成人分泌性中耳炎预后相关因素及临床疗效研究

Clinical researches of factors related to the prognosis and the therapeutic effect of adult secretory otitis media

目的分析成人分泌性中耳炎(OME)临床因素与预后的关系,找出影响成人OME治疗疗效的相关因素。方法收集291例(342耳)成人OME患者的基本资料,了解患者30 d内上呼吸道感染史、变应性疾病史、鼻及鼻窦疾病病史,评估患者咽鼓管功能。统计各临床因素与治疗有效率的相关性。比较上呼吸道感染是否合并咽鼓管功能不良与鼻及鼻窦疾病病史是否合并咽鼓管功能不良疗效的差异。结果①单因素分析显示,患者的性别(P=0.974)、单双侧发病情况(P=0.296)差异无统计学意义,与疾病疗效无明显相关性。而上呼吸道感染病史(P=0.049)与患者的疗效及预后呈正相关;鼻及鼻窦疾病病史(P=0.005)、咽鼓管功能状况(P=0.001)与患者的疗效及预后呈负相关,差异均有统计学意义。②多因素分析显示,上呼吸道感染病史(P=0.019,RR=1.692)、鼻及鼻窦疾病病史(P<0.001,RR=0.392)、咽鼓管功能不良(P<0.001,RR=0.248)仍与患者治疗疗效及预后相关。③鼻-鼻窦疾病病史合并咽鼓管功能不良治疗有效率明显降低(与鼻及鼻窦疾病病史且咽鼓管功能正常、上呼吸道感染合并或不合并咽鼓管功能不良相比,差异有统计学意义;慢性中耳炎发生率及鼓膜置管率明显升高,差异有统计学意义)。结论成人OME的危险因素为上呼吸道感染、鼻-鼻窦疾病、咽鼓管功能不良。鼻-鼻窦疾病合并咽鼓管功能不良是成人OME保守治疗效果欠佳的重要因素。

Objective To analyze the relationship between the clinical features and the prognosis of adult otitis media with effusion(OME),and to find out the related factors affecting the therapeutic effect of adult OME.Methods A total of 291 adult patients(342 ears)with OME were analyzed.The patients’basic data were collected including the patient’s history of upper respiratory tract infection,history of allergic disease,history of rhinosinusitis,and the eustachian tube function.The correlation between clinical factors and therapeutic effect was calculated.The therapeutic effect and the duration of OME were compared in upper respiratory tract infection patients combined with or without eustachian tube dysfunction and rhino-sinusitis patients combined with or without eustachian tube dysfunction.Results①Univariate analysis showed that the patient’s gender(P=0.974),single-or double-sided onset(P=0.296)had no significant correlation with the therapeutic effect.The history of upper respiratory tract infection(P=0.049)was positively correlated with the patient’s therapeutic effect and prognosis.The history of nasal and sinus disease(P=0.005)and the eustachian tube function(P=0.001)were negatively correlated with the patient’s e therapeutic effect and prognosis,both had statistical significance.②Multivariate analysis also showed that history of upper respiratory tract infection(P=0.019,RR=1.692),history of nasal and sinus disease(P<0.001,RR=0.392),eustachian tube obstruction(P<0.001,RR=0.248)were related to the therapeutic effect of OME.③The therapeutic effect of the patients with history of nasal and sinus disease combined with eustachian tube dysfunction was significantly reduced(compared with the patients with history of nasal and sinus diseases combined without eustachian tube dysfunction,the patients with upper respiratory tract infection combined with or without eustachian tube dysfunction P<0.05),the incidence of chronic otitis media and the tympanostomy rates were significantly increased(P<0.05).Conclusions The risk factors for adult otitis media with effusion are upper respiratory tract infection,nasal-sinus disease,and eustachian tube dysfunction;Nasal-sinus disease combined with eustachian tube dysfunction is an important factor related to the invalidity of conservative treatment of otitis media with effusion.