晚期喉癌患者的生存质量与其个性特征和应对方式的相关性研究

目的　探讨晚期喉癌患者的生存质量与其个性特征、应对方式等心理因素的关系。方法　对晚期喉鳞状细胞癌生存质量 (说话、工作和活动能力 )较差组 (Ⅰ组 )、生存质量较好组 (Ⅱ组 )的患者及健康人 (对照组 )各 30例分别进行生存质量 (UniversityofWashington qualityoflife ,UW QOL)、艾森克个性特征测验 (Eysenckpersonalityquestionnaire,EPQ)、应对方式问卷 (copingstylequestionnaires,CSQ)的调查 ,并作相关分析。 结果　UW QOL评分平均值 ( x±s) :Ⅱ组患者的总分(6 96 0± 15 3 3)分、活动能力 (85 7± 2 2 2 )分、娱乐 /休养 (76 2± 2 0 1)分、职业 (5 6 5± 2 3 5 )分、讲话 (72 7± 2 5 6 )分 ,显著高于Ⅰ组的 (5 83 8± 12 1 7)分、(6 2 5± 2 0 6 )分、(5 3 3± 2 1 8)分、(35 9±2 1 7)分、(35 2± 2 3 7)分 ,P <0 0 1;外貌 (82 4± 2 2 1)分也高于Ⅰ组的 (6 7 6± 2 3 4 )分 ,P <0 0 5。EPQ评分 :Ⅱ组患者P(48 5± 8 2 )分、N(48 6± 9 9)分别低于Ⅰ组患者的P(5 3 3± 9 3)分、N(5 3 6± 8 7)分 ,P <0 0 5 ;而E(5 8 4± 9 7)分显著高于Ⅰ组 (5 0 9± 9 7)分 ,P <0 0 1。CSQ评分 :Ⅱ组患者解决问题 (0 85± 0 2 0 )分、求助 (0 6 7± 0 2 1)分显著高于Ⅰ组的 (0 6     

言语识别率测试在桥小脑角肿瘤诊断中的作用

目的探讨言语识别率测试(speech recognition score test,SRS)在桥小脑角(cerebellopontine angle,CPA)肿瘤诊断中的作用。方法对19例(20耳)疑为CPA占位性病变者行SRS测试和MRI检查,并以MRI为诊断CPA的标准评估SRS对CPA肿瘤的诊断意义。结果 19例(20耳)最大言语识别率分别是0%(8耳)、4%(2耳)、8%(2耳)、12%(1耳)、20%(1耳)、40%(1耳)、44%(1耳)、56%(1耳)、68%(1耳)8、0%(2耳)。SRS测试中出现回跌现象者7耳,回跌指数(rollover index,RI)分别是0.26、0.36、0.40、0.80、0.88、1、1。头部增强MRI示CPA占位性病变者16例(16耳)(16/20,80%),最大言语识别率诊断CPA肿瘤的敏感性为75%,特异性为25%;回跌指数诊断CPA肿瘤的敏感性为37.50%,特异性为75%。接受CPA肿瘤切除术者15例(15耳),病理检查结果分别为神经鞘瘤(听神经瘤)10例(10/15,66.67%)、脑膜瘤3例(3/15,20%)、表皮样囊肿1例(1/15,6.67%)、脉络丛乳头瘤1例(1/15,6.67%)。结论 SRS测试有助于诊断桥小脑角占位病变。     

阻塞性睡眠呼吸暂停低通气综合征儿童中血清维生素D检测的意义

目的 探讨血清维生素D检测对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童的临床意义。 方法 选择因打鼾症状于山东大学齐鲁医院耳鼻咽喉科治疗的儿童69例作为实验组,70例健康儿童作为对照组,化学发光免疫测定法检测139例儿童的外周血清25(OH)D水平。有打鼾症状儿童69例根据睡眠监测结果将其分为OSAHS组(47例),单纯鼾症组(22例),69例儿童采取空腹血测定血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,并采用Conners 父母症状问卷从品行问题、学习问题、心身障碍、焦虑、冲动-多动、多动指数方面评估两组儿童行为认知异常。 结果 (1) 对照组与单纯鼾症组、OSAHS组研究对象血清25(OH)D水平分别为(25.38±10.87)、(22.00±7.84)、(17.92±6.32)ng/mL,差异有统计学意义(F=9.458, P<0.001);OSAHS组25(OH)D水平低于对照组,差异有统计学意义(P<0.001),单纯鼾症组25(OH)D水平与对照组及OSAHS组差异均无统计学意义(P值均>0.05);(2) 肥胖(-)儿童中,OSA(+)儿童25(OH)D水平明显低于OSA(-)儿童,差异有统计学意义(P=0.001)。OSA(+)儿童中,肥胖(+)儿童与肥胖(-)儿童25(OH)D水平差异无统计学意义(P=0.566); (3) OSAHS组25(OH)D水平与焦虑呈正相关(r=0.337, P=0.020),与最低血氧饱和度(LSaO₂)、低通气指数(AHI)、品行问题、学习问题、心身障碍、冲动-多动、多动指数、TG、TC、HDL-C、LDL-C无明显相关性(r值均<0.5, P值均>0.05)。 结论 25(OH)D在OSAHS儿童体内降低,对进一步了解OSAHS儿童的病理生理改变有一定的临床意义。     

优质护理应用在急性上呼吸道感染患者中对其治疗效果的影响探讨

目的 观察优质护理对急性上呼吸道感染(ARI)患者治疗效果的影响。方法 选择2019年3月～2021年5月接诊的64例ARI患者,随机分为：观察组(纳入32例,提供优质护理)、对照组(纳入32例,提供常规护理),评价组间症状消失时间、舒适度状况量表(GCQ)。结果 观察组鼻塞(3.24±0.92)d、咳嗽(3.37±0.85)d、咽部充血(3.45±0.87)d、发热消失时间(3.51±0.90)d均少于对照组(4.36±0.77)d、(4.30±0.84)d、(4.32±0.91)d、(4.86±0.87)d,且GCQ评分(70.38±3.87)分高于对照组(66.59±2.47)分,P<0.05。结论 对ARI患者实施优质护理,能够加速症状消退,提高患者舒适感,值得推广。     

代谢综合征患者听力损失的相关因素分析

目的 探讨代谢综合征(metabolic syndrome,MS)患者听力损失的相关因素,从而为预防耳聋提供临床依据.方法 回顾性分析MS合并听力损害患者40例(78耳)(A组)及同期34例(67耳)MS无听力损害患者(B组)的临床资料.结果 ①A组的糖尿病病程、空腹血糖(FBG)、糖化血红蛋白(GHbAlc)、收缩压(SBP)高于 B组,差异有统计学意义(P<0.05);A组的甘油三脂(TG)较B组增高,差异有显著统计学意义(P<0.01);A组的高密度脂蛋白(HDL)低于B组,差异有统计学意义(P<0.05),A组的胰岛素敏感指数(IAI)较B组低,差异有显著统计学意义(P<0.01);②两组血浆总胆固醇(TC)、舒张压(DBP)、体重指数(BMI)比较,差异无统计学意义(P>0.05).结论 MS患者的听力损害与患者糖尿病病程、FBG、IAI 、GHbAlc、TG、HDL 、SBP等因素相关.     

天津市变应性鼻炎变应原分析

目的了解近年天津市变应性鼻炎(AR)患者的变应原分布。方法使用标准化皮肤点刺原液阿罗格试剂,对527例拟诊AR患者进行检测。结果吸入性变应原:粉尘螨(58.7%)、屋尘螨(56.0%)、白色念珠菌(31.7%)、胶乳(23.6%)、烟曲霉(19.5%)、特异青霉(18.8%)、霉菌I(17.5%)、艾蒿(17.5%);食物性变应原:小虾(9.1%)、鲤鱼(8.4%)、大鳌虾(8.2%)、柑橘(5.4%)、核桃(4.8%)、花生(4.5%)、欧芹(4.1%)、桃子(4.1%)。患者以19～59岁居多,持续性中重度型占59.0%。"+++"级占39.9%。有家族史、哮喘组变应原阳性率及阳性强弱与对照组相比,差异有统计学意义。结论尘螨是近年天津市AR的首要变应原,其次是真菌、乳胶,花粉排序相对靠后;食物性变应原阳性率低,海产品排序靠前。AR患者以青中年、持续性中重度为主,阳性等级以"+++"为主,阳性强弱与家族史、哮喘显著相关。     

前庭性偏头痛患者的前庭功能分析北大核心CSCD

目的探讨前庭性偏头痛(vestibular migraine,VM)患者的前庭功能特点。方法对43例确诊为VM的患者(VM组)及30例健康志愿者(对照组)分别进行纯音测听、声导抗、冷热水试验(caloric test)、眼肌前庭诱发肌源性电位(ocular vestibular evoked myogenic potential,oVEMP)、颈肌前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)和视频头脉冲试验(video head impulse test,vHIT),比较分析两组结果。结果VM组患者中纯音测听、冷热水试验、oVEMP及vHIT中的水平增益、代偿性扫视异常例数分别为10例(23.3%)、14例(32.6%)、18例(41.9%)、14例(32.6%)、13例(30.2%),显著高于对照组[分别为0例(0%)、3例(10.0%)、5例(16.7%)、1例(3.3%)、0例(0%)](P<0.05),而声导抗、cVEMP及vHIT中的水平不对称性比异常例数分别为3例(7.0%)、10例(23.3%)、3例(7.0%),与对照组[分别为0例(0%)、7例(23.3%)、2例(6.7%)]差异无统计学意义(P>0.05)。43例VM患者中,oVEMP振幅比(amplitude ratio,AR)及耳间不对称比(interaural asymmetric ratio,IAR)的异常率最高,分别为41.9%及34.9%。结论 VM患者存在一定程度的前庭功能损害,纯音测听、冷热水试验、oVEMP及vHIT中的水平增益、代偿性扫视结果有助于VM患者的诊断及与其他前庭性疾病的鉴别。     

舌动脉和舌下神经的解剖特点及与舌根的解剖关系

目的:观察舌动脉、舌下神经的走行及其与舌表面标志点的关系,以及舌动脉、舌下神经的相互关 系,为临床提供舌动脉、舌下神经的形态学资料,指导舌根手术,提高手术安全性。方法:10具(20侧)甲醛固定、 颌面部发育正常的成人尸头标本,颈总动脉灌注红色乳胶。观察:①舌动脉和舌下神经的起源、走行、分段,测量 各段长度;②舌动脉和舌下神经与各解剖标志点的距离;③舌动脉和舌下神经的解剖关系。结果:舌动脉全长为 (9.73±0.83)cm;第1、2、3、4段分别为(1.81±0.46)cm、(2.98±0.45)cm、(1.24±0.39)cm、(3.79±0.28)cm。 舌动脉主干距舌盲孔前1cm、舌盲孔、舌盲孔后1cm及舌盲孔至舌骨、舌侧缘,舌动脉距舌侧缘的距离分别为 (2.34±0.20)cm、(2.48±0.14)cm、(2.43±0.26)cm、(2.53±0.33)cm、(2.14±0.16)cm、(1.11±0.09)cm。舌 下神经距舌盲孔前1cm、舌盲孔、舌盲孔后1cm、舌骨、舌侧缘及下颌骨内侧缘的距离分别为:(2.28±0.14)cm、 (2.36±0.18)cm、(2.34±0.21)cm、(1.25±0.42)cm、(1.86±0.32)cm、(2.64±0.28)cm。舌下神经与舌动脉最 小距离、舌下神经在舌骨大角距舌动脉距离、舌下神经与舌动脉交叉点距舌骨的垂直距离分别为: (0.38±0.38)cm、(0.35±0.31)cm、(1.48±0.26)c     

成年人鼻声反射与鼻阻力测量的正常参数

目的:研究正常成人鼻声反射(AR)及鼻阻力(RM)测量的正常值,以及它们之间的关系.方法:健康成人82例,采用AR检查,获得单侧鼻腔第一狭窄面积(UA1),第二狭窄面积(UA2),最小截面积(UMCA),0～5 cm、2～5 cm鼻腔容积(UV5、UV2～5).RM为通过前鼻主动测压法测量鼻压差为150 Pa 时的RM值,如鼻压差达不到150 Pa,则采用Broms(半径为200 Pa)的RM值表示,分别测量单侧吸气阻力(URins150、URins200)、单侧呼气阻力(URexp150、URexp200)及鼻气道总阻力(TRins150、TRins200、TRexp150、TRexp200),并对RM和AR测量结果进行相关性分析.结果:健康成年男女UA1分别为(0.63±0.14)、(0.60±0.14)cm2;UA2分别为(0.72±0.48)、(0.6±0.4)cm2;UMCA分别为(0.50±0.16)、(0.47±0.18)cm2;UV5分别为(5.68±1.73)、(5.16±1.85)cm3 ;UV2～5分别为(4.13±1.56)、(3.83±1.66)cm3.男女各参数值比较均差异无统计学意义(T值分别为0.093、0.134、0.392、0.408,均P>0.05).有25例鼻压差未达到150 Pa,采用Broms测量,URins150、URins200、URexp150、URexp200、TRins150、TRinst200、TRexp150、TRexp200结果分别为(0.86±0.96)、(0.45±0.61)、(0.83±0.71)、(0.52±0.88)、(0.38±0.34)、(0.18±0.24)、(0.38±0.27)、(0.19±0.24)Pa/(cm3·s).URins150、URexp150、TRins150、TRexp150与UMCA、UV5、UV2～5有显著相关性(均P<0.05).结论:RM与AR测量结果有一定相关性,可为临床提供鼻腔状态的客观参数.     

前颅底肿瘤、类肿瘤病变手术入路的应用解剖研究

目的为前颅底肿瘤、类肿瘤病变的手术入路提供应用解剖学依据.方法测量30例干燥国人颅骨的鼻棘点、Dacryon点和颞额颧点至前颅底各结构的的连线长度;颞额颧点至颅中窝内各结构的连线长度,以及部分连线与正中矢状面所成的角度.结果1.鼻棘点至筛板前缘、筛板后缘、视神经交叉沟、鞍结节、前床突、视神经管眶口、视神经管颅内口、翼管口、蝶腭孔的距离分别为(49.6±3.8)mm、(54.8±3.5)mm、(66.3±3.9)mm、(67.9±3.3)mm、(71.8±3.5)mm、(61.0±3.3)mm、(66.4±3.6)mm、(64.3±3.6)mm、(47.5±2.8)mm.鼻棘点与筛板前缘、筛板后缘、鞍结节的连线与鼻底平面所成的夹角分别为;(77.4±4.0)°、(55.5±5.4)°、(40.5±3.5)°.2.Dacryon点至筛前、后孔、视神经管眶口、颅内口、前床突、筛板前、后缘、视神经沟、鞍结节、眶上裂外侧缘的距离分别为(16.2±2.2)mm、(28.6±2.3)mm、(34.7±2.5)mm、(42.6±3.4)mm、(49.8±3.1)mm、(12.7±1.7)mm、(28.5±2.8)mm、(43.7±3.7)mm、(47.9±3.2)mm、(37.4±2.8)mm.3.颞额颧点至眶下裂外端、翼上颌连接外侧下缘、翼上颌裂下端、翼突外侧板根部、圆孔、卵圆孔、棘孔、颈内动脉管内口外缘、前床突、鞍结节的距离分别为(28.8±3.0)mm、(67.6±4.3)mm、(58.5±3.6)mm、(61.0±3.9)mm、(50.0±3.8)mm、(58.6±4.3)mm、(61.7±4.7)mm、(64.0±3.9)mm、(57.5±3.5)mm、(64.0±3.6)mm.结论有关各种颅底手术入路的测量结果有助于设计手术入路和病变的术前诊断,并可为术中准确定位提供参考依据.     

改良Valsalva法(玩具式自家鼓气吹鸣器)治疗分泌性中耳炎临床观察

目的评估使用玩具式自家鼓气吹鸣器治疗分泌性中耳炎的疗效.方法24名分泌性中耳炎患儿采用改良Valsalva法行咽鼓管吹张,每日3次以上,持续2周后复查,行耳科检查及听力学评估,包括耳镜检查、声导抗及纯音测听,无效者继续3月;另23名同样患儿作为对照组.结果治疗组患儿68%骨气导差减至小于15 dB,对照组为26%,治疗组患儿有62%其声导抗鼓室峰压值恢复正常(大于-100dapa),对照组有29%,统计学分析两组差异有显著性.结论玩具式自家吹鸣器进行改良Valsalva吹张治疗分泌性中耳炎是有效的,儿童使用时有浓厚兴趣,可作为一种治疗分泌性中耳炎的辅助器械.     

Conservative treatment of otitis media with effusion by autoinflation of the middle ear

A total of 85 children on the waiting list for grommet insertion aged between 3 and 10 years with bilateral chronic otitis media with effusion (OME) were assigned at random to an observation or treatment group. Those in the treatment group were given the Otovent® device to use three times a day for the duration of the study and both groups were then seen at monthly intervals for 3 months for pneumatic otoscopy and tympanometry. Statistically significant improvement was seen in those using the treatment with a compliance of more than 70%. This was detected on the outcome measures of tympanometry and pneumatic otoscopy after 1, 2 and 3 months. No side effects were demonstrated. We conclude that autoinflation is an effective short-term treatment for children with OME when used regularly under supervision.     

The medical treatment of secretory otitis media. A clinical trial of three commonly used regimes.

A clinical trial was undertaken to evaluate three medical treatments commonly used for chronic secretory otitis media. The treatments compared were Ephedrine nose drops, an oral antihistamine and decongestant (Dimotapp) and autoinflation of the middle ear. Changes in middle ear compliance and pressure were used as objective criteria of the efficacy of treatment in addition to changes in pure-tone threshold and to clinical assessment. Symptoms and abnormal signs tended to remit during the trial but there was no evidence from pure-tone audiometry and tympanometry that any of the treatments was beneficial. The period of observation enabled 28% of the children to avoid surgical treatment. Good and bad prognostic features are described which should help in deciding whether to manage a case conservatively or whether to proceed directly to surgery.     

The effect of a pneumococcal conjugate vaccine on the risk of otitis media with effusion at 7 and 24 months of age

OBJECTIVE: To explore the effect of a pneumococcal conjugate vaccine on the risk of otitis media with effusion and to search for subgroups in which the vaccine had a higher or lower effect. METHODS: Analyses were performed on data from the Finnish Otitis Media Vaccine Trial, a randomised controlled double-blind trial to evaluate the efficacy of pneumococcal conjugate vaccination against acute otitis media. Data on the vaccination effect against otitis media with effusion were obtained by means of symptom interview and pneumatic otoscopy during pre-scheduled follow-up visits at the age of 7 and 24 months. Two endpoint definitions were considered: otitis media/tube (otitis media or tympanostomy tube in situ (OM/T)) as the primary endpoint and otitis media with effusion as the secondary endpoint. No evidence was found of an age-dependent association with vaccination effect. Therefore, the final marginal logistic regression analyses were performed on the combined data from the two follow-up visits. RESULTS: The risk of otitis media tended to be lower in the pneumococcal vaccine group. The odds ratio for otitis media/tube was 0.94 (95% confidence interval 0.77-1.14) and the odds ratio for otitis media with effusion was 0.90 (95% confidence interval 0.69-1.19). Presence of older siblings increased the risk of otitis media/tube and otitis media with effusion at 7 months of age. In addition, it appeared that children without older siblings and attending day-care at 24 months of age tended to benefit more from the pneumococcal conjugate vaccine. In this subgroup, the odds ratio for otitis media/tube was 0.81 (95% confidence interval 0.55-1.20) and for otitis media with effusion the odds ratio was 0.43 (95% confidence interval 0.22-0.86). CONCLUSION: The effect of pneumococcal conjugate vaccination on the risk of otitis media with effusion was concordant with the efficacy seen against acute otitis media, although not distinguishable from no effect in the overall analysis. In children without older siblings, vaccination appeared to reduce the point prevalence of otitis media with effusion; this effect was not apparent in children with older siblings.     

Autoinflation of eustachian tube in young children

Inflation of the middle ear has long been thought to be beneficial in the treatment of otitis media. We describe a new system of autoinflation based on a modified Valsalva technique consisting of an anesthesia mask and a flowmeter which can be used successfully by children. An objective method to record eustachian tube opening during autoinflation using frequency spectrum analysis of the ear canal sounds is also presented. Tubal opening results of this method were compared to the traditional method using preinflation and postinflation tympanometry. Study subjects included 20 adults with normal otologic findings and 35 children with middle-ear effusion; all together 107 ears of children and adults with and without effusion were tested. Using the frequency spectrum analysis, tubal opening was recorded in 75% of adult ears and 56% of children's ears. Also, in both groups, a sound pressure peak with the same characteristic frequency around 2 kHz was associated with tubal openings. The methods described are incorporated into a clinical trial being conducted at the Children's Hospital of Pittsburgh.     

微波治疗对儿童分泌性中耳炎转归的影响

目的：探讨微波治疗对儿童分泌性中耳炎转归的影响。方法:将2003年10月～2005 年10月收治的152例分泌性中耳炎患儿按治疗方法分为微波组78例（86耳）,对照组74例（84耳）,对其结果进行分析;并对微波组78例（86耳）患儿按病程、年龄分组比较。结果:微波组有效率 75.6%,对照组51.2%,两组疗效有统计学差异（P＜0.01）;微波组疗效与病程、年龄有关。结论:微波治疗对儿童分泌性中耳炎的转归有积极作用,病程越短,疗效越好,12岁以下儿童疗效优于12岁以上儿童。     

Birth characteristics and recurrent otitis media with effusion in young children

OBJECTIVE: To study the association between birth characteristics and the recurrence of otitis media with effusion (OME). METHODS: Prospective cohort study on 136 children aged 2-7 years, who received tympanostomy tubes for bilateral otitis media with effusion. Checkups were planned 1 week after tube insertion and once every 3 months thereafter. An otologist examined the ear status to assess tube extrusion and otitis media with effusion recurrence. Outcome measure was the recurrence of otitis media with effusion within 6 months after documentation of spontaneous tube extrusion. Birth characteristics were investigated in relation with the recurrence of otitis media with effusion in 90 children with known clinical outcome. RESULTS: No statistically significant associations were found between various birth characteristics and the recurrence of otitis media with effusion. Multivariate analyses showed positive but fairly weak associations between recurrence of otitis media with effusion and low birth weight (<2500 g) and/or low gestational age (<37 weeks) and/or a history of incubator care (odds ratio (OR) 1.95, 95% confidence interval (CI): 0.21-18.2), male sex (OR 1.85, 95% CI: 0.56-6.13) and maternal medication use during pregnancy (OR 4.80, 95% CI: 0.57-40.72). A remarkable finding was the asymmetrical distribution of certain birth characteristics within the group of children with recurrence of otitis media with effusion: children with unilateral recurrence had a relatively lower gestational age, lower birth weight, lower 'birth length to birth weight' ratio than the children with bilateral recurrence. CONCLUSION: These findings suggest that determination of birth characteristics cannot help us in the treatment strategy for recurrent otitis media with effusion in childhood.     

Pharmacotherapy focusing on for the management of otitis media with effusion in children: Systematic review and meta-analysis

ObjectiveTo examine the evidence for treating children with otitis media with effusion with pharmacotherapy.Data SourcesFor the systematic review, data were retrieved from PubMed, Cochrane database, and the Japan Medical Abstracts Society Database (1st January 1995 through 31th May 2019).Study SelectionArticles addressing pharmacotherapy for the management of otitis media with effusion in children were selected in English.Data ExtractionThe database was searched using the keywords “Otitis Media with effusion or secretory otitis media” and the following medical agents: carbocysteine, antihistamines, leukotriene receptor antagonist, and steroid nasal spray.Data SynthesisAfter a critical review of 18 studies, studies addressing steroid nasal spray were eligible for quantitative synthesis. Intranasal steroids for OME showed no benefit with OR 1.155 (95% CI 0.834-1.598) within one month. Conversely, intranasal steroids have effects for OME with OR 1.858 (95% CI 1.240-2.786) for more than one month.ConclusionsWe found evidence of benefit from treatment of OME in children with intranasal steroids and S-carboxymethylcysteine at longer-term follow-up.     

Comparative study on adhesive otitis media and pars tensa cholesteatoma in children

Objective: Recurrent otitis media and persistent otitis media with effusion in early childhood may cause an atelectatic eardrum and adhesive otitis media, which sometimes progress to pars tensa cholesteatoma. When and how children with adhesive otitis media should be operated on remain controversial. Therefore, this study aimed to analyze the clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma, and to determine the risk factors of progression to cholesteatoma.Methods: Seventeen ears of 15 children with adhesive otitis media (adhesive group) and 14 ears of 13 children with pars tensa cholesteatoma (tensa cholesteatoma group) who underwent tympanoplasty were included in this study. We analyzed the following clinical characteristics of children in both groups: medical and life history, associated diseases, sites of the adhesion, and development and aeration of mastoid air cells as shown by temporal bone computed tomography.Results: Most of the children in both groups had a history of recurrent otitis media and/or persistent otitis media with effusion. They showed a male predominance and a frequent association of allergic rhinitis. The number of ears showing undeveloped mastoid air cells in the tensa cholesteatoma group was significantly larger than that in the adhesive otitis media group (P=0.0068). A lack of aeration of the middle ear, including the eustachian tube, was more frequently found in ears with pars tensa cholesteatoma than in ears with adhesive otitis media (P=0.0012). Using multivariate logistic regression, the presence of otorrhea (odds ratio [OR], 14.847; 95% confidence interval [CI], 0.834–264.184), total adhesion (OR, 28.550; 95% CI, 0.962–847.508), and undeveloped mastoid air cells (OR, 19.357; 95% CI, 1.022–366.589) were related to pars tensa cholesteatoma.Conclusion: Children with adhesive otitis media should be carefully followed up in the outpatient setting. Ears with poor mastoid development may develop pars tensa cholesteatoma. Additionally, ears with middle ear effusion, total adhesion, and the presence of otorrhea tend to be at risk of pars tensa cholesteatoma. Tympanoplasty or tympanostomy tube insertion should be considered for children with adhesive otitis media who have these risk factors to prevent progression to pars tensa cholesteatoma.     

Autoinflation as a treatment of secretory otitis media. A randomized controlled study.

This study was undertaken to evaluate the effect of a new method of autoinflation as an alternative treatment of secretory otitis media. Up to 80% of all children experience one or more episodes of eustachian tube dysfunction and secretory otitis media before school age. Common treatment of this condition is insertion of a ventilation tube in the tympanic membrane. Because of the very high incidence of secretory otitis media in childhood, insertion of ventilation tubes is the most frequently performed operation under general anesthesia in children. In addition to possible anesthetic complications, insertion of ventilation tubes may be associated with purulent suppuration, pathologic findings in the eardrum, and hearing impairment. One hundred children were consecutively randomized to undergo either autoinflation, using a new device, or placed in a control group. The children were between 3 and 10 years of age and were entered into the study after having had secretory otitis media for at least 3 months, as verified by tympanometric findings. Tympanometry was repeated at 2 weeks and at 1, 2, and 3 months after the children were entered into the study. After 2 weeks of autoinflation, the tympanometric conditions were improved in 64% of ears, unchanged in 34%, and deteriorated in the remaining 2%. In the control group, tympanometric findings were improved in 15% of ears, unchanged in 71%, and deteriorated in the remaining 14%.