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[特纳综合征的耳科疾病及管理策略]

[Otologic disorders and management strategies in Turner syndrome].

作者信息

Si Y, Xiong Y, Zhang L N, Li X H, Feng S P, Liang Y S, Zhang L Y

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou 510120, China.

Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 May 7;57(5):595-601. doi: 10.3760/cma.j.cn115330-20210723-00481.

Abstract

To analyze the incidence and risk factors of otologic disorders in patients with Turner syndrome (TS), so as to provide management strategies for ear health. This study is a prospective study based on questionnaires and a cross-sectional study. The TS patients who visited our hospital from 2010 January to 2021 March were included (A total of 71 patients with TS were included in this study. the age of TS diagnosed was 3- to 11-year-old, age of visiting ENT department was 4- to 27-year-old) and the incidence of otologic diseases in different age groups was investigated by questionnaires. The cross-sectional study included ear morphology and auditory function assessment, and further analysis of the risk factors that related to ear disease. Prism was used for data analysis. The investigation found that the incidence of acute otitis media in patients aged 3-6 and 7-12 years was higher than that of patients over 12 years old, which was 33.8%(24/71), 42.9%(30/70)and 23.5%(8/34), respectively; 21.1% (15/71) of patients were recurrent acute otitis media in patients aged 3-6 years, and about 46.6% (7/15)of them persisted beyond 6-year. The prevalence of otitis media with effusion in the three groups was 32.4%(23/71), 34.3%(24/70)and 38.2%(13/34), respectively; the recurrence rate of tympanocentesis was 100%(7/7), 42.9%(3/7)and 50.0%(1/2), which was significantly higher than that of grommet insertion. For age groups of 3-6 and 7-12 years, the prevalence of acute otitis media and secretory otitis media was lower in the X chromosome structure abnormal patients; while for patients older than 12 years, otitis media with effusion was the highest prevalence in Y-chromosome-containing karyotypes. In addition, the prevalence of acute otitis media and otitis media with effusion in patients with other system diseases were increased significantly. A cross-sectional study found that 7.0% (5/71)of the lower auricular, 4.2% (3/71)of the external auditory canal narrow, and 38.0% (27/71)of the tympanic membrane abnormality. 35.2%(25/71) had abnormal hearing, including 17 cases of conductive deafness, 6 cases of sensorineural hearing loss, and 2 cases of mixed deafness. The rest of the patients had normal hearing, but 6 of them had abnormalities in otoacoustic emission. Eustachian tube function assessment found that the eustachian tube dysfunction accounted for 38%(27/71). Hearing loss and abnormal Eustachian tube function were not significantly related to karyotype(Chi-square 2.83 and 2.84, value 0.418 and 0.417), but significantly related to other system diseases(Chi-square 13.43 and 7.53, value<0.001). The incidence of TS-related otitis media and auditory dysfunction is significantly higher than that of the general population. It not only occurs in preschool girls, but also persists or develops after school age. Accompanied by other system diseases are risk factors for ear diseases. Clinicians should raise their awareness of TS-related ear diseases and incorporate ear health monitoring into routine diagnosis and treatment.

摘要

分析特纳综合征(TS)患者耳科疾病的发病率及危险因素,为耳部健康提供管理策略。本研究是一项基于问卷的前瞻性研究和横断面研究。纳入2010年1月至2021年3月来我院就诊的TS患者(本研究共纳入71例TS患者,确诊TS的年龄为3至11岁,就诊耳鼻喉科的年龄为4至27岁),通过问卷调查不同年龄组耳科疾病的发病率。横断面研究包括耳部形态和听觉功能评估,并进一步分析与耳部疾病相关的危险因素。采用Prism进行数据分析。调查发现,3至6岁和7至12岁患者急性中耳炎的发病率高于12岁以上患者,分别为33.8%(24/71)、42.9%(30/70)和23.5%(8/34);3至6岁患者中21.1%(15/71)为复发性急性中耳炎,其中约46.6%(7/15)持续超过6岁。三组中耳积液的患病率分别为32.4%(23/71)、34.3%(24/70)和38.2%(13/34);鼓膜穿刺术的复发率分别为100%(7/7)、42.9%(3/7)和50.0%(1/2),明显高于鼓膜置管术。对于3至6岁和7至12岁年龄组,X染色体结构异常患者急性中耳炎和分泌性中耳炎的患病率较低;而对于12岁以上患者,含Y染色体核型中耳积液的患病率最高。此外,患有其他系统疾病患者的急性中耳炎和中耳积液的患病率显著增加。横断面研究发现,耳廓低位占7.0%(5/71),外耳道狭窄占4.2%(3/71),鼓膜异常占38.0%(27/71)。35.2%(25/71)听力异常,其中传导性耳聋17例,感音神经性听力损失6例,混合性耳聋2例。其余患者听力正常,但其中6例耳声发射异常。咽鼓管功能评估发现,咽鼓管功能障碍占38%(27/71)。听力损失和咽鼓管功能异常与核型无显著相关性(卡方值分别为2.83和2.84,P值为0.418和0.417),但与其他系统疾病显著相关(卡方值分别为13.43和7.53,P值<0.001)。TS相关中耳炎和听觉功能障碍的发病率显著高于普通人群。其不仅发生在学龄前女童,学龄期后也可持续或进展。合并其他系统疾病是耳部疾病的危险因素。临床医生应提高对TS相关耳部疾病的认识,将耳部健康监测纳入常规诊疗。

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