Borgstein Johannes, Gerritsma Tatjana, Bruce Iain, Feenstra Louw
Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands.
Int J Pediatr Otorhinolaryngol. 2009 Feb;73(2):257-61. doi: 10.1016/j.ijporl.2008.10.015. Epub 2008 Dec 2.
There is no consensus amongst clinicians regarding the best treatment strategy for pediatric atelectasis of the middle ear. It is the policy in our pediatric otolaryngology department to intervene early in the disease process. In an attempt to provide evidence regarding the safety of early intervention we have analyzed the audiological outcome following surgery in different stages of the disease.
Retrospective case note review.
We undertook a retrospective study of children with atelectasis treated surgically at a Dutch tertiary referral centre. Disease severity was classified according to the Erasmus Classification of Pediatric Atelectasis, and pre- and postoperative four frequency ac and bc thresholds were compared.
The study group consisted of 169 ears in 127 patients. The mean age at surgery was 9.6 years. There was an improvement in the average air-bone gap (ABG) for all stages. No deterioration in mean bone conduction thresholds was found following surgical intervention and there were no dead ears postoperatively.
This study demonstrated that surgical intervention had a favourable effect on hearing level across all stages, though hearing was markedly worse in stage V, and that a policy of intervention early in the disease process cannot be rejected on the grounds of risk of iatrogenic sensorineural hearing loss.
临床医生对于小儿中耳肺不张的最佳治疗策略尚无共识。我们小儿耳鼻喉科的政策是在疾病进程早期进行干预。为了提供有关早期干预安全性的证据，我们分析了疾病不同阶段手术后的听力结果。
回顾性病例记录审查。
我们对在一家荷兰三级转诊中心接受手术治疗的肺不张患儿进行了回顾性研究。根据小儿肺不张的伊拉斯谟分类法对疾病严重程度进行分类，并比较术前和术后四个频率的气导和骨导阈值。
研究组包括127例患者的169只耳朵。手术时的平均年龄为9.6岁。所有阶段的平均气骨导间距（ABG）均有改善。手术干预后未发现平均骨导阈值恶化，术后也没有出现全聋耳。
本研究表明，手术干预对所有阶段的听力水平都有有利影响，尽管在V期听力明显较差，并且不能以医源性感音神经性听力损失风险为由拒绝在疾病进程早期进行干预的政策。
