Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.
Chin Med J (Engl). 2012 Apr;125(7):1276-81.
Otitis media with effusion is a highly concurrent disease in young children with adenoid hypertrophy. The aim of this study was to assess the middle ear effusion and audiological characteristics in children with adenoid hypertrophy and compare the various assessment methods.
Two hundred and seven candidates who were to undergo adenoidectomy were analyzed using otoscopy, tympanometry, air-conduction auditory steady-state responses (AC-ASSR), and computerized tomography (CT) before adenoidectomy.
About 73.4% (304/414) of ears were confirmed to have middle ear effusion (MEE) by otoscopy; 75.4% (312/414) of ears revealed MEE by CT. CT scan correctly predicted all the myringotomy results, giving 100% accuracy on the diagnosis of MEE. Additionally, CT revealed two children with inner ear malformations. Type B tracing tympanogram provided a sensitivity of 91.7% and a specificity of 92.2%. Type C tympanogram with peak pressure < -200 daPa indicated effusion; type C tympanogram having acoustic stapedius reflex could exclude MEE. We excluded the AC-ASSR results of the 4 ears with malformation; 54.4% (223/410) of ears were confirmed of hearing loss. Furthermore, 5.2% (16/310) of the ears with MEE suffered from severe to profound hearing loss. The average threshold level in the 0.25 kHz frequency of children was found to have poorer hearing thresholds than those in the 0.5, 1, 2, and 4 kHz (P < 0.001) frequencies; 29.7% (92/310) of ears with MEE were regarded as normal hearing level. About 55.8% (173/310) of ears with MEE were classified as having slight-mild hearing loss.
The practitioners should pay much attention to the middle ear condition and be aware of a possible development of severe to profound hearing loss during the course of MEE in young children with adenoid hypertrophy. CT scan is good for the assessment of MEE before ventilation tube insertion.
分泌性中耳炎是腺样体肥大儿童中一种高发的疾病。本研究旨在评估腺样体肥大儿童的中耳积液和听力特征，并比较各种评估方法。
207 名拟行腺样体切除术的患者在术前通过耳镜、鼓室图、气导听觉稳态反应（AC-ASSR）和计算机断层扫描（CT）进行分析。
约 73.4%（304/414）的耳朵通过耳镜证实有中耳积液（MEE）；75.4%（312/414）的耳朵通过 CT 证实有 MEE。CT 扫描正确预测了所有鼓膜切开术的结果，对 MEE 的诊断准确率为 100%。此外，CT 还发现了 2 例内耳畸形患儿。B 型鼓室图提供了 91.7%的灵敏度和 92.2%的特异性。峰值压力＜-200daPa 的 C 型鼓室图提示积液；有镫骨肌声反射的 C 型鼓室图可排除 MEE。我们排除了 4 例畸形耳的 AC-ASSR 结果；410 例中有 54.4%（223/410）的听力损失。此外，310 例有 MEE 的耳朵中有 5.2%（16/310）患有重度至极重度听力损失。发现儿童 0.25 kHz 频率的平均阈值水平听力比 0.5、1、2 和 4 kHz（P＜0.001）频率更差；310 例有 MEE 的耳朵中，29.7%（92/310）被认为是正常听力水平。310 例有 MEE 的耳朵中，约 55.8%（173/310）被归类为轻度至中度听力损失。
对于腺样体肥大的儿童，临床医生应高度重视中耳情况，并意识到在 MEE 期间可能会出现重度至极重度听力损失。CT 扫描有利于在放置通气管之前评估 MEE。
