改良Politzer仪治疗儿童慢性分泌性中耳炎的疗效评估

Efficacy of using modified Politzer device in treating chronic otitis media with effusion in children

目的 :评估改良Politzer仪治疗儿童慢性分泌性中耳炎(otitis media with effusion,OME)的临床疗效。方法 :将确诊为双耳慢性OME伴听力损失的43例患儿随机分为A、B组。A组22例使用改良Politzer仪行咽鼓管吹张治疗;B组21例行观察随访。4周后,两组交叉。两组患儿在入组、4周及8周接受耳内镜检查、声导抗及纯音听阈测试。结果:治疗4周后A组有20耳(45%)中耳压力和纯音听阈恢复正常,14耳(32%)有好转,B组中6耳(14%)恢复正常,4耳(10%)好转,两组疗效差异有统计学意义(P<0.005)。两组交叉后,B组经过4周吹张治疗后有17耳(40%)恢复正常,13耳(31%)有好转;A组有24耳(55%)恢复正常,14耳(32%)有好转,两组疗效差异有统计学意义(P<0.05)。两组共有8例(19%)接受鼓膜置管术。结论:利用改良Politzer仪进行咽鼓管吹张能有效治疗患儿慢性OME,越早吹张治疗效果越好,从而降低手术机率。

Objective： To use of modified Politzer device in the management of chronic otitis media with effusion（OME） in children and evaluate the clinical efficacy.Methods： Forty-three Children diagnosed with bilateral chronic OME and hearing loss were randomly divided into A and B groups.Tweenty-two Children in group A,aged 4~11 years started as the treatment group underwent modified Politzer device for inflation.Another 21 Children in group B,aged 5~12 years were included as the control group underwent careful observation.After 4 weeks,a cross-over was performed.Both groups underwent otoendoscopy,tympanometry and audiometry at inclusion and after 4 and 8 weeks for evaluating the treatment efficacy.Results： In group A,the middle ear pressure and pure tone threshold were normalized in 20（45%）and improved in 14（32%） ears after 4 weeks treatment.While in B group,6（14%） ears were normalized and 4 ears were improved（10%）.Statistically significant differences were demonstrated between children with modified Politzer device for inflation and children with observation.After cross-over,17（40%） normalization and 13（31%） improvement of ears were achieved in B group,and 24（55%） normalization and 14（32%） improvement of ears were achieved in A group.Statistically differences were demonstrated between two groups（P0.05）.There were 8（19%） children were submitted to grommet surgery after 8 weeks treatment.in two groups.Conclusion： Efficiency were demonstrated in children with chronic OME inflated with Modified Politzer.The earlier treatments were given,the better effects could be achieved.It can reduce the need for surgery.