婴幼儿中耳炎的听力学特征分析

目的 分析婴幼儿中耳炎的听力学特征,探讨多种听力学测试方法在婴幼儿中耳炎的诊断和干预中的作用.方法 收集2004年12月至2007年6月由外院转入本院进行听力学诊断性检查后确诊或高度怀疑中耳炎的56例婴幼儿患者(男加例,女16例).初诊年龄为42 d至3岁,平均为5个月.患儿在完成耳鼻咽喉科常规检查后,进行了多种听力学测试方法联合诊断,包括听性脑干反应(ABR)、耳声发射(OAE)、鼓室声导抗测试(226和1000 Hz探测音),4例患儿完成了小儿行为测听.结果 56例(112耳)中有87耳诊断为中耳炎,31例为双侧,25例为单侧.56例中有49例在出生后3 d内进行了新生儿听力筛查,其中36例初筛未通过;42 d时行进一步筛查的有52例(其中有3例未行初筛直接进行了复筛),显示均为未通过.4例患儿未经过听力筛查,为家长发现听力不佳来诊.52例(104耳)进行了226 Hz鼓室声导抗测试,其中20例(28耳)鼓室图B型或c型;39例(78耳)进行了1000 Hz鼓室声导抗测试,其中38例(55耳)出现异常;56例(112耳)进行了ABR检查,其中49例(74耳)出现ABR的波I潜伏期延长;56例(112耳)进行了OAE测试,其中55例(81耳)未通过;4例(8耳)完成了小儿行为测听,均出现骨、气导差.结论 联合应用226 Hz及1000 Hz鼓室声导抗测试、ABR潜伏期及阈值测试、小儿行为测听、OAE测试多种方法能够发现婴幼儿中耳炎的特征性表现,在早期诊断中具有帮助.     

婴幼儿中耳乳突MRI异常信号影的临床分析

目的　总结分析无耳部临床表现的婴幼儿中耳乳突存在异常信号的MRI病例,探讨其诊断价值。方法  结合硬性耳内镜和1000 Hz声阻抗检查,总结分析42例（62耳）患儿无临床表现的中耳乳突存在异常信号影的MRI资料。结果　这些中耳乳突存在长T2信号影病例中,50耳可诊断为中耳炎,占80.7%;10耳提示存在一定的中耳功能障碍,占16.1%;2耳尚不能明确中耳异常长T2信号原因,占3.2%。结论　无耳部临床表现的婴幼儿中耳鼓室存在异常长T2信号的MRI患儿中有80.7%以上是与中耳炎相关,据此有助于临床制订治疗方案和疗效评估。     

儿童分泌性中耳炎鼓膜置管前后听性脑干反应的特征

目的：评价儿童分泌性中耳炎鼓膜置管前后听性脑干反应（ABR）的特征及变化。方法：回顾性分析行鼓膜置管的37例分泌性中耳炎患儿（研究组）手术前后的ABR资料,并与30例健康儿童（对照组）的ABR资料相对比;将研究组再按波形分化程度分为波形分化不良组和波形分化较好组,对两组的病程及波Ⅴ反应阈等进行比较。结果：①儿童分泌性中耳炎可以影响ABR的波形分化和各波出现率,手术后有改善;术前波形分化不良组的波Ⅴ反应阈及病程与波形分化较好组相比,差异有统计学意义（P〈0．01或P〈0．05）。②Ⅰ、Ⅲ、Ⅴ波潜伏期术后较术前明显缩短且差异有统计学意义（P〈0．05）,但手术前后波间期的改变无统计学意义。③与对照组相比,手术前后均存在部分波潜伏期及波间期的异常,且有统计学意义。结论：儿童分泌性中耳炎的ABR表现为：波形分化及出现率的改变、波间期及波潜伏期的改变、波Ⅴ反应阈的改变,鼓膜置管术可以改善这些变化,但仍未达到对照组水平。     

儿童分泌性中耳炎中耳积液病毒和支原体及衣原体检测结果分析

目的　探讨儿童分泌性中耳炎中耳积液中常见病毒、支原体和衣原体存在情况。方法　选取我院住院手术治疗的150例分泌性中耳炎患儿,对中耳积液行13种常见呼吸道病毒、支原体和衣原体聚合酶链反应检测。结果  中耳积液检测阳性率28.0%。其中鼻病毒阳性率23.3%,显著高于其他病原体阳性率4.7%（χ2=21.705,P =0.000）。学龄前患儿中耳积液检测阳性率33.7%,显著高于学龄期患儿阳性率16.3%（χ2=4.919,P =0.027）,急性-亚急性分泌性中耳炎检测阳性率41.1%,显著高于慢性分泌性中耳炎20.2%（χ2=7.574,P =0.006）。结论　儿童分泌性中耳炎中耳积液感染主要为鼻病毒,学龄前患儿及分泌性中耳炎急性-亚急性期感染更为常见。     

检测婴儿中耳炎的听力学方法敏感性比较

目的 探讨常规听力学检查中婴儿中耳炎诊断相关的的敏感因素.方法 研究对象为听力筛杳未通过的婴儿48例(96耳),男31例,女17例;年龄1.5～12个月(平均4.3个月).所有受试者均接受了颞骨CT薄层扫描和常规听力学测试.听力学检查包括气导和骨导听性脑干反应(ABR)、40 Hz-听觉相关电位(40 Hz-auditory event related potential,40 Hz-AERP)、畸变产物耳声发射(DPOAE)、声反射及226 Hz、1000 Hz探测音鼓室声导抗.统计软件采用SPSS14.0标准统计软件包.以颞骨CT结果作为诊断的依据,与以下9项因素进行Kappa一致性栓验、单因素X2检验和多因素Logistic回归分析.分析因素包括:226 Hz及1000 Hz探测音鼓室声导抗、ABR气导反应阈值、ABR骨气导反应阈值差值、ABR Ⅰ波潜伏期、ABR Ⅰ～Ⅴ波间期、40 Hz-AERP反应阈值、DPOAE反应幅值及声反射阈值.结果 96耳中,CT确诊中耳炎77耳,中耳正常19耳.以颞骨CT扫描结果作为金标准,Kappa-致性检验表明,1000 Hz鼓室声导抗测试、ABR气导反应阈值、ABR Ⅰ波潜伏期、40 Hz-AERP反应阈值和DPOAE与颞骨CT具有较好一致性(Kappa值均＞0.04,P值均＜0.001).单因素分析提示,有7个因素与婴儿中耳功能有关(P值均＜0.001):1000 Hz探测音鼓室声导抗、声反射阈值、ABR气导反应阈值、ABR气骨导反应阈值差值、ABR Ⅰ波潜伏期、40 Hz-AERP反应阈值和DPOAE.Logistic回归分析显示,1000 Hz探测音鼓室声导抗(P＜0.001)和40 Hz-AERP反应阈值(P=0.004)可以列入Logistic回归方程.结论 1000 Hz鼓室声导抗可作为婴儿中耳炎检出的敏感因素,ABR气导反应阈值、ABR Ⅰ波潜伏期、40 Hz-AERP反应阈值和DPOAE可较好地反映婴儿的中耳功能.     

唐山地区小儿分泌性中耳炎现状及分析

分泌性中耳炎（otitismedia with effusion）是儿童的常见病,多发病,因其早期常无明显临床症状,且患儿语言表述能力差,出现明显听力下降时才就诊,往往延误了病情的诊治。我科于2008年9～11月联合儿童保健科对唐山地区15876例3～6岁儿童进行了声导抗检查,对于鼓室图异常者做进一步检查,结果如下。     

中耳吹张法治疗分泌性中耳炎98例分析

1993年1月至1997年12月我们用中耳吹张法治疗分泌性中耳炎98例、134耳,现总结如下.     

低频和高频探测音鼓室声导抗测试在婴儿中耳功能诊断中的作用

目的评价低频和高频探测音鼓室声导抗测试在诊断婴儿中耳功能异常中的作用。方法使用GSI Tympstar中耳分析仪，对年龄5—25周的听性脑干反应（auditory brainstem response，ABR）检查正常婴儿15例（30耳）和Ⅰ波潜伏期延长提示可能存在中耳功能异常婴儿17例（20耳），进行226、678、1000Hz探测音鼓室声导抗测试的比较。结果226Hz探测音鼓室声导纳图的静态声导纳值、图形、峰压和梯度在2组间的差异无统计学意义。678Hz探测音鼓室声导纳图、声纳图及声导图在2组中均可见无峰型、单峰型、双峰型、三峰型图形，其与ABR检查的一致率分别为70．0％、58．0％、64．0％，kappa值分别为0．324、0．234、0．118。1000Hz探测音鼓室声导纳图、声纳图及声导图在正常组中单峰型分别为28耳（93．3％）、25耳（83．3％）、26耳（86．7％），在异常组中无峰型分别为15耳（75％）、17耳（85％）、13耳（65％），其与ABR的一致率分别为90．0％、92．0％、86．0％，kappa值分别为0．783、0．831、0．690。结论1000Hz探测音鼓室声导抗测试是诊断小于25周婴儿中耳功能的较准确的检查方法，226、678Hz探测音鼓室声导抗测试则不能提供这些婴儿中耳功能的准确的信息。     

咽鼓管异常开放症的手术治疗进展

咽鼓管异常开放症的治疗目前尚无标准的治疗方案，主要采用保守治疗与手术治疗相结合的综合疗法。本文总结了国内外治疗咽鼓管异常开放症的各类手术方式及其优劣性、可操作性、并发症的发生率，为临床医师手术方式的选择提供参考。     

婴幼儿低频探测音鼓室导抗测试与中耳CT测试结果的比较

目的:探讨226Hz探测音鼓室导抗测试在婴幼儿分泌性中耳炎患者中的诊断价值。方法:以听力复筛未通过的52例新生儿作为研究对象,均行226Hz探测音鼓室导抗测试和颞骨螺旋CT扫描,比较二者的诊断一致率,计算其Kappa值(κ值)。结果采用SPSS16.0软件包进行统计学分析。结果:52例(104耳)患儿中,经CT检查中耳正常者47耳,有中耳积液57耳。CT检查正常的47耳中,有24耳鼓室导抗图为"A"型(51.06%),1耳为"B"型(2.13%),1耳为"C"型(2.13%),21耳为"D"型(44.68%);CT检查有中耳积液57耳中,44耳为"A"型(77.19%),2耳为"B"型(3.51%),11耳为"D"型(19.30%);226Hz探测音鼓室导抗测试与CT测试结果的诊断一致率较低,κ=0.103。结论:226Hz探测音鼓室导抗测试与螺旋CT测试结果诊断一致率低。在临床实践中,不推荐使用226Hz探测音鼓室导抗测试的结果作为标准来判断婴幼儿中耳有无积液。     

学龄儿童与青年人言语诱发听性脑干反应的比较

目的 比较学龄儿童与青年人言语诱发听性脑干反应( speech-ABR)的基本特征,探讨学龄期儿童脑干言语处理能力的发育情况.方法 对纯音听阈、声导抗、耳声发射和短声听性脑干反应(click-ABR)测试结果均正常的20名青年人(21～ 26岁)和18名学龄儿童(6～11岁)行speech-ABR测试.刺激声为/da/音,采用插入式耳机,右耳给声.结果 学龄儿童与青年人speech-ABR波形均由瞬态反应(V、A、C、O波)及周期性反应(D、E、F波)等几部分构成.学龄儿童的O波潜伏期(47.80 ±0.38)ms短于青年人(48.10±0.40) ms,差异具有统计学意义(t=2.330,P=0.026);学龄儿童F波波幅(-0.21±0.15)μV大于青年人(-0.12±0.08)μV,差异具有统计学意义(t=2.146,P =0.043);二者其余各波的潜伏期及波幅差异均无统计学意义(P值均＞0.05).结论 学龄儿童与青年人speech-ABR的基本特征相近,其脑干言语处理能力不亚于青年人.     

The effect of middle ear effusions from children on in vitro ciliary activity

Summary In an attempt to clarify the effect of middle ear effusions (MEEs) on ciliary activity, the ciliary beat frequency (CBF) of nasal epithelium from normal subjects was determined following incubation in Hanks' solution containing effusions from pediatric otitis media with effusion. Both serous and mucoid types of effusions increased CBF 15 min after incubation. The mucoid type of effusion was then found to decrease CBF 6 h after incubation. Since the pH and osmotic pressure of the solution containing the effusions were within the physiological ranges for normal ciliary beating, our findings show that MEEs can influence CBF in vitro. Offprint requests to: Y. Sakakura     

Proinflammatory and immunoregulatory cytokines in the middle ear effusions

OBJECTIVE: The recognition of inflammatory mediators in middle ear effusions and their correlation with clinical parameters may allow better understanding of many complex events leading to development of permanent sequelae of otitis media and hopefully help to develop future interventions. The aim of the study was to evaluate the presence and level of proinflammatory interleukin (IL) 1beta, IL-6 and immunoregulatory IL-10 in the middle ear effusions, their mutual correlation and relationship with age, duration of the illness, number of episodes of acute otitis media, and presence of retraction pockets. METHODS: The study included 25 children (41 ears), who had been scheduled for myringotomy with the insertion of tympanostomy tubes due to otitis media with effusion. The interview (duration of the illness, number of episodes of acute otitis media), clinical and audiological examination was conducted according to the developed examination check list. Middle ear effusions (MEE) were collected aseptically, the samples centrifuged and supernatant frozen at a temperature of -80 degrees C. The IL-1beta, IL-6 and IL-10 were assayed using enzyme-linked immunosorbent assay (ELISA) kits incorporating monoclonal antibodies and the ETI system reader. The nonparametric Mann-Whitney U test was used for statistical analysis and Pearson's linear correlation coefficient was calculated. RESULTS: IL-1beta was detected in 80% of examined effusions, IL-6 in 78%, and IL-10 in 88%. There was a strong statistical correlation between IL-1beta and IL-6 concentrations (r=0.627, P=0.000), as well as IL-6 and IL-10 (r=0.66, P=0.000) No statistically significant correlation was found between levels of cytokines and clinical parameters. CONCLUSIONS: Proinflammatory and immunoregulatory cytokines participate in middle ear inflammatory response. The lack of direct correlation between IL-1beta and IL-10 may be responsible for chronic character of the disease. As no correlation between the levels of cytokines and clinical parameters was found it seems that the time of duration of inflammation rather than its intensity measured by levels of cytokines is the main factor in development of middle ear mucosa pathology.     

Prostaglandin content in human middle ear effusions

Summary The concentrations of prostaglandins (PGs) were measured by a radioimmunoassay in human middle ear effusions (MEEs) obtained from patients with otitis media with effusions. Each sample of MEE was divided into two groups: serous effusions and mucoid ones. The main PG in both the serous and mucoid effusions was TXB₂ (375 and 857pg/ml, respectively), followed by PGE₂ (173 and 459pg/ml, respectively). Smaller quantities of PGD₂ (35 and 64 pg/ml, respectively), PGF_2a (139 and 183 pg/ml, respectively), and 6keto PGF_1a (129 and 201 pg/ml, respectively) were also found in the MEEs. The amounts of each PG in the mucoid effusions were 2 or 3 times higher than those found in the serous effusions, while protein concentrations and the profile of these PGs in the MEEs were almost the same in the mucoid and serous groups. These results suggest that PGs may play an important role as a mediator of the inflammatory responses in the pathogenesis of MEEs.     

正常新生儿和婴儿的短音听性脑干反应和听觉稳态反应

目的 建立听力正常婴儿短音听性脑干反应(tone-pip ABR)和听觉稳态反应(auditorysteady state response,ASSR)反应阈的正常参考值,研究其听觉发育的生物学规律,并比较两种听力检测技术的频率特性.方法 选取0～6月龄听力正常婴儿80例(160耳),按月龄分为四组:新生儿组、42 d组、3月龄组和6月龄组,每组20例(40耳),男女例数均等,分别记录其短声ABR的潜伏期及在0.25、0.5、1、2、4、8 kHz频率范围内tone-pip ABR和ASSR的反应阈.结果 在70 dB正常听力级短声刺激下,短声ABRⅠ、Ⅲ、Ⅴ波潜伏期、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期随月龄增加逐渐缩短,波Ⅰ于42 d前、波Ⅲ于3个月前发育变化显著.tone-pip ABR波形与短声ABR相似,Ⅰ、Ⅲ、Ⅴ波潜伏期随频率增加逐渐缩短,波形分化逐渐清晰.不同频率、不同月龄tone-pip ABR和ASSR反应阈差异具有统计学意义(P值均＜0.05).除0.25 kHz外,其余频率tone-pip ABR反应阈均低于ASSR.不同月龄tone-pip ABR和ASSR听力曲线形状相似.结论 0～6月正常婴儿tone-pip ABR的潜伏期和波间期随月龄增加逐渐缩短,而反应阈无明显变化.tone-pip ABR和ASSR均有稳定的频率特异性,tone-pip ABR反应阈低于ASSR,可能更接近主观纯音听阈.     

Prospective comparison of handheld pneumatic otoscopy, binocular microscopy, and tympanometry in identifying middle ear effusions in children

Objectives

To compare pneumatic otoscopy, binocular microscopy, and tympanometry in identifying middle ear effusions in children and to determine if a significant difference exists in sensitivity and specificity based on patient age and/or experience of the examiner.

Methods

A prospective study of 102 patients, or 201 ears, enrolled over a 1-year period in a tertiary medical center. Sensitivity, specificity, positive predictive value, and negative predictive value were determined for staff and resident-performed pneumatic otoscopy, staff and resident-performed binocular microscopy, and tympanometry. Tympanometry data were stratified for age. A kappa correlation was used to compare each tool to myringotomy result (gold standard) and to compare staff versus resident.

Results

Binocular microscopy by staff pediatric otolaryngologist was the most sensitive, 88.0% (95% CI 81.4-94.7), and specific, 89% (95% CI 83.1-94.9). Resident binocular microscopy revealed a sensitivity of 81.5% (95% CI 73.6-89.5) and specificity 78.9% (95% CI 71.2-86.6). Staff was more sensitive and specific than resident at pneumatic otoscopy, sensitivity 67.9% (95% CI 57.6-78.3) and specificity 81.4% (95% CI 73.8-88.9) versus 57.7% (95% CI 46.7-68.7) and 78.4% (95% CI 70.4-86.4). Tympanometry had a much lower specificity for ages 5-12 months than for older children.

Conclusions

Binocular microscopy by staff pediatric otolaryngologist revealed the best sensitivity and specificity. Pneumatic otoscopy even performed by an inexperienced examiner is more sensitive and specific than tympanometry. The tympanometer is less specific in children under 1 year of age.