疗的34例（64耳）作为观察组。观察对比治疗5个月～1年后两组患者患耳的恢复状况、并发症发生情况及复发率。结果观察组显效24例、有效31例、无效9例,总有效率为86.0%,显著高于对照组的18、23、15、73.2%（χ2=11.400,P＜0.05）。治疗后5个月～1年内的随访发现,观察组无复发的病例,对照组有2例出现病情的反复,其复发率为5.9%,两组复发率差异显著（χ2=9.654,P＜0.05）;对照组出现1例中耳化脓性感染,观察组无并发症发生。结论鼓膜置管联合鼻内镜下腺样体切除治疗儿童分泌性中耳炎的疗效确切,能减少并发症的发生,降低复发率。     

经鼻内镜腺样体切除治疗儿童分泌性中耳炎的临床价值

目的：探讨腺样体切除对儿童内分泌性中耳炎听力的影响。方法：选取我院2008年9月~2010年9月收治的180例内分泌性中耳炎患者,采用经鼻内镜腺样体切除术治疗的90例患者为治疗组,采用保守治疗的90例患者为对照组,回顾性分析其3个月的随访资料,比较两组患者的手术疗效、术后并发症以及治疗组各频率听阈变化情况。结果：治疗组患者显效61例,有效24例,总有效率为94.44%;对照组显效52例,有效22例,总有效率为82.22%,治疗组患者疗效明显优于对照组,两组比较,差异有统计学意义（P〈0.05）。治疗组患者并发症发生率（8.89%）明显低于对照组（36.67%）,两组比较,差异有统计学意义（P〈0.05）。治疗组患者治疗后各频率听阈均明显上升,治疗前后比较,差异有统计学意义（P〈0.05）。结论：鼻内镜下腺样体切除术治疗儿童分泌性中耳炎,疗效满意,并发症少,能显著提高患儿的生活质量,值得在临床推广应用。     

Otolaryngologists' perceptions of the indications for tympanostomy tube insertion in children

BACKGROUND: Bilateral myringotomy with insertion of tympanostomy tubes is the most common operation that children in Canada undergo. Area variations in surgical rates for this procedure have raised questions about indications used to decide about surgery. The objective of this study was to describe the factors that influence otolaryngologists to recommend tympanostomy tube insertion in children with otitis media and their level of agreement about indications for surgery. METHODS: A survey was sent to all 227 otolaryngologists in Ontario in the fall of 1996. The influence of 17 clinical and social factors on recommendations to insert tympanostomy tubes were assessed. Case vignettes were used to determine the effect of multiple factors in decisions about the need for surgical management. RESULTS: Surveys were returned by 138 (68.3%) of the 202 eligible otolaryngologists. There was agreement (more than 90% of respondents) about 6 indications for surgery: persistent effusion, a lack of improvement after 3 months of antibiotic therapy, a history of persistent effusion for 3 or more months per episode of otitis media, more than 7 episodes of otitis media in 6 months, a bilateral conductive hearing loss of 20 dB or more and a persistently abnormal tympanic membrane. Some respondents were more likely to recommend tube insertion if there were parental concerns about hearing problems or the frequency or severity of episodes of otitis media. Otolaryngologists agreed about the role of tympanostomy tubes in 1 of 4 case vignettes but disagreed about whether adenoidectomy should also be performed in that instance. Most viewed tympanostomy tube insertion as beneficial, with few adverse effects. INTERPRETATION: There is a lack of consensus among practising otolaryngologists in Ontario as to which children with recurrent otitis media or persistent effusion should undergo bilateral myringotomy with tympanostomy tube insertion. These findings suggest the need to revisit clinical guidelines for this procedure.     

腺样体切除术联合桉柠蒎胶囊治疗分泌性中耳炎的临床疗效观察

目的：探讨腺样体切除术联合桉柠蒎胶囊治疗分泌性中耳炎的临床疗效。方法选择门诊分泌性中耳炎患者104例,采用随机对照分组试验,其中治疗组52例,对照组52例,治疗组采用腺样体切除、术常规治疗基础上加用桉柠蒎胶囊,对照组单服腺样体切除术以及常规治疗。结果治疗组的总有效率为88.5%（46/52）,对照组的总有效率为73.1%（38/52）,两组比较差异有统计学意义（χ2=3.96,P〈0.05）,两组均未见明显不良反应。结论腺样体切除术联合桉柠蒎胶囊治疗分泌性中耳炎是一种疗效显著的治疗方案。     

腺样体切除术对儿童分泌性中耳炎患儿不同频率听阈变化的影响

目的探讨应用腺样体切除术治疗儿童分泌性中耳炎的临床疗效,进一步观察该手术术式对不同频率听阈变化的影响。方法选取48例儿童分泌性中耳炎患儿进行观察,随机分成观察组（腺样体切除）和对照组（鼓膜穿刺抽液）各24例,比较两组患儿的疗效及术后3个月与术前不同频率（250Hz、500Hz、1000Hz）听阈变化情况。结果观察组治愈12例,有效11例,无效1例,总有效率95．8％;对照组治愈10例,有效9例,无效5例,总有效率79．2％,两组疗效比较,差异有统计学意义（P〈0．05）。观察组术后3个月不同频率（250Hz、500Hz、1000Hz）听阈较术前比对照组改善明显,差异有统计学意义（P〈0．05）。结论腺样体切除术治疗儿童分泌性中耳炎疗效确切,能明显改善患儿的听力,值得推广和应用。     

唐山市急性上呼吸道感染继发急性中耳炎患儿临床治疗分析

目的：探讨唐山市急性上呼吸道感染继发急性中耳炎患儿临床治疗分析。方法：将118例急性上呼吸道感染继发急性中耳炎患儿分为两组,全部患者给予头孢曲松钠治疗,对照组采用氯霉素滴耳液治疗,观察组采用布地奈德混悬液雾化吸入治疗,对比两组疗效及临床症状改善情况。结果：观察组总有效率显著高于对照组（93.22％ vs 77.97％）差异有统计学意义;观察组病原菌转阴率（89.43％）、鼓室压有效降低率（94.92％）显著高于对照组（65.71％ and 81.36％）,差异有统计学意义;观察组听力改善程度、起效时间、住院时间均显著优于对照组,差异有统计学意义;观察组不良反应发生率与对照组对比（6.78％ vs 16.95％）,差异无统计学意义。结论：布地奈德混悬液雾化吸入联合头孢曲松治疗小儿急性上呼吸道感染继发急性中耳炎的疗效显著,能显著改善患儿临床症状,改善听力水平,促进咽鼓管功能恢复。     

腺样体、扁桃体切除术治疗儿童顽固性分泌性中耳炎的疗效分析

目的:探讨腺样体、扁桃体切除术对儿童顽固性分泌性中耳炎(OME)的疗效。方法:对我院102例166耳保守治疗反复发作的顽固性OME患儿,经常规专科检查、鼻腔鼻窦CT检查确诊为腺样体肥大或(和)扁桃体肥大,行腺样体或腺样体+扁桃体切除术。并于术后随访过程中进行常规电耳镜检查及听力学检测,并结合症状改善情况对其进行疗效评估。结果:经6-12个月随访,治愈134耳(80.7%),有效21耳(12.7%),无效11耳(6.6%),总有效率为93.4%。结论:腺样体切除或腺样体+扁桃体切除术是治疗儿童顽固性OME的一种有效治疗手段。     

耳内镜下鼓膜置管术治疗儿童分泌性中耳炎的疗效研究

目的:为了进一步探讨耳内镜下鼓膜置管术治疗儿童分泌性中耳炎的临床实际治疗效果,从而为临床治疗实践提供指导和借鉴。方法:本文选取了我院2010年11月-2013年1月间入院治疗的136例儿童分泌性中耳炎患者为研究对象,针对患者的相关临床资料进行了比较分析,针对患者采用不同资料方法后相关临床治疗效果进行了比较研究。结果:两组患者实施不同治疗方法后,治疗组患者总有效率高于对照组患者水平;中耳积液时间组间比较,治疗组患者水平优于对照组患者水平;复发率组间比较,治疗组患者低于对照组患者水平,且组间比较P均<0.05,差异具有统计学意义。结论:在临床治疗儿童分泌性中耳炎的过程中,采用耳内镜下鼓膜置管术联合腺样体切除术治疗方法的临床效果显著,是治疗儿童分泌性中耳炎的安全可靠选择。     

Trimethoprim-sulfamethoxazole v. amoxicillin in the treatment of acute otitis media.

Although amoxicillin has long been the preferred drug for treatment of acute otitis media, resistant strains of two relatively common causal organisms have emerged, prompting a search for other antibiotics. We performed a randomized double-blind trial comparing amoxicillin and trimethoprim-sulfamethoxazole in 221 children in whom acute otitis media was diagnosed in an outpatient setting. Diagnosis was on the basis of symptoms, otoscopic examination and acoustic reflectometry. No culture specimens were taken. A research nurse, using the same methods, evaluated patients in a follow-up home visit at around 14 days and measured compliance by examination of the medicine bottle. Equal proportions of children in the two groups were cured or improved (88% and 87%). Therapeutic efficacy was related to compliance in both groups, and there were few side effects in either group. This study had statistical power of 80% to detect a difference of 15%. We conclude that trimethoprim-sulfamethoxazole can be considered a first-line antibiotic in the treatment of acute otitis media.     

鼻内镜下腺样体切除术对小儿分泌性中耳炎的治疗作用

目的:探讨鼻内镜下腺样体切除术对小儿分泌性中耳炎的治疗效果。方法:对我院因腺样体肥大入院的134例分泌性中耳炎患儿行鼻内镜下腺样体切除术,观察其疗效。结果:术后随访半年,121例痊愈(90.3%),6例好转(4.5%),7例无效(5.2%)。结论:对合并有腺样体肥大的分泌性中耳炎患儿,鼻内镜下腺样体切除术能在直视下进行,增加了手术的安全性和准确性,手术疗效显著。     

鼓膜置管联合腺样体切除术治疗分泌性中耳炎对临床疗效免疫功能及预后的影响

目的:研究分泌性中耳炎行鼓膜置管和腺样体切除术联合治疗对疗效、免疫功能及预后的影响.方法:资料取2015年5月至2016年5月本院分泌性中耳炎110例患者予回顾分析,设行鼓膜置管术医治者为观察1组,联合腺样体切除术医治者为观察2组,另选健康体检者为对照组,对比两组效果.结果:观察两组与对照组CD4+、CD4+/CD8+值均比观察1组优,且观察两组总并发症率比观察1组低,差异具有统计学意义(P<0.05).结论:分泌性中耳炎者行联合方案效果满意,可推广.     

内镜手术治疗腺样体肥大致儿童分泌性中耳炎

目的:探讨腺样体肥大致儿童分泌性中耳炎的诊治方法和手术效果。方法:对37例患儿行内镜下腺样体切除+鼓膜置管术。结果:患儿术后听力均提高,拔管后随访13~17个月未见复发。结论:内镜下腺样体切除+鼓膜置管术对腺样体肥大致儿童分泌性中耳炎有确切疗效。     

鼻内镜下腺样体切除术治疗儿童分泌性中耳炎

目的探讨鼻内窥镜下腺样体切除术治疗儿童分泌性中耳炎的疗效。方法对53例因腺样体肥大引起分泌性中耳炎的儿童，在鼻内窥镜下用电动切割器行腺样体切除术并结合其他辅助治疗，观察其疗效。结果53例患儿48例治愈，好转3例，总有效率96．23％。结论鼻内窥镜下用电动切割器切除腺样体治疗儿童分泌性中耳炎，安全可靠，疗效显著，并发症少.     

微波理疗在50例儿童急性分泌性中耳炎中的临床应用分析

目的 探讨微波理疗对儿童急性分泌性中耳炎治疗的效果.方法 将2011年1月~2011年6月治疗的50例急性分泌性中耳炎患儿按治疗方法分为微波治疗组28例(35耳)、对照组22例(31耳),对两组的疗效进行比较.结果 微波组总有效率为91.4%,对照组总有效率为80.6%,2组疗效差异有统计学意义(P<0.05).结论 及早对儿童急性中耳炎进行微波治疗,能提高其疗效.     

小儿腺样体肥大与分泌性中耳炎的关系

目的探讨小儿腺样体肥大与分泌性中耳炎的关系。方法总结2005年1月~2006年12月住院的62例腺样体肥大并发104侧患分泌性中耳炎的患儿。按病程将患儿分为3组,观察其手术前后鼓室图的变化。结果第1组(病程3个月~1年)手术有效率为100%;第2组(病程1年~2年)手术有效率为90.63%;第3组(病程2年~3年)手术有效率为68.75%。结论小儿分泌性中耳炎的转归与腺样体肥大的病程有关,病程愈长,分泌性中耳炎愈顽固。     

儿童腺样体切除术在治疗相关疾病中的意义

目的 探讨腺样体切除术在治疗儿童鼻窦炎、卡他性中耳炎、慢性咳嗽及鼾症中的作用。方法 回顾性分析78例腺样体切除术患儿鼻窦炎、卡他性中耳炎、慢性咳嗽及鼾症的转归。结果 78例患儿切除肥大腺样体，辅以相应的药物治疗，临床症状均明显好转，有效率100％。结论 切除肥大的腺样体是治疗儿童鼻窦炎、卡他性中耳炎、慢性咳嗽及鼾症有效而又安全的方法，可作为病因治疗的首选手术。     

不同方法治疗儿童不同程度分泌性中耳炎的疗效观察

目的分析采用不同方法治疗儿童不同程度分泌性中耳炎的临床疗效,为临床治疗儿童不同程度的分泌性中耳炎提供参考依据。方法不伴腺样体肥大儿童患者20例为A组,伴腺样体肥大且单纯声导抗测试异常40例为B组,伴腺样体肥大且声导抗测试异常且伴有听力损失患儿20例为C组。A组患儿采用鼓膜置管术治疗,B组采用腺样体切除术治疗,C组患儿采用腺样体切除术和鼓膜置管术联合治疗。术后3个月内所有患者服用抗生素预防感染,6个月后观察治疗效果。结果 3组患儿经手术后症状均好转,与术前比较各频率气导听阈明显下降（P〈0.05）;C组患儿术后并发症高于A、B两组。结论采用不同方法治疗儿童不同程度的分泌性中耳炎有助于提高治疗效果,医生要注意使用不同手术方法,减少术后并发症。     

鼻内镜下腺样体切除术临床分析

目的：探讨鼻内镜下腺样体切除术的临床疗效。方法：对鼻内镜下腺样体切除术的87例患儿的临床表现、治疗方法和预后进行回顾性分析。结果：腺样体切除术后患儿临床症状明显好转。结论：腺样体切除是治疗儿童分泌性中耳炎和鼾症的有效、安全的方法。