鼓室置管对儿童分泌性中耳炎中耳功能影响的研究

目的探讨鼓室置管治疗儿童分泌性中耳炎对中耳功能的影响。方法选取47例(58耳)临床诊断为分泌性中耳炎的患儿,分别在鼓室置管术前及术后1个月、6个月进行纯音测听、声导抗、畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)检查和耳镜检查,以评估鼓室置管手术前后中耳功能的变化及术后的并发症。结果鼓室置管术后1个月、6个月分别行耳镜和声导抗检查,均较术前听力明显提高。术后6个月与术后1个月检查结果比较,听力改变差异无统计学意义。与鼓室置管术前比较,DPOAE引出率及部分频率幅值提高,差异具有统计学意义。鼓室置管术后的并发症主要是中耳感染、分泌性中耳炎复发、鼓膜穿孔和鼓膜内陷。结论鼓室置管治疗儿童分泌性中耳炎,应用检测纯音测听、声导抗、DPOAE和耳镜检查,了解鼓室置管术后的并发症情况,综合评价对中耳功能的影响,具有临床指导意义。     

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.     

分泌性中耳炎恢复期多频鼓室导纳测试的意义

本文采用多频鼓室导纳测试技术 ,对儿童分泌性中耳炎恢复期的患者进行预后判断 ,并依此进行后续治疗 ,对减少中耳炎的复发 ,具有显著效果。1　资料与方法1.1　临床资料　选择 4～ 12岁分泌性中耳炎患者共 16 0例(2 36耳 ) ,男 76例 ,女 84例 ,平均年龄 6 .4岁。首次就诊常规行 2 2 6Ｈｚ探测音声导抗测试、多频鼓室导纳测试[1] ,经抗生素、激素、滴鼻、间接咽鼓管吹张、Ｈｅ -Ｎｅ激光理疗等综合保守治疗 1～ 2月后 ,再次行声导抗测试 ,并对Ａｓ型曲线且无明显鼻窦炎、腺样体肥大等鼻及鼻咽部病变患儿行多频鼓室导纳测试 ,对共振频率异常者…     

鼓室置管术及相关处理治疗小儿分泌性中耳炎

目的 :提高对小儿分泌性中耳炎 (SOM)的诊疗水平。方法 :对 80例 (144耳 )小儿 SOM均行鼓室置硅胶管术 ,其中 30例同时行增殖体刮除和 (或 )扁桃体摘除术、10例行腭裂修复术、2 0例鼻窦炎患者行抗炎引流治疗。结果 :80例患儿随访 0 .5～ 1年 ,83%耳 (6 5例 12 0耳 )听力明显改善 ,纯音听阈 ,声导抗检查恢复正常。结论 :对 SOM的患儿应及时进行综合性治疗 ,方可改善听力。     

学龄前患儿鼻及鼻咽部疾病声导抗异常的临床分析

目的 通过观察分析学龄前鼻及鼻咽部疾病患儿无症状性的鼓膜形态及声导抗异常,初步探讨相关疾病导致潜在性分泌性中耳炎的危险因素.方法 研究对象为81例(162耳)经纤维电子鼻明镜、过敏原皮肤点刺试验及鼻窦CT检查分别确诊为变应性鼻炎、慢性鼻-鼻窦炎及腺样体肥大的患儿,主诉均无耳部症状但体检发现鼓膜异常,进一步行声导抗检测判定是否合并潜在的分泌性中耳炎,同时分析治疗前后相关检查结果的变化.结果 81例(162耳)鼓膜形态异常的患儿中声导抗异常者15例(29耳),在各相关疾病中所占比例分别为:变应性鼻炎13.6％[ 6/44,耳数(下同)],慢性鼻-鼻窦炎18.2％ (12/66),腺样体肥大21.2％ (11/52);组间比较差异具有统计学意义(x2=63.02,P＜0.05).治疗2周后29耳中有28耳由C型转为A型,治疗4周后1耳由B型转为C型,随访3个月,未见复发.结论 部分学龄前鼻及鼻咽部疾病患儿鼓膜形态及声导抗检查结果存在异常,有发展为分泌性中耳炎的潜在危险,其中腺样体肥大对中耳功能的影响较大.对相关疾病的早期干预可阻断分泌性中耳炎的发展趋势.     

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。     

鼓室置管联合鼻内镜下腺样体切除术治疗分泌性中耳炎的疗效观察

目的探讨鼓室置管术加腺样体切除术治疗儿童分泌性中耳炎的疗效。方法将保守治疗无效的75例(96耳)分泌性中耳炎患儿随机分为两组:治疗组39例(51耳),行鼓室置管术加鼻内镜下腺样体切除术;对照组36例(45耳),单纯行鼓室置管术。结果治疗组患儿术后咽鼓管功能、鼓膜形态、中耳积液吸收。鼓室压图峰压值改善情况明显优于对照组(P<0.05)。结论鼓室置管术联合鼻内镜下腺样体吸切除术治疗儿童SOM有较好的疗效,并且避免了传统的腺样体刮除术的缺点。     

鼓膜置管术治疗小儿分泌性中耳炎

目的：探讨提高小儿分泌性中耳炎（SOM）疗效水平的方法。方法：120例（202耳）小儿SOM均行鼓膜置管术。对有腺样体及扁桃体肥大患儿同时行腺样体作和（或）扁桃体切除术，有鼻窦炎者行抗炎引流治疗。结果：120例患儿术后随访6－12个月，106例听力明显改善（占88．3％），纯音听阈声导抗检查基本恢复正常疗效。结论：对小儿SOM及时行置管等综合治疗，可以获得显著。     

鼓室置管术及相关处理治疗慢性分泌性中耳炎50例

目的：评价鼓室置管术对慢性分泌性中耳炎（SOM）的治疗效果。方法：对50例（58耳）保守治疗无效的慢性SOM均用鼓室置管器行鼓室置管术，术后全身应用抗生素、沐舒坦及类固醇3-5d，用α-糜蛋白酶冲洗鼓室，吸净鼓室分泌物，行咽鼓管吹张。5例合并鼻窦炎病人予对症治疗，1例鼻息肉病人行息肉摘除术。结果：50例病人随访0.5-1年，90％病人（45例49耳），听力明显改善，纯单听阈、声导抗检查恢复正常。结论：SOM的病人病程在2个月以上，积极保守治疗无效后，用置管器行鼓室置管加相关治疗，疗效较好。     

腺样体肥大患儿鼓室导抗图与分泌性中耳炎的关系探讨北大核心CSCD

目的探讨腺样体肥大患儿的不同鼓室导抗图与分泌性中耳炎的关系。方法回顾性分析2009年1月～2011年6月收治的328例腺样体肥大患儿的临床资料,分析统计分泌性中耳炎的发病例（耳）数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104例（169耳）最终经鼓膜穿刺或鼓膜置管确诊为分泌性中耳炎（31．71％,104／328）,其中鼓室导抗图为B型者89例152耳,最终确诊为分泌性中耳炎者为86例147耳。阳性率为96．71％（147／152）;鼓室导抗图为C型（负压在～150daPa以上）者33例49耳,最终确诊为分泌性中耳炎者为16例20耳,阳性率为40．82％（20／49）;鼓室导抗图为As型者2例2耳最终均确诊为分泌性中耳炎。结论腺样体肥大患儿无论有无听力下降主诉,均应行声导抗测试,B型鼓室导抗图对鼓室积液判断的准确率最高,c型次之,As型也有鼓室积液的可能。     

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。     

Follow-up study of secretory otitis media after adenoidectomy and tonsillectomy

Questionnaires concerning the pre- and post- operative conditions were conducted on 92 patients with secretory otitis media who underwent adenotomy or adeno-tonsillectomy. Fifty-three patients of them further received microscopic inspection of the eardrum and hearing tests. The questionnaires indicated that episodes of fever-up or cold decreased markedly after the operations. However, even after the operations, one-third of the patients experienced acute otitis media, and one-fourth complained of nasal symptoms such as nasal obstruction and nasal discharge. About a half of the patients showed normal findings of the eardrum after the operations. Secretory otitis media was cured in almost all cases; 80% of the ears showed type A tympanograms. However, about 35% of the ears showed unfavorable prognoses after the operations; recurrence and elongated cure were found in 75% and 25% of these ears, respectively. The younger the patients, the higher the incidence of unfavorable prognosis became. Recurrence was most frequently observed in patients younger than 6-year-old, and it usually occurred 4-9 months after the operations mainly in winter. The present study suggested that patients must be followed for at least 1 year after operation and that nasal symptoms must be carefully treated in patients not older than 5 years.     

腺样体肥大儿童分泌性中耳炎发生率及其影响因素分析

目的探讨腺样体肥大儿童分泌性中耳炎(SOM)的发病情况及其影响因素。方法对6 256例住院手术治疗的腺样体肥大儿童进行纤维鼻咽镜或鼻内镜及声导抗检查,对声导抗结果异常的患儿行纯音测听或ABR检查,统计分析不同年龄、不同腺样体肥大程度及不同病程患儿SOM的发生率。结果 6 256例腺样体肥大患儿中合并SOM者2 702例(43.19%,2 702/6 256),而病史中有明确听力减退主诉者仅654例(10.45%,654/6 256);3～5岁年龄段SOM的发生率最高,为69.76%(1 119/1 604),随年龄增长,SOM发生率逐渐下降;Ⅲ°腺样体肥大患儿中SOM发生率为61.73%(1 639/2 655),显著高于Ⅰ度(21.11%,163/772)、Ⅱ度(31.81%,900/2 829)腺样体肥大患儿(P<0.05);不同病程腺样体肥大患儿中SOM发生率差异无统计学意义(P>0.05)。结论本组腺样体肥大患儿SOM发生率为43.19%,低龄和腺样体肥大程度是腺样体肥大患儿并发SOM的影响因素,而病程对其无明显影响。     

儿童腺样体切除术对相关疾病转归的影响

目的探讨腺样体切除术在治疗儿童分泌性中耳炎、鼻窦炎及鼾症的临床作用。方法对住院行腺样体切除术的68例分泌性中耳炎、鼻窦炎及鼾症患儿的临床表现、治疗方法和预后进行回顾性分析。结果68例患儿经切除肥大的腺样体,辅以相应的药物治疗,临床症状均明显好转。结论腺样体肥大较易成为儿童分泌性中耳炎、鼻窦炎及鼾症发病的基础因素。切除肥大的腺样体是治疗儿童分泌性中耳炎、鼻窦炎及鼾症有效、安全的方法。     

Assessment of the hearing organ in the patients with allergic perennial and seasonal allergic rhinitis

We studied 60 patients with allergic rhinitis (30 with seasonal and 30 with perennial rhinitis). Assessment of atopic status was based on medical history, physical examination, skin-prick testing, total IgE levels and nasal smears. Audiometry and tympanometry have been performed. Audiometric conductive hearing loss was found in 26.7% patients with perennial rhinitis and in 10% patients with seasonal rhinitis. Type B tympanogram were found in 20% of the patients with perennial rhinitis and in 3.33% of the patients with seasonal rhinitis. Type C tympanogram were found in 20% of the patients with perennial and in 6.67% with seasonal rhinitis. Secretory otitis media and retraction pockets were more common in patients with perennial rhinitis allergy. Local allergic reaction in the middle ear and dysfunction of the Eustachian tube can be the most responsible for these disorders. Tympanostomy and ventilation tubes were needed in secretory otitis and myringoplasty in the cases of the retraction pockets. Appropriate treatment of allergic rhinitis may decrease the need and frequency of surgical procedures and may reduce costs associated with hospitalization.     

声反射在成人分泌性中耳炎中的诊断价值

目的提高耳科门诊成人分泌性中耳炎中耳积液的检出率,探讨声反射在协助诊断分泌性中耳炎是否伴有中耳积液中的临床价值。方法回顾性分析耳鼻咽喉科门诊169例确诊为分泌性中耳炎伴有中耳积液的成年患者的临床资料,并对听力正常与听力下降患者的鼓室图、同侧声反射及纯音测听等资料进行对比。结果169例(237耳)经鼓膜穿刺证实为中耳积液的患者中,223耳(94.1%)未引出声反射,14耳(5.9%)引出声反射;鼓室图异常200耳(84.4%),正常者37耳(15.6%);216耳(91.1%)有传导性听力下降,21耳(8.9%)听力正常。不论听力是否下降,同侧声反射的未引出率均高于异常鼓室图的概率(P<0.05);在不同听力及不同类型鼓室图中,声反射的未引出率没有差异(P>0.05),具有无创、快捷及客观等优点,能更好的帮助临床工作者评估分泌性中耳炎的疗效及预后。结论声反射能协助提高成人分泌性中耳炎伴中耳积液的检出率,具有无创、快速及客观等优点,能更好地帮助临床工作者评估分泌性中耳炎的疗效及预后。     

山东省滨州市儿童分泌性中耳炎流行病学调查

目的了解中国山东滨州地区儿童分泌性中耳炎的发病率及各种致病因素。方法在山东省滨州市按照随机整群抽样的流行病学调查方法,共随机抽取小学、幼儿园2～7岁儿童1536例,分2～3岁、4～5岁、6～7岁=三个年龄组,以鼓室导抗为诊断标准,结合耳镜检查,对儿童分泌性中耳炎进行横断面流行病学调查。结果山东省滨州市2—7岁儿童分泌性中耳炎发病率为6．25％。2～3岁发病率为19．65％,4～5岁发病率为5．85％,6～7岁发病率为2．68％。2～3岁发病率最高,随着年龄的增长发病率有所降低,年龄组发病率差异有统计学意义。中国山东省滨州市2。3岁、4～5岁、6～7岁儿童分泌性中耳炎的发病率与西方文献报道差异无显著性。儿童分泌性中耳炎病因复杂,包括鼻-鼻窦炎、变应性鼻炎、扁桃体炎及腺样体肥大等,鼻、咽部疾病所占比例大,尤其是腺样体肥大所占比例最大。结论儿童分泌性中耳炎的发病率较高,病因复杂。     

A history of acute suppurative otitis media and allergic symptomatology in children with chronic secretory otitis media and controls

The parents of children with secretory otitis media and the parents of healthy children attending for routine school or community medical examinations have been questioned about previous acute otitis media, aural discharge, chronic nasal symptoms and allergic disorders. Eighty-nine pairs of children, matched for age and sex, were available for analysis. There was a significantly higher incidence of acute otitis media, aural discharge and chronic nasal symptoms in the secretory otitis group (P = less than 0.001). Amongst the allergic symptoms and disorders, the only significant differences demonstrated were for drug allergy, eye itching and eye running (P = less than 0.05). The results confirm that a relationship exists between acute otitis media and secretory otitis media and also support the conventional image of the child with secretory otitis as a mouth breather with nasal symptoms. They do not lend support to the view that allergy is an important factor in the pathogenesis of secretory otitis.     

鼻内镜下咽鼓管扩张导管治疗慢性分泌性中耳炎13例分析

目的 探讨鼻内镜下咽鼓管扩张导管治疗慢性分泌性中耳炎的方法和疗效。方法 对13例(15耳)慢性分泌性中耳炎患者采用经鼻内镜下插入咽鼓管扩张导管至其峡部,加压并持续扩张其球囊2min,然后经外耳道行鼓膜穿刺抽液,用地塞米松冲洗鼓室,再用含丝裂霉素C明胶海绵涂擦鼓膜穿刺部5min。结果 全部病例均一次插管成功,随访4~5个月,11例(11耳)疗效满意,耳闷胀感消失,声阻抗提示鼓室图由“B”型恢复为“A”型,纯音听阈测试提示听力提高10~20dB,内镜检查鼓室无积液,无感染、出血、鼓膜穿孔等并发症。2例伴有过敏性鼻炎患者(4耳)于术后3个月又出现闷胀感,轻度听力下降,但无鼓室积液,经抗炎和抗过敏治疗后症状消失。结论 鼻内镜下咽鼓管扩张导管治疗分泌性中耳炎操作简便、微创,疗效好。     

Point and period prevalence of otitis media with effusion evaluated by daily tympanometry

Previous studies on daily tympanometric screening using an automatic impedance tympanoscope indicated relatively high incidences of type B tympanograms of one day's duration, which is contrary to our conceptions of the pathogenesis and pathology of otitis media with effusion. We therefore repeated the study in 51 otherwise healthy children (100 ears) attending kindergarten. Tympanometry was performed daily for one month using both the conventional impedance apparatus AZ7 and the automatic impedance tympanoscope ZS 331. The impedance apparatus did not indicate any one-day type B tympanograms and only a few short-lasting episodes occurring either in the beginning or end of the study period. Several ears had type B tympanograms on all days examined. The point prevalence was 15 per cent and the period prevalence 17 per cent, which accord well with findings of previous epidemiological studies of secretory otitis. The impedance tympanoscope indicated 16 cases of B-curves lasting only one day and considerably higher point and period prevalences, which make the impedance tympanoscope unsuited for both scientific and clinical purposes.