儿童分泌性中耳炎诊断方法比较  

Comparison of Diagnostic Methods of Secretory Otitis Media in Children

作　　者：康一 施俊 柴永川 朱伟栋[1,2] 杨洁 汪照炎[1,2] 吴皓[1,2] 

机构地区：[1]上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科,上海200011 [2]上海交通大学医学院耳科学研究所,上海耳鼻疾病转化医学重点实验室

出　　处：《听力学及言语疾病杂志》2017年第6期603-606,共4页Journal of Audiology and Speech Pathology

摘　　要：目的探讨耳内镜、颞骨高分辨率CT、鼓室声导抗及纯音测听等检查对儿童分泌性中耳炎(secretory otitis media,SOM)的诊断价值。方法对207例(414耳)腺样体肥大患儿分别行耳内镜、鼓室声导抗、纯音测听及颞骨高分辨率CT检查,以颞骨CT检查结果作为分泌性中耳炎的诊断标准,分别计算耳内镜、声导抗及纯音测听诊断分泌性中耳炎的准确度。结果 207例414耳中,CT诊断SOM(中耳积液)125耳(30.19%,125/414),其中116耳(92.80%,116/125)鼓膜穿刺证实有中耳积液;与颞骨CT结果比较,耳内镜(诊断中耳积液128耳,其中CT检查阴性4耳)、鼓室声导抗(B型导抗图133耳,其中CT检查阴性8耳)、纯音测听(0.5~4kHz气骨导差≥15dB 81耳,其中CT检查阴性2耳)三种检查诊断SOM的敏感性分别为99.20%(124/125)、100%(125/125)、63.20%(79/125),特异性分别为98.62%(285/289)、97.23%(281/289)、99.31%(287/289),诊断符合率分别为98.79%(409/414)、98.07%(406/414)、88.41%(366/414)。耳内镜下见鼓室积液联合B型鼓室导抗图诊断SOM的符合率(99.52%)高于任一种单项检查和其他任何两种联合检查。结论以耳内镜下见鼓室积液联合B型鼓室导抗图诊断分泌性中耳炎准确、安全。Objective To investigate the diagnostic value of endotoscopy,tympanometry,pure tone audiometry(PTA)and high resolution temporal bone CT in children with secretory otitis media(SOM).Methods The study comprised 414 ears in 207 children with adenoid hypertrophy.Endotoscopy,tympanometry,PTA and high resolution temporal bone CT were conducted to evaluate the function of middle ear.Based on the imaging findings of tympanic cavity fluid by high resolution temporal bone CT,the diagnostic accordance rate of endotoscopy,tympanograms and PTA for SOM were studied.Results The diagnostic accordance rate of endotoscopy,tympanometry and PTA for SOM were 98.79%(409/414),98.07%(406/414)and 88.41%(366/414),respectively.The sensitivity of the three examinations were 99.20%(124/125),100%(125/125),63.20%(79/125),respectively.The specificity of the three examinations were 98.62%(285/289),97.23%(281/289),99.31%(287/289),respectively.The diagnostic accordance rate of endotoscopy combined with tympanometry for SOM was significantly higher than any single examination or any combined examinations.Conclusion Endotoscopy combined with tympanometry shows a great value in diagnosing SOM,which is accurate and safe.

关 键 词：分泌性中耳炎 耳内镜 声导抗 纯音听阈 颞骨高分辨率CT 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]