婴儿分泌性中耳炎的随访分析

Follow-up study of otitis media with effusion in newborns and infants

目的:研究婴儿分泌性中耳炎的病程发展特点,为临床观察和治疗提供依据。方法:新生儿听力筛查未通过者,在3月龄内做全面的听力检查,对确诊鼓室积液者进行跟踪随访,每个月复查一次声导抗(226 Hz和1kHz),每3个月完成一次全面的听力复查。将随访至半年以上者纳入研究,共46例,分析影响因素、痊愈时间和病程特点。结果:46例中初筛双耳未通过24例,单耳22例;复筛双耳未通过22例,单耳24例,其中2例单耳未通过者初筛和复筛时的耳别发生了变化;3个月内69耳诊断为分泌性中耳炎(双耳23例,单耳23例),226Hz声导抗(A型、B型或C型)、1kHz声导抗无正峰,DPOAE未引出,ABR反应阈20~60dBnHL。痊愈37例(80.4%),年龄4~18月龄,其中随访半年(9月龄)以内痊愈29例;未愈9例,其中7例在随访半年(7~9月龄)未复诊但电话随访听力好转;另2例病情反复、且由单耳转变为双耳,最终鼓膜置管。影响因素有呛奶、长期鼻塞、反复感冒。结论:婴儿分泌性中耳炎自愈性高,建议适当延长观察等待期,避免及控制影响因素有利于病情痊愈。仅个别病情反复、迁延不愈者方需有创干预。

Objective：To study the natural history of otitis media with effusion（OME）in infants,to guide clinical observation and treatment.Method：Newborns and infants born who failed newborn hearing screening and diagnosed OME were studied.Those with OME were diagnosed within 3months old and followed-up.All subjects were examined with tympanometry once a month and with whole audiometric evaluation once three months.The causes,the time of recovery,and the disease course were analyzed in 46 infants followed-up at least 6months.Result：24infants were failed bilateral and 22 with monaural in initial hearing screening.22 infants were failed bilateral and 24 with monaural in repeated screening.The failed ears side changed in 2with monaural.69ears（bilateral in 23 cases and unilateral in 23cases）were diagnosed OME.In these 69 ears,the 226 Hz tympanograms showed type A,type B,or type C,the 1 000 Hz tympanograms had no peak,the distortion-product otoacoustic emission（DPOAE）were not found,the response thresholds of auditory brainstem response（ABR）were 20-60 dBnHL.37cases（80.4%）were recovered,and 9cases were unrecovered.The first recovered case was in 4months old,the last one was in 18 months old.29 recovered cases were followed-up less than 6months（with 9months old）,7cases in the 9unrecovered cases didn＇t return visit after followed-up 6months,but they were found that the hearing level improved by the telephone follow-up.The other 2cases showed recurrence and from unilateral ear to both ears.The causes included choking milk,rhinobyon,and cold repeatedly.Conclusion：OME in infants has the selfhealing nature.We suggest to observe the infants for a long time.Avoiding the causes is benefit to self-healing.