Knutsson Johan, Priwin Claudia, Hessén-Söderman Anne-Charlotte, Rosenblad Andreas, von Unge Magnus
Dept of Otorhinolaryngology, Västmanland County Hospital, Sweden; Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden; Dept of Otolaryngology, Örebro University Hospital, Sweden.
Dept of Otorhinolaryngology, Sophiahemmet University, Stockholm, Sweden.
Int J Pediatr Otorhinolaryngol. 2018 Apr;107:140-144. doi: 10.1016/j.ijporl.2018.02.012. Epub 2018 Feb 7.
To evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation.
Four different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored postoperatively every third month by an otolaryngologist.
Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50-6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03-2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation.
Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly.
1b.
评估鼓膜造口通气管的材料（硅胶与氟塑料）和形状（短管与长管）对通气管排出时间、耳漏发生情况、堵塞情况、通气管取出及持续性穿孔发生情况的影响。
使用了四种不同类型的通气管；长阿姆斯特朗管、唐纳森管、谢泼德管和直管，分别代表通气管材料（硅胶或氟塑料）和形状（短管、双凸缘或长管、单凸缘）的四种特定组合。400名计划接受双侧通气管植入的儿童被纳入一项随机试验。患者右耳植入一种类型的通气管，左耳植入另一种类型的通气管。术后每三个月由一名耳鼻喉科医生监测通气管排出及并发症的发生率。
22名儿童在手术期间被排除。在研究的378名儿童中，平均年龄为35.3个月。63.8%为男孩。短管比长管排出更早；风险比（HR）为4.84（95%置信区间3.50 - 6.69，p < 0.001）。长阿姆斯特朗管最不容易排出。硅胶管导致通气管侧耳首次感染的时间显著更长，HR为1.68（95%置信区间1.03 - 2.76，p = 0.039）。唐纳森管首次感染的平均时间最长（p = 0.025）。感染对通气管排出率无显著影响（p = 0.879）。在通气管堵塞、取出或持续性穿孔方面未发现显著差异。
长管早期排出的可能性较小。长阿姆斯特朗管早期排出的倾向最小。硅胶管首次感染的时间显著更长。唐纳森管导致的感染最少。感染对排出率无显著影响。
1b。
