【摘要】 目的:探讨儿童腺样体肥大程度与分泌性中耳炎发生及预后的相关性,指导临床医师对分泌性中耳炎作出早期诊断和治疗。方法:239例住院手术切除腺样体的儿童,常规行鼻咽侧位片、声导抗检查;部分伴耳部症状、声导抗显示C型曲线或查体可疑鼓室积液征者行颞骨CT检查或术中行鼓室穿刺。经统计学分析,比较分泌性中耳炎与腺样体肥大程度及咽鼓管咽口情况的相关性。结果:在239例腺样体肥大儿童中,经鼓室穿刺证实合并分泌性中耳炎者34例(63耳,14.2%),其中鼓室曲线呈B型者33耳(52.4%),C型(<-200 dapa)者10耳(15.9%),C型(>-200 dapa)者20耳(31.7%)。结果表明分泌性中耳炎的发生与腺样体肥大程度及咽鼓管园枕受压迫的程度呈正相关。结论:声导抗检查不能作为分泌性中耳炎诊断的金标准,必要时可行颞骨CT明确诊断;对腺样体肥大伴分泌性中耳炎的儿童鼻内镜下腺样体切除为其主要疗法,配合鼓室穿刺多可治愈,对反复发作的分泌性中耳炎行鼓室置管术,避免术后并发症的发生。更多还原

【Abstract】 Objective: The purpose of the study was to explore the relationship between adenoid hypertrophy and the occurrence and prognosis of secretory otitis media in children and to guide the clinical doctors on the early diagnosis and treatment of secretory otitis media. Methods: To obtain a collection of appropriate medical histories, nasopharyngeal lateral slice endoscopy, acoustic immittance and pure tone hearing threshold tests were performed routinely on 239 hospitalized children whose adenoid bodies were resected prior to surgery. Those who had ear symptoms or presented with a C type curve in acoustic immittance testing were suspected to have a middle ear effusion, and underwent further exmaination through a temporal bone CT or a tympanic cavity puncture examination during the operation. Through the use of statistical software we analyzed the relationship between secretory otitis media, the degree of adenoid hypertrophy and the condition of Eustachian tube Results: Among 239 children with adenoid hypertrophy, 34 children(14.2%) were complicated with secretory otitis media confirmed by tympanic cavity puncture in which 33 ears(52.4%) were type B, 10 ears(15.9%) were type C(<- 200 dapa), 20 ears(31.7%) were C(>- 200dapa). The results demonstrated that the occurrence of secretory otitis media was positively associated with the degree of adenoid hypertrophy and compression of the Eustachian tube. Conclusion: Acoustic immittance cannot be used as the gold standard of the diagnosis of secretory otitis media. Temporal bone CT is necessary for patients who have ear symptoms or present with a C type curve in acoustic immittance or have a suspected middle ear effusion in order to ensure diagnosis. For children with adenoid hypertrophy, endoscopic adenoidectomy is the main therapy with high rates of resolution given adjunctive tympanic cavity puncture. In cases of recurrent secretory otitis media, tympanic cavity catheterisation can be used to reduce the risk of postoperative complications.更多还原