Yousaf Mohammad, Khan Farida
Department of ENT, Abbottabad International Medical College, Abbottabad, Pakistan.
J Ayub Med Coll Abbottabad. 2012 Jan-Mar;24(1):83-5.
Otitis media with effusion (OME) is a leading cause of hearing difficulty in children. OME must be detected early and managed properly to prevent hearing and speech impairment in children. This study was aimed to compare results of medical and surgical treatments in terms of hearing improvement, recurrence of Middle Ear Effusion (MEE), time to offer surgical intervention.
The study was conducted from June 2008 to December 2011. A performa was used to collect data. Every child having hearing difficulty was examined with pneumatic otoscope for fluid level and tympanic membrane mobility. These children were investigated with pure tone audiometry for level of hearing loss and tympanometry to confirm the middle ear effusion. X-Ray nasopharynx lateral view was taken to see if there were adenoids. All patients were treated conservatively in the first phase. Those not responding to conservative treatment were treated with myringotomy and adenoidectomy with or without ventilation tubes. Patients were followed-up for up to 36 months.
Middle ear effusion cleared in 80 (71.5%) out of 112 ears. No improvement was noted in 32 ears for 9 months. Resistant and recurrent cases were managed with adenoidectomy and myringotomy alone or with insertion of ventilation tubes (VT). Recurrence was noted more common with myringotomy alone than with ventilation tubes. Medical treatment failed in 32 ears. MEE recurred in 9 ears. VT was put in 41 ears. The hearing level improved with VT by 10-15 dB after first 3 months.
All children with OME should be treated conservatively. It is cost effective and relieves MEE in about 70% of patients. The ears with OME that fails to resolve or recur should be managed with myringotomy and VT insertion or adenoidectomy.
分泌性中耳炎（OME）是儿童听力障碍的主要原因。必须尽早发现并妥善处理OME，以防止儿童出现听力和言语障碍。本研究旨在比较药物治疗和手术治疗在听力改善、中耳积液（MEE）复发以及提供手术干预时间方面的结果。
本研究于2008年6月至2011年12月进行。使用一份表格收集数据。对每例有听力障碍的儿童用鼓气耳镜检查液平面和鼓膜活动度。这些儿童接受纯音听力测定以评估听力损失程度，并进行鼓室导抗图检查以确诊中耳积液。拍摄鼻咽部侧位X线片以查看是否存在腺样体。所有患者在第一阶段均接受保守治疗。对保守治疗无反应的患者接受鼓膜切开术和腺样体切除术，可选择插入或不插入通气管。对患者进行长达36个月的随访。
112只耳中有80只（71.5%）中耳积液清除。32只耳在9个月内无改善。难治性和复发性病例单独采用腺样体切除术和鼓膜切开术或插入通气管（VT）进行处理。单独鼓膜切开术比插入通气管更容易复发。32只耳药物治疗失败。9只耳MEE复发。41只耳插入了通气管。插入通气管后前3个月听力水平提高了10 - 15 dB。
所有OME患儿均应首先接受保守治疗。这具有成本效益，并且能使约70%的患者MEE得到缓解。未能缓解或复发的OME耳应采用鼓膜切开术和插入通气管或腺样体切除术进行处理。
