儿童及青少年慢性化脓性中耳炎临床特点

Analysis of clinical characteristics of chronic suppurative otitis media in children-adolescence and adults

目的回顾性总结儿童及青少年慢性化脓性中耳炎的临床特点,为儿童及青少年慢性化脓性中耳炎的临床早期诊断和早期干预提供思路。方法比较儿童及成人慢性化脓性中耳炎在临床特征方面的异同。对105例(116耳)儿童及青少年和108例(112耳)成人慢性化脓性中耳炎患者的术中听骨链损伤程度及病变范围进行总结和比较。结果儿童及青少年组病史(5.6±4.8)年较成人组(17.8±14.8)年短,术前骨气导间距,儿童及青少年组(38.9±12.1)dB较成人组(28.6±11.9)dB大,两者之间有显著性差异。儿童及青少年组胆脂瘤发生率(69.8%)高于成人组,病变同时累及鼓室、鼓窦、乳突的占70.4%,较成人组(30.2%)有显著性差异。在听骨链破坏程度上,儿童及青少年组与成人组无显著性差异。结论儿童及青少年慢性化脓性中耳炎较成人具有病史短,起病隐匿,在短时间内就表现为听力损伤重的特点;胆脂瘤发生率高,进展快,病变范围广,需要早期诊断及早期干预,预防并发症的发生。

OBJECTIVE To review and compare the similarities and differences between children-adolescence and adults with chronic suppurative otitis media,to give some help for early diagnosis and intervention of children-adolescence chronic suppurative otitis media.METHODS To review the clinical data of chronic suppurative otitis media in children-adolescence group（105 cases,116 ears）and adults group（108cases,112 ears）,and compare the ossicular chain damage and the range of the lesion in children and adults with cholesteatoma.RESULTS The history of children-adolescence group（5.6±4.8）years was shorter than the adults group（17.8±14.8）years.The ABG in children-adolescence group（38.9±12.1）dB was larger than that in adults group,there was significant difference（Z=-5.034,P=0.000）.Cholesteatoma was more common in children-adolescence group than in adults group.There was no signi？cant difference in ossicular chain damage in children-adolescene group and adults group with cholesteatoma（Z=-1.818,P=0.069）.There were 70.4%（57/81）ears in children-adolescence group with the lesion extension of tympanum,antrum and mastoid,and 30.2%（16/53）ears in adults group,the difference was signi？cant（Z=-4.550,P=0.000）.CONCLUSION Chronic suppurative otitis media in children and adolescence,compared with those in adults,have the characteristics of a shorter history,a more rapid growth rate,a higher incidencerate in cholesteatoma,and more severe hearing loss in early stage.Cholesteatoma in children and adolescence demonstrate a more destructively and invasively growth,and thus it needs early intervention.