Mandel E M, Rockette H E, Bluestone C D, Paradise J L, Nozza R J
Otitis Media Research Center, Children's Hospital of Pittsburgh, PA 15213.
Pediatr Infect Dis J. 1992 Apr;11(4):270-7. doi: 10.1097/00006454-199204000-00003.
In a previous trial involving 109 children with chronic otitis media with effusion of at least a 2 months' duration that had been unresponsive to medical treatment, we compared the efficacy of myringotomy with tube insertion, myringotomy alone and no surgical intervention with regard to time with middle ear effusion, hearing status and other indices over a 3-year period. Because interpretation of the results was rendered difficult by certain complexities of study design, the present trial with a revised protocol was carried out in an additional group of 111 children. As in the previous trial, myringotomy with tube insertion resulted in less time with effusion and better hearing than did either myringotomy alone or no surgery. However, acute and chronic otorrhea and tympanic membrane perforation developed not uncommonly after tube insertion. Myringotomy alone offered no advantage over no surgery regarding the percent of time with effusion or the number of episodes of acute otitis media. Currently for children with long-standing middle ear effusion, we recommend either watchful waiting with periodic hearing assessment or myringotomy with tube insertion, individualizing the recommendation for each child.
在之前一项涉及109名患有慢性中耳积液且病程至少2个月、药物治疗无效的儿童的试验中，我们比较了鼓膜切开置管术、单纯鼓膜切开术和不进行手术干预在3年时间里对中耳积液时间、听力状况及其他指标的疗效。由于研究设计的某些复杂性使结果的解读变得困难，因此在另外111名儿童中进行了本项采用修订方案的试验。与之前的试验一样，鼓膜切开置管术导致积液时间缩短，听力改善，优于单纯鼓膜切开术或不进行手术。然而，置管后急性和慢性耳漏以及鼓膜穿孔并不少见。就积液时间百分比或急性中耳炎发作次数而言，单纯鼓膜切开术与不进行手术相比并无优势。目前，对于患有长期中耳积液的儿童，我们建议要么密切观察并定期进行听力评估，要么进行鼓膜切开置管术，针对每个儿童的建议进行个体化处理。
