婴儿分泌性中耳炎临床干预策略探讨

The clinical intervention strategy study on 65 infants with secretory otitis media

目的分析婴儿分泌性中耳炎(SOM)影响因素,探讨婴儿SOM临床干预措施。方法对确诊为SOM的65例(112耳)婴儿进行跟踪随访,每3个月随访1次,共随访2次,随访时对每例患儿复查声导抗、瞬态诱发性耳声发射、听性脑干反应(ABR)、耳纤维内镜组合检查,分析其SOM病情的变化,且在随访时询问家长患儿是否有反复呛奶、反复上呼吸道感染及是否处于二手烟环境等影响因素。结果第1次随访时存在不同颜色鼓室积液耳转归为正常声导抗结果为:淡黄色积液、琥珀色积液、咖啡色积液转归分别为26、25、15耳,转归比分别为68.42%、59.52%、46.88%;第2次随访时存在不同颜色鼓室积液耳转归为正常声导抗结果为:淡黄色积液、琥珀色积液、咖啡色积液转归分别为10、9、7耳,转归比分别为83.33%、52.94%、41.18%。首次确诊时ABR阈值、第1次随访ABR阈值、第2次随访ABR阈值逐渐降低,两两之间具有差异且差异具有统计学意义(P<0.05)。随访病例中未痊愈的患儿与反复呛奶、反复上呼吸道感染及是否处于二手烟环境显著相关(P<0.05)。结论淡黄色积液型SOM转归为正常声导抗的几率最大,琥珀色次之,咖啡色最小;SOM有较强的自愈性,有效的预防上呼吸道感染及正确指导患儿家长喂养和生活环境管理有助于婴儿分泌中耳炎的康复。

OBJECTIVE To analyze the influencing factors and to explore the clinical intervention measures infant secretory otitis media(SOM).METHODS 65 infants(112 ears) diagnosed with SOM were followed up every 3 months for 6 months.During the follow-up,each patient was reexamined for the acoustic immitance,TEOAE,and hearing combined acoustic brainstem respone(ABR) and otofibroscope examination to analyze the changes of SOM syptoms,and asked parents whether the infants have repeated choking milk,repeated upper respiratory tract infections,and whether they are in a second-hand smoke environment during the follow-up.RESULTS At the first follow-up,the ears with different colors of tympanic effusion were converted to normal acoustic impedance.The results were:pale yellow effusion,amber effusion,and brown effusion were 26 ears,25 ears and 15 ears,respectively.The outcome ratios were 68.42%,59.52%,and 46.88%,respectively.At the second follow-up,there were different colors of tympanic effusion and the ears were converted to normal acoustic impedance.The results were:pale yellow effusion,amber effusion,brown effusion were 10 ears,9 ears and 7 ears,respectively,and the outcome ratios were 83.33%,52.94% and 41.18%,respectively.The ABR threshold at the first diagnosis,the ABR threshold at the first follow-up,and the ABR threshold at the second follow-up gradually decreased.There was a difference between the two pairs and the difference was statistically significant(P<0.05).The unhealed children in the follow-up cases were significantly associated with repeated choking milk,repeated upper respiratory tract infections and whether they were in a second-hand smoke environment (P<0.05).CONCLUSION The yellowish effusion-type SOM has the highest chance of returning to normal acoustic resistance,followed by amber,and the brown color;SOM has strong self-healing.Effective prevention of upper respiratory tract infection and correct guidance of Parents’ feeding and living environment management can help infants recover from otitis media.