渗出性中耳炎的远期结果

为探讨抗组胺剂、减充血剂对儿童渗出性非化脓性中耳炎(OME)的作用及儿童OME的自然病史,作者应用双盲法,并用安慰剂作为对照,对74例OME儿童做了长达12周的随访观察。受试儿童均符合下列条件,6月～10岁,随访前已用标准剂量的抗生素治疗,经鼓气耳镜检查证实鼓膜异常,鼓室压图异常,可确诊为OME者。唇裂、腭裂、慢性消耗病、免疫缺陷病、曾用皮质类固醇及双侧听力损失大于25dB或单侧大于35dB者均不作为受试对象。受试儿童均由一位医师做听力检查,2岁以上者用纯音测听法,2岁     

分泌性中耳炎及鼓室置管治疗的并发症

分泌性中耳炎(OME)是以中耳积液和听力下降为主要特征的中耳非化脓性炎症性疾病。急性OME一般预后良好,但对慢性或反复发作性的OME,若不及时正确地治疗,会导致一些并发症的发生;另外在临床工作中,OME的手术治疗———鼓室置管术,也存在多种并发症。这些并发症在治疗上较OME本身更加困难,且效果不佳,给患者造成极大痛苦,因此深入地认识这些并发症,了解各种并发症的原因及转归,有重要的临床意义。1 OME的并发症OME是耳鼻咽喉科的常见病、多发病,儿童发病率较高,大约80%的儿童曾患过OME,是儿童听力下降和语言障碍的重要原因。大部分O…     

分泌性中耳炎患者吸鼻试验检测结果分析

目的 观察分析分泌性中耳炎(otitis media with effusion,OME)患者吸鼻试验结果,探讨咽鼓管闭合功能在OME发病中的作用.方法 选择56例成人OME患者、16例儿童OME患者、66例健康成年人和20例健康儿童做为研究对象,对4组人群采用问卷调查及使用咽鼓管功能综合检查仪进行吸鼻试验检测,并对结果进行统计分析.结果 以外耳道压低于基线10 dapa(含10 dapa)定为吸鼻试验阳性.成人OME组吸鼻试验阳性率为64.86％(对照组为9.09％),儿童OME组吸鼻试验阳性率为70.83％(对照组为38.24％),均明显高于对照组(P值均＜0.05),而成人与儿童OME患者吸鼻试验阳性率差异无统计学意义(X2=0.289,P＞0.05).结论 OME患者吸鼻试验阳性率明显高于健康对照组,提示咽鼓管闭合功能不全参与了OME的发病.     

儿童肥胖对分泌性中耳炎患病率及预后的影响

目的 本研究旨在明确儿童肥胖与分泌性中耳炎(otitis media with effusion,OME)患病率及预后的关系.方法 选取2017～2019年因OME就诊宁波大学附属人民医院的患儿共112例进行研究,112例全部行鼓膜置管术治疗;另选取130例年龄、性别与研究组相匹配的儿童作为对照组,并根据年龄、性别、体...     

成人分泌性中耳炎

与儿童分泌性中耳炎（otitis media with effusion,OME）不同,成人OME的发病率低（0.55%）（Robinson等,1987）,不引起语言发育障碍等重大后遗症,因此临床工作中关注度低,相应的文献研究也较少,其重要性往往被低估。虽然成人OME的诊断与儿童相同,但两者的治疗却大相径庭。其差异主要为成人OME的病因诊治十分重要,同时鼓膜切开置管术治疗成人OME不如处理儿童患者有效。     

表面活性物质治疗分泌性中耳炎的实验研究

急性中耳炎、分泌性中耳炎 (OME)是儿童最常见的疾病。 85 %的儿童至少有一次中耳炎发作史 ,5 0 %的2～ 5岁儿童曾患过 OME。 OME不仅对儿童听力有影响 ,而且增加了患急性中耳炎的风险。约 2 5 %的 OME患儿需采用手术治疗。手术需在全麻下进行 ,增加了医疗费用 ,且对患儿及其父母心理造成打击。因此 ,寻求有效的治疗 OME的药物具有重要的临床意义。 OME的病因是多方面的 ,其中感染或 /和咽鼓管功能障碍是最重要的因素。咽鼓管重要的生理功能是调节中耳与鼻咽部气压平衡。在正常状态下处于关闭状态 ,只在吞咽时瞬间开放。咽鼓管软骨…     

儿童分泌性中耳炎相关因素研究

分泌性中耳炎(otitis media with effusion,OME)是引起小儿听力下降的重要原因之一,对儿童的言语、语言和认知发育有十分显著的影响,是小儿耳鼻咽喉科常见病。有关OME病因和发病机制至今仍不很明确,为了提高对儿童OME的认识,现将大庆油田总医院耳鼻咽喉科2007年1月～2011年10月收治的124例(196耳)儿童OME患儿的临床资料分析如下。     

内镜下中耳置管并腺样体切除治疗小儿分泌性中耳炎

小儿分泌性中耳炎(otitis media with effusion,OME)是一种常见病、多发病,亦是儿童致聋的重要原因,且有上升趋势,对于OME的治疗越来越受到重视,目前的治疗方法多种多样,各家报道不一,我们采用内镜下鼓膜置管并腺样体切除治疗OME患儿62例,取得满意效果,现报告如下.     

分泌性中耳炎的临床诊断与处理指南(摘要)

美国儿科学会(AAP)、家庭医生学会(AAFP)和美国耳鼻咽喉-头颈外科学会(AAO-HNS)召集分泌性中耳炎(otitis media with effusion,OME)分组于2004年发布了关于OME诊断与处理的临床实践指南。这个指南适用于2个月～12岁。伴或不伴发育残疾或具有OME潜在危险的儿童。儿童保健、耳鼻咽喉科学、流行病学、感染性疾病、     

199 表面活性物质治疗分泌性中耳炎的实验研究

急性中耳炎、分泌性中耳炎(OME)是儿童最常见的疾病。85％的儿童至少有一次中耳炎发作史，50％的2～5岁儿童曾患过OME。OME不仅对儿童听力有影响，而且增加了患急性中耳炎的风险。……     

Cytokines in children with otitis media with effusion

We assayed 38 middle ear effusions from 23 children aged 4–13 years (mean 7) undergoing tympanostomy tube placements. All fluid was assayed for tumor necrosis factor (TNF) α, interleukin (IL) 1β, IL-8, and IL-10. Cytokine concentrations were measured by means of an enzyme-linked immunosorbent assay. Detectable levels of IL-1β, IL-8, and IL-10 were found in all of the effusions. TNF-α was detected in 18 of the middle ear effusions (47.4%). The mean concentration of TNF-α, IL-1β, IL-8, and IL-10 was, respectively, 0.423 ± 1.39, 30.58 ± 68.7, 7001.9 ± 6743, and 56 ± 58.7 pg/ml. There was a strong, statistically significant correlation between the concentrations of TNF-α and IL-1β (r = 0.87, P = 0.001) and between IL-1β and IL-8 (r = 0.53, P = 0.001). There was no correlation between the concentrations of IL-10 and other cytokines examined or between tympanic membrane pathology and the concentrations of TNF-α, IL-1β, IL-8, or IL-10. The presence of IL-10 in middle ear effusions may be one of the causes of a lack of clinical features of acute inflammation and may lead to a chronic inflammatory state. Received: 25 August 1999 / Accepted: 5 January 2000     

Otoacoustic emissions in children with otitis media with effusion

OBJECTIVES: Otoacoustic emissions (OAE) are transmitted from the cochlea to the ear canal via the middle ear and the transmission properties of the middle ear directly influence OAE characteristics. The purpose of this study was to establish the mechanisms of changes occurred in middle ear by tympanometric, audiometric and OAE examination. METHODS: Audiometric and tympanometric examination were performed and otoacoustic emissions were recorded from 22 normal ears and 52 ears with middle ear effusions and repeated 3 months later. RESULTS: Results of the air conduction in study group were significantly different from the control group and we found significant recovery in 3 months. When we analysed the DPOAE evaluation results in our study, some of the DPOAE parameters were found to be different between the control and the study group at low frequencies. Changes in the amplitude, especially at low frequencies, were statistically significant after 3 months. CONCLUSION: The results of this study revealed that measurement of otoacoustic emissions, especially distortion product otoacoustic emissions, is helpful in evaluating the condition of middle ear during the treatment.     

Speech improvement with velopharyngoplasty in patients with lip-jaw-palate clefts

BACKGROUND: Despite successful closure of the hard and soft palate and intensive speech therapy a velopharyngeal insufficiency is not completely avoidable in each case of cleft palate. An improvement by velopharyngoplasty should be possible. PATIENTS AND METHODS: Two hundred and ninety patients suffering from cleft palate were examined before and one year after velopharyngoplasty according to Sanvenero-Rosselli. Four main symptoms of the affected speech were assessed: changes of the resonance, inappropriate nasal air emission, articulary disorders (deviations from articulation areas), and non-physiological facial expression during speaking, each divided into three grades. Afterwards, the complete speech quality was classified. RESULTS: Assessing the symptoms separately and summarised the therapy including velopharyngoplasty was suitable to improve the speech quality in 83.1% of the cases, resulting in a widely unaffected speech. The improvement was greater in younger patients undergoing operation (Gamma-test, p < 0.001). But the final results were independent from age due to poorer initial situation in younger patients (Gamma-test, p < 0.001). CONCLUSIONS: The velopharyngoplasty is an important method for repair of velopharyngeal insufficiency in patients with cleft palate. In each individual case it is necessary to consider carefully if and when this operation should be performed. An intensive interdisciplinary co-operation of all specialists involved in the treatment is indispensable.     

Vestibular rehabilitation with biofeedback in patients with central imbalance

Central Nervous System disorders may cause important functional unbalance in the maintenance of balance and posture. There is no effective rehabilitation for these symptoms until now.ObjectiveThe aim of this paper is to evaluate the use of tongue electrotactile stimulation on patients with central imbalance using BrainPort.Materials and MethodsThis is a prospective case series study. We evaluated 8 patients with central imbalance, 6 men and 2 women, with mean age of 67.75 years. The patients were submitted to Computed Dynamic Posturography (CDP) and then received 18 sessions of electrotactile stimulation by BrainPort® device for 20 minutes, twice a day. Then they were submitted to a new CDP test and to a self-perception scale to assess symptom remission, partial improvement and no improvement at all.Results75% of the patients reported being more stable. There was no improvement in the balance control of the mass center in these patients.ConclusionThe patients were able to use the electrotactile stimulus to improve their balance control.     

Multifrequency tympanometry in adults with otitis media with effusion

We compared the diagnostic values of multifrequency tympanometry (MFT) and conventional 226-Hz tympanometry in adults with otitis media with effusion (OME) and discuss whether the resonant frequency (RF) can be used as a reliable method in adults with OME. Prospective study was designed to compare the normal hearing group and the group with OME. In the OME group (n = 85), conductive or mixed hearing loss was found, air-bone gap was more than 10 dBHL, and acoustic reflex was not elicited. In the normal hearing group (n = 36), pure tone threshold was less than or equal to 15 dBHL and air-bone gap was less than 10 dBHL. Levene's test was used to compare the difference between the OME group and the normal hearing group on day1, day15, day30, day90, respectively. The relationship among multifrequency tympanometry, 226-Hz tympanometry and acoustic reflex test in ears recovering from OME was also investigated. A statistically significant decrease in RF value was found in ears with OME compared to normative data. In follow-up visits, both the RF values and the percentage of type A tympanograms increased while the percentage of type B and C tympanograms decreased. A high agreement between middle ear resonant frequency test and acoustic reflex test in ears recovering from OME was found. The resonant frequency test provides more detailed information than the 226-Hz tympanometry. Multifrequency tympanometry may be a more sensitive and objective diagnostic tool in adults with OME.     

Treatment of sinusitis with corticosteroids in combination with antibiotics in experimentally induced rhinosinusitis

OBJECTIVES: The objective of this study was to investigate the effects of corticosteroids, antibiotics, and their combination in the therapy of experimental bacterial rhinosinusitis. METHODS: Twenty-eight rabbits underwent experimental induction of bacterial rhinosinusitis with Staphylococcus aureus. The animals were assigned randomly to 1 of 4 treatments (saline solution, methylprednisolone, cefazolin sodium, methylprednisolone-cefazolin sodium) for 7 days. After the treatment period, sinus mucosa samples of the animals were examined stereologically. In addition, mucosa samples were used in the determination of myeloperoxidase (MPO) activity. RESULTS: Methylprednisolone, cefazolin, and methylprednisolone-cefazolin had a positive effect on the reduction of neutrophil infiltration to the sinus mucosa in experimental bacterial rhinosinusitis as compared to the group treated with saline solution. However, the effects of methylprednisolone, cefazolin, and methylprednisolone-cefazolin did not significantly differ (p > .05). Similarly, the use of methylprednisolone, cefazolin, and methylprednisolone-cefazolin decreased MPO activity as compared to the group with saline solution (p < .05), and the difference among methylprednisolone, cefazolin, and methylprednisolone-cefazolin was statistically significant (p < .05). The most significant decrease in MPO (neutrophil marker enzyme) activity was determined in the animals treated with methylprednisolone-cefazolin (p < .05). CONCLUSIONS: Administering corticosteroids as an adjunct to antibiotics may accelerate the healing process in experimentally induced rhinosinusitis. In this model of rhinosinusitis, an MPO assay was supportive of this hypothesis, although stereological examination showed no statistically significant difference.     

Decreased miRNA-320e correlates with allergy in children with otitis media with effusion

ObjectiveOtitis media with effusion (OME) is a common childhood disease and the main cause of conductive hearing loss in this age group. Many factors predispose to OME but allergy is still widely disputed. The answer may lay in the molecular mechanisms of ear exudate formation and the recent studies showed miRNAs might take part in it. MiRNAs are also potent regulators of allergic response. As miRNAs are present in the middle ear, we hypothesized their expression differs between allergic and non-allergic patients and reflects the difference in pathomechanism of effusion formation between these two groups.Materials and methodsThis study aimed to establish the expression of 5 different miRNAs (miR-223-3p, miR-451a, miR-16-5p, miR-320e, miR-25-3p) in ear exudates in children diagnosed with OME. The allergy group consisted of 18 patients whereas the non-allergic group had 36 patients. MicroRNA was isolated from the middle ear fluid collected during myringotomy and transcribed into cDNA. MiRNA expression was measured with TaqMan™ MicroRNA Assays and analyzed with DataAssist software. The comparative CT method was used for calculating the relative quantification of gene expression based on the endogenous control gene expression (U6 snRNA-001973).ResultsMiR-320e expression was significantly decreased in allergic children with OME. Other studied miRNAs also showed reduced expression in allergic children, but the decrease was not significant.ConclusionsMiRNA expression differs between children with and without allergy in the course of OME, but further studies are needed to explain the exact role of miR-320e and its target genes in OME pathology in allergic patients.     

Predictors of outcome in children with otitis media with effusion

Otitis media with effusion (OME) is the commonest cause of hearing impairment in young children. The fluctuating nature of the condition makes identification of those with persistent disease difficult without subjecting each child to a period of ‘watchful waiting’. The aim of this study was to determine if the outcome of this observation period could in any way be predicted. The study involved the retrospective analysis of 517 children, aged 3–15 years (mean 5 years and 4 months) in whom the diagnosis of OME had been established. All children had been subjected to an observation period before a decision on surgery was taken. There was a significant correlation between the degree of hearing loss at presentation and after the period of observation. Sex was not a reliable predictor of outcome, but age less than 4 years and presentation in autumn or winter were associated with a poor audiometric outcome. This study identifies a predictive influence on the resolution of OME for these three factors and points the way for future research aimed at identifying the subgroup of children with OME who would benefit from early surgical intervention.     

Pharyngeal reflux in children with chronic otitis media with effusion

Objective—To investigate whether there is an association between chronic otitis media (COM) with effusion and pharyngeal reflux in children by using 24-h pH monitoring with a dual probe.

Material and Methods—This was a prospective study. The study group consisted of 25 children with COM with effusion and the control group comprised 12 healthy children. All children underwent 24-h esophageal pH monitoring with a dual probe (distal and proximal esophageal pH monitoring).

Results—In the study group, the frequencies of pharyngeal and gastroesophageal reflux (GER) were 48% and 64%, respectively, and the corresponding values in the control group were 8.3% and 25%. Both of these differences were significant (p<0.05). In the study group, 28% of patients were positive for at least 1 symptom of GER; 72% of the patients did not have any symptoms but 56% of these patients had silent GER.

Conclusions—These findings indicate that pharyngeal reflux may play an important role in the etiology of COM with effusion. If patients have typical symptoms of GER, such as pyrosis, regurgitation, dysphagia and emesis, the presence of GER should be considered. The presence of silent GER and pharyngeal reflux should also be considered.