腺样体切除对儿童分泌性中耳炎听力的影响

目的探讨腺样体切除术对分泌性中耳炎听力的影响。方法对72例确诊为腺样体肥大所致的分泌性中耳炎患儿随机分为非手术组和手术组，分别进行药物治疗和手术治疗。结果非手术组治疗后听阈≤20dB12耳，手术组治疗后听阈≤20dB36耳，两组治疗后听阈改变经x^2检验差异有显著性。结论腺样体切除术对分泌性中耳炎所致的听力下降的改善是非常有效的。     

鼓膜穿刺或鼓膜置管联合腺样体切除治疗儿童分泌性中耳炎疗效分析

目的　对比分析腺样体切除术联合鼓膜穿刺（adenoidectomy with auripuncture,AT+A）与腺样体切除术联合鼓膜置管（adenoidectomy with tympanostomy tube,AT+T）对儿童分泌性中耳炎的临床疗效。方法　选取我院于2010年9月至2014年9月收入治疗的分泌性中耳炎患儿92例,将其根据治疗方式的不同分为AT+T组和AT+A组,其中AT+T组48例,AT+A组44例,回顾性分析两组患者的治疗效果,治疗前后听阈的变化以及术后复发率和感染并发症等一系列临床资料。结果　治疗后随访一年内两组患者听阈得到了明显的下降,纯音听力提高,但两者不存在显著性差异（P >0.05）。AT+T组总有效率97.9%,AT+A组的总有效率为95.4%,两者无显著差异（P >0.05）。AT+T组中耳积液的平均时间为（7.3±0.8）d,感染率为6.3%,复发率为4.2%,AT+A组中耳积液的平均时间为（11.7±0.4）d,感染率为15.9%,复发率为11.4%,均存在显著性差异（P <0.05或P <0.01）。结论　AT+T和AT+A两种治疗方式均能有效的提高分泌性中耳炎患儿的听力水平,对分泌性中耳炎患儿具有良好的治疗效果,但是AT+T较AT+A能显著缩短中耳积液时间,有效降低患儿的复发率和感染率,更加适用于分泌性中耳炎患儿的临床治疗。     

Efficacy of allergy immunotherapy as a treatment for patients with chronic otitis media with effusion

OBJECTIVE: Controversy persists over the significance of allergy as it might relate to chronic middle-ear disease as no controlled study of the efficacy of allergy immunotherapy has been published. The aim of this study was (1) to evaluate the atopic status of patients with intractable chronic otitis media with effusion or drainage from their middle ear and (2) to determine in this select population the efficacy of specific allergy immunotherapy in preventing or limiting the duration of their chronic middle-ear disease. METHODS: This was a prospective, cohort study of patients cared for in a private community practice. History, examination, audiogram, tympanometry and recurrence of effusion/infection were recorded on 89 patients (52 children <15 years old, 37 adults) referred with (1) effusion found to warrant myringotomy and ventilation tubes, or (2) chronic drainage from a perforation or tube. All were evaluated for allergy by intradermal skin testing according to criteria of the American Academy of Otolaryngic Allergy. A control cohort of 21 patients who refused therapy was included. Intervention consisted of immunotherapy for dust, pollen, and molds. Recurrence or persistence of fluid or drainage following 2-8 years of therapy was compared to the patient's pretreatment status. RESULTS: All 89 OME patients proved to be atopic. Most were allergic to dust (94%), animals (44%) and molds (88%) while 9% were allergic only to seasonal pollens. Associated allergic diseases included asthma (21%) and allergic rhinitis/sinusitis (63%). Otitis was the sole symptom among 37%. Immunotherapy provided complete resolution of effusion or drainage in 85% of 127 ears. CONCLUSION: Intradermal testing proved all 89 patients with intractable middle-ear disease in this study who presented with chronic effusion or chronic draining perforations or tubes to be atopic. Specific allergy immunotherapy significantly improved 5.5% and completely resolved 85% of chronic otitis media with effusion in these ears. None of the controls resolved spontaneously (p<0.001). This supports the hypothesis that in many, otitis media with effusion is an immune mediated allergic disease and suggests that these patients deserve consideration for aggressive evaluation and allergy treatment, as most respond to immunotherapy.     

手术治疗儿童腺样体肥大致反复发作的分泌性中耳炎

目的：探讨治疗儿童经手术切除肥大腺样体后致顽固性分泌性中耳炎的疗效。方法：对32例行腺样体切除后患儿进行听力、声阻抗、纯音测听方面的检查。结果：治愈28例,好转3例,无效1例,有效率96.9%。结论：切除腺样体可作为治疗儿童反复发作的分泌性中耳炎（otitis media with effusion OME）的手段之一。     

鼻内镜下腺样体切除术对儿童慢性鼻窦炎和分泌性中耳炎转归的影响

目的：探讨鼻内镜指导下吸切器切除腺样体对儿童慢性鼻窦炎和分泌性中耳炎临床转归的影响。方法：对15例并发慢性鼻窦炎和(或)分泌性中耳炎的腺样体肥大患儿,在鼻内镜指导下采用Xomed电动吸切器行腺样体切除术,再辅以药物治疗后观察其转归情况。结果：15例患儿睡眠打鼾停止,无腺样体残留及并发症发生。术后慢性鼻窦炎和(或)分泌性中耳炎经药物治疗后均痊愈。结论：鼻内镜下吸切器腺样体切除术,是一种微创、有效的手术,且对与腺样体肥大有关的慢性鼻窦炎和分泌性中耳炎亦有良好的治疗效果。     

Adenoidectomy for otitis media with effusion in 2-3-year-old children

Objective

To compare the efficacy of three surgical treatment combinations - myringotomy and tympanostomy tube insertion (M&T), adenoidectomy with M&T (A-M&T), and adenoidectomy with myringotomy (A-M) - in reducing middle-ear disease in young children with chronic OME.

Methods

Children 24-47 months of age, with a history of bilateral middle-ear effusion (MEE) for at least 3 months, unilateral for 6 months or longer or unilateral for 3 months after extrusion of a tympanostomy tube, unresponsive to recent antibiotic, were randomly assigned to either M&T, A-M&T, or A-M. Treatment assignment was stratified by age (24-35 months, 36-47 months), nasal obstruction (no, yes) and previous history of M&T (no, yes). Subjects were followed monthly and with any signs or symptoms of ear disease for up to 36 months.

Results

Ninety-eight subjects were randomly assigned to the three treatment groups. Fifty-six subjects (57%) were 24-35 months of age; 63% had nasal obstruction, and 36% had previously undergone M&T. During the 36 months after entry, subjects were noted to have MEE for the following percentages of time: 18.6% in the M&T group, 20.6% in the A-M&T group, and 31.1% in the A-M group (M&T vs. A-M&T, p = 0.87; M&T vs. A-M, p = 0.01). By 36 months, there were no differences in the number of further surgical procedures for ear disease needed among the groups.

Conclusions

Adenoidectomy with or without tube insertion provided no advantage to young children with chronic OME in regard to time with effusion compared to tube insertion alone. Fewer tympanostomy tubes were placed in children undergoing A-M as their initial procedure, but this should be balanced by the performance of the more invasive surgical procedure and their increased time with effusion.     

咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎疗效分析

目的 探讨咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎的中短期疗效及安全性.方法 回顾性分析2020年7月至2021年2月就诊的分泌性中耳炎伴腺样体肥大患儿66例,其中35例采用咽鼓管球囊扩张联合腺样体切除术为治疗组,31例采用单纯腺样体切除术为对照组,比较两组术后疗效及并发症发生比例.结果 术后1个月、3个月治...     

阻塞性睡眠呼吸暂停综合征患儿分泌性中耳炎发病分析

目的分析小儿阻塞性睡眠呼吸暂停综合征(obstructivesleepapneasyndrome,OSAS)群体中伴发分泌性中耳炎(otitismediawitheffusion,OME的发病情况。方法回顾性分析2000年1月至2004年5月在我科住院治疗的OSAS患儿260例中伴发OME的发病情况、声导抗、多导睡眠监测检查结果及其治疗方法。103例(130耳)行鼓室穿刺术,27例患儿(35耳)行鼓膜置管术。结果260例小儿OSAS病例中伴OME130例(165耳),睡眠呼吸暂停和低通气指数(apneahypopneaindex,AHI)与腺样体肥大程度有相关性,腺样体病理性肥大者中重度OSAS病例数明显高于腺样体中度肥大者。AHI与不同类型鼓室图未发现有明显的相关性。结论小儿OSAS群体中伴发OME的发病率较高,对OSAS小儿常规进行声导抗检查是十分必要的。     

Comparison between myringotomy and tympanostomy tubes in combination with adenoidectomy in 3-7-year-old children with otitis media with effusion

The specific aim of this study was to compare, by means of a randomized clinical trial, the efficacy between the two surgical combinations - adenoidectomy with myringotomy and tympanostomy (A + T) and adenoidectomy with myringotomy (A + M) - in reducing middle ear disease in children with otitis media with effusion (OME). Seventy-eight 3-7-year-old patients (156 ears) with a history of bilateral middle ear effusion for at least 3 months were randomly assigned to either A + T or A + M. Hearing threshold levels, recurrence rate of the effusion and episodes of acute otitis media (AOM) and otorrhea were evaluated for a follow-up period of 1 year. Audiometry testing showed that there was no statistically significant difference in the hearing loss levels of both groups during the whole follow-up period. Free of AOM episodes were 72% of the patients in the A + T group and 75% of those in the A + M group. None of the patients with A + M had episodes with otorrhea which contrasted with the 40% occurrence rate in the A + T group. During the follow-up period we documented a 10% recurrence rate of OME in the A + T group and 14% recurrence rate in the A + M group. Overall our data suggests that the insertion of tympanostomy tubes in association with adenoidectomy provides no additional benefit to adenoidectomy in association with myringotomy alone in terms of hearing loss or AOM episode occurrences in patients with bilateral otitis media with effusion. Furthermore no relationship was found between the choice of operative intervention and the recurrence rate of OME despite the slightly greater relative risk in the A + M group.     

Trends in otitis media surgery: a decrease in adenoidectomy

OBJECTIVE: Large variability in adenoidectomies and tympanostomy tube insertions between Norway and Finland has been suggested, but not yet confirmed. Objective is to compare trends in paediatric adenoidectomies and tympanostomy tube insertions for Norway and Finland from 1999 to 2005. METHODS: National Finnish and Norwegian databases (STAKES and NPR) provided information on children between 0 and 7 years operated in the years 1999-2005. Surgical rates were viewed in the light of child density, age and gender, and compared bi-nationally. RESULTS: Adenoidectomies were more common in Finland throughout the study period. Adenoidectomies in both countries decreased markedly from 1999 to 2005. The Finnish adenoidectomy rates were reduced from 212 to 133 per 10,000 children, equivalent Norwegian figures were 84 and 44 per 10,000 children. Tympanostomy tube insertions increased from 97 to 147 per 10,000 children in Finland in the same study period. In Norway the rates were more stable, 119 and 123 per 10,000 in 1999 and 2005, respectively. Peak-age for otitis media surgery was the second year of life in Finland, sixth in Norway. Boys were more frequently operated on in both countries. CONCLUSION: Our study confirmed differences in the approach to otitis media surgery and revealed a decreasing trend in adenoidectomies in both countries. Similar data from other countries is needed to confirm the latter.     

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。     

Laser myringotomy in otitis media with effusion: long-term follow-up

Otitis media with effusion is a leading cause of conductive hearing loss in children. Myringotomy and insertion of tympanostomy tubes is the accepted form of treatment. Recently, several studies utilizing laser myringotomy have been published, but few of them present late results. The objective of this study was to compare late results of the treatment with laser and classical myringotomy. A clinical effectiveness trial was conducted in three groups of children: (1) 37 children treated with laser myringotomy (ML), (2) 29 children treated with laser myringotomy and the insertion of tympanostomy tubes (ML+V) and (3) 43 children treated with classical myringotomy and the insertion of tympanostomy tubes (MC+V). All types of surgery were performed under general anesthesia because adenoidectomy and/or tonsillectomy was done at the same time. The results of treatment were assessed on the basis of the otoscopic examination (recurrences of effusion, condition of the tympanic membrane, and audiological examination (pure-tone audiometry, tympanometry and DPOAE). The minimum follow-up period was 1 year. The recurrence rate was lowest in the ML+V (11%) group, and highest in the ML group (36%). The difference between ML+V and MC+V was not significant. Permanent changes in the tympanic membrane were observed in 8% of the ears after ML, 19% after ML+V and 31% after MC+V. The difference was significant between the ML and MC+V groups. PTA was significantly higher in the MC+V group than in the control group of otologically healthy children. Mean amplitudes of DPOAE, measured in treated children with normal tympanometry results, were significantly lower than in the control group, but within the normal range. The use of CO₂ laser during myringotomy has no negative effect on the function of the cochlea. Healing of the tympanic membrane after laser myringotomy was uneventful with a low percentage of permanent sequelae.     

Relation between adenoid size and otitis media with effusion

AimsThis study compares the efficacy of adenoidectomy on otitis media with effusion (OME) in patients with different size of adenoids and the connection between differently sized adenoids and middle ear effusion.Material and methodsChildren with a history of at least 3 months’ OME underwent adenoidectomy and myringotomy without the insertion of a tympanostomy tube. Treatment assignment was stratified by adenoids’ size causing choanal obstruction (grade I-III) and according to Eustachian tube ostium obstruction (grade A–C). The subjects were followed for 12 months.ResultsAdenoidectomy was significantly more effective in children with adenoids in contact with torus tubarius (grade B, C) compared to those with small adenoids without contact (P < 0.001). The volume of the adenoids was irrelevant (P = 0.146). The size of adenoids did not affect the viscosity of the middle ear secretion. The distribution of mucous and serous secretion was not dependent on the size of adenoids; the efficacy of adenoidectomy was 82% in mucous as well as serous secretion.ConclusionThe relation between adenoids and torus tubarius is more important than the volume of the adenoids. The viscosity of middle ear fluids (serous or mucous) did not influence the rate of treatment efficacy.     

咽喉反流与儿童分泌性中耳炎

咽喉反流是指胃内容物反流到食管上括约肌水平。分泌性中耳炎是儿童常见的疾病,可导致儿童听力损失和语言发育迟缓。近10年的研究支持咽喉反流与分泌性中耳炎有关系,但是咽喉反流引起分泌性中耳炎的确切病因机制尚未十分明确。本文对近期有关咽喉反流与儿童分泌性中耳炎相关性的文献进行检索与回顾,总结咽喉反流与儿童分泌性中耳炎相关性的最新进展。     

儿童分泌性中耳炎危险因素分析

目的 探讨武汉市部分幼儿园儿童分泌性中耳炎的危险因素,并与相关文献分析比较.方法 调查武汉市部分幼儿园3～6岁的儿童,对其进行常规耳鼻咽喉科体检,电耳镜检查鼓膜结合声导抗测试,并问卷调查母亲牛育年龄、生产情况、喂养情况,家庭吸烟史,耳科病史,鼻漏,喷嚏,鼻塞,睡眠打鼾,扁桃体炎发作情况等.结果 144例分泌性中耳炎患儿和288例对照者进行危险因素统计学分析,发现鼻塞(OR=2.60,P=0.002),鼻涕(OR=1.442,P=0.003),硬腭高拱(OR=4.411,P＜0.0001),急性中耳炎病史(OR=1.77,P=0.025)是患病的危险因素.进行多因素同归分析后发现喂养情况(OR=0.746,P=0.047),鼻塞(OR=2.56,P=0.003),硬腭高拱(OR=4.35,P＜0.001),鼻炎(OR=1.397,P=0.098),急性中耳炎病史(OR=1.735,P=0.032)为分泌性中耳炎的影响因素.结论 中耳炎病史是分泌性中耳炎的危险因素.但急性扁桃体炎并不是分泌性中耳炎的危险因素,另外发现母乳喂养是分泌性中耳炎的保护因素.有急性中耳炎病史且经常鼻塞的儿童应定期进行耳鼻咽喉科体检.     

The role of allergy in otitis media with effusion

The role of allergy in chronic otitis media with effusion (OME) is controversial. New evidence from cellular biology and immunology explain the basics of allergic reactions and allow more accurate diagnosis of allergies and inflammatory disease throughout the unified airway. This article examines the epidemiologic, methodological, and immunologic studies of allergic causes of OME, including (1) evidence for and against OME as an allergic disease, (2) allergy as a cause for eustachian tube obstruction, (3) examination of the most sensitive diagnostic tests for allergy, and (4) the effect of treatment of underlying allergies in improving and resolving middle ear disease.     

中耳炎病理过程中渗出液的病理转归与肉芽组织的形成

目的：为探讨中耳炎病理过程中潴留渗出液的病理转归和肉芽组织的形成机理。方法：对美国明尼苏达大学颞骨病理实验室３０６耳各型伴渗出液的中耳炎颞骨连续切片进行了光镜组织病理学观察研究。结果：在中耳炎从早期病理阶段向更晚期病理阶段进展的过程中,渗出液的性质和溜留状态处于动态变化当中;肉芽组织由两种方式的粘膜下成纤维细胞增生而成;潴留渗出液的吸收,机化与肉芽组织形成是同时发生在同一区域的同一病理过程中。结论     

儿童分泌性中耳炎的外科手术干预

目的探讨儿童分泌性中耳炎的手术干预方式，为儿童听力筛查中分泌性中耳炎患儿的干预措施选择提供临床资料。方法总结2004-2008年我院90例儿童分泌性中耳炎接受手术治疗且资料完整者45例（82耳）的年龄特点、听力下降时间、手术方式、手术前后听力状况比较。结果术前平均纯音听阈FrrA（pure-tone threshold average，500Hz，1000Hz，2000Hz，4000Hz听阈均值）从8dBHL-61dBHL，平均（34.8&#177;12.09）dBHL。术后PTA从0dB HL-38dB HL，平均（15.9&#177;7.88）dB HL，3耳术后听闯提高，4耳无改善，75耳听阈降低，占91.5％，平均听阈降低18.9dBHL。手术方式：鼓膜置管术9例，腺样体切除＋鼓膜置管术29例，腺样体切除＋扁桃体切除＋鼓膜置管术7例。结论腺样体切除＋鼓膜置管术是我们治疗儿童分泌性中耳炎的基本术式；扁桃体切除术不作为治疗分泌性中耳炎常规选择；对儿童分泌性中耳炎的术式选择应该个体化。     

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     

长期低剂量阿奇霉素治疗儿童慢性分泌性中耳炎

目的 观察阿奇霉素治疗儿童慢性分泌性中耳炎的疗效.方法 将35例(60耳)患儿分为阿奇霉素组(18例,31耳)与对照组(17例,29耳),两组患者同时给0.5%麻黄碱滴鼻,波氏球咽鼓管吹张2周,阿奇霉素组同时口服阿奇霉素10 mg/kg,开始3天每天1次,以后每周2次,疗程为8周;对照组口服阿莫西林,25 mg/kg,3次/日,疗程为2周.8周后对比观察两组的治疗效果.结果 阿奇霉素组的治疗有效愈率为80.64%,显著高于对照组44.83%(P＜0.01);治疗后阿奇霉素组听阈为(18.55±4.52)dB,显著好于对照组[(27.48±7.27)dB,P＜0.01].结论 长期低剂量口服阿奇霉素治疗儿童慢性分泌性中耳炎效果较好.