学龄前患儿鼻及鼻咽部疾病声导抗异常的临床分析

Clinical analysis of abnormal acoustic admittance in preschool children with nasal andnasopharyngeal disorders

目的通过观察分析学龄前鼻及鼻咽部疾病患儿无症状性的鼓膜形态及声导抗异常，初步探讨相关疾病导致潜在性分泌性中耳炎的危险因素。方法研究对象为81例（162耳）经纤维电子鼻咽镜、过敏原皮肤点刺试验及鼻窦CT检查分别确诊为变应性鼻炎、慢性鼻-鼻窦炎及腺样体肥大的患儿，主诉均无耳部症状但体检发现鼓膜异常，进一步行声导抗检测判定是否合并潜在的分泌性中耳炎，同时分析治疗前后相关检查结果的变化。结果81例（162耳）鼓膜形态异常的患儿中声导抗异常者15例（29耳），在各相关疾病中所占比例分别为：变应性鼻炎13．6％[6／44，耳数（下同）]，慢性鼻．鼻窦炎18．2％（12／66），腺样体肥大21．2％（11／52）；组间比较差异具有统计学意义（x^2=63．02，P〈0．05）。治疗2周后29耳中有28耳由C型转为A型，治疗4周后1耳由B型转为C型，随访3个月，未见复发。结论部分学龄前鼻及鼻咽部疾病患儿鼓膜形态及声导抗检查结果存在异常，有发展为分泌性中耳炎的潜在危险，其中腺样体肥大对中耳功能的影响较大。对相关疾病的早期干预可阻断分泌性中耳炎的发展趋势。

Objective To investigate the risk factors of related disorders, which could lead to potential otitis media by observing the abnormal configuration of drum and abnormal acoustic immittance without symptoms in preschool children. Methods Eighty-one cases （162 ears ） received flexible pharyngorhinoscopy, skin prick test, CT examination of sinus, and were diagnosed as allergic rhinitis, chronic sinusitis, adenoid hypertrophy. They had no complaints of ear related symptoms , but were observed to have abnormality in ear drum by physical examined . Acoustic immittance measurement were performed, so as to estimate whether they were accompany with potential otitis media. The ehanges of examination and tests were analyzed before and after the treatment. Results There were 15 cases（29 ears） with abnormal acoustic admittance among 81 cases（ 162 ears） who had no ear related symptoms but had different degree abnormality in ear drum. The morbidity rate of these 15 patients was 13.6% （6/44 ears） in allergic rhinitis patients, 18. 2% （12/66 ears） in chronic sinusitis patients, and 21. 2% （11/52 ears） in adenoid hypertrophy patients, respectively. The differences among the three diseases had statistical significance （x^2 = 63.02,P 〈 0.05 ）. Among 29 ears, 28 ears whose type of tympanic pressure curve were transfered from type C to type A two weeks after treatment. One ear whose type of tympanic pressure curve transferred from type B to type C four weeks after treatment. All cases had been followed up with no recurrent cases. Conclusions Some preschool children with nasal and nasopharyngeal disorders had abnormal configuration of drum and abnormal acoustic immittance, and had potential risk for otitis media. Among the disorders, adenoid hypertrophy impact more on middle ear function. The early intervention of related diseases could prevent the developing trend of otitis media.