OSAHS患儿术前及术后听觉功能变化的临床研究

Clinical study of auditory function for children with obstructive sleep apnea-hypopnea syndrome before and after adenotonsillectomy

目的了解4～7岁阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿听觉功能的变化状况,分析双侧扁桃体切除术联合鼻内镜下腺样体消融手术后中、重度OSAHS患儿听功能的变化。方法2016年3月至6月,笔者采用病例抽样的方法抽取就诊于湖南省儿童医院耳鼻咽喉-头颈外科门诊的4～7岁OSAHS患儿,按病情轻、中、重度分组,并选择健康儿童作为对照组。各组均行多导睡眠仪监测(PSG)、纯音测听(PTA)、听性脑干反应(ABR)检测、畸变产物耳声发射(DPOAE)。其中,中、重度OSAHS组分别于术后半年复查1次PSG、PTA、DPOAE及ABR检查,对照组行ABR、DPOAE和ABR检查。结果中、重度OSAHS儿童PTA、ABR、DPOAE结果较轻度OSAHS及对照组均有统计学差异(P<0. 05),轻度OSAHS及对照组儿童PTA、ABR、DPOAE无统计学差异(P> 0. 05)。结论中、重度OSAHS可引起4～7岁儿童听功能受损,主要表现为中、高频听力受损,且OSAHS病情程度越重,听功能受影响越严重。双侧扁桃体切除术联合鼻内镜下腺样体消融术对腺样体肥大合并扁桃体肥大的OSAHS儿童治疗效果好,手术有助于耳蜗功能的部分改善。

Objective To explore the changes of auditory function in children aged from 4 to 7 yearswith obstructive sleep apnea hypopnea syndrome （OSAHS） and examine the influence of auditory function onchildren with mediumsevere OSAHS after bilateral amygdala resection plus adenoidectomy under endoscopicablation. Methods Children of varying degrees of OSAHS aged from 4 to 7 years were selected as researchsubjects. They were divided into mild,medium and severe OSAHS groups according to the results of polysomnography （PSG,n = 40 each）. Three groups were monitored by PSG for at least 7h and those with mediumsevere OSAHS were reoperated under general anesthesia. The healthy control group was made up of 40 healthychildren and their parents confirmed having no snoring or hearingrelated history. The study group receivedPSG,pure tone audiometry （PTA）,auditory brainstem response （ABR） and distortion product otoacoustic emission （DPOAE）. Cases of mediumsevere OSAHS were reexamined by PSG,PTA,DPOAE and ABR for 6months postoperation while healthy control group repeated ABR,DPOA and ABR. Multifactorial variance analysis was used for comparing the experimental data between groups. And t test was performed for the same groupat pre and postoperation. Results Significant differences existed in PTA,ABR and DPOAE in cases of moderatesevere OSAHS （P 〈 0. 05）. And significant differences existed between mild OSAHS and healthy controls. No significant difference existed between PTA,ABR and DPOAE in those with mild OSAHS and healthycontrols P 〉 0. 05 . Conclusion Mediumsevere OSAHS can impair listening function of children aged 4 to 7 years with middle and highfrequency hearing loss. The more advanced degree of OSAHS,the more severe listening function impairment. Bilateral amygdala resection plus adenoidectomy under endoscopic ablation of adenoid hypertrophy is efficacious for children with OSAHS and tonsil hypertrophy. It may improve cochlear function partially.