鼓膜置管联合腺样体切除术治疗分泌性中耳炎疗效观察

目的探讨鼓膜置管联合腺样体切除术治疗分泌性中耳炎(OME)术后的并发症及患者免疫功能恢复快慢情况。方法选取2011年10月至2012年10月于我科行手术治疗的OME患者126例。按照随机分配隐匿方法(封口信封)分为两组:A组(仅行鼓膜置管术,n=62)和B组(行鼓膜置管联合腺样体切除术,n=64),另选取60例体检健康的人群作为C组。A组与B组患者分别于术前、术后1个月、术后2个月检查血清中CD4+、CD8+、CD4+/CD8+的值,并与C组结果对比分析。A组与B组患者均于置管取出两个月后检查并发症情况,并对比两组的结果。结果 A组与B组术前免疫功能检查结果与C组比较显著下降(P<0.05);置管取出两个月后B组的并发症发病率明显低于A组(P<0.05);术后1个月,B组的免疫检测结果高于A组(P<0.05),且与C组比较差异无统计学意义(P>0.05);术后2个月免疫检测结果A组与B组差异无统计学意义(P>0.05),同时分别与C组比较差异无统计学意义(P>0.05)。结论联合两种术式的治疗方法能降低OME患者术后的并发症,其结果可能与联合术式能较快恢复患者的免疫功能有关。     

Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy

ObjectiveClinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy.Material and MethodsIn a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss.ResultsThe study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB.ConclusionAn objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.     

Immunologic-mediated eustachian tube obstruction: a double-blind crossover study

Eight subjects with seasonal allergic rhinitis confirmed by positive skin tests and serum radioallergosorbent test to ragweed or timothy grass pollen were identified. A double-blind provocative antigen challenge was performed with intranasal insufflation of 50 mg of dry pollen to which the subject was either sensitive (ragweed or timothy) or not sensitive (pine). Before and after pollen insufflation, measurements of nasal function by nasal rhinomanometry and eustachian tube (ET) function by the nine-step tympanometry test were performed for up to 14 days. The ability to dilate the ET was documented in 14 of the 16 ears of the eight subjects before challenge. Within 30 min after antigen challenge transient obstruction of the ET associated with inability to dilate upon swallowing was observed in all 14 ears. Clinical symptoms of allergic rhinitis, including rhinorrhea and nasal obstruction, were produced in all subjects. ET function changes were reversible in three of 14 ears within 2 hr but persisted for more than 3 days in six of the ears. As a control, insufflation of pine pollen did not alter ET function or rhinomanometric values or produce clinical symptoms in the eight subjects. These findings suggest an allergic basis for ET obstruction and possibly for the development of otitis media with effusion.     

CO2激光鼓膜造孔治疗分泌性中耳炎的剂量的研究

目的探讨CO2激光在治疗分泌性中耳炎时的剂量关系.方法在对34例耳鼓膜行CO2激光造孔后观察其在第7天、第14天、第21天鼓膜开放情况.结果造孔直径大于或等于2.5mm的鼓膜于第21天开放率同造孔小于2.5mm的鼓膜差异显著(P＜0.05).结论造孔直径直接决定鼓膜开放时间的长短.     

Birth characteristics and acute otitis media in early life

Objective

To assess whether preterm birth and low birth weight were associated with single and recurrent episodes of acute otitis media (AOM) the first 18 months of life.

Methods

The study population consisted of 33,192 children in the Norwegian Mother and Child Cohort, conducted at the Norwegian Institute of Public Health. The majority of all pregnant women in Norway were invited to participate and the response rate was 44%. Participating women received questionnaires during pregnancy and when the child was 6 and 18 months. Main outcome measures were maternal reports of AOM at ages 6, 11 and 18 months. Information on birth weight and gestational age was obtained from the Medical Birth Registry of Norway. Regression analyses were performed controlling for a variety of potential confounders.

Results

Preterm birth was slightly associated with both single and recurrent episodes of AOM the first 18 months of age. The adjusted relative risk (aRR) for having any episode of AOM was 1.37, 95%CI (1.12-1.68) if born before week 33, and the aRR for having recurrent AOM was 1.34, 95%CI (1.01-1.77) if born in weeks 33-36 (reference group: ≥37 weeks). A corresponding tendency was not found for low birth weight.

Conclusions

The finding indicates a modest increased risk of having AOM in children born preterm, and preterm birth seems to be more important than low birth weight in determining risk of having AOM in early life.     

Otological findings among Nigerian children with sickle cell anaemia

BACKGROUND/AIM: Various degrees of hearing loss have been associated with sickle cell anaemia, especially of the sensorineural type (SNHL). However, there is little information on hearing pattern among sickle cell children in Nigeria. This study is to determine the prevalence of sensorineural hearing loss (SNHL) among children with sickle cell anaemia (SCA). PATIENTS AND METHODS: Eighty (80) stable children aged 4-15 with Hbss attending the pediatric sickle cell clinic and also 60 control patients with HbAA, matched for age, sex at the pediatric general medical clinic of the University of Ilorin teaching hospital, Ilorin, Nigeria, all had prospective study of their pure tone audiological assessment (PTA) and tympanometric evaluations done over a year period. RESULTS: Their age range was 4-15 years with a mean of 9.4 for the Hbss and 9.7 for the control group. The male/female ratio was 1.3:1 and 1.5:1 for SCA and control subjects respectively. 25 subjects (50 ears) had abnormal audiograms among the SCA subjects and OME was the cause in 22 subjects and only three (3) had mild SNHL which was bilateral. However, in the control group 15 had abnormal audiograms and all were due to OME and none had SNHL. OME was bilateral in 19 subjects with SCA, two on the left and only one on the right. In the control group, 11 of the OME was bilateral and only four were on the left side. The prevalence of SNHL was 3.8% and OME was 27.5%. CONCLUSION: We have found a prevalence rate for SNHL of 3.8% for 80 subjects with HbSS, and all cases have been a mild bilateral high frequency SNHL. Our findings suggested that SNHL is uncommon in early childhood, specifically during the years of language acquisition and early schooling. This could mean an age dependant prevalence rate of SNHL among SCA patients. However, no difference in the incidence of OME among both groups which can lead to educational difficulties from the resultant speech and language defects.     

Sex and grommet operations

Sex differences in patients having grommet operations in Scotland were analysed to provide further evidence on whether girls should be managed differently from boys. In children treated at less than one year, 64% were boys, but this proportion declined with age and, after the age of 13 years, became less than 50%. The median age at treatment and the repeat operation rate were similar for both sexes. Different management according to the sex of the patient does therefore not appear to be justified.     

The cartilaginous Eustachian tube: Reliable CT measurement and impact of the length

Purpose

Balloon dilation of the Eustachian tube is a treatment option for obstructive Eustachian tube dysfunction. The desired balloon position is in the cartilaginous portion. However, the balloon catheter may slide into the bony portion without the surgeon's knowledge. Knowing the length of the cartilaginous portion may improve catheter positioning, but there is no published research on measuring this portion selectively or on whether the length has an impact on development of disease or treatment outcome.To evaluate whether a measurement obtained from CT images is valuable and accurate, to standardize the manner of which the length is measured, and to compare our radiologic measurements to procedural findings, we designed a combined study. Further, we tested the length's influence on development of disease and treatment outcome.