儿童与成人分泌性中耳炎的临床分析

目的：探讨儿童与成人分泌性中耳炎（SOM）在病因、病程、临床特征和听力学等方面的异同。方法：对42例（74耳）儿童和34例（43耳）成人SOM患者术前临床资料及听力学检查资料进行对比分析。结果：儿童SOM平均病程较成人短,以腺样体肥大多见,成人以中耳乳突炎多见。C型鼓室导抗图的成人患者鼓室负压大于儿童（P〈0．05）。儿童与成人SOM各频率气导听阈均提高,并且都可出现骨导听阈提高,以高频2、4kHz为主,且成人高频4kHz骨导听阈提高较儿童明显（P〈0．05）。结论：儿童病程一般较成人短,以腺样体肥大多见,易引起中耳积液。儿童SOM与成人一样都可以引起感音神经性聋,以高频损害为主,但高频下降没有成人明显,但由于可造成儿童学语与认知方面的不良后果,应及时干预和诊治。     

分泌性中耳炎的临床诊治进展

分泌性中耳炎是一种以中耳积液和听力下降为主要特征的中耳非化脓性炎性疾病,以儿童多见,可导致患儿语言发育障碍、平衡功能障碍等,故而了解其病因和发病机制和诊疗方法,对于改善患者症状和生活质量具有重要意义,本文综述了近些年分泌性中耳炎的临床诊治进展。     

鼻内镜下导管吹张法治疗分泌性中耳炎

分泌性中耳炎是临床常见病,病因至今尚未完全明了,冬春季多发,是引起小儿听力下降的常见原因之一[1,2],治疗以服用抗生素、激素、清除中耳积液为主.2004年3月～2005年3月我科采用鼻内镜下导管吹张法治疗分泌性中耳炎27例(36耳),结果满意.报道如下.     

以耳鸣为主诉的分泌性中耳炎74例

分泌性中耳炎患者常以耳胀满感听力下降为主诉,以耳鸣为首发症状就诊常导致误诊.现将资料完整的74例(113耳)分泌性中耳炎分析如下.1 临床资料1.1 一般资料 以耳鸣为首发症状的74例113耳患者中,男39例60耳,女35例53耳:年龄为5～72岁.≤14岁者22例32耳:15～45岁者35例56耳,≥46岁者17例25耳,平均41岁,右耳51例,左耳62例,所有患者均经临床及听力学检查并经鼓室穿刺抽吸有积液者.其中1例鼻咽癌,9例扁桃体肥大.5例腺样体肥大,12例急慢性鼻炎,26例急慢性咽炎.病程≥30天16例24耳,<30天58例89耳.1.2 耳鸣特征 吹风样34耳,搔抓声21耳,流水音22耳,哨音8耳,汽笛音9耳,蝉鸣音6耳,难以表达者13耳.病程短者主要表现为前3种耳鸣.汽笛音蝉鸣音仅出现在病程长患者.     

儿童分泌性中耳炎相关骨导听力下降的临床分析

目的：分析儿童分泌性中耳炎相关的骨导听力下降的病因、诊断和治疗方法。方法：回顾性分析150例（225耳）分泌性中耳炎儿童中35例（37耳）骨导听力下降的临床资料。结果：35例患儿均给予鼓膜切开置管或（和）鼻内镜下腺样体切除术,术后给予药物治疗。34例患儿骨导听阈恢复正常,1例患儿随访6个月改善不明显。结论：35例（23．3％）患儿的暂时性听阈移位或永久性听阈移位的发病机制与分泌性中耳炎有关。儿童分泌性中耳炎的发病病程中有发展成骨导听力下降的可能,应引起高度重视,及早干预避免病情发展。     

儿童分泌性中耳炎致骨导听力下降的临床特征分析

目的 探讨儿童分泌性中耳炎致骨导听力下降的特点、病因和预后.方法 回顾性分析75例(82耳)分泌性中耳炎患儿骨导听力下降的临床资料,并对其发病年龄、病程、积液性质和积液量与骨导听阈的关系进行观察.结果 75例患儿(82耳)骨导听力下降,平均骨导阈值在2.0 kHz和4.0kHz处增高最明显.骨导听阈与病程和积液性质显著相关(P＜0.01或P＜0.05),与年龄、积液量无关.75例患儿均采取鼓膜切开置管术和(或)腺样体切除术,术后给予药物治疗.随访6月,听力恢复正常者76耳,气导听阈下降但骨导听阈无改善者6耳.结论 分泌性中耳炎可导致儿童骨导阈值增高,是导致儿童耳聋的危险因素之一,及早干预可避免病情发展.     

双耳感音神经性聋患儿合并分泌性中耳炎的临床诊治

目的 探讨双耳感音神经性聋并发分泌性中耳炎患儿的症状特点, 为及时诊治此类患者提供临床依据。方法 收集经手术治疗的双耳感音神经性聋并发分泌性中耳炎患儿(A组)17例(34耳)的病历资料, 分析其误诊原因、临床特点及并发症发生率, 并与同期行手术治疗的单纯双耳单纯分泌性中耳炎患儿(B组)17例(34耳)进行鼓室粘连发生率的比较。手术前后应用听性脑干反应(ABR)检查随诊听力变化。结果 A组均以家属发现听力下降为首诊症状, 在当地首诊曾诊断为突发性聋7例, 耳闷塞感、耳鸣、耳痛等症状叙述不清, 均无法采集到确切的分泌性中耳炎发病时间;行双耳鼓膜置管时发现中耳粘连5例(7耳), 手术前后ABR检查Ⅴ波阈值改善0～30 dB nHL, 平均17.3 dB nHL, 手术前后Ⅴ波阈值改善, 差异有统计学意义(P < 0.05)。B组患儿无1例误诊, 首诊诉耳痛或耳鸣、耳闷塞感等耳部不适症状15例, 发病时间明确, 首诊诉听力下降2例, 鼓膜置管时中耳粘连1例(1耳)。A组并发症发生率高于B组, 差异有统计学意义(P < 0.05)。结论 双耳感音神经性聋并发分泌性中耳炎患儿临床病史采集困难, 易误诊, 临床并发症发生率高, 应及时干预;鼓膜置管对听力改善效果明显。     

鼓膜打孔及腺样体切除术治疗儿童分泌性中耳炎

分泌性中耳炎(secretory otitis media,SOM)是以中耳积液(包括浆液、黏液或浆-黏液)及听力下降为主要特征的中耳炎性疾病,小儿发病率较高,是引起儿童听力下降的常见原因之一。腺样体肥大是导致儿童分泌性中耳炎的常见病因,我科近年来应用腺样体切割吸引器在鼻内镜直视下切除腺样体,配合CO_2激光鼓膜打孔治疗儿童分泌性中耳炎取得了较好的疗效,现报道告如下。     

儿童分泌性中耳炎的听力学特点

分泌性中耳炎(otitis media with effusion, OME)是儿童常见的耳科疾病,学龄前儿童(2～5岁)高发.该病以传导性听力损失和中耳积液为主要特征,是儿童听力损失的主要病因之一[1,2].儿童分泌性中耳炎在发病早期常易被忽略,就诊时多已出现听力下降.因此,尽早完善听力学检查,对于儿童分泌性中耳炎的...     

鼓膜打孔及腺样体切除术治疗儿童分泌性中耳炎

分泌性中耳炎(secretory otitis media,SOM)是以中耳积液(包括浆液、黏液或浆黏液)及听力下降为主要特征的中耳炎性疾病,小儿发病率较高,还表现为语言发育迟缓,慢性中耳炎急性发作,是引起小耳听力下降的常见原因之一.腺样体肥大是导致儿童分泌性中耳炎的常见病因.传统的治疗方法有抗感染治疗、鼓膜穿刺、鼓膜置管术等,但治疗效果不理想.我科自2005年以来,采用鼓膜打孔及腺样体切除术治疗分泌性中耳炎100例,疗效显著,报告如下.     

以听力突然下降为特征的分泌性中耳炎（附24例报告）

目的：提高对以听力突然下降为特征的分泌性中耳炎的确诊率。方法：回顾性分析24例（28耳）以听力突然下降为特征的分泌性中耳炎的临床资料,结果：11例患者被误诊或漏诊,各频率的平均气导阈值在60．2－66．5dBHL,平均骨导阈值在40．5－58．6dBHL,听力图示感音神经性聋9耳,混合性聋19耳,鼓室压图为B型,治疗后听力明显改善,结论,鼓室积液影响圆窗及卵圆窗间的相位差,导致听力突下降,它们的听力图无特征,并对产生误诊的原因进行了讨论。     

语言障碍儿童与分泌性中耳炎的关系(附1 108例分析)

目的:探讨儿童语言障碍与分泌性中耳炎(SOM)的关系。方法:对1108例语言障碍儿童进行听性脑干诱发电位(ABR)和声导抗检测,并按ABR反应阈将1108例患儿分为反应阈正常组、轻度听力障碍组、中度听力障碍组、重度听力障碍组。结果:所有受检耳中,听力障碍者占59.97%,SOM占12.64%;语言障碍患儿中B型图在各组中所占百分率由高到低依次为:轻度听力障碍组、中度听力障碍组、重度听力障碍组、正常反应阈组,两两比较,差异有统计学意义(P<0.01);部分SOM患儿ABR反应阈治疗后的均值较治疗前下降(P<0.01),但在重度听力障碍组,治疗后ABR反应阈仍表现为重度听力障碍。结论:听力障碍是儿童语言障碍的主要原因;伴轻、中度听力障碍的SOM患儿随着SOM的好转,部分语言障碍可随之改善,但伴重度听力障碍的SOM患儿的语言障碍并不随SOM的好转而好转。     

Routine nasopharyngeal biopsy in adults presenting with isolated serous otitis media: is it justified?

Nasopharyngeal malignancy accounts for less than 2 per cent of all head and neck cancers. Serous otitis media (SOM) causing deafness is a recognized indicator of nasopharyngeal obstruction and the possibility of a nasopharyngeal malignancy must be considered in all adults. Examination under anaesthesia (EUA) and biopsy of the nasopharynx is routinely undertaken in many centres to rule out nasopharyngeal malignancy in adults with SOM. The purpose of this 10-year retrospective study was to evaluate the case records of all adult cases of SOM, including their presentation, clinical findings, management and nasopharyngeal biopsy results. Eighty-five patients were included in the study. Fifty-nine presented with unilateral SOM and 26 with bilateral SOM. The primary presenting complaint in all cases was hearing loss. A nasopharyngeal mass was documented in 55 patients (69 per cent). Four nasopharyngeal masses were noted to have irregular or exophytic mucosa on flexible nasendoscopy. All patients underwent a EUA of the ears and a nasopharyngeal biopsy. The four patients with suspicious-looking masses were all found to have malignancies (two squamous cell carcinomas, one B-cell non-Hodgkin lymphoma and one adenocarcinoma). Three of these patients presented with unilateral SOM and one with bilateral SOM. All other patients with masses were found to have benign lymphoid hyperplasia. In total, 4.7 per cent of the adults with conductive hearing loss secondary to SOM were found to have a malignancy on nasopharyngeal biopsy. We would advocate a high index of suspicion of a nasopharyngeal tumour in adults presenting with SOM. If a mass is found in the nasopharynx then it should be biopsied. If no mass is found then it is not necessary to biopsy; however, close follow up, with repeat fibre-optic nasendoscopy, is advised.     

耳蜗性耳硬化症3例报告及文献复习

目的：探讨耳蜗性耳硬化症的临床特点。方法：结合文献复习,报告3例2007年3月-2008年10月诊治的经高分辨颞骨CT确认的耳蜗性耳硬化症患者。结果：3例以反复发作性眩晕或（和）平衡障碍为首要主诉,同时有进行性听力下降病史。2例（各1耳）为单纯感音神经性聋,考虑为“纯”耳蜗性耳硬化症,其余为伴不同程度骨导下降的混合性聋。高分辨颞骨CT的特点：耳蜗、前庭、半规管及内耳道等部位可见低密度区,耳蜗区呈现“晕影”征或“双环”征,密度有不均。结论：对不能解释原因的感音神经性聋、存在前庭症状的混合性聋并呈进行性听力下降的慢性病史者应考虑耳蜗性耳硬化症的可能,CT对耳蜗性耳硬化症的临床诊断有重要价值。     

Duration and complications following grommet insertion in childhood

We report 1000 insertions of ventilation tubes in 534 children for secretory otitis media (SOM) within a period of 6 years. In 77.5% of the cases, the air-bone gap was greater than 20 dB. The grommets are allowed to undergo spontaneous expulsion which happened in 319 ears, about 7 months after insertion. SOM recurred in 32.6% of the cases once, in 5.0% of the cases twice, and in 1.9% three times, requiring re-insertion of grommets. Recurrence appeared between 4 and 65 months after the first insertion. In three cases perforations of the tympanic membrane persisted and required tympanoplasty. Tympanometric examination and pure tone audiometry are necessary, in addition to pure tone audiometry to follow up successfully ventilated middle ears and to show recurrence as early as possible. Pre-existing but unsuspected sensorineural hearing loss was discovered in 10 cases. The deprivation of neural auditory pathways in early childhood and the possible retardation of speech development caused by SOM are mentioned. Normal hearing is the most important goal of therapy in children suffering from SOM, and insertion of ventilation tubes is the preferred method of achieving that goal safely. Adenoidectomy and treatment of upper airway infections are indispensable parts of the therapy of SOM. Regular follow up after insertion of grommets and even after their expulsion is necessary because of the high rate of late recurrence of SOM. Induction of cholesteatoma by grommets was not observed.     

细菌性脑膜炎致聋患者内耳影像学观察及人工耳蜗置入术

目的 :了解细菌性脑膜炎后内耳MRI影像学的变化 ,及对人工耳蜗置入术的影响。方法 :细菌性脑膜炎致聋患者 5例 (10耳 )行听性脑干诱发反应 (ABR)和内耳MRI检查 ,实施人工耳蜗置入术。结果 :MRI成像检查 ,耳蜗膜迷路形态异常 5耳 ,前庭形态异常 3耳 ,半规管形态异常 8耳 ;10耳的平均听阈为 (10 2 .0± 7.1)dBHL ,手术耳的平均听阈为 (98.0± 5 .7)dBHL ,非手术耳的平均听阈为 (10 6 .0± 6 .5 )dBHL ;实施人工耳蜗置入术时 3耳没能将电极全部插入 ;发病到发现听力下降平均为 (15 .8± 15 .0 )d ,小儿较成人发现听力下降时间延迟。结论 :细菌性脑膜炎可引起不同程度的内耳形态异常 ,人工耳蜗置入术前进行MRI检查可以发现内耳形态异常的程度 ,利于正确选择术耳及手术的顺利进行     

Hearing loss in children and adults: audiometric configuration,asymmetry, and progression

OBJECTIVE: The purpose of this study was to characterize the sensorineural hearing losses of a group of children and adults along three parameters important to the hearing instrument fitting process: 1) audiometric configuration, 2) asymmetry of loss between ears, and 3) progression of loss over several years. DESIGN: Audiograms for 248 60- and 61-yr-old adults and 227 6-yr-old children were obtained from the audiological database at Boys Town National Research Hospital. Based on right-ear air-conduction thresholds, the configurations were assigned to one of six categories: sloping, rising, flat, u-shaped, tent-shaped, and other. Left- and right-ear thresholds were compared to determine asymmetry of loss. Progression of loss was evaluated for 132 children for whom additional audiograms over an 8-yr period were available. RESULTS: In general, the children's hearing losses were more evenly distributed across configuration categories while most of the adult's audiograms were sloping or u-shaped in configuration. The variability of loss at each frequency was greater for the children than the adults for all configuration categories. Asymmetrical losses were more common and the degree of asymmetry at each frequency was more extensive among the children than the adults. A small number of children showed either improved or deteriorated hearing levels over time. In those children for whom progressive hearing loss occurred, no frequency was more vulnerable than another. CONCLUSIONS: The results of the present study suggest that substantial differences in audiological characteristics exist between children and adults. Implications for amplification include the development of appropriate fitting protocols for unusual audiometric configurations as well as protocols for binaural amplification in cases of asymmetric hearing losses.     

Binaural masking level differences in children with a history of otitis media

The binaural hearing of children with and without a history of otitis media (OM) was assessed by determining their binaural masking level differences (BMLDs). The test was also administered to a group of adults. BMLDs for the non-OM children were not significantly different from those of adults. However the mean BMLD of the OM children was significantly lower than that of non-OM children. Some children in the OM group had small (15-25 dB HL) sensitivity deficits in one or both ears. However, no correlation was found between BMLD and hearing level in cases of either symmetric or asymmetric loss. Exclusion of OM children with residual middle ear abnormalities did not abolish the significant difference between the OM and non-OM groups. We suggest that the small BMLDs in the OM group may be associated with these children having difficulties detecting and attending to signals in noisy environments.     

新生儿及婴儿期腭裂患儿分泌性中耳炎的发病情况

目的：了解新生儿及婴儿期腭裂患儿发生分泌性中耳炎（SOM）和听力损失情况,探讨其中耳功能障碍的发病时间规律及SOM早期预测方法。方法：出生后1～2周行听性脑干反应（ABR）筛查,无感音神经性聋的73例新生儿及婴儿腭裂患儿,在婴儿期于每月龄末行ABR和声导抗检查。结合鼓室导抗图形、静态声顺值、镫骨肌声反射和ABR波V阈值作为SOM的判断指标;以ABR波V阈值作为2～4kHz范围的听损伤分级标准。结果：73例（146耳）腭裂患儿发生疑似SOM,发生率为100％,均于出生后6个月内发生,平均发生年龄为2．5月龄。其中115耳（78．8％）1岁内发生SOM,平均发病年龄为5．4月龄,出生后6个月时为相对发病高峰期;SOM的前驱期平均为3．8个月。婴儿期腭裂患儿56．2％会出现不同程度的听力损伤,ABR波V阈值平均为48．6dBnHL。结论：婴儿期腭裂患儿SOM发病率高,可引起听力损失,严重影响中耳功能,其发生呈渐进性过程;作为发生中耳功能障碍的高危人群,出生后1个月时应行听力检查,每2～3个月定期复查,无条件者至少6～12个月进行耳科检查,以早期发现、及时诊断。     

分泌性中耳炎与耳鸣

目的 探讨分泌性中耳炎(Secretory Otitis Media,SOM)患者的耳鸣特点。方法:选择以耳鸣为第一主诉的SOM患者23例,采用耳鸣分类调查表和耳鸣问卷进行耳鸣的分类统计,积极对因治疗后仍遗留长期耳鸣者采用耳鸣习服疗法治疗。结果:客观耳鸣2例2耳,主观耳鸣21例29耳,以单调、连续耳鸣居多,耳鸣匹配以低频为主。对病因治愈后仍遗留长期耳鸣者采用习服疗法,患者均能较快地适应和习惯耳鸣。结论:SOM既可引起客观性耳鸣,也可引起主观性耳鸣,而且耳鸣可以成为第一主诉。文中对耳鸣病因、耳鸣成为第一主诉的原因以及治疗方法进行了讨论。