Maw A R, Parker A
Department of Otolaryngology, Bristol Royal Infirmary, United Kingdom.
Acta Otolaryngol Suppl. 1988;454:202-7. doi: 10.3109/00016488809125027.
One hundred and fifty children aged between 2 and 9 years with bilateral SOM were allocated at random to three groups: Adeno-tonsillectomy (47 cases), adenoidectomy (47 cases) and neither procedure (53 cases). A further 42 children were allocated to either adenoidectomy or no surgery. In all only one ear was treated at random by myringotomy and insertion of a ventilation tube. The unoperated ear was examined six weeks, six months, nine months, one, two and three years post-operatively for otoscopic clearance of the effusion, impedance change and improvement in mean hearing threshold. Thus the effects on middle ear status of adenoidectomy alone and in combination with tonsillectomy were assessed. There was a significant clearance of middle ear fluid, change from no peak to peak impedance measurement and hearing gain as a result of both procedures with a late trend favouring the combined operation. Neither pre-operative tonsils size nor the number of attacks of tonsillitis affect outcome. However there is a relationship between age and radiographic post-nasal space airway size with clearance of the effusion one year after surgery. These findings permit recommendation for adenoidectomy with improved expectation for resolution of SOM if cases are selected with reference to these two variables. They also suggest in which cases the operation should not be recommended. Despite the trends in outcome favouring combined operations, the extra morbidity associated with the addition of tonsillectomy does not at present justify recommendation for removal of the tonsils in addition to adenoidectomy for cases with SOM. Tonsillectomy in these children should be assessed on grounds of tonsillar pathology per se and not on the status of the middle ear.
150名年龄在2至9岁之间的双侧分泌性中耳炎患儿被随机分为三组：腺样体扁桃体切除术组（47例）、腺样体切除术组（47例）和未进行任何手术组（53例）。另外42名儿童被随机分配到腺样体切除术组或不进行手术组。所有患儿中，仅随机选择一只耳朵进行鼓膜切开术并插入通气管。对未手术的耳朵在术后6周、6个月、9个月、1年、2年和3年进行检查，观察耳镜下积液清除情况、阻抗变化以及平均听力阈值的改善情况。由此评估了单纯腺样体切除术以及与扁桃体切除术联合进行时对中耳状况的影响。两种手术方式均使中耳积液显著清除，从无峰值到出现峰值阻抗测量值发生变化，听力也有所提高，且后期趋势显示联合手术更具优势。术前扁桃体大小和扁桃体炎发作次数均不影响手术结果。然而，年龄与放射学后鼻孔气道大小之间存在关联，且与术后1年积液清除情况有关。这些研究结果表明，如果根据这两个变量选择病例，腺样体切除术有望改善分泌性中耳炎的病情，同时也指出了哪些病例不建议进行该手术。尽管结果趋势显示联合手术更具优势，但目前对于分泌性中耳炎病例，除腺样体切除术外额外进行扁桃体切除术所带来的额外发病率并不足以支持推荐这种手术方式。对于这些儿童，扁桃体切除术应根据扁桃体本身的病理情况进行评估，而不是基于中耳的状况。
