Steele Karen M, Carreiro Jane E, Viola Judith Haug, Conte Josephine A, Ridpath Lance C
From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice.
J Am Osteopath Assoc. 2014 Jun;114(6):436-47. doi: 10.7556/jaoa.2014.094.
Childhood acute otitis media (AOM) is highly prevalent. Its usual sequela of middle ear effusion (MEE) can lead to conductive hearing loss, for which surgery is commonly used.
To evaluate the efficacy of an osteopathic manipulative treatment (OMT) protocol on MEE resolution following an episode of AOM. The authors hypothesized that OMT provided adjunctively to standard care for young children with AOM would reduce the duration of MEE following the onset of AOM.
We compared standard care only (SCO) and standard care plus OMT (SC+OMT) for the duration of MEE following AOM. Patients were aged 6 months to 2 years. The SC+OMT group received OMT during 3 weekly visits. Weekly tympanometric and acoustic reflectometer (AR) readings were obtained from all patients.
There were 52 patients enrolled, with 43 completing the study and 9 dropping out. No demographic differences were noted. Only ears from each patient with abnormal tympanograms at entry were included. There were 76 ears in the tympanogram analysis (38 from SCO; 38 from SC+OMT) and 61 ears in the AR data analysis (31 from SCO; 30 from SC+OMT). Dependence of bilateral ear disease noted in AR readings was accounted for in statistical analysis. Tympanogram data demonstrated a statistically significant improvement in MEE at visit 3 in patients in the SC+OMT group (odds ratio, 2.98; 95% confidence interval, 1.16, 7.62; χ(2) test for independence, P=.02). The AR data analysis showed statistically significant improvement at visit 3 for the SC+OMT group (z=2.05; P=.02). There was no statistically significant change in MEE before or immediately after the OMT protocol.
A standardized OMT protocol administered adjunctively with standard care for patients with AOM may result in faster resolution of MEE following AOM than standard treatment alone. (ClinicalTrials.gov number NCT00520039.).
儿童急性中耳炎（AOM）非常普遍。其常见的后遗症中耳积液（MEE）可导致传导性听力损失，对此通常采用手术治疗。
评估整骨手法治疗（OMT）方案对AOM发作后MEE消退的疗效。作者假设，对患有AOM的幼儿在标准治疗基础上辅助进行OMT可缩短AOM发作后MEE的持续时间。
我们比较了仅采用标准治疗（SCO）和标准治疗加OMT（SC+OMT）两种方案下AOM后MEE的持续时间。患者年龄为6个月至2岁。SC+OMT组在每周一次的3次就诊期间接受OMT治疗。从所有患者那里每周获取鼓室图和声学反射仪（AR）读数。
共纳入52例患者，43例完成研究，9例退出。未发现人口统计学差异。仅纳入每名患者初诊时鼓室图异常的耳朵。鼓室图分析中有76只耳朵（SCO组38只；SC+OMT组38只），AR数据分析中有61只耳朵（SCO组31只；SC+OMT组30只）。统计分析中考虑了AR读数中双侧耳部疾病的相关性。鼓室图数据显示，SC+OMT组患者在第3次就诊时MEE有统计学意义的改善（优势比，2.98；95%置信区间，1.16，7.62；独立性χ(2)检验，P=.02）。AR数据分析显示，SC+OMT组在第3次就诊时有统计学意义的改善（z=2.05；P=.02）。在OMT方案实施前或实施后即刻，MEE无统计学意义的变化。
对AOM患者在标准治疗基础上辅助实施标准化OMT方案，可能比单纯标准治疗能使AOM后MEE更快消退。（ClinicalTrials.gov编号NCT00520039。）
