88例儿童鼻炎鼻窦炎与分泌性中耳炎关系的研究

Relationship between children's rhinitis and nasosinusitis and secretory otitis media:research of 88 cases

目的 探讨儿童鼻炎鼻窦炎与分泌性中耳炎的关系.方法 2006年2月～2007年3月我们对88例3岁至15岁的儿童进行临床检查及鼻窦冠状位CT扫描等诊断方法确诊为鼻炎鼻窦炎患儿和50例无伴发鼻窦炎的儿童进行了声导抗检查,患儿均行耳镜检查、鼓气耳镜检查.用声导抗仪进行鼓室压图检测,分析分泌性中耳炎的发病情况,及治疗方法.结果 88例鼻炎鼻窦炎患者鼓室压图异常（B型）35例＋C型28例.对照组10耳B型曲线,两组之间分泌性中耳炎发生率差异有显著性（P＜0.01）.保守治疗抗炎、丙酸倍氯米松喷鼻,氨溴索口服,且对有鼻窦炎的患儿行鼻负压吸引2个月后,可改善鼻腔通气;同时为20例保守治疗无效的病例行鼓膜置管可改善中耳负压,复查声导抗多数患儿的听功能均有不同程度的改善.结论 分泌性中耳炎的成因并非是一种因素作用,而是多种因素相互作用的结果.儿童鼻炎鼻窦炎与分泌性中耳炎存在着密切的关系,对鼻炎鼻窦炎患儿应常规进行耳部并声导抗检查,以便及早发现诊断分泌性中耳炎,并给予抗炎、抗过敏、鼓室通气治疗,以防导致听力下降。

Objective To explore the relationship between children＇s rhinitis and nasosinusitis and secretory otitis media. Methods We enrolled 88 children aged 3 to 15 years old who were diagnosed as rhinitis and sinusitis by clinical examination and coronal CT scan in 2006 February to 2007 March and 50 cases of children without rhinitis and sinusitis. They all underwent otoscopic examination, pneumatic otoscope inspection and acoustic immittance examination. The incidence of secretory otitis media and methods of treatment were analyzed. Results The tympanograms of experimental group presented as 35 cases of type B and 28 type C, while the control group was 10 type B and 0 type C. Differences in the incidence of the two groups of secretory otitis media were significant （P〈0.01）. Conservative treatments of anti inflammatory, beclomethasone dipropionate nasal spray, ambroxol oral and negative pressure suction for 2 months to improve ventilation of nasal cavity were carried out. Moreover, 20 conservative treatment ineffective cases underwent grommet insertion for improving negative middle ear pressure. Reexamine tympanograms showed that most of the children＇s listening were improved in varying degrees. Conclusion The cause of secretory otitis media is not only one factor, but the result of many factors and interactions. Children＇s rhinitis and sinusitis and secretory otitis media has close relationship. Ear and acoustic impedance tests were recommend for rhinitis and sinusitis in children in order to detect secretory otitis media early and anti-inflammatory, anti-allergic and tympanic ventilation should be adapted to prevent hearing loss.