重新评估 CO₂ 激光鼓膜切开术治疗持续性急性中耳炎的儿童。

Department of Otolaryngology and Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

J Chin Med Assoc. 2011 Sep;74(9):413-8. doi: 10.1016/j.jcma.2011.08.006. Epub 2011 Sep 25.

BACKGROUND

This study aimed to re-evaluate the utility of CO(2) laser myringotomy in children with persistent acute otitis media (PAOM).

METHODS

From September 2002 to April 2008, 40 children with PAOM received CO(2) laser myringotomy. PAOM was defined as continuing symptoms and signs after systemic antibiotic treatment. Before laser myringotomy, the eardrums were checked under videotelescopy, pure tone audiometry or behavior audiometry and tympanometry. Middle ear effusions were collected using our own designed bottle culture device after laser myringotomy. The patients were followed up at outpatient clinics for 3 months. Cultured middle ear pathogens, healing time of the eardrums, hospital course (for admitted patients), and the development of middle ear effusions were recorded.

RESULTS

Forty children with 53 ears with PAOM were enrolled. Eight patients (20%) had bilateral disease and underwent bilateral laser myringotomy. The overall culture rate was 28.3%, and Streptococcus pneumoniae was the most common pathogen. Eight patients (20%) were admitted for intravenous antibiotics. The average eardrum healing time was 22 days in those with positive cultures, and 16.4 days in those with negative cultures (p=0.125). All eardrums healed in 1 month. The resolution rate was 62.5% at 1 month. Patients with bilateral PAOM were prone to have positive middle ear culture (5/8) compared with those with unilateral PAOM (8/32) (p=0.086).

CONCLUSION

CO(2) laser myringotomy is an applicable means of treating PAOM. S pneumoniae is the most common pathogen in PAOM. CO(2) laser myringotomy allows for the drainage and culture sampling of middle ear effusion, relieving the need of taking prolonged medication.

背景

本研究旨在重新评估 CO2 激光鼓膜切开术在持续性急性中耳炎（PAOM）患儿中的应用价值。

方法

2002 年 9 月至 2008 年 4 月，40 例 PAOM 患儿接受 CO2 激光鼓膜切开术。PAOM 定义为全身抗生素治疗后仍有症状和体征。在激光鼓膜切开术前，使用视频显微镜、纯音测听或行为测听和鼓室压测量对鼓膜进行检查。激光鼓膜切开术后使用我们自行设计的瓶培养装置收集中耳积液。患者在门诊进行 3 个月的随访。记录培养的中耳病原体、鼓膜愈合时间、住院时间（住院患者）以及中耳积液的发展情况。

结果

40 例 53 耳 PAOM 患儿入组。8 例（20%）患儿双侧发病，行双侧激光鼓膜切开术。总培养率为 28.3%，最常见的病原体是肺炎链球菌。8 例（20%）患儿接受了静脉抗生素治疗。培养阳性的患儿鼓膜愈合时间平均为 22 天，培养阴性的患儿为 16.4 天（p=0.125）。所有鼓膜均在 1 个月内愈合。1 个月时的缓解率为 62.5%。双侧 PAOM 患儿（5/8）比单侧 PAOM 患儿（8/32）更容易出现中耳培养阳性（p=0.086）。