Crowson Matthew G, Ryan Marisa A, Ramprasad Vaibhav H, Choi Kevin J, Raynor Eileen
Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Int J Pediatr Otorhinolaryngol. 2017 Mar;94:121-126. doi: 10.1016/j.ijporl.2017.01.023. Epub 2017 Jan 21.
Pediatric patient caregivers may prefer to avoid a surgical intervention and request a medical management option for eustachian tube dysfunction (ETD). However, there are limited published data evaluating the efficacy of intranasal fluticasone in the medical management of ETD as an alternative to tympanostomy tube placement. The objectives of this study were to: 1) determine if intranasal fluticasone (INF) prevented tympanostomy tube placement in children with ETD, and 2) describe differences in patient response to INF related to cleft lip and/or palate (CLP) and Down syndrome.
Case series with planned chart review at a Tertiary academic hospital. We reviewed pediatric patients treated with INF for ETD. Inclusion criteria included ETD, no prior intranasal or oral steroid therapy, and no prior tympanostomy tube placement. Outcomes included time-to- tympanostomy tube placement with or without INF and therapy compliance. Kaplan-Meier survival analyses with log-rank tests and Fisher's exact tests were used to examine outcome variables.
676 fulfilled inclusion criteria. 393 (58.7%) were male, and 355 (52.5%) Caucasian with mean age of 27.1 months old. 92 (13.6%) had CLP and 46 (6.8%) had Down Syndrome. 266 (39.4%) received INF, and 202 (88.2%) were compliant at their next visit. 474 (70.1%) had tympanostomy tubes placed. Children treated with INF were less likely to have tympanostomy tubes placed than children not treated (52.6% vs. 81.5%; p < 0.0001). Using survival analyses, INF use was associated with significantly longer mean time-to-tympanostomy tube than no INF use (199.4 vs. 133.7 days; p < 0.0001). INF did not reduce time-to-tympanostomy tube in patients with CLP (p = 0.05) or Down Syndrome (p = 0.27).
INF significantly reduces the number of children requiring tympanostomy tube placement for ETD. The CLP and Down Syndrome anatomical variants may attenuate INF efficacy. Further in vivo characterization of INF action on eustachian tube tissues will help further substantiate these observations.
小儿患者的照料者可能更倾向于避免手术干预，而要求采用药物治疗方案来处理咽鼓管功能障碍（ETD）。然而，关于鼻用氟替卡松作为鼓膜置管替代方案用于ETD药物治疗的疗效，已发表的数据有限。本研究的目的是：1）确定鼻用氟替卡松（INF）能否预防ETD患儿进行鼓膜置管；2）描述唇腭裂（CLP）和唐氏综合征患儿对INF的反应差异。
在一家三级学术医院进行的病例系列研究及计划中的图表回顾。我们回顾了接受INF治疗ETD的儿科患者。纳入标准包括ETD、既往未接受过鼻内或口服类固醇治疗以及既往未进行过鼓膜置管。结局指标包括有无INF治疗情况下至鼓膜置管的时间以及治疗依从性。采用Kaplan-Meier生存分析、对数秩检验和Fisher精确检验来检验结局变量。
676例符合纳入标准。393例（58.7%）为男性，355例（52.5%）为白种人，平均年龄27.1个月。92例（13.6%）患有CLP，46例（6.8%）患有唐氏综合征。266例（39.4%）接受了INF治疗，其中202例（88.2%）在下次就诊时依从治疗。474例（70.1%）进行了鼓膜置管。接受INF治疗的儿童比未接受治疗的儿童进行鼓膜置管的可能性更小（52.6%对81.5%；p<0.0001）。通过生存分析，使用INF与至鼓膜置管的平均时间显著长于未使用INF相关（199.4天对133.7天；p<0.0001）。INF并未缩短CLP患者（p=0.05）或唐氏综合征患者（p=0.27）至鼓膜置管的时间。
INF显著减少了因ETD需要进行鼓膜置管的儿童数量。CLP和唐氏综合征的解剖变异可能会削弱INF的疗效。进一步对INF作用于咽鼓管组织的体内特征进行研究，将有助于进一步证实这些观察结果。
