Ryding Marie, White Peter, Kalm Olof
Department of Otorhinolaryngology, Hospital of Ostersund, SE-831-83, Ostersund, Sweden.
Int J Pediatr Otorhinolaryngol. 2004 Feb;68(2):197-204. doi: 10.1016/j.ijporl.2003.10.013.
The etiology of secretory otitis media (SOM) is multifactorial. The main factors discussed are infection and tubal dysfunction. This study aimed to detect poor tubal function and tympanic membrane pathology in young adults after extremely long-standing SOM.
Thirty-four patients, 16-25 years old, with previous chronic SOM persisting at least 6 years (mean 11.2 years, range 6.2-18.6 years), were retrospectively examined at a mean of 18 years after their first myringotomy or tube insertion and comparison was made with 15 controls. The medical records were scrutinized, otomicroscopic examination was performed and the Eustachian tube function was studied in a mini pressure chamber.
The mean age at SOM onset was 2.4 years (range 0.5-8.4 years) and the mean period from the last myringotomy or when the last tube had disappeared to follow-up was 6.7 years (range 1.3-12.8 years). Tympanic membrane pathology was found in 76% of the ears of SOM patients and in none (0%) of controls (P<0.001). The youngest patients had more atrophy than the older patients (P<0.05) and more myringosclerosis was observed in patients with shorter interval between SOM ending and examination. The patients were found to have significantly poorer active tubal function; i.e. higher inability to equilibrate negative or negative and positive middle ear pressure, compared with controls (P<0.001). The majority of the patients (74%) still experienced some kind of discomfort in their ears at the time of examination.
Still in adulthood patients with chronic SOM during childhood exhibit dysfunction of the tube and tympanic membrane pathology to a high extent.
分泌性中耳炎（SOM）的病因是多因素的。所讨论的主要因素是感染和咽鼓管功能障碍。本研究旨在检测长期患有SOM的年轻成年人的咽鼓管功能不良和鼓膜病变情况。
回顾性检查了34例年龄在16 - 25岁之间、既往慢性SOM持续至少6年（平均11.2年，范围6.2 - 18.6年）的患者，这些患者在首次鼓膜切开术或置管术后平均18年接受检查，并与15名对照组进行比较。仔细查阅病历，进行耳显微镜检查，并在小型压力舱中研究咽鼓管功能。
SOM发病的平均年龄为2.4岁（范围0.5 - 8.4岁），从最后一次鼓膜切开术或最后一根通气管消失至随访的平均时间为6.7年（范围1.3 - 12.8年）。SOM患者76%的患耳存在鼓膜病变，而对照组无一例（0%）出现（P<0.001）。最年轻的患者比年长患者有更多的萎缩（P<0.05），并且在SOM结束至检查间隔时间较短的患者中观察到更多的鼓膜硬化。与对照组相比，发现患者的主动咽鼓管功能明显较差；即平衡中耳负压或正负压力的能力较低（P<0.001）。大多数患者（74%）在检查时仍感到耳部有某种不适。
即使到了成年期，儿童期患有慢性SOM的患者仍在很大程度上表现出咽鼓管功能障碍和鼓膜病变。
