儿童腺样体切除与分泌性中耳炎术后的复发

目的 探讨儿童腺样体切除与分泌性中耳炎术后的复发情况.方法 回顾性分析本院耳鼻咽喉-头颈外科自2006年1月至2006年8月收治的100例分泌性中耳炎患儿.所有患儿都行了鼓膜切开置通气管,其中伴腺样体切除者74例,未行腺样体切除者26例,术后均随访3个月.结果 腺样体切除者74例合并分泌性中耳炎有148耳,术后3个月内脱管和复发有27耳(18.24%).腺样体未切除26例合并分泌性中耳炎26耳,术后3个月内脱管和复发17耳(65.38%).腺样体未切除复发的17耳有8耳(8例患儿)接受2次手术,且腺样体均全部切除,术后随访3个月无1耳复发.结论 切除腺样体可有效控制分泌性中耳炎患儿术后复发.     

分泌性中耳炎的外科治疗现状

分泌性中耳炎是耳鼻咽喉头颈外科常见和多发的中耳非化脓性疾病,是儿童听力下降的常见原因。听力下降伴耳闷、耳鸣及耳痛是其突出临床表现。对于保守治疗效果欠佳、影响患儿听力的SOM的处理在临床上一直是一个棘手的问题。通过外科手段干预成为了大多数临床医生的治疗方案,包括鼓膜手术、腺样体手术、咽鼓管手术等方法。本文现就国内外关于分泌性中耳炎的外科治疗现状做一综述。     

鼻内镜下等温等离子腺样体切除对合并腺样体肥大分泌性中耳炎患儿的临床疗效

目的:观察采用鼻内镜下等温等离子腺样体切除对合并腺样体肥大分泌性中耳炎患儿治疗的临床疗效.方法:选取2018年2月至2020年11月期间于我院行手术治疗的114例合并腺样体肥大分泌性中耳炎患儿,随机分为对照组(n=57,采用鼻内镜下切吸钻腺样体切除术)和研究组(n=57,采用鼻内镜下等温等离子腺样体切除).术后1 m对比两组临床疗效,听力水平及并发症;采用酶联免疫法检测肿瘤坏死因子(Tumor necrosis factor-ɑ,TNF-ɑ)、白介素-6(Interleukin 6,IL-6)、白介素-8(Interleukin 8,IL-8)水平.结果:研究组临床总有效率明显高于对照组(P<0.05);治疗后,两组患儿0.5 kHz、1 kHz、2 kHz各频率气导听力水平均较治疗前上升,且以研究组上升更为明显(P<0.05);TNF-ɑ、IL-6、IL-8水平均较治疗前明显下降(P<0.05),且研究组更为明显(P<0.05);研究组并发症率与对照组未见统计学差异(P>0.05).结论:鼻内镜下等温等离子腺样体切除治疗的疗效明显,可改善患儿的炎性因子水平及听力症状,且具有一定安全性.     

鼓膜置管术治疗儿童分泌性中耳炎的疗效及术后复发的影响因素分析

目的 探究鼓膜置管术治疗儿童分泌性中耳炎（OME）的疗效并分析患儿术后复发的影响因素。方法 选取2017年7月至2019年6月山西省儿童医院收治的130例OME患儿作为研究对象,随机分为两组,对照组（65例）采取保守治疗,观察组（65例）采取鼓膜置管术治疗,比较保守治疗和鼓膜置管术治疗的临床疗效和术后并发症、各频率骨导听阈等情况;对鼓膜置管术治疗患儿随访1年,根据术后是否复发分为复发组（18例）和未复发组（47例）,比较复发组和未复发组患儿的一般资料;多因素Logistic回归分析影响OME患儿术后复发的因素;构建预测术后复发的列线图预测模型,并评价其预测效能。结果 鼓膜置管术治疗的总有效率明显高于保守治疗,术后并发症发生率明显低于保守治疗,治疗后患儿骨导听阈和临床疗效也明显优于对照组患儿。小龄、通气管保留时间短、反复呼吸道感染、乳突气化不良、过敏性鼻炎均是导致鼓膜置管术治疗OME患儿术后复发的危险因素。构建的列线图预测模型区分度较好,校准度较高。结论 鼓膜置管术治疗儿童OME具有总有效率高、术后并发症少、临床疗效好、见效快等优势,构建OME患儿术后复发的风险预测模型为临床上提高患儿生...     

鼻内镜下腺样体切除治疗儿童OSAHS的临床分析

儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)是指睡眠过程中频繁发生部分或全部上气道阻塞,扰乱儿童正常通气和睡眠结构而引起的一系列病理生理变化。据流行病学调查显示,中国儿童OSAHS发病率为1%～3%[1]。主     

腺样体切除术对儿童慢性鼻窦炎的影响

目的 探讨腺样体切除术治疗儿童慢性鼻窦炎的疗效及影响因素.方法 回顾分析我院1999年3月～2006年10月150例施行腺样体切除术并随访6月以上的慢性鼻窦炎患儿的临床疗效.结果 150例中治愈98例(治愈率65.3%),好转41例(27.3%),无效11例(占7.3%),术中无任何并发症,总有效率为92.6%.结论 腺样体切除术是治愈Ⅰ型儿童慢性鼻窦炎的有效方法.     

腺样体肥大儿童焦虑抑郁情绪调查

目的：探讨腺样体肥大（AH）患儿的焦虑和抑郁心理状况及经鼻内镜腺样体切除手术和心理干预对其的影响。方法：对40例AH患儿的心理状况进行分析，并与中国常模和治疗后三个月的心理状况进行对比。结果：AH患儿儿童抑郁障碍白评量表（DSRSC）、儿童焦虑性情绪障碍筛查表（SCARED）因子分较中国常模明显增高。术后三个月各项目评分趋于正常。结论：AH患儿存在显著的心理卫生障碍，经鼻内镜腺样体切除术和心理治疗有助于患儿的身心康复。     

110例鼻内窥镜下经口腺样体切割术后体会

目的探讨鼻内窥镜下经口径路腺样体切割术的疗效及手术技巧。方法110例患者均在鼻内镜下经口将软腭向上牵拉明视下行腺样体切割吸引。结果术后观察6～24个月,全部病例经一次手术术前症状均消失,术后无复发。结论娴熟的内镜操作技术和经口径路腺样体切割结合起来,使腺样体切除手术具有直观、安全、彻底,且不易损伤腺样体周围组织等优点。     

低温等离子腺样体融切术治疗儿童鼾症的临床价值研究

目的:分析低温等离子腺样体融切术治疗儿童鼾症的临床价值.方法:收集本院2018年12月至2020年11月收治的84例鼾症患儿的临床资料.按不同治疗方法分为A组(n=44,低温等离子腺样体融切术)与B组(n=40,动力系统腺样体切吸术).比较两组疗效.结果:A组治疗后总有效率为93.18％,B组为87.50％,组间比较无...     

Nasopharyngeal secretory immunoglobulins in children with recurrent acute otitis media and secretory otitis media

Secretory IgA (SIgA) and secretory IgM (SIgM), total IgA and total IgM were measured in plasma and nasopharyngeal secretions (NPS) from young children with different degrees of otitis proneness. Significantly higher levels of plasma IgM and lower levels of NPS-SIgM were found in children with recurrent episodes of acute otitis media (rAOM) compared with children suffering from secretory otitis media (SOM) and healthy controls. Both plasma IgA and NPS-SIgA were evenly distributed in the three groups of children investigated, and in most children the levels of NPS-SIgA exceeded plasma IgA levels. Plasma SIgA was significantly increased in children with rAOM and SOM, probably resulting from frequent occurrence of inflammatory events at the nasopharyngeal level. No correlation could be demonstrated between NPS-SIgA and plasma IgA, or between NPS-SIgM and plasma IgM. Also, for both NPS-SIgA and NPS-SIgM, there was no correlation with age. A negative correlation was observed between the transudation index of albumin to the nasopharynx and the ratio of NPS-SIgA to total NPS-IgA. A ratio of 1 (100%) corresponded to a transudation index of 8%. The ratios of NPS-SIgA to total NPS-IgA varied considerably and a range of 39%-88% could only to some extent be explained by transudation of plasma IgA to NPS. The results of the present study show that the children with rAOM and SOM are well furnished with locally produced SIgA antibodies at the nasopharyngeal level. In children with SOM, the nasopharyngeal hypofunction in the case of low NPS-SIgM seems to be less pronounced compared with that of otitis-prone children.     

Pneumococcal acute otitis media in children

Objectives   To evaluate the clinical and laboratory findings of Streptococcus pneumoniae acute otitis media in children during a 1 year period.
Methods   From October 1995 to September 1996, 113 children aged 2 months to 14 years (median 18 months), with S. pneumoniae acute otitis media were studied. Susceptibility testing was performed by the Kirby-Bauer method and the E- test, and serotyping by the Quellung reaction.
Results   E- test assays detected five isolates (4.4%) to be highly resistant to penicillin and 13 (11.5%) that had intermediate resistance. All isolates were found to be susceptible to vancomycin, rifampicin and cefotaxime. In total, 25 isolates (22.1%) were resistant to one or more drugs. Fifty per cent of the penicillin-resistant or intermediately resistant S. pneumoniae isolates were resistant to multiple drugs, whereas only 2.1% of the penicillin-susceptible isolates were resistant to multiple drugs. The predominating serogroups of the isolates with reduced susceptibility to penicillin were the 19 (61.1%), 9 (16.7%), 23 (11.1%), 6 (5.5%) and 14 (5.5%) whereas those of the susceptible isolates were the 19 (26.3%), 14 (13.7%), 3 (11.6%), 6 (11.6%), 9 (8.4%), 1 (5.3%) and 12 (5.3%).
Conclusions   Streptococcus pneumoniae isolates from children with acute otitis media were penicillin-insensitive in 15.9%. The multiresistant S. pneumoniae isolates belonged to serogroups: 19 (45.4%), 9 (27.3%), 6 (18.2%) and 23 (9.1%).     

Incidence and recurrence of acute otitis media in Taiwan's pediatric population

OBJECTIVE:

To report the incidence and recurrence of acute otitis media (AOM) in Taiwan''s pediatric population.

METHODS:

Information from children (aged< = 12 years) with a diagnosis of AOM was retrieved from the 2006 National Healthcare Insurance claims database. We calculated the cumulative incidence rate and the incidence density rate of recurrent AOM within one year after the initial diagnosis in 2006. We used a multivariate logistic regression model to assess the predictors for recurrence of AOM.

RESULTS:

The annual incidence rate of AOM was estimated to be 64.5 cases per 1,000 children. The overall one-year cumulative incidence rate of recurrence was 33.1%, and the incidence density rate was 33.5 cases per 100 person-years, with the highest figure (41.2 cases per 100 person-years) noted for children aged 0-2 years. Recurrence was significantly associated with age, gender, place of treatment, and physician specialty.

CONCLUSION:

AOM remains a major threat to children''s health in Taiwan. Male children and very young children require more aggressive preventive strategies to reduce the risk of recurrence.     

Antipolysaccharide antibodies in 450 children with otitis media

We have measured antibodies to pneumococcal and Haemophilus polysaccharides in a prospective study of 450 children aged 2–16 years with otitis media requiring grommets (ear tubes). Pneumococcal antibody levels were significantly higher in the 2–6 year (P < 0.004) and 7–10 year (P < 0.04) study groups in comparison with age-matched controls. There was no difference in Haemophilus antibody levels between the study and control group children for the age groups 2–6 years and 11–16 years. Haemophilus antibody levels were significantly lower in the 7–10 year (P < 0.003) group in comparison with age-matched controls. Eighty-eight out of 450 (19.6%) children had pneumococcal antibody levels below the 25th percentile. Nineteen out of 88 (21.6%) children with pneumococcal antibody levels below the 25th centile were test immunized with 23 valent Pneumococcal polysaccharide and unconjugated Haemophilus type b capsular polysaccharide. Of these 19 children (aged 4–11 years), five mounted suboptimal responses to both polysaccharide antigens, whilst one child failed to respond to Haemophilus polysaccharide alone. There was no significant difference in the prevalence of IgG subclass deficiency between the normal responders and poor responders to immunization (P= 0.12). We found no evidence of specific polysaccharide antibody deficiency in the vast majority of the 450 children studied. However, the significance of poor antibody responses to test immunization in a small minority of children with otitis media is unclear. Long-term follow up of these children is required to determine whether poor immunization responses herald the development of frank antibody deficiency.     

Mannan-binding protein--levels in plasma and upper-airways secretions and frequency of genotypes in children with recurrence of otitis media.

We have investigated a possible association between recurrence of otitis media and low concentrations of mannan-binding protein (MBP) in plasma and upper-airway secretions. The protein concentration was measured in plasma (n = 76), nasopharyngeal secretions (n = 83) and middle ear effusions (n = 73) from otitis-prone children, children with less recurrence of acute otitis media, children with no previous history of acute otitis media, but suffering from secretory otitis media, and healthy children. Moreover, genetic polymorphisms associated with low MBP plasma levels were investigated in DNA from nasopharyngeal tonsils of 89 children with recurrence of otitis media. A wide range of MBP plasma concentrations was found. No statistically significant differences in MBP plasma concentration were observed between patients and controls. Nor was there any increased frequency of the genotypes associated with low MBP plasma concentrations. Thus, our results do not support the assumption that low concentration and/or MBP deficiency alone predispose to recurrence of otitis media in Caucasian children. MBP was detected in both nasopharyngeal secretions (1/175 of plasma level) and middle ear effusions (1/4 of plasma level), suggesting a role for the protein in the local mucosal immune defense system at these locations. In contrast, MBP was undetectable in 53 samples of mixed-saliva.     

Epidemiology and antimicrobial susceptibility of non-typeable Haemophilus influenzae in otitis media in Taiwanese children

Background

Concerns about non-typeable Haemophilus influenzae (NTHi) in otitis media (OM) have grown after the introduction of pneumococcal conjugate vaccine (PCV). We aim to better understand the clinical role of NTHi in pediatric OM.