鼻内窥镜置管术治疗分泌性中耳炎100例观察

1998年6月至2002年12月，我们应用鼻窦内窥镜下咽鼓管置管注药治疗分泌性中耳炎100例，经6～12个月观察，疗效满意。现报告如下。     

鼻内镜下咽鼓管球囊扩张术治疗老年慢性分泌性中耳炎患者的疗效

目的探讨鼻内镜下咽鼓管球囊扩张术治疗老年慢性分泌性中耳炎患者的临床疗效。方法 80例慢性分泌性中耳炎患者均为单耳。根据手术治疗方式不同分为对照组40例,采用鼓膜置管术治疗;研究组40例,采用鼻内镜下咽鼓管球囊扩张术治疗。随访6个月后,采用咽鼓管功能障碍评分调查问卷(ETDQ-7)评估患者手术前后咽鼓管功能评分,并对比Valsalva测试(捏鼻鼓气法)、整体临床疗效及并发症发生率。结果术后6个月两组ETDQ-7、Valsalva测试评分均低于术前,且研究组低于对照组(P<0.05);研究组治疗总有效率高于对照组(P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论给予老年慢性分泌性中耳炎患者鼻内镜下咽鼓管球囊扩张术治疗效果显著,能有效改善患者咽鼓管功能,减轻临床症状与体征,提高患者听力水平,安全性较高。     

儿童分泌性中耳炎63例治疗分析

儿童分泌性中耳炎临床多见。1999～2004年,我们共收治儿童分泌性中耳炎患者63例。现分析其治疗方法并报告如下。     

外耳道吹氧法治疗分泌性中耳炎28例疗效分析

1998年9月～2004年6月,我科采用外耳道吹氧法治疗分泌性中耳炎患者28例,获得满意疗效.现报告如下.     

中耳变压疗法治疗老年人分泌性中耳炎疗效观察

目的 探讨中耳变压疗法治疗老年人分泌性中耳炎的疗效.方法 选择56例(62耳)老年人分泌性中耳炎患者,按年龄、病程配对分为中耳变压疗法组(治疗组)和Valsava法组(对照组),治疗后随访3个月,比较其疗效.结果 治疗组纯音听阈均值和气骨导差明显低于对照组(均.P＜0.05).治疗组痊愈2耳,显效2耳,有效20耳,无效7耳,总有效率为77.42%(24/31耳),对照组痊愈1耳,显效1耳,有效14耳,无效15耳,总有效率为51.61%(16/31耳),两组间总有效率差异有统计学意义(P＜0.05);治疗组听力减退分级≥2级耳为6耳(19.35%),明显少于对照组的14耳(45.16%)(P＜0.05).结论 应用中耳变压疗法治疗老年人分泌性中耳炎疗效优于传统Valsava法,对老年人分泌性中耳炎听力康复十分有利.     

鼻内镜辅助咽鼓管疏通、给药治疗分泌性中耳炎60例疗效分析

2003年12月-2005年12月,我们行鼻内镜辅助咽鼓管疏通给药治疗分泌性中耳炎60例（82耳）,疗效满意。现报告如下。     

儿童分泌性中耳炎60例的临床疗效分析

目的探讨儿童分泌性中耳炎的有效治疗方法。方法回顾性分析儿童60例(96耳)分泌性中耳炎综合治疗的疗效。结果治愈76耳(79.2%),好转12耳(12.5%),无效8耳(8.3%),总有效率为91.7%。结论综合治疗是治疗儿童分泌性中耳炎的有效方法。     

丙酸氟替卡松鼻喷剂治疗分泌性中耳炎疗效观察

目的探讨丙酸氟替卡松鼻喷剂治疗分泌性中耳炎的临床疗效。方法选择2011年6月至2012年5月SOM患者80例,随机分为对照组和观察组,对照组采用常规治疗方法,观察组加用丙酸氟替卡松鼻喷剂治疗3周后,观察第一周及第三周的治疗疗效,鼓室压力及语频气导值。结果两组资料均达到满意疗效,比较结果后,加用丙酸氟替卡松观察组起效更快(P<0.05)。结论丙酸氟替卡松治疗分泌性中耳炎结合常规治疗能较快达到满意疗效。     

尿激酶与微波理疗治疗分泌性中耳炎60例

目的 观察尿激酶及微波对分泌性中耳炎的临床疗效.方法 选取临床确诊的分泌性中耳炎患者60例,均行患耳尿激酶鼓室注射及微波理疗等综合治疗.结果 本组大多数病人均有满意的疗效,没有并发症出现.结论 尿激酶与微波理疗治疗分泌性中耳炎安全并有较好的疗效.     

中耳变压疗法治疗儿童分泌性中耳炎的疗效观察

目的探讨用中耳变压疗法治疗儿童分泌性中耳炎的疗效。方法采用中耳变压疗法治疗37例(70耳)分泌性中耳炎患儿,与同期行Valsalva法治疗的36例(70耳)进行对照。结果治疗组显效61耳,有效3耳,无效6耳,有效率为91.43%;对照组显效35耳,有效8耳,无效27耳,有效率为61.4%。治疗组疗效明显高于对照组(P0.001),且无不良副反应发生。结论中耳变压疗法能够明显减轻儿童中耳负压,改善听力,操作上安全,简便,值得在临床上推广应用。     

Immunochemistry of otitis media with effusion.

For investigation of the nature and origin of middle ear effusions, immunochemical studies were performed on more than 400 patients diagnosed as having otitis media with effusion. Although results of cellulose acetate and disc electrophoretic analyses and quantitation of IgG, IgA, and IgM suggested that proteins found in the effusions were derived for the most part from the serum, quantitative analysis of secretory IgA revealed the existence of appreciable amounts of secretory IgA in both serous and mucoid effusions. The antigenicity and subunit structure of the secretory IgA isolated from middle ear effusions were identical or very similar to those of secretory IgA obtained from other external secretions. Radioactive single radial diffusion analysis of IgE showed that the mean concentrations of IgE in effusions and sera were within normal ranges. Findings of this study suggest that the middle ear maintains the local immunologic defense system, that the middle ear effusion is at least partially an external secretion, and that IgE in middle ear effusions obtained from old patients, rather than being a local product, may be derived from the serum.     

The role of allergy in recurrent otitis media with effusion.

OBJECTIVE: To compare the OME groups that improved when treated with adenoidectomy, VT and medication, and which of them recurred. METHODS: Twenty-two consecutive children with recurrent OME (11%) were selected among 200 children who had adenoidectomies and had been inserted a ventilation tube (VT) for OME. The patients were selected for allergy evaluation because of recurrent OME not responsive to medical therapy and adenoidectomy, requiring more than one myringotomy with tubes. The control group consisted of 24 healthy children that were treated with adenoidectomy and VT, and had no recurrence. RESULTS: Eight (36.4%) patients had positive skin tests for inhalant and food allergens. Two subjects of the control group (8.3%) had positive skin tests for inhalant and food allergens. This was statistically significant (p:0.032). A pattern to multiple positive nasal and food reactions was shown in the study group rather than in the control subjects. CONCLUSIONS: The possibility of allergy should be considered in OME cases that did not improve with drug treatment and adenoidectomy and VT insertion but recurred, and a thorough search for allergen was made for proper diagnostic and therapeutic management.     

Lysozyme activity and immunoglobulins in middle ear effusion fluid in acute purulent otitis media and in otitis media with effusion.

147 samples of punctured middle ear effusion fluid from cases of otitis media with effusion and 150 samples from patients with acute purulent otitis media were tested for lysozyme activity. In otitis media with effusion the concentration was 182.0 U/ml, in acute otitis 433.8 U/ml. The lysozyme concentration in otitis media with effusion depended upon the nature of the effusion. Serous fluid showed an activity of 124.8 U/ml and mucoid 311.6 U/ml, respectively. In culture-positive cases of acute otitis media the lysozyme level was 423.4 U/ml. Culture-negative cases showed about the same concentration, 438.3 U/ml. The possible role of lysozyme in defence systems of the middle ear is discussed.     

Relationship between pediatric obesity and otitis media with effusion

Although eustachian tube dysfunction and bacterial infection have been shown to cause otitis media with effusion (OME), other etiologies are possible. One of the most common medical conditions in children is obesity, which can have effects throughout the body. Little is known, however, about the relationship between obesity and OME. Obesity may result in altered cytokine expression, gastroesophageal reflux disease, or fat accumulation, all of which may contribute to OME. Conversely, OME may induce taste changes through middle ear cavity inflammation, thus contributing to obesity. A similar pattern of taste change has been shown in patients with gustatory nerve anesthesia. Further research on the relationship between obesity and OME may help to determine the exact etiology of OME and contribute to our knowledge about the causes of obesity.     

The etiology,pathophysiology, and management of otitis media with effusion

Otitis media with effusion (OME) is a common and important condition that may result in developmental delay in children, and significant health care resources are devoted to its management. Newer techniques including polymerase chain reaction are implicating organisms not previously considered important in etiology. The role of gastroesophageal reflux as a cause of OME is likely to receive greater research attention. Regarding prevention, more is being learned about potentially modifiable risk factors such as environmental smoke, care outside the home, and breast feeding. Although immunization may to play a role in the future, existing evidence suggests that the general population of children should not be immunized in order to prevent OME. Several major studies have recently added to the understanding of epidemiology and management. Large trials in the United States, the Netherlands, and the UK suggest that OME is not an appropriate condition to include in a screening program. In addition, the advantages of early treatment with ventilation tubes over watchful waiting in terms of language development tend be modest and diminish by about 18 months. Treatment with hearing aids should be further evaluated. The search for effective medical management continues, and better ways are being identified of targeting interventions to those children with OME who are most likely to benefit.     

A case of otitis media with effusion by Mycoplasma pneumoniae

A 10-year-old male demonstrating otitis media with effusion by Mycoplasma pneumoniae is reported. The patient was brought to my hospital because of hearing disturbance. Beta-lactam antibiotics were not effective and we performed a tympanotomy. Microbacterial materials were obtained from the middle ear effusion and nasopharynx. Mycoplasma pneumoniae was detected by the PCR method from both materials and antibody to Mycoplasma pneumoniae was also detected. It is very rare for otitis media with effusion due to Mycoplasma pneumoniae to occur without pneumonia. It is reported that some cases of otitis media with effusion have demonstrated good results by long-term low-dose macrolide therapy. We believe some of these cases were caused by Mycoplaema pneumoniae.     

Glucocorticosteroids in allergic inflammation: Clinical benefits in otitis media with effusion

Allergy and otitis media with effusion are often considered as comorbidities. Evidence points to a role for allergy in the pathogenesis of otitis media with effusion in reports of increased prevalence of allergy in patients with otitis media with effusion and presence of late-phase allergic-response inflammatory mediators and cytokines in the middle-ear effusion of allergic subjects. However, the exact mechanism remains unknown. Many speculations have been made, but well-controlled studies to prove the efficacy of anti-allergic medication in the treatment of otitis media with effusion are lacking. Therefore, we do not recommend the use of glucocorticosteroids in allergic patients with otitis media with effusion.     

Role of Streptococcus pneumoniae and Haemophilus influenzae in the development of acute otitis media and otitis media with effusion in a gerbil model

The efficacy of amoxicillin/clavulanate and cefuroxime was determined in a gerbil model of otitis media with a mixed Streptococcus pneumoniae plus Haemophilus influenzae middle ear (ME) infection. Results were compared with those obtained in a previous single H. influenzae model. All untreated animals inoculated with the mixed inoculum developed acute otitis media (AOM), whereas 86.7% of those inoculated with H. influenzae developed otitis media with effusion (OME). Antibiotics eradicated H. influenzae from the ME more efficiently in AOM than in OME, and this difference was highly significant (P80% of animals developed culture-negative OME.     

Role of nasal allergy in chronic secretory otitis media

Nasal allergy seems to be one of the important causes of chronic secretory otitis media (SOM) in children and adults. Chronic SOM is unequivocally related to disturbed function of the eustachian tube, which facilitates communication of the middle ear with the nasopharynx, nasal cavity, and indirectly with paranasal sinuses. The most serious consequences of chronic SOM are decreased elasticity of the tympanic membrane and hearing impairment. Allergic reactions in the nasal mucosa leading to release of various mediators result in development of three types of nasal response characterized predominantly by nasal obstruction. Eustachian tube functions can be affected directly by the mediators released in the nasal mucosa or indirectly by the nasal obstruction. Nasal challenges with allergens performed by rhinomanometry, combined with tympanometry and eventually audiometry, may be a useful diagnostic supplement for this disorder.