儿童分泌性中耳炎76例误漏诊原因分析及治疗观察

Analysis of the Causes of Misdiagnosis and Mistreatment of Secretory Otitis Media in 76 Children

目的探讨儿童分泌性中耳炎的误漏诊原因。方法回顾性分析我院2012年6月—2016年6月住院治疗的儿童分泌性中耳炎误漏诊病例资料。结果本组76例,占我院同期收治本病患者的8.92%。临床表现以鼻塞、流涕等上呼吸道症状为主34例,听力下降18例,打鼾16例,以头痛为主8例。专科检查发现鼓膜凹陷51例,鼓膜充血19例;鼓室导抗检查,呈B型导抗图52例,C型导抗图24例;33例出现不同程度的听力损失。76例均在外院误漏诊,其中漏诊40例,仅诊断为腺样体肥大;误诊36例,误诊为上呼吸道感染27例,药物中毒性耳聋4例,急性化脓性中耳炎3例,突发性耳聋2例。76例均在我院经专科查体、鼓室导抗检查和听力检查确诊分泌性中耳炎,根据病情分别予腺样体切除术、鼓膜穿刺术或置管引流、药物对症治疗等,症状消失或明显改善。结论儿童分泌性中耳炎是耳鼻喉科常见疾病,临床工作中应以患儿的主诉、临床表现、听力检查结果为基础多方面综合判断,尤其应高度警惕存在腺样体肥大的患儿,以降低误漏诊率。

Objective To investigate the causes of misdiagnosis and mistreatment of secretory otitis media in chil-dren ,so as to reduce misdiagnosis and mistreatment. Methods A retrospective analysis of our hospital in June 2012 to 2016 June hospitalized 852 cases of children with secretory otitis media in 76 cases of misdiagnosis and mistreatment of clinical da-ta. Results 76 cases of this group, accounting for 8.92% of the disease in our hospital during the same period. The clinical manifestations of 8 cases with headache, stuffy nose, runny nose and other respiratory symptoms in 34 cases, 18 cases of hear-ing loss, 16 cases of snoring. There were 19 cases of tympanic membrane congestion, 51 cases of tympanic membrane depres-sion, 52 cases of B type anti sign, 24 cases of C type anti sign, 33 cases of hearing loss in different degrees. 76 cases were misdiagnosed in the external hospital, 40 cases were missed diagnosis, only diagnosed as adenoidal hypertrophy; 37 cases were misdiagnosed, 27 cases were misdiagnosed as upper respiratory tract infection, 4 cases of drug induced deafness, 2 cases of sudden deafness, 3 cases of acute suppurative otitis media. 76 cases were diagnosed with secretory otitis media by specialist examination, tympanum conduction test and hearing examination in our hospital. All patients were cured by adenoidectomy, tympanic membrane puncture or catheter, drug symptomatic treatment according to the condition. Conclusion Secretory otitis media in children is a common disease in Department of ENT. Clinical work should be based on childrens complaints, clinical manifestations and hearing test results, especially in children with adenoidal hypertrophy, should be highly vigilant, compre-hensive judgment in many aspects, in order to reduce misdiagnosis and missed diagnosis rate.