Velepic Marko, Starcevic Radan, Bonifacic Marta, Ticac Robert, Kujundzic Milodar, Udovic Dunja Skalamera, Manestar Dubravko, Malvic Goran, Zubovic Sanja, Velepic Mitja
Clinic of Otorhinolaryngology Head and Neck Surgery, Clinical Medical Center University of Rijeka, Croatia.
Int J Pediatr Otorhinolaryngol. 2011 May;75(5):686-90. doi: 10.1016/j.ijporl.2011.02.014. Epub 2011 Mar 12.
To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion.
161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum.
The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes (z=1.565; p=0.0587). There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz (t=2.173; p=0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower. Sequelae: scars of the eardrum (chi-square=28.107; ss=1; p<0.001) and attic retractions (chi-square=4.592; ss=1; p=0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on.
A criterion that could influence the approach to the therapy of CSOM in children.
探讨鼓膜的临床状态是否可作为慢性分泌性中耳炎（CSOM）治疗的纳入标准。比较根据该标准选取的两组患者中，腺样体切除术以及腺样体切除术联合鼓膜置管术治疗CSOM的效果。
对87例儿童的161耳进行CSOM治疗。耳显微镜检查显示鼓膜无病理改变（粘连过程迹象、锤骨旋转和危险的鼓室上隐窝回缩）。患者被随机分为两组：第一组59耳采用鼓膜切开术、鼓膜置管术和腺样体切除术治疗，另一组102耳仅采用腺样体切除术治疗。治疗至少6个月后，进行耳显微镜检查和听力学评估，以显示中耳积液（MEE）的消退情况、听力学结果和鼓膜临床后遗症的发生率。
单纯腺样体切除术使MEE消退的效果与腺样体切除术联合鼓膜置管术的治疗结果无显著差异（z = 1.565；p = 0.0587）。两种治疗方法的纯音听力测定结果无差异。仅在腺样体切除术联合鼓膜置管术治疗中，2000 Hz频率处（t = 2.173；p = 0.031）气骨导间距（ABG）值较低。后遗症：鼓膜瘢痕（卡方 = 28.107；自由度 = 1；p < 0.001）和鼓室上隐窝回缩（卡方 = 4.592；自由度 = 1；p = 0.032）在置管治疗中更常见。对置管治疗后鼓膜临床后遗症的发生率进行了评论。
该标准可能会影响儿童CSOM的治疗方法。
