Gates G A, Avery C A, Prihoda T J, Cooper J C
Division of Otorhinolaryngology, University of Texas Health Science Center, San Antonio 78284-7777.
N Engl J Med. 1987 Dec 3;317(23):1444-51. doi: 10.1056/NEJM198712033172305.
To study the effectiveness of adenoidectomy and of the placement of tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 children, aged four through eight years, to receive bilateral myringotomy and no additional treatment (Group 1), placement of tympanostomy tubes (Group 2), adenoidectomy (Group 3), or adenoidectomy and placement of tympanostomy tubes (Group 4). The 491 children who underwent one of these treatments were examined at six-week intervals for up to two years. The mean time spent with effusion of any type in either ear over the two-year follow-up in the four groups was 51, 36, 31, and 27 weeks, respectively (P less than 0.0001), comparing Group 1 with each of the other groups. Hearing was equivalent in Groups 2, 3, and 4, and was significantly better than in Group 1. The most frequent sequela, purulent otorrhea, occurred one or more times in 22, 29, 11, and 24 percent of the subjects in Groups 1, 2, 3, and 4, respectively (P less than 0.001). Adenoidectomy plus bilateral myringotomy lowered the overall post-treatment morbidity (as measured by hearing acuity in the most severely affected ear [P = 0.0174] and the number of surgical retreatments required [P = 0.009]) more than did tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. We conclude that adenoidectomy should be considered when surgical therapy is indicated in children four to eight years old who are severely affected by chronic otitis media with effusion.
为研究腺样体切除术及鼓膜置管术治疗慢性分泌性中耳炎的疗效，我们将578名4至8岁的儿童随机分组，分别接受双侧鼓膜切开术且不进行其他治疗（第1组）、鼓膜置管术（第2组）、腺样体切除术（第3组）或腺样体切除术加鼓膜置管术（第4组）。接受上述其中一种治疗的491名儿童每隔六周接受检查，为期两年。在两年的随访中，四组患儿任一耳朵出现任何类型积液的平均时长分别为51周、36周、31周和27周（P<0.0001），第1组与其他各组相比均是如此。第2组、第3组和第4组的听力相当，且明显优于第1组。最常见的后遗症——化脓性耳漏，在第1组、第2组、第3组和第4组中的发生率分别为22%、29%、11%和24%，其中有一名或多名受试者出现该症状（P<0.001）。与单独鼓膜置管术相比，腺样体切除术加双侧鼓膜切开术能降低总体治疗后发病率（以最严重受影响耳朵的听力 acuity衡量[P = 0.0174]以及所需的再次手术治疗次数[P = 0.009]），且与腺样体切除术加鼓膜置管术的效果相同。我们得出结论，对于4至8岁受慢性分泌性中耳炎严重影响的儿童，若需进行手术治疗，应考虑腺样体切除术。
