121 ( 100191), 2004 2008 90 45 (82 ) PTA (pure-tone threshold average, 500 Hz, 1 000 Hz, 2 000 Hz, 4 000 Hz ) 8 db HL ~ 61 db HL, (34.8 ± 12.09) db HL PTA 0 db HL ~ 38 db HL, (15.9 ± 7.88) db HL, 3, 4, 75, 91.5%, 18.9 db HL : 9, + 29, + + 7 + ; ; ; ; R764.21, R764.92 A 1672-2922(2009)02-0121-05 Surgical intervention for otitis media with effusion in children PAN Tao, MA Fu-rong, KE Jia Dept. of Otolaryngology, Peking University Third Hospital, Beijing 100191 Abstract Objective To review surgically treated pediatric otitis media with effusion (OME) cases for better understanding of surgical intervention and hearing screening in such cases. Methods From 90 OME cases surgically treated between 2004 and 2008, 45 (82 ears) with complete clinical data were reviewed for their age distribution, hearing loss duration, surgical techniques and pre- and post-operative hearing data. Results The PTA over 500, 1 000, 2 000 and 4000 Hz improved from 34.8 ± 12.09 db HL pre-operatively to 15.9 ± 7.88 db HLpost-operativelyt. Post-operative hearing improved in 75 ears(91.5%), remained unchanged in 4 ears and deteriorated in 3 ears. Conclusion Adenoidectomy and ventilation tube placement are basic surgical treatments for OME in children. Tonsillectomy should not be a routine treatment option for pediatric OME patients. Surgical management for OME in children should be individualized. Key words Hearing screening; Otitis media with effusion; Surgical intervention, 4,, [1] [3],,,,,, [4, 5] [2], [6] [7] [8] : ( : :, 2007BAI18B12 ) ( :2005-1032) :,, : Email: pantao6422@gmail.com :, Email:furongma@126.com,,, 2004
122 Chinese Journal of Otology Vol. 7, No.2, 2009 [3],,, 2004 2008 [9] 2008,,,, [10] 1,, 1.1 2004 2008, 75% ~ 90% 3, 90,, 45, 82, 39, 4 3, 4 32, 13 4 ~ 17, [11] ; (8.1 ± 3.39) 45 1 [3, 9] : 45 (45 / 45, 100%),, 12 (12 / 45, 26.7% ), 26 (26 / 45, 57.8%), 18 (18 / 45, 40.0%) [12],, 3 ~ 120, [13-16] ; (23.9 ± 24.20),, 2; PTA (pure-tone threshold average, 500 Hz, 1 000 Hz, 2 000 Hz, 4 000 Hz [15,17],, ) 8 db HL ~ 61 db HL, (34.8 ± 12.09) db,, HL 35, 5,, B 73, 10 [18] C 9 27, 39
123, 16 1.2 3,,,, B C 1 +, 1.3 ( 1) 9 29 + + 7
124 Chinese Journal of Otology Vol. 7, No.2, 2009 1.4 :,,, [22],, :, 30,,,,,, 4 2 2.1 PTA 0 db HL ~ 38 db HL,, [16] (15.9 ± 7.88 db HL 3, 4 ; 75 (75 / 82, 91.5%), 3.1.3 18.9 db HL 3, 2.2 12, (12 / 12) 26, (26 / 26) 3 3.1 :,,,,,, +, +, + +, 3.1.1 3.2 Armstrong 1954,, 3 ~ 6, [19, 20],,, Lous [3], + 6, 45 29,,, 12 ~ 14 [9],, van Heerbeek [21], 5 3 2 7, 9,, Meyer 19 [3, 9], Roydhouse + Maw [23] +, Paradise [17], (6 ), (3 ) 3.1.2,,,,, 91.5%
125, 3, 4 )., 2008, 43(12): 884-885. : (1) 11 Schraff SA. Contemporary indications for ventilation tube placement. Curr Opin Otolaryngol Head Neck Surg, 2008, 16 (5):,,, 406-411., 12 Maw AR. The long term effect of adenoidectomy on established ; (2) otitis media with effusion in children. Auris Nasus Larynx, 1985,12 Suppl 1: S234-S236. 13 Robb PJ. Adenoidectomy: does it work? J Laryngol Otol, 2007,, 121(3): 209-214. 14 Nguyen LH, Manoukian JJ, Yoskovitch A, et al. Adenoidectomy: selection criteria for surgical cases of otitis media. Laryngoscope, 2004, 114(5): 863-866. 15 Stewart IA. Evaluation of factors affecting outcome of surgery for otitis media with effusion in clinical practice. Int J Pediatr Otorhi-. ( nolaryngol, 1999, 49 Suppl 1: S243-S245. 1 Zielhuis GA, Rach GH, Van den Broek P. The occurrence of otitis 16 Roydhouse N. Adenoidectomy for otitis media with mucoid effusion. Ann Otol Rhinol Laryngol Suppl, 1980, 89(3 Pt 2): 312-315. media with effusion in Dutch pre-school children. Clin Otolaryngol, 1990, l5(2): 147-153. 17 Paradise JL, Bluestone CD, Colborn DK, et al. Adenoidectomy and 2 Casselbrant ML, Mandel EM. Epidemiology [M]. Rosenfeld RM, adenotonsillectomy for recurrent acute oti tis media: parallel randomized clinical trials in children not previously treated with tym- Bluestone CD. Evidence based otitis media. Hamilton, Ont.: BC Becker, 1999: 117-136. panostomy tubes. JAMA, 1999, 282(10): 945-953. 3 Lous J. Which children would benefit most from tympanostomy 18 Schilder AG, Lok W, Rovers MM. International perspectives on tubes(grommets)? A personal evidence-based review. Int J Pediatr management of acute otitis media: a qualitative review. Int J Pediatr Otorhinolaryngol, 2004, 68 (1): 29-36. Otorhinolaryngol, 2008, 72(6): 731-736. 4 Sadé J, Fuchs C. Secretory otitis media in adults:. The role of 19 Armstrong BW. Prolonged middle ear ventilation: the right tube in mastoid pneumatization as a risk factor. Ann Otol Rhinol Laryngol, the right place. Ann Otol Rhinol Laryngol, 1983, 92 (6 Pt1): 582-1996, 105(8): 643-647. 586. 5 Sadé J, Fuchs C. Secretory otitis media in adults:. The role of 20 Morris MS. Tympanostomy tubes: types, indications, techniques mastoid pneumatization as a prognostic factor. Ann Otol Rhinol and complications. Otolaryngol Clin North Am, 1999, 32 (3): 385- Laryngol, 1997, 106(1):37-40. 390. 6 Sadé J. The nasopharynx, eustachian tube and otitis media. 21 van Heerbeek N, Ingels KJ, Snik AF, et al. Eustachian tube function in children after insertion of ventilation tubes. Ann Otol Rhi- J Laryngol Otol, 1994, 108(2): 95-100. 7 Hurst DS, Fredens K. Eosinophil cationic protein in mucosal biopsies from patients with allergy and otitis media with effusion. Otonol Laryngol, 2001, 110(12): 1141-1146. 22 Cuetin JM. The history of tonsil and adenoid surgery. Otolaryngol laryngol Head Neck Surg, 1997, 117(1): 42-48. Clin North Am, 1987, 20(2): 415-419. 8 Ylikoski J, Panula P. Neuropeptides in the middle ear mucosa. 23 Maw AR, Herod F. Otoscopic, impedance, and audiometric ORL J Otorhinolaryngol Relat Spec, 1988, 50(3): 176-182. findings in glue ear treated by adenoidectomy and tonsillectomy. 9 Rosenfeld RM, Culpepper L, Doyle KJ, et al. Clinical practice A prospective randomised study. Lancet, 1986, 327 (8495): guideline: otitis media with effusion. Otolaryngol Head Neck Surg, 1399-1402. 2004, 130 (5 Suppl): S95-S118. 10 ( :2009-3-31)