Schultz-Coulon H J
HNO. 1987 Feb;35(2):55-60.
Ventilation tubes ("grommets") appear to be the logical treatment of chronic secretory otitis media, based on the theory of its pathogenesis. Usually they have an impressive immediate effect, and enjoy great popularity. However, there are critics who restrict the indications, for two reasons: it has been observed repeatedly that the spontaneous healing rate in secretory otitis media is about 80%, and follow up studies over several years suggest that persistent lesions of the middle ear (scars and defects of the tympanic membrane, conductive hearing loss, cholesteatoma etc.) occur somewhat more often in grommet-treated ears than in ears without ventilation tubes. A therapeutic advantage of ventilation tubes in the resolution of chronic secretory otitis media has not been proved. Therefore, according to our present knowledge the only treatment effect of ventilation tubes is the immediate elimination of conductive hearing loss. As development studies in children suggest that a conductive hearing loss does not become a handicap for speech and mental development unless it has persisted for several months, ventilation tubes seem to be indicated only when a bilateral middle ear effusion of greater than 25 dB persists for more than 3 months. However, in children with delayed speech development one should not wait such a long time, because they particularly depend upon normal hearing ability.
基于慢性分泌性中耳炎的发病机制理论，通气管（“鼓膜通气管”）似乎是其合理的治疗方法。通常它们会立即产生显著效果，且广受欢迎。然而，有批评者对其适应症加以限制，原因有二：反复观察发现分泌性中耳炎的自然愈合率约为80%，并且多年的随访研究表明，与未置通气管的耳朵相比，鼓膜通气管治疗的耳朵中耳持续病变（鼓膜瘢痕和缺损、传导性听力损失、胆脂瘤等）的发生率略高。鼓膜通气管在解决慢性分泌性中耳炎方面的治疗优势尚未得到证实。因此，根据我们目前的知识，鼓膜通气管唯一的治疗效果是立即消除传导性听力损失。由于对儿童的发育研究表明，除非传导性听力损失持续数月，否则不会对言语和智力发育造成障碍，所以似乎只有当双侧中耳积液大于25分贝且持续超过3个月时才考虑使用鼓膜通气管。然而，对于语言发育迟缓的儿童，不应等待这么长时间，因为他们尤其依赖正常的听力能力。
