儿童期腭裂合并分泌性中耳炎的临床特点及手术治疗效果观察

Clinical characteristics and surgical treatment of cleft palate with secretory otitis media in children

目的探讨儿童期腭裂合并分泌性中耳炎的的临床特征,腭裂修复后行等离子鼓膜打孔治疗分泌性中耳炎的临床效果。方法选择2014年12月至2016年12月上海交通大学医学院附属上海儿童医学中心收治的70例腭裂合并分泌性中耳炎患儿作为研究对象进行前瞻性研究,53例(共106耳)为双侧中耳积液,17例(共17耳)为单侧中耳积液。经改良兰氏法修复腭裂,修复腭裂后用等离子鼓膜打孔治疗分泌性中耳炎,术后对患者进行语言训练。比较术后语音清晰度、V波反应阈值和听力损失情况。结果 57.14%患儿鼓室中的积液为黏稠的积液,42.86%患儿鼓室中的积液为稀薄的积液;治疗后的语音清晰度显著地高于治疗前(P<0.05);术后的V波反应阈值显著低于术前,术后的听力损失情况显著好于术前(P<0.05)。结论儿童期腭裂合并分泌性中耳炎的患儿的鼓室中的积液多为黏稠状,采用改良兰氏修复法和术后语言训练可以治疗腭裂和腭裂语音,采用等离子鼓膜打孔技术则可以有效地治疗分泌性中耳炎。

Objective To explore the clinical characteristics of cleft palate with secretory otitis media in children,and the effect of cleft palate repair and myringotomy for treatment of ion.Methods 70 cases of cleft palate combined with secretory otitis media in children from December 2014 to December 2016 in Shanghai Children's Medical Center of Shanghai Jiaotong University School of Medicine were enrolled in this prospective study,including 53 patients(106 ears)bilateral middle ear effusion,17 cases(17 ears)with middle ear effusion.Cleft palate was repaired with modified Lan's method,patients with cleft palate were treated with plasma tympanic membrane drilling for secretory otitis media,and language training was performed after the operation.The situation of speech intelligibility and V wave response threshold and hearing loss after operation were compared.Results There were 57.14%children with tympanic effusion of viscous fluid,42.86%thin effusion;after the treatment,speech intelligibility was significantly higher than before treatment(P<0.05).V wave response threshold after operation was significantly lower than preoperative and postoperative,hearing loss was significantly better than preoperative(P<0.05).Conclusion Most of children have thick tympanic cavity effusion fluid.The modified Langmuir repair method and postoperative can treat cleft palate and cleft palate speech,plasma myringotomy technology can effectively treat secretory otitis media.