儿童分泌性中耳炎手术治疗的远期转归

Long-term effects of tympanostomy tube insertion on children with otitis media with effusion

目的观察鼓室置管对分泌性中耳炎儿童患者的远期效果及对听力及鼓膜形态的影响。方法回顾性分析2003年9月至2007年6月治疗的78例儿童分泌性中耳炎患者。采用鼓室置管术,合并腺样体肥大者同时行鼻内镜下腺样体切除术。通气管留置时间4～28个月,随访4～7年。结果 56例(71.8%)自觉听力恢复正常,18例(23.1%)觉听力明显改善,仅有4例(5.1%)无明显改善,平均听力提高约20dBHL。42耳(44.7%)鼓膜形态正常,16耳(17.0%)出現鼓膜钙化,25耳(26.6%)鼓膜局部变薄、18耳(19.1%)鼓膜内陷,3耳(3.2%)鼓膜穿孔,2耳(2.1%)鼓膜肉芽,0例胆脂瘤,8耳(8.5%)鼓室积液并再次手术。鼓室置管后患者听力提高将近20dBHL,但高达53.2%的患儿鼓膜出现异常改变。结论鼓室置管导致近一半患儿鼓膜出现异常改变,严格的掌握手术适应证很重要,术后需严格随访及跟进处理。

Objective To study the long-term effects of tympanostomy tube insertion on the tympanic membrane and hearing results. Methods From September 2003 to June 2007, tympanostomy tubes were inserted in 78 children for otitis media with effusion, adenoidectomy were performed in 10 cases combined by adenoid hypertrophy. Ventilating tubes were retained for 4 - 28 months, and all patients were followed up for 4 - 7 years, audiometric testing and tympanic membrane abnormalities were recorded. Results Subjectively 71.8% of the patients noticed hearing recovery, while 23.1% improved, 5.1% no improvement. The improvement of hearing was about 20 dB HL on average. 44. 7 % patients showed normal tympanic membrane, while tympanosclerosis was observed in 16 ears（ 17.0% ）, Segmental atrophy changes of the tympanic membrane were seen in 25 ears（26. 6% ）, Retraction were seen in 18 ears（ 19.1% ）, the eardrum was perforated in 3 ears（3.2% ）, granulation happened to 2 ears（2. 1% ）, and no cholesteatoma was found in all cases. Repeated intubation was performed in 8 ears（ 8. 5% ）for recurrence. Tympanostomy tube insertion can effectively improve hearing in a large percentage of children for otitis media with effusion. However, tympanic membrane abnormity were found in 53.2% patients. Conclusion Tympanic membrane abnormity were found in about one half of patients after tympanostomy tube insertion,so surgery must be under strict indication and following up timely with appropriate management when necessary.