Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy

Objective: Clinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy. Material and Methods: In a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss. Results: The study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB. Conclusion: An objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.

Meta-analysis on the treatment of adenoid hypertrophy in children with integrated traditional Chinese and western medicine

Objective: To evaluate the effect of combined Chinese and western medicine on children withadenoidal hypertrophy. Methods: System comprehensive retrieve hownet (CNKI), a database of ten thousand China (WanFang), Chinese biomedical database (CBM), weipu database (VIP), PubMed, Embase and Cochrane library database, retrieval time from March 1, 2009 to December 31, 2019, the use of "Cochrane bias risk assessment tools to have included in the quality of literature evaluation, and to use the literature on into RevMan 5.3 software for Meta quantitative analysis. A total of 10 references were included in this study, and a total of 464 clinical cases were included in the total sample size for meta-analysis, including 242 in the experimental group and 222 in the control group. Results: The statistical data show that the total effective rate of combined traditional Chinese and western medicine for the treatment of adenoid hypertrophy in children is higher than that of western medicine alone (OR = 4.27, 95% CI: 2.50, 7.13, P <0.00001) The effect of nasal congestion caused by adenoid hypertrophy in children is better than that of western medicine alone (MD =-0.64, 95% CI [-0.94, -0.35], P <0.0001);the effect of improving snoring symptoms in children Better than using western medicine alone, the difference is statistically significant (MD =-0.66, 95% CI [-1.11, -0.21], P <0.01);the effect of reducing the relative ratio of adenoid and posterior nostril is better than that of pure The difference was statistically significant when treated with Chinese or Western medicine (MD =-0.18, 95% CI [-0.24, -0.12], P <0.00001). Conclusion: Based on the existing data and methods, traditional Chinese medicine combined with western medicine has a reliable effect on adenoid hypertrophy in children. It is superior to western medicine alone in terms of treatment efficiency and improvement of clinical symptoms, without serious adverse reactions.

Assessment of Intranasal Steroid ,Effect in Management of Adenoid Hypertrophy in Children between 2-11 Years Old

Adenoid hypertrophy associated with high morbidity in children. However, in severe cases surgery recommended, some medical treatments are effective too. This study is based on effect of nasal steroid spray, mometasone, in decreasing upper airway obstruction and other symptoms of adenoid hypertrophy. In a clinical trial study 51 children with adenoid hypertrophy divided in two groups： 2-4 years old and 5-11 years old. Each patient receive nasal momethasone （one puff each nostril twice a day） for 3 months and their symptoms evaluated before treatment, 3 months after treatment initiation and 3 months after stop it with questionnaire and lateral neck radiography. Decreasing in all symptoms score and upper airway obstruction was statistically significant in both groups 3 months after treatment and its effect maybe stable for next 3 months. Nasal momethasone spray is effective in decreasing adenoid size and severity of symptoms of adenoid hypertrophy and this response is more obvious in 2-4 years old children.

儿童腺样体肥大中医临床实践指南

检索儿童腺样体肥大相关文献,形成专家问卷,依据中华中医药学会团体标准编写规则,通过3轮德尔菲法专家问卷调查及专家论证会进行意见整理及总结分析,在此基础上完成同行征求意见、质量评价及适用性评价,最终形成《儿童腺样体肥大中医临床实践指南》。此次制定明确指南适用范围、规范性引用文件、术语和定义、诊断、辨证、治疗、预防和调护,以期为儿童腺样体肥大中医临床实践、诊疗规范等提供重要参考。

Assessment of the intraoperative wound degree as well as postoperative immune function and ventilation function of plasma radiofrequency ablation for the treatment of adenoid hypertrophy

Objective:To study the intraoperative wound degree as well as postoperative immune function and ventilation function of plasma radiofrequency ablation for the treatment of adenoid hypertrophy.Methods: A total of 118 children with adenoid hypertrophy who underwent surgical treatment in our hospital between May 2013 and April 2016 were selected and divided into the control group (n=59) who accepted conventional endoscopic cutting aspirator and the observation group (n=59) who accepted the plasma radiofrequency ablation according to the single-blind randomized controlled method. Before and after operation, the levels of peripheral blood trauma-related indexes, humoral immunity and complement indexes as well as nasal ventilation function indexes were determined.Results:Before operation, the differences in trauma-related indexes, humoral immunity and complement indexes as well as nasal ventilation function indexes were not statistically significant between two groups of children. Immediately after operation, the peripheral blood SP, PGE2 and CRP contents of observation group were lower than those of control group;24 h after operation, peripheral blood IgG, IgM, IgA, C3 and C4 contents of observation group were lower than those of control group;1 week after operation, TIR and TER levels of observation group were lower than those of control group while NPV and MCSA levels were higher than those of control group.Conclusion:Plasma radiofrequency ablation for treatment of adenoid hypertrophy causes smaller intraoperative wound and has more advantages in optimizing the body's immune function and ventilation function.

推拿联合中药治疗儿童腺样体肥大临床疗效观察

目的 观察推拿联合中药治疗儿童腺样体肥大的临床疗效。方法 将符合纳入标准的90例患儿随机分为西药对照组(糠酸莫米松鼻喷剂喷鼻)、中药治疗组(内服自拟化痰散结方)和综合治疗组(内服自拟化痰散结方联合小儿推拿),每组各30例。3组患儿均连续治疗1个月,观察3组患儿治疗后的总有效率、治疗前后中医主次症状积分以及鼻咽部X线侧位片腺样体厚度/鼻咽腔宽度(A/N)值的变化情况。结果 综合治疗组总有效率为96.43%,明显高于中药治疗组(79.31%)和西药对照组(50.00%),差异有统计学意义(P<0.05)。治疗后,3组患儿主次症状(除腺样体面容外)积分、A/N值均明显低于本组治疗前(P<0.05),且综合治疗组明显低于中药治疗组和西药对照组(P<0.05)。结论 推拿联合中药治疗儿童腺样体肥大,可提高疗效,明显改善患儿临床症状,缩小腺样体体积,同时接受度及安全性高,值得临床推广与应用。

海派中医特色优势病种儿童腺样体肥大中医临床诊疗专家共识

腺样体是具有免疫作用的位于鼻咽顶和后壁交界处的淋巴组织团块,其随着年龄的增长而逐渐萎缩[1],腺样体肥大是指由于各种因素刺激腺样体淋巴组织而产生的病理性增生;对于该病的治疗中医优势较为明显,海派儿科根据多年临床实践经验在本病的治疗中提出“运脾治鼻”理念[2-4],并在临床以及机制研究中得到验证,但是目前尚缺乏基于流派经验的专家共识,本研究以龙华医院海派“徐氏儿科流派”学术思想为基础,结合文献研究结果制定儿童腺样体肥大中医诊疗专家共识。

叶伟成教授运用徐氏儿科健脾化痰散结理论治疗小儿腺样体肥大

儿童腺样体肥大的临床发病率逐年增多,目前临床上首选手术治疗,但手术后容易复发且常并发腺样体面容、分泌性中耳炎,严重者会引起儿童阻塞性睡眠呼吸暂停低通气综合征等并发症,久之会严重影响儿童的生长发育、身心健康和生活质量。叶伟成教授运用徐氏儿科健脾化痰散结法治疗腺样体肥大,运用二陈汤健脾化痰,加用夏枯草等散结药物,临床疗效显著。

基于“痰湿”理论探析小儿推拿结合中药治疗腺样体肥大

腺样体肥大是儿童生长发育过程的临床常见病,属于中医“痰核”“鼻痹”“积结”等范畴,现代PAH患儿多具有湿邪为患、久聚成痰的证候特点,文章从“痰湿”角度探析小儿推拿结合中药治疗,认为其总属标实本虚,气虚为发病基础,痰湿为病理因素,病性为本虚标实,病位涉及肺脾肝肾,病机总属素体气虚、痰湿内盛,外界六淫的湿邪和内生痰湿的演变贯穿腺样体肥大发生发展的全部过程,将小儿推拿手法和中药配合得体,圆机活法,用之有效,并附有验案一则,为临床治疗思路提供参考。

头颅侧位片和鼻内镜检查诊断儿童腺样体肥大的价值观察

目的观察头颅侧位片和鼻内镜检查在儿童腺样体肥大中的诊断价值。方法选取我院2022年1月~9月因腺样体肥大原因就诊的14岁以下患儿共116例,均行头颅侧位片及鼻内镜检查,将两种检查的结果进行比较,绘制A/N值的受试者工作特征曲线(ROC曲线)进行分析。结果两组检查的结果差异无统计学意义,ROC曲线提示头颅侧位片A/N值对儿童腺样体肥大有较高的诊断价值。结论头颅侧位片和鼻内镜检查结果较一致,头颅侧位片可以成为儿童腺样体肥大诊断的筛查工具。

无锡地区腺样体肥大儿童的过敏原分布及临床意义分析

目的研究腺样体肥大儿童的过敏原分布及其临床意义。方法回顾性分析2021年1月至2022年10月无锡市第二人民医院耳鼻喉科收治的223例腺样体肥大儿童的过敏原检测结果,并设不伴腺样体肥大的儿童43例作为对照组,对结果进行比较。结果腺样体肥大组总过敏原阳性率为54.7%,对照组总过敏原阳性率为27.9%,两组差异有统计学意义(P<0.05)。腺样体肥大组中吸入性过敏原阳性率为41.3%,以户/粉尘螨、霉菌为主;食入性过敏原阳性率为32.3%,以牛奶、鸡蛋白为主。腺样体肥大组按年龄分组,2~7岁组总过敏原阳性率为54.0%;8~14岁组总过敏原阳性率为55.7%,两者差异无统计学意义(P>0.05)。结论过敏原刺激是腺样体肥大发生的病因之一,户/粉尘螨、霉菌、牛奶、鸡蛋白是无锡地区腺样体肥大儿童的常见过敏原。并且过敏原刺激对腺样体肥大的影响并不随着年龄增长而呈下降趋势。因此,进行血清过敏原检测,可以了解患儿的特异性过敏原,对腺样体肥大儿童的非手术治疗提供方向。

两种切除术对扁桃体肥大伴腺样体肥大患儿围术期指标及并发症的影响

目的探讨两种切除术对扁桃体肥大伴腺样体肥大患儿围术期指标及并发症的影响。方法选取阜宁县人民医院于2018年1月—2020年12月收治的90例扁桃体-腺样体肥大患儿为研究对象,以随机数表法分为两组,对照组(n=45)采用传统术式切除,观察组(n=45)则以等离子切除,比较两组围术期指标、疼痛评分、通气功能、并发症发生率。结果观察组手术时间(43.81±6.20)min、出血量(18.91±4.45)mL、切口愈合时间(4.33±1.28)d、住院时间(6.27±1.05)d,均优于对照组,差异有统计学意义(t=12.102、14.922、8.021、5.644,P均<0.05)。观察组术后各时刻疼痛评分均低于对照组,且术后氧减指数、呼吸紊乱指数及呼吸暂停时间均优于对照组,并发症总发生率低于对照组,差异有统计学意义(P均<0.05)。结论对扁桃体-腺样体肥大患儿以等离子切除术治疗能改善围术期指标,术后疼痛轻且通气功能改善好,并发症发生率低。

清咽散瘀汤治疗肺胃瘀热型小儿腺样体肥大临床观察

目的探讨自拟清咽散瘀汤每治疗肺胃瘀热型小儿腺样体肥大的临床效果。方法选取肺胃瘀热型小儿腺样体肥大患儿64例,随机分为对照组与观察组,每组32例。对照组常规西医用药,观察组自拟清咽散瘀汤治疗,2组连续治疗1个月,评价患儿症状、炎症指标变化以及临床效果。结果2组治疗后中医证候积分评分比较,观察组低于对照组,差异有统计学意义(P<0.05);观察组治疗后炎症指标WBC、CRP、PCT均低于对照组(P<0.05);2组总有效率比较,观察组高于对照组,差异有统计学意义(P<0.05)。结论自拟清咽散瘀汤从肺胃瘀热型证型特点着手,发挥清热解毒、活血化瘀、消肿散结的功效,标本兼治,快速改善临床症状,调控机体炎症状态,效果显著,值得推广。

瑞芬太尼在扁桃体腺体肥大患儿围术期的麻醉效果与安全性

目的比较瑞芬太尼与艾司氯胺酮应用于扁桃体腺体肥大患儿围术期的麻醉效果与安全性。方法80例扁桃体腺体肥大患儿随机分为两组。对照组使用艾司氯胺酮与丙泊酚进行麻醉维持,观察组使用瑞芬太尼与丙泊酚进行麻醉维持。比较两组的麻醉效果、麻醉恢复时间以及不良反应。结果观察组的麻醉总有效率明显高于对照组,麻醉后拔管时间、麻醉后睁眼时间、复苏室停留时间均明显短于对照组,不良反应总发生率明显低于对照组(P<0.05)。结论瑞芬太尼配合丙泊酚应用于扁桃体腺体肥大患儿可强化术中麻醉效果,缩短苏醒时间与拔管时间,降低术后不良反应风险.

微创等离子消融术在扁桃体腺样体肥大患者治疗中的应用及对其免疫能力及氧化应激水平的影响

目的探讨微创等离子消融术在扁桃体腺样体肥大患者治疗中的应用效果及对其免疫能力及氧化应激水平的影响。方法将100例扁桃体腺样体肥大患者随机分为两组各50例。对照组行扁桃体剥离术治疗,观察组行微创等离子消融术治疗。比较两组免疫功能、氧化应激指标与并发症风险。结果术后1个月,观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P<0.05)。术后,观察组SOD高于对照组,MDA低于对照组(P<0.05)。观察组并发症发生率低于对照组(P<0.05)。结论微创等离子消融术在扁桃体腺样体肥大患者治疗中的应用效果较好,可加快患者术后免疫功能恢复,降低氧化应激风险和并发症发生率。

腺样体肥大患儿腺样体组织中半胱氨酰白三烯受体1的表达及其影响因素

目的分析半胱氨酰白三烯受体1(CysLTR1)在腺样体肥大(adenoid hypertrophy,AH)患儿腺样体组织中的表达特点,探究CysLTR1在AH形成中的作用机制及CysLTR1表达的影响因素。方法选取2020年10月1日—2021年10月1日在威海市立医院耳鼻咽喉科行腺样体切除术患儿71例,对其切除标本行CysLTR1免疫组化染色,根据染色结果分为CysLTR1高表达组及低表达组。收集两组患儿性别、年龄、腺样体肥大程度、有无变应性鼻炎、有无其他合并症(分泌性中耳炎、慢性鼻窦炎、呼吸睡眠暂停综合征)等资料并进行比较,通过多因素logistic回归分析影响AH患儿CysLTR1表达的危险因素。结果免疫组化染色结果显示,CysLTR1在71例AH患儿腺样体组织中均有表达,高表达组患儿的腺样体肥大程度、有无变应性鼻炎及有无其他合并症与低表达组相比差异有显著性(χ^(2)=9.003~49.196,P<0.05)。多因素logistic回归分析显示,重度腺样体肥大、变应性鼻炎以及有其他合并症均为影响AH患儿CysLTR1表达的独立危险因素(P<0.05)。结论CysLTR1在AH患儿腺样体组织中表达与腺样体肥大程度、有无变应性鼻炎及其他合并症相关,且上述3指标为CysLTR1高表达的独立危险因素。

儿童/青少年口呼吸与口腔微生态的研究进展

口呼吸作为儿童/青少年生长发育期常见的问题,一直为正畸医师所关注。长时间持续慢性的口呼吸会引起儿童/青少年牙颌面部矢状向、横向和垂直向生长发育异常,还会出现肌功能的不良变化包括咬、颊、舌肌肌力下降等,严重者可诱发全身系统性疾病。随着2007年人类微生物组计划的启动,人们开始关注口腔微生物组改变同疾病发生发展间的相互关联。本文就儿童/青少年时期口呼吸、口腔微生态,及其相关性研究作一综述。

常克教授基于痰、湿、瘀理论以经方论治儿童腺样体肥大经验

仲景经典医著《伤寒论》和《金匮要略》在儿科有着广泛的应用与实践,通过总结常克教授的临床经验,探索仲景经方治疗儿童腺样体肥大的治疗思路,系统整理儿童腺样体肥大的证治规律,开拓儿童腺样体肥大的治疗。

青少年儿童腺样体肥大的影像学测量诊断与正畸治疗的相关性

腺样体肥大是青少年儿童时期的常见病,长期不愈可致患儿出现上颌骨狭窄、下颌骨变长、腭盖高拱、开唇露齿、缺乏表情等典型的“腺样体面容”。腺样体肥大程度与正畸治疗效果息息相关,同时也是儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)最常见的原因之一,因此临床上对腺样体肥大患者的诊断具有重要价值。正畸医生可利用影像学图像中的不同参数指标进行分析,做出诊断,最后评估矫治的可行性并制定矫治计划。本文主要对腺样体肥大的影像学测量方法及诊断进行综述总结,为正畸临床治疗提供参考。

加减疏风清热汤在扁桃体伴腺样体肥大切除术中的应用

目的探讨加减疏风清热汤在扁桃体伴腺样体肥大切除术中的应用效果。方法选取2019—2022年在该院行扁桃体及腺样体切除术患儿为研究对象,以随机数字表法分为两组,各51例。对照组予以西药头孢唑啉钠治疗,研究组采用加减疏风清热汤治疗。对比两组的疗效、免疫功能、中医证候评分、血清因子水平及并发症发生情况。结果研究组的临床疗效、免疫功能、血清因子水平显优于对照组(P<0.05);而研究组的炎症水平、中医证候评分及并发症发生率显著低于对照组(P<0.05)。结论加减疏风清热汤应用于儿童肺脾气虚型低温等离子切除扁桃体伴腺样体肥大的治疗中,效果极佳,能增强免疫功能,抑制抗炎,改善中医证候积分及血清因子水平,并发症少,值得推广。