小儿腺样体肥大与分泌性中耳炎

Adenoid vegetation and secretory otitis media in children

目的探讨腺样体肥大患儿的不同鼓室图与分泌性中耳炎的关系及分泌性中耳炎的诊断。方法对2009年1月—2011年6月期间本院收治的328例腺样体肥大患儿(包括单纯腺样体肥大及合并有慢性扁桃体炎及扁桃体肥大者)的病例资料进行回顾性分析。分析统计分泌性中耳炎的发病率及声导抗测试诊断分泌性中耳炎的阳性率。结果 328例腺样体肥大患儿中有105例最终经鼓膜穿刺或鼓膜置管确诊为分泌性中耳炎(32.31%);声导抗测试鼓室导抗图表现为B型者89例152耳,其中最终确诊为分泌性中耳炎者为86例147耳,阳性率为96.63%;C导抗图(负压在-150dapa以上)者33例49耳,其中最终确诊为分泌性中耳炎者为16例20耳,阳性率为40.82%;As导抗图2例2耳亦最终确诊为分泌性中耳炎。结论对于腺样体肥大患儿不论主诉有无听力下降,常规进行声导抗测试,同时结合认真的体格检查及电耳镜或耳内镜检查,可大大降低小儿分泌性中耳炎的误诊率。

Objective To study the relationship between adenoid vegetation and secretory otitis media in children and its diagnosis. Methods A retrospective study was carried out among 328 children with adenoid vegetation （both simple adenoid vegetation and those associated with chronic tonsillitis and tonsillar hypertrophy） treated from August 2010 to May 2012. The incidence of secretory otitis media and the rate of positive diagnostic tympanometry were analyzed. Results Secre- tory otitis media was diagnosed in 105 cases （32.31%） by tympanic membrane puncture or tympanostomy tube. Tympano- gram was type B in 89 cases （152 ears）, of which secretory otitis media was confirmed in 86 cases （147 ears） yielding a posi- tive rate of 96.63% （147/152）. Tympanogram was type C in 33 cases （49 ears）, of which the diagnosis of secretory otitis media was confirmed in 16 cases （20 ears）, yielding a positive rate of 40.82% （20/49）. The diagnosis of secretory otitis media was also confirmed in 2 cases （2 ears） with type As tympanograms. Conclusions Complaint of hearing loss or not, children with adenoid vegetation should be checked with routine tympanometry. Careful physical examination, electric otoscopy or ear endoscopy combined with tympanometry can greatly reduce the rate of missed diagnosis of secretory otitis media. [