Westerberg Brian D, Morzaria Sanjay, Kozak Frederick K, Price David
Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada.
J Otolaryngol. 2005 Aug;34 Suppl 2:S64-9.
With emerging early hearing detection and communication development programs, physicians are increasingly requested to review young children with sensorineural hearing loss (SNHL) and associated conductive hearing loss (CHL). The purpose of this critical review is to develop an evidence-based approach to the management of the child less than 2 years of age with fluctuating CHL and coexisting SNHL.
A critical review of the 1966-2002 MEDLINE database was performed to address the diagnosis, natural history, and management of otitis media with effusion (OME) and the management of acute otitis media (AOM) in the child under 2 years of age with underlying SNHL.
Pneumatic otoscopy should be used to diagnose middle ear effusion. Clearance of OME may be prolonged in children with craniofacial abnormalities. Antibiotics provide a small short-term increase in the resolution of OME and may be warranted in children with coexisting SNHL and OME for 4 to 6 weeks. If OME persists for 8 to 12 weeks, bilateral myringotomy and tube placement (BM&T) with short-term tubes will improve hearing and help resolve OME. AOM in children less than 2 years of age should be treated with a 10-day course of antibiotics. Prophylactic antibiotics may be useful in avoiding tube placement in children less than 2 years of age with recurrent AOM. BM&T with short-term tubes are recommended if recurrent AOM persists. Pneumococcal vaccination can decrease episodes of AOM by 6 to 7%.
An evidence-based algorithm for the management of fluctuating CHL in children less than 2 years of age with an underlying SNHL is presented.
随着早期听力检测和沟通发展项目的不断涌现，越来越多的医生被要求对患有感音神经性听力损失（SNHL）及相关传导性听力损失（CHL）的幼儿进行评估。本综述的目的是制定一种基于证据的方法，用于管理年龄小于2岁、CHL波动且并存SNHL的儿童。
对1966年至2002年的MEDLINE数据库进行综述，以探讨2岁以下患有潜在SNHL的儿童中耳积液（OME）的诊断、自然病程及管理，以及急性中耳炎（AOM）的管理。
应使用鼓气耳镜诊断中耳积液。患有颅面异常的儿童中耳积液的清除时间可能会延长。抗生素可在短期内略微提高中耳积液的消退率，对于并存SNHL和OME的儿童，使用4至6周可能是合理的。如果OME持续8至12周，双侧鼓膜切开置管术（BM&T）并使用短期置管将改善听力并有助于消除中耳积液。2岁以下儿童的AOM应采用为期10天的抗生素疗程进行治疗。预防性使用抗生素可能有助于避免2岁以下患有复发性AOM的儿童进行置管。如果复发性AOM持续存在，建议进行BM&T并使用短期置管。肺炎球菌疫苗接种可使AOM发作减少6%至7%。
提出了一种基于证据的算法，用于管理年龄小于2岁、患有潜在SNHL且CHL波动的儿童。
