腺样体肥大儿童并发分泌性中耳炎的调查及影响因素分析

Investigation and influencing factors analysis of secretory otitis media in children with adenoid hypertrophy

目的调查腺样体肥大与儿童分泌性中耳炎(SOM)的发生情况,并分析及其影响因素。方法选择2013年1月-2016年6月青岛大学附属妇女儿童医院收治的1 348例腺样体肥大患儿为研究对象,对所有患儿术前均常规进行256Hz声导抗检查,记录鼓室导抗图类型,同时进行鼻咽镜或硬管鼻内镜检查,采用χ~2检验及Logistics回归分析儿童SOM发生率及其影响因素。结果 1 348例腺样体肥大患者中,合并SOM 587例,SOM发生率为43.55%,其中主诉听力下降159例,占11.79%。随着年龄减少,SOM发生率增高,3~5岁患儿发病率最高为69.81%;随着腺样体增生程度增加,SOM发生率增高,腺样体Ⅲ度肥大发生率最高为61.17%;多因素分析显示,3~5岁(OR=3.722,P<0.001)及腺样体Ⅲ度肥大(OR=2.246,P<0.05)是SOM发生的危险因素,而不同性别和不同病程儿童SOM发生率比较,差异无统计学意义(P>0.05)。结论腺样体肥大患儿SOM的发生率较高,腺样体肥大与儿童SOM显著相关,低龄儿童以及腺样体增生程度越高,SOM的发生率越高。

Objective To investigate the incidence rate of secretory otitis media（ SOM） in children with adenoid hypertrophy,analyze the influencing factors. Methods A total of 1 348 children with adenoid hypertrophy treated in the hospital were selected as study objects from January 2013 to June 2016. All the children received 256 Hz acoustic impedance test before surgery,the types of tympanum were recorded,epipharyngoscope test or rigid nasal endoscopy test were performed at the same time before operation. The incidence rate and influencing factors of SOM in children with adenoid hypertrophy were calculated by χ~2 test and logistic regression analysis. Results There were587 children with SOM in 1 348 adenoidal hypertrophy children,the incidence rate of SOM was 43. 55%,of which 159 children complained hearing loss,accounting for 11. 79%. The incidence rate of SOM increased with the decrease of age,and the incidence rate in 3-5-year-old children was the highest（ 69. 81%）. With the increase of severity of adenoids,the incidence rate of SOM increased,the incidence rate of adenoid hypertrophy of stage Ⅲ was the highest（ 61. 17%）. Multivariate analysis showed that 3-5 years old（ OR = 3. 722,P〈0. 001） and adenoid hypertrophy of stage Ⅲ（ OR = 2. 246,P〈0. 05） were the risk factors of SOM,but there was no statistically significant difference in the incidence rate of SOM among children of different genders and courses of disease（ P〈0. 05）. Conclusion The incidence rate of SOM in children with adenoidal hypertrophy is high. Adenoidal hypertrophy is significantly associated with SOM in children. The incidence rate of SOM is high in young children and children with severe adenoid hypertrophy.