鼓室置管术治疗儿童分泌性中耳炎50例临床分析

目的探讨儿童分泌性中耳炎的有效治疗方法。方法对分泌性中耳炎的患儿经非手术治疗无效者,采用鼓室置管术及扁桃体、腺样体切除术。结果儿童分泌性中耳炎50例(89耳)1年左右中耳功能恢复正常,听力保持在25 dB以内达95%。结论鼓室置管及扁桃体、腺样体切除是治疗儿童分泌性中耳炎的有效方法。     

腺样体切除合鼓室注射地塞米松治疗中耳炎50例临床观察

目的:比较腺样体切除与腺样体切除+鼓室注射地塞米松治疗儿童慢性分泌性中耳炎的疗效。方法:将50例(共82耳)腺样体肥大引起的分泌性中耳炎患儿随机分成治疗组(45耳)和对照组(37耳),全麻鼻内镜下行腺样体等离子切除术,并对治疗组鼓室内注射0.5~2ml地塞米松,所有患儿均随诊6个月,根据术后两组听力恢复情况进行疗效评定。结果:治疗组治愈38耳,有效5耳,无效2耳,总有效率为95.6%;对照组治愈28耳,有效3耳,无效6耳,总有效率为83.8%。治疗组疗效优于对照组,差异有统计学意义(P0.05)。结论:腺样体切除+鼓室注射地塞米松治疗腺样体肥大引起的儿童慢性分泌性中耳炎比单纯腺样体切除疗效好,值得临床推广应用。     

Gold laser versus curettage adenoidectomy: incidence of complications and otorrhea after concurrent pressure-equalization tube placement

OBJECTIVES: To measure the incidence of postoperative complications and otorrhea in patients undergoing Gold laser or curettage adenoidectomy with pressure-equalization (PE) tube placement. STUDY DESIGN: A prospective study of 100 patients, ages 8 to 48 months, undergoing Gold laser (n = 50) or curettage adenoidectomy (n = 50) and PE tube placement in a pediatric outpatient setting. METHODS: Pediatric patients with chronic otitis media with effusion and adenoid hypertrophy after failure of medical management were included in the study. Adenoid size and middle ear status were recorded at surgery. The total adenoidectomy procedure time was recorded. All patients were evaluated at 1 week, 1 month, and 4 months postoperatively. The incidence of nasal complications and otorrhea was recorded. RESULTS: There was no statistical difference in age, race, sex, adenoid size, or middle ear status between groups. The laser group had a shorter procedure time (P = .001) and a lower incidence of otorrhea (P = .024). There was no difference in nasal complications between groups. CONCLUSIONS: The Gold laser adenoidectomy technique can be safely performed with PE tube placement and may offer advantages over the traditional curettage adenoidectomy technique.     

Routine histologic examination is unnecessary for tonsillectomy or adenoidectomy

OBJECTIVE: To determine whether the current practice and incurred cost of histologic examination of tonsillectomy and adenoidectomy specimens is warranted. STUDY DESIGN: Review article based on medical literature. SUBJECTS AND METHODS: A retrospective PubMed review of all pertinent literature regarding tonsillectomy, adenoidectomy, and related surgical pathology was conducted. References of the articles obtained were reviewed for additional sources. RESULTS: Twenty studies report 54,901 patients and found 54 malignancies (0.087% prevalence). Of these, 48 (88% of the patients) had suspicious features such as tonsillar asymmetry, cervical lymphadenopathy, or abnormal tonsil appearance, preoperatively. The remaining six patients without any suspicious features (better representing true occult malignancy) were 0.011% of the total cases. CONCLUSION: Submission of tonsillectomy, adenoidectomy, or both specimens is warranted only when patients demonstrate findings associated with malignancy: tonsillar asymmetry, history of cancer, neck mass, tonsil firmness or lesion, weight loss, and constitutional symptoms.     

耳内镜下经口鼻低温等离子腺样体切割 消融术的临床研究

目的 探讨耳内镜下经口鼻联合径路低温等离子腺样体切割消融术的优点。 方法 将该科2010年6月～2012年10月72例腺样体肥大患者分为两组，耳内镜下经口鼻联合径路电动切割吸引器腺样体切除术35例，耳内镜下经口鼻联合径路低温等离子腺样体切割消融术37例，随访6个月并进行回顾性分析。 结果 耳内镜下经口鼻联合径路电动切割吸引器组，术中出血量多、手术耗时长且术后再出血2例，术后疼痛反应重且鼻咽顶后鼻孔区复发3例。耳内镜下经口鼻联合径路低温等离子腺样体切割消融术组，术中极微量出血2～5 mL，术后无1例出血，术后无需鼻腔填塞、疼痛反应轻微且无复发病例。 结论 耳内镜下经口鼻联合径路低温等离子腺样体切割消融术具有易暴露，手术时间短，术中不出血或极微量出血，疼痛反应轻微，无复发等优点，值得临床推广。     

Pathological and biochemical study in the adenoid of mucopolysaccharidosis II

In the patients with mucopolysaccharidosis II (MPS II, Hunter's syndrome), conductive and sensorineural hearing deficits are frequently observed. Two patients with MPS II underwent adenoidectomy and an ear douche, and their conductive hearing loss recovered after the surgery. Pathological examination of the adenoids revealed the infiltration of faintly PAS-positive plasmacytes with perinuclear vacuole and strongly Alcian-blue positive fibrotic area. Biochemical study was performed by chromatoscanning of electropholesis. The amount of glycosaminoglicans (GAG) in the specimens was increased 2.8-fold compared with the normal control. The electropholetic pattern showed an increase of dermatan sulfate (DS), heparan sulfate (HS) and hyaluronic acid (HA) in the adenoids of the patients. The ratio of DS to HS was 1.1–1.2. In the patients of MPS II, the accumulation of GAG occurs in the pharyngeal tonsil and causes conductive hearing impairment. We recommend adenoidectomy for such patients.     

鼻内镜下腺样体切除3种术式分析

目的比较鼻内镜下经鼻腺样体切除术(TEA1)、鼻内镜下经口腺样体切除术(TEA2)、内镜辅助经口腺样体切除术(ETA)的优缺点。方法分析340例接受腺样体肥大手术患者的临床资料,比较3种术式的手术效果和并发症情况。结果3种手术方式有效率比较无显著性差异(P均0.05)。腺样体残留TEA1组5例,ETA组2例,TEA2组0例;鼻腔粘连TEA1组5例,TEA2组3例,ETA组0例。3组并发症比较有显著性差异(P均0.05)。结论ETA具有手术效果好、对患者损伤小、并发症少的优点,是治疗腺样体肥大的首选术式。     

Hypoxia in sleeping children: overnight studies can be reduced to 4 hours without loss of clinical significance

Twelve recordings of overnight pulse oximetry representing a range of severity of obstructive sleep disturbance were evaluated by 7 experienced clinicians. Each recording was then scored by counting the number of minutes in each hour affected at any time by a fall in saturation to below 90%. Comparison of the clinical evaluation and the overall scores gave a clear level of 5 minutes per hour at and above which all the assessors agreed that the charts had clinically important dcsaturation. Overnight pulse oximetry was then performed on 25 children aged between 12 months and 10 years about to undergo adenotonsillectomy. The charts were scored by the method above with a score of 5 or more indicating a positive result for hypoxic episodes. The scores for shortened analysis periods of 1, 2, 3 and 4 hours duration were compared with the overall score and no cases which were negative, up to and including 4 hours, became positive in the overall result. Thus recording pulse oximetry for 4 hours provides sufficiently accurate information for clinical purposes.