Different treatment methods and efficacy analysis of otitis media with effusion in children with different hearing loss
-
摘要: 目的 探讨分析不同听力损失儿童分泌性中耳炎(OME)的治疗方法及效果。方法 收集2020年1月—2021年12月浙江大学医学院附属儿童医院耳鼻咽喉头颈外科收治的OME患儿318例(556耳)，根据不同听力损失程度及病史并结合鼓室内积液的性质选择不同治疗方法，分为保守治疗组：临界听力损失及轻度听力损失且病程 < 3个月；鼓膜切开组：轻度听力损失且病程≥3个月或者中度及重度听力损失且病程 < 3个月，鼓室积液为稀薄的浆液性液体；鼓膜置管组：轻度听力损失且病程≥3个月或者中度及重度听力损失且病程 < 3个月，鼓室积液为黏稠或者胶冻样的黏液性液体，以及中度及重度听力损失且病程≥3个月。95%的患儿同时合并腺样体肥大或同时合并扁桃体肥大诊断符合阻塞性睡眠呼吸暂停(OSA)，同时予鼻内镜下腺样体切除术或者扁桃体伴腺样体切除术。比较不同治疗组的疗效及复发情况。结果 保守治疗组及鼓膜切开组术后1个月、3个月、6个月随诊，鼓膜置管组术后每3个月随诊，平均1年取管，取管后1个月、3个月、6个月随诊。保守治疗组、鼓膜切开组、鼓膜置管组3组治疗有效率分别为95.6%、89.6%、90.9%，分别复发6、4、5耳，差异无统计学意义。术后遗留鼓膜穿孔者4耳，其中鼓膜置管组3耳，鼓膜切开组1耳。多因素logistic回归分析发现，合并变应性鼻炎(OR=0.073，95%CI：0.013~0.401，P=0.003)是影响OME治疗效果的因素。结论 儿童OME治疗不仅要结合病史时间，还要结合不同听力损失程度及鼓室内积液的性质选择不同的手术方案，可以得到同样效果，并且复发率低，创伤小，安全性好。变应性鼻炎是导致OME治疗效果不佳的因素。Abstract: Objective To explore and analyze the treatment methods and effects of otitis media with effusion in children with different hearing loss.Methods Clinical data of 318 children (556 ears) with otitis media with effusion(OME)admitted to Department of Otorhinolaryngology Head and Neck Surgery, Children Hospital Affiliated to Zhejiang University of Medicine from January 2020 to December 2021 were collected. Different treatment methods were selected according to the degree of hearing loss, combined with course of disease and the characteristics of effusion in tympanic cavity. They were divided into drug treatment group: critical hearing loss and mild hearing loss, and the course of disease was less than 3 months; myringotomy group: mild hearing loss and course of disease ≥3 months or moderate and severe hearing loss and course of disease < 3 months, tympanic effusion was rarefied liquid; tympanostomy tube insertion group: mild hearing loss and course of disease ≥3 months, or moderate and severe hearing loss group and course of disease < 3 months, tympanic effusion is sticky or jelly liquid, and moderate and severe hearing loss group and course of disease ≥3 months. 95% of children with adenoid hypertrophy or tonsillar hypertrophy and adenoid hypertrophy were diagnosed as obstructive sleep apnea hypopnea syndrome(OSA) and underwent endoscopic adenoidectomy or tonsillectomy and adenoidectomy. The curative effect and recurrence of different treatment groups were compared.Results The drug treatment group and myringotomy group were followed up in 1, 3 and 6 monthes after operation. The tympanostomy tube insertion was followed up every three months after operation, with an average of one year. The patients were followed up in 1, 3 and 6 monthes after taking the tube off. The effective rates of drug treatment group, myringotomy group and tympanostomy tube insertion group were 95.6%, 89.6% and 90.9% respectively. The three groups recurred in 6, 4 and 5 ears respectively, and the difference was not statistically significant. Tympanic membrane perforation was left in 4 ears, 3 ears in tympanic tube group and 1 ear in myringotomy group. Multivariate Logistic regression analysis showed that allergic rhinitis(OR=0.073, 95%CI: 0.013-0.401, P=0.003) was the factor influencing the therapeutic effect of OME.Conclusion the treatment of OME in children should not only be combined with course of disease, but also combined with different hearing loss and the characteristics of effusion in tympanic cavity. Different treatment methods can get the same effect, with low recurrence rate, small damage and satisfactory safety. Allergic rhinitis affects the therapeutic effect of OME.
-
-
表 2 不同听力损失病程比较
耳(%) 听力损失 耳数 无病史 急性病程 慢性病程 临界 87 61(70.1) 18(20.7) 8(9.2) 轻度 286 165(57.7) 41(14.3) 80(28.0) 中度及重度 183 59(32.2) 34(18.6) 90(49.2) χ2值 55.881 P值 < 0.001 
下载: 导出CSV
表 3 不同听力损失治疗方法选择
耳 听力损失 耳数 保守治疗 鼓膜切开 鼓膜置管 临界 87 87 0 0 轻度 286 206 25 55 中度及重度 183 4 63 116
下载: 导出CSV
表 4 不同治疗组治疗效果比较
耳(%) 组别 耳数 痊愈 好转 无效 保守治疗组 297 218(73.4) 66(22.2) 13(4.4) 鼓膜切开组 88 58(65.9) 20(22.7) 10(11.4) 鼓膜置管组 121 90(74.4) 20(16.5) 11(9.1) χ2值 8.220 P值 0.084
下载: 导出CSV
表 5 不同治疗组复发耳数比较
耳(%) 组别 耳数 复发 未复发 保守治疗组 283 6(2.1) 277(97.9) 鼓膜切开组 79 4(5.1) 75(94.9) 鼓膜置管组 110 5(4.5) 105(95.5) χ2值 2.610 P值 0.271
下载: 导出CSV
-
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会小儿学组. 儿童分泌性中耳炎诊断和治疗指南(2021)[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(6): 556-567. doi: 10.3760/cma.j.cn115330-20210511-00264
[2] 于海洋, 毛传远, 翟冰, 等. 鼻内镜下经咽鼓管置管治疗分泌性中耳炎[J]. 中华耳科学杂志, 2004, 2(2): 106-108. doi: 10.3969/j.issn.1672-2922.2004.02.007
[3] Lee JY, Kim SH, Song CI, et al. Risk factors for persistent otitis media with effusion in children: a case-control study[J]. Yeung-nam Univ J Med, 2018, 35(1): 70-75. doi: 10.12701/yujm.2018.35.1.70
[4] Gestro M, Condemi V, Bardi L, et al. Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study[J]. Int J Biometeorol, 2017, 61(10): 1749-1764. doi: 10.1007/s00484-017-1356-7
[5] Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical Practice Guideline: Otitis Media with Effusion(Update)[J]. Otolaryngol Head Neck Surg, 2016, 154(1 Suppl): S1-S41.
[6] 陈文欣, 付勇. 腺样体肥大在儿童分泌性中耳炎发病机制中的作用研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(17): 1359-1362. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201817017.htm
[7] 李瑞红. 糖皮质激素联合盐酸氨溴索治疗分泌性中耳炎的疗效及对病菌清除率与不良反应的分析[J]. 首都食品与医药, 2019, 26(7): 63. doi: 10.3969/j.issn.1005-8257.2019.07.054
[8] 李熙星, 陈雨濛, 张光远, 等. 类固醇激素治疗儿童分泌性中耳炎的临床研究进展[J]. 中华耳科学杂志, 2020, 18(3): 459-463. doi: 10.3969/j.issn.1672-2922.2020.03.007
[9] 梁玉芳, 杨军. 分泌性中耳炎对儿童的影响及诊断治疗策略[J]. 上海交通大学学报(医学版), 2007, 27(1): 35-38. doi: 10.3969/j.issn.1674-8115.2007.01.010
[10] Principi N, Marchisio P, Esposito S. Otitis media with effusion: benefits and harms of strategies in use for treatment and prevention[J]. Expert Rev Anti Infect Ther, 2016, 14(4): 415-23. doi: 10.1586/14787210.2016.1150781
[11] 唐红燕, 胡瑞丹, 李庆, 等. 成都市2~7岁儿童分泌性中耳炎患病现状调查[J]. 听力学及言语疾病杂志, 2019, 27(1): 83-84. https://www.cnki.com.cn/Article/CJFDTOTAL-TLXJ201901021.htm
[12] 陶佳, 罗仁忠, 陈彦球, 等. 鼓膜切开或置管-儿童腺样体肥大合并分泌性中耳炎手术治疗方式对比[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(3): 207-210. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202003006.htm
[13] 刘薇, 韩书婧, 刘珊珊, 等. 儿童复发性分泌性中耳炎致病因素meta分析[J]. 中国眼耳鼻喉科杂志, 2021, 21(1): 41-45, 50. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH202101011.htm
[14] 万学梅, 杨军. 儿童分泌性中耳炎鼓膜置管术后留置时间与复发的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(7): 500-503, 509. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201707003.htm
[15] Yaman H, Yilmaz S, Guclu E, et al. Otitis media with effusion: recurrence after tympanostomy tube extrusion[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(3): 271-274.
[16] Kuo CL, Tsao YH, Cheng HM, et al. Grommets for otitis media with effusion in children with cleft palate: a systematic review[J]. Pediatrics, 2014, 134(5): 983-994.
-