Roberts D G, Johnson C E, Carlin S A, Turczyk V, Karnuta M A, Yaffee K
Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Arch Pediatr Adolesc Med. 1995 Aug;149(8):873-7. doi: 10.1001/archpedi.1995.02170210047008.
To determine the natural history of middle ear effusion (MEE) in newborns and compare the results of pneumatic otoscopy with tympanometry and acoustic reflex measurements in the evaluation of the middle ear of neonates.
A descriptive natural history study with comparison of three evaluation methods for MEE.
County hospital nursery and pediatric clinic.
Sixty-eight full-term, healthy neonates were studied on day 1 of life; 65 on day 2; and 24 on day 3. Thirty-eight infants returned at 2 weeks of age, and from this group, 23 returned at 2 months of age.
Two independent observers performed otoscopy. An audiologist performed tympanometry and ipsilateral acoustic reflex measurements. Infants were evaluated daily from birth by all three methods for up to 3 days.
The time to resolution of MEE as determined by three methods.
In the first 3 hours of life, all babies examined had MEE diagnosed in both ears. By the third day, MEE apparently had resolved in 73% of ears by otoscopy, 88% by acoustic reflex measurements, and 92% by tympanometry. At 2 weeks, MEE was present by otoscopy in 13% (10/75 of ears). These were primarily newly acquired MEEs. Interobserver agreement by otoscopy as determined by kappa scores was moderate on days 1 and 3, poor on day 2, and excellent at 2 weeks and 2 months.
Middle ear effusion diagnosed by otoscopy apparently resolves in 72 hours in most neonates. Interobserver agreement of otoscopists was excellent after babies were discharged from the nursery, suggesting that pneumatic otoscopy can be used to diagnose MEE in neonates this age. Most MEEs that are diagnosed 2 weeks and 2 months after birth are new and asymptomatic.
确定新生儿中耳积液（MEE）的自然病程，并比较在评估新生儿中耳时，鼓气耳镜检查与鼓室图及声反射测量结果。
一项描述性自然病程研究，比较三种评估MEE的方法。
县医院新生儿室和儿科诊所。
68名足月儿、健康新生儿在出生第1天接受研究；65名在出生第2天；24名在出生第3天。38名婴儿在2周龄时复诊，其中23名在2月龄时复诊。
两名独立观察者进行耳镜检查。一名听力学家进行鼓室图及同侧声反射测量。从出生起，对婴儿进行为期3天的每日三项检查评估。
通过三种方法确定MEE消退的时间。
在出生后的前3小时内，所有接受检查的婴儿双耳均诊断为MEE。到第3天，通过耳镜检查，73%的耳MEE明显消退；通过声反射测量为88%；通过鼓室图为92%。在2周龄时，耳镜检查发现13%（75只耳中的10只）存在MEE。这些主要是新出现的MEE。通过kappa评分确定，耳镜检查观察者间一致性在第1天和第3天为中等，第2天较差，在2周龄和2月龄时为优。
耳镜检查诊断的中耳积液在大多数新生儿中72小时内明显消退。婴儿出院后，耳镜检查观察者间一致性良好，提示鼓气耳镜可用于诊断该年龄段新生儿的MEE。出生后2周和2月龄时诊断出的大多数MEE是新出现的且无症状。
