Fiebach A, Matschke R G
HNO. 1987 Feb;35(2):61-6.
We report 1000 insertions of ventilation tubes in 534 children for secretory otitis media (SOM) within a period of 6 years. In 77.5% of the cases, the air-bone gap was greater than 20 dB. The grommets are allowed to undergo spontaneous expulsion which happened in 319 ears, about 7 months after insertion. SOM recurred in 32.6% of the cases once, in 5.0% of the cases twice, and in 1.9% three times, requiring re-insertion of grommets. Recurrence appeared between 4 and 65 months after the first insertion. In three cases perforations of the tympanic membrane persisted and required tympanoplasty. Tympanometric examination and pure tone audiometry are necessary, in addition to pure tone audiometry to follow up successfully ventilated middle ears and to show recurrence as early as possible. Pre-existing but unsuspected sensorineural hearing loss was discovered in 10 cases. The deprivation of neural auditory pathways in early childhood and the possible retardation of speech development caused by SOM are mentioned. Normal hearing is the most important goal of therapy in children suffering from SOM, and insertion of ventilation tubes is the preferred method of achieving that goal safely. Adenoidectomy and treatment of upper airway infections are indispensable parts of the therapy of SOM. Regular follow up after insertion of grommets and even after their expulsion is necessary because of the high rate of late recurrence of SOM. Induction of cholesteatoma by grommets was not observed.
我们报告了在6年时间里为534名患有分泌性中耳炎（SOM）的儿童插入1000根通气管的情况。在77.5%的病例中，气骨导差大于20分贝。通气管可自行排出，319只耳朵出现这种情况，约在插入后7个月。SOM复发率为：32.6%的病例复发一次，5.0%的病例复发两次，1.9%的病例复发三次，需要再次插入通气管。复发发生在首次插入后的4至65个月之间。有3例鼓膜穿孔持续存在，需要进行鼓室成形术。除了纯音听力测定外，鼓室导抗检查和纯音听力测定对于成功随访通气的中耳并尽早发现复发是必要的。在10例病例中发现了先前存在但未被怀疑的感音神经性听力损失。文中提到了幼儿期神经听觉通路的剥夺以及SOM可能导致的言语发育迟缓。正常听力是SOM患儿治疗的最重要目标，插入通气管是安全实现该目标的首选方法。腺样体切除术和上呼吸道感染的治疗是SOM治疗中不可或缺的部分。由于SOM晚期复发率高，通气管插入后甚至排出后都需要定期随访。未观察到通气管诱发胆脂瘤的情况。
