分泌性中耳炎复发的相关因素分析

Etiological Analysis on Recurrent Otitis Media with Effusion

目的探讨分泌性中耳炎（otitis media with effusion,OME）复发相关的影响因素。方法分析经鼓膜切开置管术治疗的255例慢性分泌性中耳炎患者的临床资料,其中取出通气管后一年内复发者85例,未复发者170例。对与分泌性中耳炎复发相关的可能因素包括年龄、性别、病程、吸烟环境、反复呼吸道感染、慢性鼻-鼻窦炎、鼻腔结构异常、腺样体肥大或鼻咽淋巴组织增生、乳突气化情况、既往置管手术史、中耳通气管留置时间等进行单因素分析及多因素Logistic回归分析。结果单因素分析发现,年龄、反复呼吸道感染（χ^2=22.546,P=0.000）、慢性鼻-鼻窦炎（χ^2=5.211,P=0.023）、腺样体肥大或鼻咽淋巴组织增生（χ^2=10.338,P=0.002）、乳突气化不良（χ^2=15.196,P=0.000）、通气管留置时间（3～6月）（χ^2=11.347,P=0.001）对分泌性中耳炎复发的影响有统计学意义。Logistic回归分析显示,小龄、反复呼吸道感染（P=0.001,OR=2.992）、腺样体肥大或鼻咽淋巴组织增生（P=0.021,OR=2.198）、乳突气化不良（P=0.000,OR=3.433）、通气管留置时间（3～6 m）（P=0.010,OR=2.237）5个因素对分泌性中耳炎复发的影响有统计学意义。反复呼吸道感染对学龄前、学龄期儿童和青少年复发性分泌性中耳炎影响有显著意义,腺样体肥大或鼻咽淋巴组织增生对学龄前儿童OME复发的影响有显著意义（P〈0.05）。结论小龄、反复呼吸道感染、慢性鼻-鼻窦炎、腺样体肥大或鼻咽淋巴组织增生、乳突气化不良、通气管留置时间较短可能是导致分泌性中耳炎复发的主要因素。反复呼吸道感染对学龄前、学龄期儿童和青少年的影响较成人更为显著,腺样体肥大对学龄前儿童的影响最为明显。

Objective To investigate the recurrent etiologic causes in otitis media with effusion（OME）.Methods The patients with OME had been conducted clinical evaluation and ventilation tube insertion.Among 255 cases observed,85 cases were recurrence within one year,while 170 cases were recovered.Factors including age,gender,course of disease,smoking environment,recurrent respiratory tract infection,chronic nasal sinusitis,nasal structural abnormalities,adenoid hypertrophy/nasopharyneal lymphadenosis,and mastoid gasification condition,history of tube insertion,duration of ventilation tube were evaluated by univariate analysis and multivariate logistic regression analysis and compared among preschool children,school age children and adults.Results In univariate analysis,it was strongly associated with age,higher prevalence of recurrent respiratory tract infection（χ^2=22.546,P=0.000）,chronic nasal sinusitis（χ^2=5.211,P=0.023）,adenoid hypertrophy/nasopharyneal lymphadenosis（χ^2=10.338,P=0.002）,mastoid pneumatization adverse（χ^2=15.196,P=0.000）and duration of ventilation tubeand（χ～2=11.347,P=0.001）.In multivariate logistic regression model,five of these factors were found to be predictors of recurrent OME,which were younger age,recurrent respiratory tract infection（P=0.001,OR=2.992）,adenoid hypertrophy/nasopharyneal lymphadenosis（P=0.021,OR=2.198）,mastoid pneumatization adverse（P=0.000,OR=3.433）and duration of ventilation tube（3～6m）（P=0.010,OR=2.237）.When comparing the difference mong preschool children,school age children and adults,recurrent respiratory tract infections in preschool anschool age children had the statistic significance（P〈0.05）,and adenoid hypertrophy in preschool had the statistsignificance（P〈0.05）.Conclusion Younger age,recurrent respiratory tract infection,chronic nasal sinusitis,adnoid hypertrophy/nasopharyneal lymphadenosis,mastoid pneumatization adverse and less time of ventilation tuare the risk factors causing recurrence of OME.When comparing the recurrent preschool children,school age chidren and adults cases,more recurrent respiratory tract infection in preschool and school age children have statistsignificance,and adenoid hypertrophy in preschool has the statistic significance.