鼓膜置管联合鼻内镜下腺样体切除术对分泌性中耳炎患者听力水平及复发的影响

周金兰　　钟康华　　李桃根　　敖红敏　　刘庆涛

[摘要] 目的 探讨鼓膜置管联合鼻内镜下腺样体切除术对分泌性中耳炎（SOM）患儿听力水平及复发的影响。 方法 选择2017年2月至2019年1月江西省新余市人民医院治疗的SOM患儿82例（106耳），按随机数字表法将其分为两组，每组各41例。对照组接受鼻内镜下腺样体切除术治疗，观察组接受鼓膜置管与鼻内镜下腺样体切除术联合治疗。比较两组临床疗效、听力水平、复发率及并发症等。 结果 观察组总有效率（96.15%）高于对照组（74.07%），复发率（3.85%）低于对照组（20.37%），差异有统计学意义（P<0.05）。术前两组听觉脑干诱发电位（ABR）阈值、ABRⅠ波潜伏期比较，差异无统计学意义（P>0.05）;术后观察组ABR阈值为（27.23±4.16）dB、ABRⅠ波潜伏期為（1.54±0.11）dB，低于对照组的（35.41±3.69）dB、（1.67±0.14）dB，差异有统计学意义（P<0.05）;两组并发症总发生率比较，差异无统计学意义（P>0.05）。 结论 联合鼓膜置管、鼻内镜下腺样体切除术治疗SOM效果确切且术后并发症、复发率较低，能够恢复患儿听力，可作为治疗SOM优选术式于临床推广。

[关键词] 分泌性中耳炎;鼓膜置管;鼻内镜下腺样体切除术;听力水平;复发

[中图分类号] R746.2          [文献标识码] B          [文章编号] 1673-9701（2021）12-0091-04

Effect of tympanic membrane catheterization combined with nasal endoscopic adenoidectomy on the hearing level and recurrence of patients with secretory otitis media

ZHOU Jinlan   ZHONG Kanghua   LI Taogen   AO Hongmin   LIU Qingtao

Department of Otolaryngology， Xinyu People′s Hospital in Jiangxi Province， Xinyu   338000， China

[Abstract] Objective To explore the effect of tympanic membrane catheterization combined with nasal endoscopic adenoidectomy on the hearing level and recurrence of children with secretory otitis media（SOM）. Methods A total of 82 children with SOM （106 ears） treated in our hospital from February 2017 to January 2019 were selected and divided into two groups according to the random number table method， with 41 cases in each group. The control group received nasal endoscopic adenoidectomy， and the observation group received the combined treatment of tympanic membrane catheterization and nasal endoscopic adenoidectomy. The clinical efficacy， hearing level， recurrence rate， and complications were compared between the two groups. Results The total effective rate（96.15%） of the observation group was higher than that of the control group （74.07%）， and the recurrence rate （3.85%） of the observation group was lower than that of the control group （20.37%）. The difference was statistically significant （P<0.05）. There was no significant difference in the auditory brainstem response （ABR） threshold and ABR Ⅰ wave latency between the two groups before operation （P>0.05）. The ABR threshold （27.23±4.16） dB and ABR Ⅰ wave latency （1.54±0.11） dB after operation of the observation group were lower than those （[35.41±3.69]dB， [1.67±0.14]dB） of the control group， and the difference was statistically significant（P<0.05）. There was no significant difference in the total incidence of complications between the two groups （P>0.05）. Conclusion The combination of tympanic membrane catheterization and nasal endoscopic adenoidectomy is effective in the treatment of SOM with low postoperative complications and recurrence rate. It can restore children's hearing and can be used as an optimal surgery for the treatment of SOM in clinical promotion.

[Key words] Secretory otitis media; Tympanic membrane catheterization; Nasal endoscopic adenoidectomy; Hearing level; Recurrence

分泌性中耳炎（Secretory otitis media，SOM）作为耳鼻喉科常见病，多以中耳腔积液、听力下降等为主要表现，若不及时治疗，对患儿生长发育影响较大[1-2]。目前SOM发病机制仍未完全明晰，但腺样体肥大已成为临床公认的诱发SOM重要原因。鼻内镜下腺样体切除术在SOM治疗中使用较为普遍，能夠将腺样体组织清除，缓解患儿临床症状。鼓膜置管术作为SOM保守治疗无效后常用术式，能够将鼓室内积液吸除，改善鼓室内外气压，恢复咽鼓管功能[3-5]。鉴于此，本研究将探讨SOM患儿采用鼓膜置管、鼻内镜下腺样体切除术联合治疗对听力水平及复发的影响，以指导临床治疗，现报道如下。……