儿童腺样体肥大与分泌性中耳炎的关系研究

Adenoidal hypertrophy and secretory otitis media in children

目的探讨腺样体肥大儿童中分泌性中耳炎发病情况及其影响因素。方法258例住院手术治疗的腺样体肥大的儿童,均常规进行病史采集、鼻咽侧位片、声导抗检查;对部分患儿进行鼻内镜检查录像,单盲评估腺样体肥大程度及其与咽鼓管咽口的关系。统计分析分泌性中耳炎发生率及其影响因素。结果在258病例中经声导抗检查证实合并分泌性中耳炎者108例(41.9%),而病史中有明确听力减退主诉者仅27例(10.5%);对合并和未合并分泌性中耳炎病例的相关影响因素统计分析发现,患儿性别、病程长短、腭扁桃体大小等因素对分泌性中耳炎发病无明显影响,低龄患儿、腺样体过度肥大、腺样体与咽鼓管园枕或咽口关系密切者发生分泌性中耳炎可能性大,多元回归分析证明其中影响最显著的因素是腺样体与咽鼓管园枕或咽口关系密切程度。结论有必要对所有腺样体肥大患儿常规进行听力学检查,以确认或除外分泌性中耳炎诊断。低龄患儿、腺样体过度肥大或与咽鼓管园枕及咽口关系密切是分泌性中耳炎的促发因素。

Objective To study the prevalence of secretory otitis media in children with adenoidal hypertrophy and influencing factors. Methods Clinical history, x-ray images of the nasopharynx and acoustic immitance data were collected in 258 cases of pediatric adenoidal hypertrophy admitted for surgical treatment. Video nasal endoscopy was performed in 68 cases for direct examination of the adenoid. The prevalence of secretory otitis media was determined and po- tential influencing factors analyzed using multivariate regression. Results Secretory otitis media was confirmed in 108 cases （41.9%） by acoustic immitance tests, although only 27 （10.5%） cases had audiologic complaints. Gender, disease duration and tonsillar hypertrophy showed no effect on the prevalence. The probability of otitis media appeared to be higher in younger children, with more severe adenoidal hypertrophy and closer proximity to the Eustachian tube. Conclusion Audiological examination in children with adenoidal hypertrophy is crucial in identifying secretory otitis media. Factors that may increase the chance of secretory otitis media include young age, severe adenoidal hypertrophy and close spatial relationship between the adenoid and Eustachian tube.