Polunin M M, Chernova O V
Pirogov Russian National Research Medical University, Department of Otolaryngology of Pediatric Faculty, Moscow, Russia, 117997; Morozovskaya Pediatric Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia, 119049.
Pirogov Russian National Research Medical University, Department of Otolaryngology of Pediatric Faculty, Moscow, Russia, 117997.
Vestn Otorinolaringol. 2020;85(1):10-13. doi: 10.17116/otorino20208501110.
To study the efficacy and safety of treatment of exudative (secretory) otitis media (EOM) in children of early age taking into account the anatomical features of the auditory tube.
We examined and treated 30 children (51 ears) by balloon dilatation (BD) at the age of 1 to 3 years, with recurrent EOM (more than 6 months). The 21st child was diagnosed with a 2-sided process, and 9 with a one-sided process. All patients have previously unsuccessfully used conservative methods of treatment. According to the results of the examination and treatment, the children were divided into 2 groups. In group 1 (16 children, 30 ears) included children suffering from ESR in combination with hypertrophy of adenoids 2-3 art. with a block of pharyngeal mouths of auditory tubes, which at stage 1 of treatment was carried out endoscopic adenotomy and shunting of the tympanic cavities. In follow-up, this group of children after shunt loss was diagnosed with relapse of EOM (type B was registered on tympanometry). In this group, balloon dilation of auditory tubes was performed in the second stage after adenotomy and bypass surgery. In group 2 (14 children, 21 ear) included children with relapsing course of EOM, the adenoid vegetation 1 degree without block the pharyngeal orifices of the auditory tubes, which in the first phase was conducted on bypass the tympanic cavity. After the loss of shunts, during the control examination, a relapse of EOM was diagnosed, in connection with which, the children underwent balloon dilation of the auditory tubes.
During tympanometry in 1 month. complete restoration of middle ear function in 17 children (56.7%, 28 ears) (tympanograms type A) was revealed. 4 children (13.3%, 6 ears) were diagnosed with partial recovery of middle ear function (tympanograms type C). 9 children (30%, 17 ears) retained exudate in the tympanic cavity, these patients underwent a second course of conservative therapy, after which the function of the middle ear was restored. 9 children after BD with persistent exudate in the middle ear cavities underwent tympanostomy (in this case, long-term wearing shunts were used).
Balloon dilation of the cartilaginous part of the auditory tube is minimally invasive, effective in 70% of cases and a safe approach to the treatment of children suffering from a recurrent course of EOM.
考虑咽鼓管的解剖学特征，研究早期儿童渗出性（分泌性）中耳炎（EOM）的治疗效果和安全性。
我们对30名1至3岁复发性EOM（超过6个月）的儿童（51只耳朵）进行了球囊扩张术（BD）检查和治疗。第21名儿童被诊断为双侧病变，9名儿童为单侧病变。所有患者此前采用保守治疗方法均未成功。根据检查和治疗结果，将儿童分为2组。第1组（16名儿童，30只耳朵）包括患有EOM并伴有腺样体2 - 3度肥大且咽鼓管咽口阻塞的儿童，在治疗的第1阶段进行了内镜下腺样体切除术和鼓室分流术。在随访中，该组儿童分流失败后被诊断为EOM复发（鼓室图显示为B型）。在这组中，在腺样体切除术和分流术后的第二阶段进行了咽鼓管球囊扩张术。第2组（14名儿童，21只耳朵）包括EOM复发病程的儿童，腺样体肥大1度，未阻塞咽鼓管咽口，在第一阶段进行了鼓室分流术。分流失败后，在对照检查中诊断为EOM复发，因此，这些儿童接受了咽鼓管球囊扩张术。
在1个月后的鼓室图检查中，发现17名儿童（56.7%，28只耳朵）的中耳功能完全恢复（鼓室图为A型）。4名儿童（13.3%，6只耳朵）被诊断为中耳功能部分恢复（鼓室图为C型）。9名儿童（30%，17只耳朵）鼓室内仍有渗出液，这些患者接受了第二个疗程的保守治疗，之后中耳功能得以恢复。9名中耳腔持续有渗出液的儿童在BD术后接受了鼓膜造孔术（在这种情况下，使用了长期佩戴的分流管）。
咽鼓管软骨部球囊扩张术微创，70%的病例有效，是治疗复发性EOM儿童的安全方法。
