自动咽鼓管吹张对儿童分泌性中耳炎预后的影响

Effect of autoflation on the prognosis of otitis media with effusion in children

目的探讨自动咽鼓管吹张治疗儿童分泌性中耳炎(OME)的效果。方法收集2019年1月至2020年1月在上海交通大学医学院附属新华医院耳鼻咽喉头颈外科确诊的OME患儿325例(486耳),男177例,女148例,年龄3~8岁,病程25~86 d。根据患儿在随访期间除观察等待外,是否使用自动咽鼓管吹张器将其分为两组,其中自动咽鼓管吹张组142例(215耳),观察等待组183例(271耳)。对随访3个月内两组患儿的平均听阈、鼓室图曲线变化进行分析,并在随访3个月后评估两组OME的痊愈情况。使用SPSS 23.0软件进行统计学分析。结果随访1个月和2个月时,自动咽鼓管吹张组听阈显著低于观察等待组,差异有统计学意义(t=2.1395和2.6806,P值均<0.05);随访3个月时,两组间听阈差异无统计学意义(t=1.1585,P>0.05)。随访1、2、3个月时,观察等待组听阈<20 dB HL的患耳分别为89耳(33%,89/271)、200耳(74%,200/271)和220耳(81%,220/271);自动咽鼓管吹张组<20 dB HL的患耳分别为176耳(82%,176/215)、178耳(83%,178/215)和183耳(85%,183/215)。随访1个月、2个月时,观察等待组听阈<20 dB HL的耳数明显少于自动咽鼓管吹张组,差异有统计学意义(P值均<0.05),而在随访3个月时两组差异无统计学意义(P>0.05)。随访1、2、3个月时,自动咽鼓管吹张组患儿鼓室图A型比例分别为74%(159/215)、79%(170/215)和85%(183/215),观察等待组鼓室图A型比例分别为36%(98/271)、71%(192/271)和76%(206/271),自动咽鼓管吹张组鼓室图A型曲线比例均明显高于观察等待组,差异有统计学意义(P值均<0.05)。随访3个月后,观察等待组的痊愈率为74%(201/271),自动咽鼓管吹张组的痊愈率为83%(178/215),自动咽鼓管吹张组的痊愈率显著高于观察等待组,差异有统计学意义(P<0.05)。结论自动咽鼓管吹张可以早期提高OME患儿的听力、恢复正常中耳压力,提高随访3个月后的痊愈率,减少手术的几率。

Objective To investigate the effect of autoinflation on the prognosis of OME in children.Methods Total of 325 pediatric patients,age ranged from 3 to 8 years,with OME(486 ears)diagnosed in our department from January 2019 to January 2020 were collected.Among them,177 were males,148 were females.Disease course ranged from 25 to 86 days.According to watchful waiting and autoinflation application during follow-up,these children were divided into two groups including 183 cases(271 ears)and 142 cases(215 ears),respectively.The average auditory threshold and tympanogram curve type in two groups were analyzed in the period of 3 months follow-up,and the recovery of OME was evaluated.Results At the end of 1-and 2-month follow-up,the auditory threshold of patients in autoinflation group was significantly lower than that in watchful waiting group(t=2.1395 and 2.6806,P<0.05).However,at the end of 3-month follow-up,there was no significant difference between two groups(t=1.1585,P>0.05).At the end of 1-,2-and 3-month follow-up,89(33%,89/271),200(74%,200/271),220(81%,220/271)and 176(82%,176/215),178(83%,178/215),183(85%,183/215)ears in watchful waiting group and autoinflation group had a hearing threshold<20 dB HL,respectively,in which ears with auditory threshold<20 dB HL in watchful waiting group were significantly less than those in autoinflation group at the end of 1 and 2 month follow-up(P<0.05),However,ears with auditory threshold<20 dB HL in watchful waiting group were not significantly different from that in the autoflation group at the end of 3-month follow-up(P>0.05).The proportion of ears with type A tympanogram curve was 74%(159/215),79%(170/215),and 85%(183/215)at the end of 1-,2-and 3-month follow-up in autoinflation group and 36%(98/271),71%(192/271)and 76%(206/271)in watchful waiting group,respectively.Proportion of ears with type A tympanogram curve in autoflation group was significantly higher than that in watchful waiting group(P<0.05).Conclusion Autoinflation can improve the hearing of children with OME in early stage,restore normal middle ear pressure,increase recovery rate,and reduce the choice of surgical treatment of OME.