腺样体切除加鼓室置管治疗顽固性分泌性中耳炎(附36例报告)

Treatment of severe otitis media with effusion with adenoidectomy and myringotomy:with a report of 36 cases

目的 :探讨腺样体切除加鼓室置管治疗顽固性分泌性中耳炎的效果。方法 :对 36例经保守治疗反复发作的顽固性分泌性中耳炎患儿术前施行了耳部检查、鼻咽侧位片与鼻内窥镜检查 ,确定腺样体肥大与分泌性中耳炎的关系 ,然后施行腺样体切除加鼓室置管术 ,手术后跟踪随访。结果 :术后经过 6个月～ 3年余的随访 ,2 6例在 1～ 6个月听力恢复正常 ,声阻抗检查鼓室压力在 4 0～ 80之间 ;6例听力基本正常 ,只是某些频率下降了 10～ 2 0dB ;4例遗留轻度的气导听力下降。鼻咽侧位片显示已无肥大腺样体 ,部分患者鼻咽镜检查示咽鼓管咽口的压迫已经解除。结论 :腺样体肥大压迫或接近咽鼓管咽口是顽固性分泌性中耳炎的主要原因 ,鼻内窥镜检查是确定二者是否有关的有效方法。鼓室置管可较快地提高听力 。

Objective: To detect the treatment effects of severe otitis media with effusion with adenoidectomy and myringotomy.Methods: 36 cases of severe otitis media with effusion , which had been treated with conservative methods for long time , were studied. All patients had got otoscope , nasal pharynx X-ray screen, nasoendoscope ,hearing and tympanogram examination and were followed up 6 months to 3 years after operation. Results: 26 cases′ hearings recovered within 6 months while their tympanograms showed that tympano- pressures ranged from 40-80mmH 20. Other 6 cases′ hearing also restored except one or tow frequencies of audiograms decreased 10-20 dB. 4 casas still had slightly conductive hearing loss. Nasal pharynx X-ray films of all cases showed that the track of nasal pharynx were wide and the enlarged adenoids disappeared. Naso-pharynxscope exams indicated that the openings of eustachian tubes were normal.Conclusion: The mainly reason of otitis media with effusion is oppressed by the enlarged adenoids, and nasal pharynxscope exams is the effective way to find it. Hearing level can restored rapidly.After the myringotomy, adenoidectomy can avoid the recurrence of otitis media with effusion.