中耳风险指数预测小儿胆脂瘤型中耳炎行鼓室成形术短期听力恢复不佳的价值及影响因素分析  

Value and influencing factors of middle ear risk index in predicting short-term outcome of cholesteatoma-type otitis media with drum chamber shaping

作　　者：周雪冰[1] 葛玥铭 董洁 张雅婷 匡柏旭 ZHOU Xuebing;GE Yueming;DONG Jie;ZHANG Yating;KUANG Baixu(Department of Otolaryngology,Tangshan Maternal and Child Health Hospital,Tangshan 063000,China)

机构地区：[1]唐山市妇幼保健院耳鼻喉科,063000

出　　处：《天津医药》2025年第4期374-377,共4页Tianjin Medical Journal

基　　金：河北省医学科学研究课题计划(20241211)。

摘　　要：目的探讨中耳风险指数(MERI)对小儿胆脂瘤型中耳炎行耳内镜下鼓室成形术(TEES)术后6个月听力恢复不佳的预测价值及影响TEES术后听力恢复不佳的相关因素。方法纳入接受TEES治疗的胆脂瘤型中耳炎儿童70例,且术后6个月进行随诊,行纯音测听以采集患儿气骨导差(ABG)值,并据此分为预后良好组(ABG≤20 dBHL,49例)和预后不良组(ABG>20 dBHL,21例)。比较2组患儿一般资料以及术前、术后6个月的MERI、ABG及生活质量改善[中耳炎-6问卷(OM-6)评分]情况。采用多因素Logistic回归分析胆脂瘤型中耳炎患儿TEES术后恢复不佳的危险因素,并绘制受试者工作特征(ROC)曲线分析MERI对胆脂瘤型中耳炎患儿TEES术后听力恢复不佳的预测价值。结果与预后良好组相比,预后不良组患儿的病程较长,MERI评分高,术前术后ABG、OM-6评分较高,高风险占比较高(P<0.05)。多因素Logistic回归分析示,病程长、MERI高、术前ABG和OM-6评分升高均为小儿胆脂瘤型中耳炎行TEES术后恢复不佳的独立危险因素。ROC曲线分析显示,MERI预测胆脂瘤型中耳炎患儿TEES术后6个月听力恢复不佳的曲线下面积为0.828(95%CI:0.718~0.907),敏感度81.0%,特异度75.5%。结论MERI可作为预测小儿胆脂瘤型中耳炎行TEES短期听力恢复的有效工具,病程越长,MERI越高,术前ABG和OM-6评分越高,患儿术后听力恢复不佳的风险越高,临床需加以重视。Objective To analyze the short-term prognosis value of middle ear risk index(MERI)in predicting the poor hearing recovery 6 months after transcanal endoscopic ear surgery(TEES)for children with cholesteatoma-type middle ear infection and the related factors affecting poor hearing recovery after TEES surgery.Methods A total of 70 children with cholesteatoma-type middle ear infection who underwent TEES were selected as the research subjects,and their outcomes were followed up for 6 months postoperatively.Pure tone audiometry was performed to collect the air-bone-gap(ABG)values of children,and they were divided into two groups according to ABG values:the group with good prognosis(ABG≤20 dBHL,n=49)and the group with poor prognosis(ABG>20 dBHL,n=21).The general information and the postoperative outcomes of MERI,ABG and quality of life improvement(Otitis Media-6,OM-6 score)of the two groups were compared.The independent risk factors for poor hearing recovery of TEES for children with cholesteatoma-type middle ear infection were analyzed by multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was developed to study the predictive value of MERI in patients with cholestatomatous otitis media with TEES.Results Compared with the good prognosis group,the disease course of children in the poor prognosis group was longer,the scores of MERI,ABG and OM-6 before and after surgery were higher,the proportion of high-risk was higher(P<0.05).The multivariate Logistic regression analysis showed that longer course of illness,higher MERI,higher preoperative ABG values and higher preoperative OM-6 scores were independent risk factors for poor hearing recovery of TEES for children with cholesteatoma-type middle ear infection.The ROC curve showed that the AUC(95%CI)of MERI predicting poor hearing recovery at 6 months post-TEES in cholesteatoma otitis media children was 0.828(95%CI:0.718-0.907),sensitivity was 81.0%and specificity was 75.5%.Conclusion MERI can be used as an effective tool to predict the sh

关 键 词：中耳炎 胆脂瘤 鼓室成形术 生活质量 儿童 中耳风险指数 听力恢复 

分 类 号：R764.21[医药卫生—耳鼻咽喉科] R764.92[医药卫生—临床医学]