不同听力损失儿童分泌性中耳炎治疗方法选择及疗效分析

Different treatment methods and efficacy analysis of otitis media with effusion in children with different hearing loss

目的:探讨分析不同听力损失儿童分泌性中耳炎(OME)的治疗方法及效果。方法:收集2020年1月—2021年12月浙江大学医学院附属儿童医院耳鼻咽喉头颈外科收治的OME患儿318例(556耳),根据不同听力损失程度及病史并结合鼓室内积液的性质选择不同治疗方法,分为保守治疗组:临界听力损失及轻度听力损失且病程<3个月;鼓膜切开组:轻度听力损失且病程≥3个月或者中度及重度听力损失且病程<3个月,鼓室积液为稀薄的浆液性液体;鼓膜置管组:轻度听力损失且病程≥3个月或者中度及重度听力损失且病程<3个月,鼓室积液为黏稠或者胶冻样的黏液性液体,以及中度及重度听力损失且病程≥3个月。95%的患儿同时合并腺样体肥大或同时合并扁桃体肥大诊断符合阻塞性睡眠呼吸暂停(OSA),同时予鼻内镜下腺样体切除术或者扁桃体伴腺样体切除术。比较不同治疗组的疗效及复发情况。结果:保守治疗组及鼓膜切开组术后1个月、3个月、6个月随诊,鼓膜置管组术后每3个月随诊,平均1年取管,取管后1个月、3个月、6个月随诊。保守治疗组、鼓膜切开组、鼓膜置管组3组治疗有效率分别为95.6%、89.6%、90.9%,分别复发6、4、5耳,差异无统计学意义。术后遗留鼓膜穿孔者4耳,其中鼓膜置管组3耳,鼓膜切开组1耳。多因素logistic回归分析发现,合并变应性鼻炎(OR=0.073,95%CI:0.013~0.401,P=0.003)是影响OME治疗效果的因素。结论:儿童OME治疗不仅要结合病史时间,还要结合不同听力损失程度及鼓室内积液的性质选择不同的手术方案,可以得到同样效果,并且复发率低,创伤小,安全性好。变应性鼻炎是导致OME治疗效果不佳的因素。

Objective:To explore and analyze the treatment methods and effects of otitis media with effusion in children with different hearing loss.Methods:Clinical data of 318 children(556 ears)with otitis media with effusion(OME)admitted to Department of Otorhinolaryngology Head and Neck Surgery,Children Hospital Affiliated to Zhejiang University of Medicine from January 2020 to December 2021 were collected.Different treatment methods were selected according to the degree of hearing loss,combined with course of disease and the characteristics of effusion in tympanic cavity.They were divided into drug treatment group:critical hearing loss and mild hearing loss,and the course of disease was less than 3 months;myringotomy group:mild hearing loss and course of disease≥3 months or moderate and severe hearing loss and course of disease<3 months,tympanic effusion was rarefied liquid;tympanostomy tube insertion group:mild hearing loss and course of disease≥3 months,or moderate and severe hearing loss group and course of disease<3 months,tympanic effusion is sticky or jelly liquid,and moderate and severe hearing loss group and course of disease≥3 months.95%of children with adenoid hypertrophy or tonsillar hypertrophy and adenoid hypertrophy were diagnosed as obstructive sleep apnea hypopnea syndrome(OSA)and underwent endoscopic adenoidectomy or tonsillectomy and adenoidectomy.The curative effect and recurrence of different treatment groups were compared.Results:The drug treatment group and myringotomy group were followed up in 1,3 and 6 monthes after operation.The tympanostomy tube insertion was followed up every three months after operation,with an average of one year.The patients were followed up in 1,3 and 6 monthes after taking the tube off.The effective rates of drug treatment group,myringotomy group and tympanostomy tube insertion group were 95.6%,89.6%and 90.9%respectively.The three groups recurred in 6,4 and 5 ears respectively,and the difference was not statistically significant.Tympanic membrane perforation was left in 4 ears,3 ears in tympanic tube group and 1 ear in myringotomy group.Multivariate Logistic regression analysis showed that allergic rhinitis(OR=0.073,95%CI:0.013-0.401,P=0.003)was the factor influencing the therapeutic effect of OME.Conclusion:the treatment of OME in children should not only be combined with course of disease,but also combined with different hearing loss and the characteristics of effusion in tympanic cavity.Different treatment methods can get the same effect,with low recurrence rate,small damage and satisfactory safety.Allergic rhinitis affects the therapeutic effect of OME.