Lee Chang Ho, Yoo Chan Kee, Hong Jong Eui, Kim Hong Joong, Lim Dae Geun, Kim Kwang Joong
Department of Otolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-712, Republic of Korea.
Int J Pediatr Otorhinolaryngol. 2011 May;75(5):635-8. doi: 10.1016/j.ijporl.2011.01.040. Epub 2011 Feb 27.
Finding a resolution of middle ear effusion using myringotomy, or dry tap (DT), is relatively common, but its clinical outcome is confounded by general anesthesia (GA). The confounding effect of GA and a time delay can be removed because laser myringotomy can be completed under topical anesthesia, which is a routine procedure for otitis media with effusion (OME) before GA in our clinic. DT without GA would clarify the clinical outcome, and the percentage of recurrence for OME after DT would be clinically relevant. The objectives of the present study are (1) to clarify the clinical nature of DT without including the confounding effect of GA and a time delay and (2) to determine if OME recurs when a ventilation tube (VT) is not used for DT.
The control group consisted of 308 children who received an unilateral myringotomy due to a natural resolution in the contralateral ear. The experimental group consisted of 296 children who had a bilateral myringotomy, and a ventilation tube was not inserted for DTs after laser myringotomy under topical anesthesia. The rate of DT and the recurrence rate of OME without tube insertion was the main outcome measure.
In the control group, which showed a natural resolution, the rate of DT was 16.9% (52/308) of patients, and DT was more common in non-B tympanometry, which only had a recurrence rate of 17.3% (9/52). In the study group, 3.7% of patients showed unilateral DT (UDT) with contralateral positive effusion, and 5.4% of patients showed bilateral DTs (BDTs). BDT showed a non-B tympanometry pattern and a low rate of recurrence (25.0%), which was similar to the control group. UDT showed a B-type tympanometry in 81.8% of the patients, and the recurrence rate was significantly higher (68.2%; 15/22) than the BDT and control patients. BDT or DT with signs of natural resolution showed a low rate of OME recurrence regardless of tympanometry, and thus, patients do not need a VT.
DT was not rare even without GA and the associated time delay, and DT was more common in the children that showed a natural resolution. However, microscopy and tympanometry was imperfect to predict dry tap, and thus, the surgeon needs to be prepared for individualized management of DT. UDT with B-type tympanometry and contralateral persistent effusion frequently recurred without tubes, and thus, VT for UDT appeared to be necessary.
通过鼓膜切开术或干抽液（DT）来解决中耳积液相对常见，但其临床结果受到全身麻醉（GA）的干扰。由于激光鼓膜切开术可在局部麻醉下完成，而在我们诊所，这是在全身麻醉前针对分泌性中耳炎（OME）的常规操作，因此可以消除全身麻醉和时间延迟的混杂效应。不进行全身麻醉的干抽液将阐明临床结果，并且干抽液后OME的复发率在临床上具有相关性。本研究的目的是：（1）阐明不包括全身麻醉和时间延迟混杂效应的干抽液的临床性质；（2）确定在干抽液时不使用通气管（VT）时OME是否会复发。
对照组由308名因对侧耳自然痊愈而接受单侧鼓膜切开术的儿童组成。实验组由296名接受双侧鼓膜切开术的儿童组成，在局部麻醉下进行激光鼓膜切开术后，干抽液时未插入通气管。主要观察指标是干抽液率和未插入通气管时OME的复发率。
在显示自然痊愈的对照组中，干抽液率为患者的16.9%（52/308），干抽液在非B型鼓室图中更常见，其复发率仅为17.3%（9/52）。在研究组中，3.7%的患者出现对侧积液阳性的单侧干抽液（UDT），5.4%的患者出现双侧干抽液（BDT）。BDT显示为非B型鼓室图模式且复发率较低（25.0%），与对照组相似。UDT在81.8%的患者中显示为B型鼓室图，其复发率显著高于BDT和对照组患者（68.2%；15/22）。无论鼓室图如何，具有自然痊愈迹象的BDT或DT显示OME复发率较低，因此，患者不需要通气管。
即使不进行全身麻醉和相关的时间延迟，干抽液也并不罕见，并且在显示自然痊愈的儿童中更常见。然而，显微镜检查和鼓室图检查在预测干抽液方面并不完美，因此，外科医生需要为干抽液的个体化管理做好准备。具有B型鼓室图和对侧持续性积液的UDT在不使用通气管的情况下经常复发，因此，UDT似乎需要使用通气管。
