腺样体肥大儿童的中耳功能评估  

The Functions of the Middle Ears of Children with Adenoid Hypertrophy

作　　者：王武庆[1] 张毅博[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200031

出　　处：《听力学及言语疾病杂志》2010年第2期135-137,共3页Journal of Audiology and Speech Pathology

摘　　要：目的探讨腺样体肥大对儿童中耳功能的影响。方法回顾性分析272例（544耳）腺样体肥大患儿的临床资料，患儿年龄2～12岁，平均6．3岁，分为主诉无听力下降组（A组）94例（188耳）和主诉有听力下降组（B组）178例（356耳），均于腺样体摘除术前行鼓膜镜、声导抗和中耳CT检查。结果CT显示272例（544耳）中有鼓室积液209例（396耳）（72．79％，396／544），其中，A组37例（65耳），占34．57％（65／188），B组172例（331耳），占92．98％（331／356），以上均经手术证实鼓室有积液；两组中B型鼓室导抗图377耳，其中，经CT及手术证实鼓室有积液的共373耳（98．94％，373／377），其中A组61耳（93．85％，61／65），B组312耳（100％，312／312），B组B型鼓室图对中耳积液的阳性预测值高于A组（P〈0．01）；C型鼓室导抗图73耳中，峰压值小于-200daPa的14耳及镫骨肌反射未引出的51耳中23耳经CT及手术证实鼓室有积液，镫骨肌反射可引出的22耳鼓室均无积液。CT发现B组有2例（4耳）前庭水管扩大和1例（2耳）耳蜗畸形。结论对于腺样体肥大儿童．B型鼓事导抗图对中耳积液的预测值高，C型鼓室导抗图峰压值负于-200daPa不排除鼓室积液，应以CT作最终确认。Objective To explore the influence of adenoid hypertrophy on the state of the middle ear in children. Methods Two hundred and seventy two adenoid hypertrophy patients, aged from 2 to 12 years old, were examined with otoscopy, tympanometry and temporal bone computered tomography before adenoidectomy. The average age of the patients was 6. 3 years old. These patients were divided into two groups：Group A contained 94 normal hearing patients（ 188 ears） ,GroupB178 patients（356 ears） containing of hearing loss. Results Out of the temporal bone computed tomography （CT） revealed that 209 patients（396 ears） had middle ear effusions in（72.79%, 396/544 ears）, and 37 patients（65/188 ears,34.57%） hydrotympanum in Group A and 172 patients（331/356 ears,92.98%） in Group B. All the 396 ears effusion were confirmed by operation. Three hundred seventy three ears effusion were confirmed by the CT and operation in the two groups,377 ears with B type tympanogram（373/377,98.94%）, 93.85%（61/65 ears ） in Group A, 100% （312/312 ears） in Group B, respectively. The positive predictive value for middle ear effusion of the B--type tympanogram was higher in Group B than in Group A（P〈0.01）. Fourteen ears with peak pressure 〈- 200 daPa revealed hydrotympanum and 23 ears with normal acoustic stapedius reflex revealed no fluid by CT and operation in 73 ears with C-type tympanogram. CT also revealed two patients suffered from large vestibular aqueduct syndrome and one with cochlear malformation in Group B. Conclusion Type B tracing tympanogram has a high positive predictive value for middle ear effusion in adenoid hypertrophy children. Type C tympanogram could not exclude effusion when the peak pressure is 〈-200 daPa. CT is the best tool for identifying hydrotympanum.

关 键 词：腺样体 中耳炎 声导抗 计算机体层摄影 

分 类 号：R764.04[医药卫生—耳鼻咽喉科]