Center for Childhood Deafness, Language and Learning, Boys Town National Research Hospital, Omaha, Nebraska, USA.
Department of Otolaryngology, Boys Town National Research Hospital, Omaha, Nebraska, USA.
Ear Hear. 2021 Sep/Oct;42(5):1195-1207. doi: 10.1097/AUD.0000000000001038.
To describe the impact of effusion volume, viscosity, and purulence on the audiologic profiles of children with otitis media with effusion.
Fifty-one ears from children between the ages of 8 months and 11 years who had a diagnosis of otitis media with effusion and were scheduled for tympanostomy tube placement were recruited from medical clinics. The control group consisted of 17 ears from children between the ages of 10 months and 11 years without a recent history of otitis media and were recruited from a database of research volunteers. Participants received a comprehensive audiologic testing battery consisting of tympanometry, otoacoustic emissions, behavioral audiometric thresholds, and auditory brainstem response testing. For children with otitis media, this testing battery occurred 1 to 2 days before surgery. Middle ear effusions were characterized and collected on the day of surgery during tympanostomy tube placement from ears with otitis media with effusion. The comprehensive audiologic testing battery was completed postoperatively as well for most participants.
Effusion volume, categorized in each ear as clear, partial, or full, effected the audiologic results. Ears with full effusions had moderate hearing losses, few to no measurable otoacoustic emissions, and delayed Wave V latencies. Ears with partial effusions and clear ears both had slight to mild hearing losses and normal Wave V latencies, though ears with partial effusions had fewer measurable otoacoustic emissions than clear ears. Normal-hearing control ears with no recent history of otitis media with effusion demonstrated normal audiometric thresholds, present otoacoustic emissions, and normal Wave V latencies. Repeat postoperative testing demonstrated improvements in audiologic testing results for all of the otitis media with effusion volume groups, with no significant differences remaining between the three otitis media with effusion groups. However, significant differences between otitis media with effusion ears and normal-hearing control ears persisted postoperatively, with otitis media with effusion ears demonstrating significantly poorer audiometric thresholds and reduced otoacoustic emissions as compared to normal control ears. The effect of effusion viscosity and purulence could not be systematically evaluated because minimal variability in effusion viscosity and purulence was observed in our sample, with nearly all effusions being mucoid and nonpurulent.
Effusion volume observed at the time of tympanostomy tube surgery was found to play a significant role in outcomes and responses on a range of audiologic tests that compose the standard clinical pediatric audiologic assessment battery. Full middle ear effusions were associated with a moderate hearing loss, and few to no measurable otoacoustic emissions were detected. Ears with a recent diagnosis of otitis media with effusion but clear at the time of tympanostomy tube placement had less hearing loss and a greater number of present otoacoustic emissions than ears with full or partial effusions but were still found to have poorer hearing sensitivity than the healthy control ears. Differences between ears with otitis media with effusion and healthy control ears persisted on postoperative assessments of otoacoustic emissions and audiometric thresholds, though there were no remaining effects of the presurgical effusion volume group.
描述中耳积液量、黏度和脓性程度对分泌性中耳炎儿童听力学特征的影响。
从因分泌性中耳炎而拟行鼓膜置管术的 8 月龄至 11 岁儿童的 51 耳中招募研究对象，从中耳炎病史数据库中招募 10 月龄至 11 岁无近期中耳炎病史的儿童的 17 耳作为对照组。所有参与者均接受全面的听力学测试，包括鼓室图、耳声发射、行为听阈测试和听觉脑干反应测试。对于中耳炎儿童，该测试在手术前 1 至 2 天进行。术中在鼓膜置管期间对分泌性中耳炎的中耳积液进行特征分析和采集。大多数参与者在术后也完成了全面的听力学测试。
积液量以每耳积液完全、部分或少量的方式分类，影响了听力学结果。中耳积液完全的耳有中度听力损失，几乎没有或没有可测量的耳声发射，以及延迟的波 V 潜伏期。中耳积液部分和少量的耳均有轻度至中度听力损失和正常的波 V 潜伏期，但中耳积液部分的耳声发射可测量性较少量的耳声发射差。无近期分泌性中耳炎病史的正常听力对照耳显示正常的听阈、存在的耳声发射和正常的波 V 潜伏期。所有分泌性中耳炎积液组的术后听力学测试结果均有所改善，三组之间无显著差异，但中耳炎组与正常听力对照组之间的差异仍存在，中耳炎组的听阈明显较差，耳声发射较正常对照组减少。由于我们的样本中中耳积液的黏度和脓性变化极小，几乎所有的中耳积液都是黏液性和非脓性的，因此无法系统评估中耳积液黏度和脓性的影响。
在鼓膜置管术中观察到的积液量在一系列构成标准临床儿科听力学评估组合的听力学测试中的结果和反应中起着重要作用。中耳完全积液与中度听力损失相关，几乎检测不到可测量的耳声发射。在鼓膜置管时明确的近期分泌性中耳炎诊断的耳与部分或完全积液的耳相比，听力损失较小，存在更多的可测量耳声发射，但与健康对照组相比，仍表现出较差的听力敏感性。术后耳声发射和听阈评估中耳积液与健康对照组之间的差异仍然存在，但术前积液量组无剩余影响。
