听力正常儿童慢性分泌性中耳炎手术方式选择及疗效  

Choices of Surgical Methods for Chronic Otitis Media with Effusion and Treatment Outcomes in Children with Normal Hearing

作　　者：范文焱 倪坤[1] 陈芳[1] 李静雨 李晓艳[1] FAN Wenyan;NI Kun;CHEN Fang;LI Jingyu;LI Xiaoyan(Department of Otolaryngology Head and Neck Surgery,Shanghai Children's Hospital,Shanghai Jiaotong University)

机构地区：[1]上海交通大学附属儿童医院,上海市儿童医院耳鼻咽喉头颈外科

出　　处：《中华耳科学杂志》2020年第5期843-846,共4页Chinese Journal of Otology

摘　　要：目的探讨听力正常的慢性分泌性中耳炎儿童手术方式的选择。方法选取2018年1月至2019年3月于我院诊断为阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAHS),并合并有分泌性中耳炎,且听力学测试无明显异常,经保守治疗3月无效的患儿共167例,随机分为实验组和对照组,实验组手术方式为射频下双侧扁桃体切除术+经口内镜下腺样体射频消融,对照组手术方式为射频下双侧扁桃体切除术+经口内镜下腺样体射频消融+耳内镜下鼓膜置管术。实验组于术后2周、4周、3个月、7个月、1年复查,对照组于术后6个月门诊取出鼓膜通气管,于7个月、1年时复查。比较两组患儿的疗效。结果实验组患儿分别于术后2周、4周、3个月、7个月、1年进行复查,有效率分别为62.22%、95.56%、97.78%、98.89%、98.89%。术后7个月时,实验组有效率为98.89%,对照组为97.83%,使用精确概率检验,P>0.05(P=1.0000),无统计学差异。术后1年时,实验组有效率为98.89%,对照组为96.74%,使用精确概率检验,P>0.05(P=0.6209),无统计学差异。结论当慢性分泌性中耳炎患儿未确诊显著听力下降、且存在有OSAHS的诊断证据需行腺样体扁桃体切除术时,无需再行鼓膜置管。Objective To report selection of surgical management for otitis media with effusion and outcomes in children with normal hearing.Methods Children(n=167)who were diagnosed with obstructive sleep apnea(OSA)syndrome and otitis media with effusion between January 2018 and March 2019,and failed 3 months of conservative treatments but showed no audiological abnormalities,were identified and randomly assigned to a study and a control group.Children in the study group received radiofrequency tonsil ablation+transoral endoscopic radiofrequency adenoid ablation;whereas those in the control group received additional endoscopic tympanostomy tube insertion.Children in the study group were followed up at postoperative 2 weeks,4 weeks,3 months,7 months and 1 year.The tympanostomy tube was removed at 6 months for those in the control group,who were then followed up at 7 months and 1 year.Treatment outcomes were compared between the two groups.Results The rate of improvement for children in the study group was 62.22%at 2 weeks,95.56%at 4 weeks,97.78%at 3 months,98.89%at 7 months and 98.89%at 1 year,while that in the control groups was 97.83%at 7 months(P>0.05)and 96.74%(P>0.05),respectively.Conclusions In children with otitis media with effusion and OSA but no hearing loss,tonsillectomy is indicated with no need for tympanostomy tube insertion.

关 键 词：分泌性中耳炎 听力正常 鼓膜置管 腺样体切除 

分 类 号：R764[医药卫生—耳鼻咽喉科]