儿童分泌性中耳炎的外科手术干预

Surgical intervention for otitis media with effusion in children

目的探讨儿童分泌性中耳炎的手术干预方式,为儿童听力筛查中分泌性中耳炎患儿的干预措施选择提供临床资料。方法总结2004—2008年我院90例儿童分泌性中耳炎接受手术治疗且资料完整者45例(82耳)的年龄特点、听力下降时间、手术方式、手术前后听力状况比较。结果术前平均纯音听阈PTA(pure-tone threshold average,500Hz,1000Hz,2000Hz,4000Hz听阈均值)从8dBHL～61dBHL,平均(34.8±12.09)dBHL。术后PTA从0dBHL～38dBHL,平均(15.9±7.88)dBHL,3耳术后听阈提高,4耳无改善,75耳听阈降低,占91.5%,平均听阈降低18.9dBHL。手术方式:鼓膜置管术9例,腺样体切除+鼓膜置管术29例,腺样体切除+扁桃体切除+鼓膜置管术7例。结论腺样体切除+鼓膜置管术是我们治疗儿童分泌性中耳炎的基本术式;扁桃体切除术不作为治疗分泌性中耳炎常规选择;对儿童分泌性中耳炎的术式选择应该个体化。

Objective To review surgically treated pediatric otitis media with effusion （OME） cases for better understanding of surgical intervention and hearing screening in such cases. Methods From 90 OME cases surgically treated between 2004 and 2008, 45 （82 ears） with complete clinical data were reviewed for their age distribution, hearing loss duration, surgical techniques and pre-and post-operative hearing data. Results The PTA over 500, 1 000, 2 000 and 4000 Hz improved from 34.8±12.09 dB HL pre-operatively to 15.9±7.88 dB HLpost-operativelyt. Post-operative hearing improved in 75 ears（91.5%）, remained unchanged in 4 ears and deteriorated in 3 ears. Conclusion Adenoideetomy and ventilation tube placement are basic surgical treatments for OME in children. Tonsillectomy should not be a routine treatment option for pediatric OME patients. Surgical management for OME in children should be individualized.