鼓室置管对婴儿期腭裂患者中耳功能障碍的治疗效果  

Early treatment of middle ear disease in cleft palate infants

作　　者：李薇[1] 尚伟[2] 于爱华[1] 张哓恒[1] 刘玉欣[3] 万秀明[1] 贾暮云 李宁毅[2] 

机构地区：[1]青岛大学医学院附属医院耳鼻咽喉科,山东青岛266003 [2]青岛大学医学院口腔颌面外科,山东青岛266003 [3]青岛市妇女儿童医疗保健中心耳鼻咽喉科,山东青岛266011

出　　处：《华西口腔医学杂志》2007年第5期458-462,共5页West China Journal of Stomatology

基　　金：人事部留学回国人员启动基金资助项目(2001-119);青岛市科技发展指导计划基金资助项目(2000-01-43)

摘　　要：目的比较鼓室置管和鼓膜穿刺术治疗婴儿期腭裂患儿分泌性中耳炎(SOM)的效果,探讨腭裂中耳功能障碍的最佳治疗方法和早期干预时机。方法19例患SOM伴听力损失的婴儿期腭裂患儿的38耳在唇裂修复术同期行鼓室置管术,平均置管年龄为6.9月龄;15例患SOM的婴儿期腭裂患儿30耳行鼓膜穿刺术,平均穿刺年龄为6.6月龄。术后1周至12个月内于每个月行听性脑干反应(ABR)和声导抗检查作为判断指标,比较两种手术的疗效。结果38耳鼓室置管术前ABRⅤ波平均阈值为55.41dBnHL,术后1周～12个月的平均值为28.48dBnHL,术后听力提高26.93dBnHL。置管术后峰压点平均升高90.72daPa,坡度:比值法升高0.01,压力范围法降低84.00daPa,静态声顺值平均升高0.04mL;B型鼓室图(24耳)转化为A型者19耳,转化率为79.17%。30耳鼓膜穿刺术前ABRⅤ波平均阈值为40.63dBnHL,术后1周为26.50dBnHL,听力提高14.13dBnHL。穿刺后1周B型鼓室图(22耳)转化为A型者9耳,转化率为40.91%;穿刺后1月和3月ABRⅤ波阈值和鼓室图与穿刺术前比较无统计学差异(P>0.05)。结论鼓室置管术治疗婴儿期SOM,听力恢复快且疗效稳定,虽有发生并发症的可能,但仍是较好的治疗手段;鼓膜穿刺术在1周内的疗效较好,但复发率高,最好不作为婴儿期腭裂SOM的常规治疗手段。Objective To explore the effect of myringotomy with insertion of tube and tympanocentesis on alleviating secretory otitis media CSOM） and hearing loss in cleft palate infants. Methods Nineteen cleft lip and palate infants with SOM and hearing loss （38 ears） were treated with myringotomy with insertion of ventilation tube at the same time of repair of the cleft lip, who were performed averagely at 6.9 months of age. Fifteen cleft lip and palate infants with SOM （30 ears） were treated with tympanocentesis at the same time of repair of the cleft lip averagely at 6.6 months of age. All cases were followed up from 1 week to 12 months and estimated by auditory brainstem response （ABR） and acoustic immitance audiometry. Results The average wave V reacting thresholds of ABR were separately 55.41 dBnHL and 28.48 dBnHL, and 79.17% tympanogram B changed to tympanogram A in cleft palate infants with insertion of tube before and after operation. The average wave V reacting thresholds of ABR were separately 40.63 dBnHL and 26.50 dBnHL, and 40.91% tympanogram B changed to tympanogram A in cleft palate infants with tympanocentesis preoperatively and in 1 week postoperatively, in whom the average hearing thresholds and tympanograms had no significant difference preoperatively and in 1 or 3 months postoperatively （P〉0.05）. Conclusion The early myringotomy with insertion of tube is effective to restore the function of the middle ear in cleft palate infants with SOM, so to suggest to be performed at the same time of the repair of cleft lip within the first 1-year of life. The tympanocentesis should not be used as a regular management in the cleft palate infants with SOM.

关 键 词：婴儿 腭裂 分泌性中耳炎 鼓室置管 鼓膜穿刺 

分 类 号：R782.2[医药卫生—口腔医学]