腺样体与咽鼓管圆枕的毗邻关系及其与分泌性中耳炎的相关性

Adjacent patterns between adenoid and eustachian cushion and its clinical relation with otitis media with effusion

目的观察腺样体肥大儿童的腺样体与咽鼓管圆枕的毗邻关系,探讨其与分泌性中耳炎的相关性。方法144例腺样体肥大(或同时扁桃体肥大)70°鼻内镜下行等离子消融术患儿,术中观察并记录腺样体与咽鼓管圆枕的毗邻关系,并将其分为Ⅰ、Ⅱ、Ⅲ共3型;比较3组患儿分泌性中耳炎发病率、腺样体重度肥大(A/N比值是否大于0.7)的发生率并计算有无统计学差异。结果本组患儿分泌性中耳炎发病率23.6%;腺样体与咽鼓管圆枕的毗邻关系及合并分泌性中耳炎,Ⅰ型3例(9.1%,3/33)、Ⅱ型10例(16.9%,10/59)、Ⅲ型21例(40.4%,21/52),Ⅰ型与Ⅱ型分泌性中耳炎发生率无显著性差异(χ2=1.077,P=0.299),Ⅰ型与Ⅲ型有显著性差异(χ2=9.757,P=0.002),Ⅱ型与Ⅲ型有显著性差异(χ2=7.542,P=0.006);Ⅰ型和Ⅱ型组腺样体A/N>0.7之和为34.9%,三型组A/N>0.7为82.2%,Ⅰ型及Ⅱ型腺样体重度肥大率之和与Ⅲ型有显著性差异(χ2=30.556,P=0.000)。结论腺样体与咽鼓管圆枕毗邻关系及腺样体的肥大程度与分泌性中耳炎有显著相关性。

OBJECTIVE To explore the adjacent patterns between adenoid and Eustachian cushion in hypertrophic adenoid children and to study its relationship with otitis media with effusion(OME).METHODS A retrospective analysis was conducted in 144 cases of pediatric adenoidal hypertrophy(or concurrent tonsil hypertrophy) admitted for adenoid ablation under the 700 nasal endoscope.Children were divided into 3 groups(TypeⅠ,Ⅱ and Ⅲ) according to adjacent patterns between adenoid and Eustachian cushion.The incidence of OME,severe hypertrophy of adenoid(A/N>0.7)in different group were analyzed.RESULTS There were 34 children(23.6%) with OME,3(9.1%) in type Ⅰ,10(16.9%) in type Ⅱ and21(40.4%)in type Ⅲ.No significant difference was existed between the incidence of OME in type Ⅰ and Ⅱ.In contrast,significant difference were found in the incidence of OME between the type Ⅲ and type Ⅰ,Ⅱ.The incidence of severe adenoid hypertrophy was 34.9%in type I andⅡ children and 82.2%in type Ⅲ children(P<0.05).CONCLUSION Adjacent patterns between adenoid and Eustachian cushion,the degree of adenoid hypertrophy play an important role in the incidence of OME.