Discussion on timing and method of surgical treatment for infants with middle ear effusion
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摘要: 目的 研究因新生儿听力筛查未通过而诊断为中耳积液的婴儿，对其进行手术干预的时机与方式。方法 ① 对3月龄以内诊断为中耳积液的婴儿每月进行1次随访，把坚持随访的103例患儿纳入研究对象。②首先随访3个月，3个月后将未愈者分为好转组(Ⅰ组)、反复组(Ⅱ组)、持续组(Ⅲ组)，再继续观察3个月，必要时酌情药物对症处理；6个月后有好转者，继续观察，病情持续或加重者，建议手术治疗，暂不接受手术者继续观察，均观察至痊愈或手术。手术方式为先鼓膜切开，再根据中耳情况是否行置管。③分析自愈时间的分布；比较随访3个月、6个月和最终自然痊愈例数比的差异；比较不同影响因素的自愈率；比较Ⅰ、Ⅱ、Ⅲ组的最终手术率。结果 ① 103例患儿自愈月龄的中位数分布为7.00[5.76，8.24]月龄，9月龄后的自愈例数显著减少；随访3个月、6个月和6个月以上自然痊愈总数为43例(41.75%)、67例(65.5%)、81例(78.64%)，差异有统计学意义(P < 0.05)。②颌面畸形者自愈率(8.33%)最低，与其他因素相比差异有统计学意义(P < 0.05)。③最终22例手术治疗，其中Ⅰ组1例(3.45%)、Ⅱ组4例(30.77%)、Ⅲ组17例(94.45%)，差异有统计学意义(P < 0.05)。④17例行鼓膜置管术，1例行鼓膜置管术及腺样体手术，4例患儿仅行鼓膜切开。22例术后听力均恢复正常，但4例单纯切开者鼓膜愈合后又反复出现鼓室积液，其中2例因积液未吸收而再次手术。结论 婴儿鼓室积液确诊后可至少观察6个月以上再考虑手术干预，随访期的病程特点和影响因素对判断婴儿鼓室积液手术干预时间有重要意义。因观察期较长，手术方式建议鼓膜置管，单纯切开愈合后再次积液的可能性大。Abstract: Objective To investigate the timing and method of surgical intervention for neonates diagnosed with middle ear effusion after hearing screening failure.Methods ① A total of 103 children were enrolled in this study and received follow-up evaluations for every month. ② After the first follow-up period for 3 months, the uncured cases were divided into three groups according to the course of the illness. Group Ⅰ is the group of improvement, group Ⅱ is the group of relapse, and the group Ⅲ is the persistent group. The infants will receive symptomatic treatment if necessary. After 6 months, surgical treatment would be recommended in the persistent cases and aggravation, the cases of improvement and cases that the parents don't receive the operation would continue to be observed. All patients were observed till they were cured or operated. The operation was performed with tympanostomy and ventilation tube insertion if necessary. ③The distribution of self-healing time was analyzed. Compare the difference of the number of the cases who followed up for 3 months, 6 months and finally recovered naturally. The self-healing rates of different influencing factors were compared. The final operation rate of group Ⅰ, groupⅡ and group Ⅲ were compared.Results ① The median distribution of self-healing time(month age) in 103 cases was 7.00[5.76, 8.24], and the number of self-healing cases decreased significantly after 9 months of age. There were 43 cases(41.75%), 67 cases(65.5%) and 81 cases(78.64%) recovered naturally after 3 months, 6 months and follow-up in the end, and the difference was statistically significant. ②The self-healing rate of maxillofacial deformities was the lowest(8.33%), and the difference was statistically significant compared with other factors. ③The final 22 cases underwent surgical treatment, including 1 case in group Ⅰ(3.45%), 4 cases in group Ⅱ(30.77%), and 17 cases in group Ⅲ(94.45%), with statistically significant difference. ④17 children underwent tympanoplasty, 1 patient underwent tympanoplasty and adenoidectomy, and 4 children only underwent tympanotomy. The hearing of 22 cases returned to normal after operation, but 4 cases of patients with tympanotomy had recurrent tympanic effusion, among which 2 cases had serious effusion and had to be operated again.Conclusion The infants diagnosed with tympanic effusion can be observed for more than 6 months before surgical intervention is considered. The characteristics of disease course and influencing factors during the follow-up period are of great significance to determine the time of surgical intervention for tympanic effusion in infants. Due to the long observation period, the operative method is suggested to perform tympanotomy tubes, and the possibility of recurrence after tympanotomy is high.
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Key words:
- middle ear effusion /
- infant /
- hearing screening /
- tympanotomy tubes
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表 1 不同影响因素下患儿转归情况
例(%) 影响因素 例数 转归 χ2 P 手术 自愈 食管外反流 31(30.10) 0(0) 31(100.0) 46.30 < 0.01 鼻部变态反应 27(26.21) 6(22.22) 21(77.78) 反复呼吸道感染 17(16.50) 1(5.88) 16(94.12) 颌面畸形 12(11.65) 11(91.67) 1(8.33) 不确定因素 16(15.53) 4(25.00) 12(75.00) 
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表 2 随访3个月后未愈的3组患儿转归情况
例 指标 总体(n=60) Ⅰ组(n=29) Ⅱ组(n=13) Ⅲ组(n=18) χ2 P 6个月 31.88 < 0.01 痊愈 24 18 6 0 好转 13 8 3 2 反复 7 3 3 1 持续 16 0 1 15 >6个月 31.85 < 0.01 痊愈 38 28 9 1 好转 1 0 0 1 反复 5 1 3 1 持续 16 0 1 15 手术 22 1 4 17 1031.86 < 0.05
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