摘要
目的分析儿童非分泌性中耳炎的鼓膜完整的传导性聋病例特点,总结其临床特点及诊疗经验、制定诊疗策略,以更好地指导临床工作。方法回顾性分析北京儿童医院耳鼻咽喉头颈外科2013年1月至2019年12月住院手术治疗的83例鼓膜完整的、非分泌性中耳炎的传导聋患儿的临床资料。总结分析患儿的病史、临床表现、耳部查体、听力学特点、颞骨CT、术中探查情况,分析诊疗路径。结果83例患儿,听力损失以轻中度为主,言语频率平均气导阈值(46.2±14.9)dB HL。按其病因:先天性胆脂瘤52例(63.7%)、粘连性中耳炎13例(15.7%)、外伤后听骨链中断9例(10.8%)、听骨链畸形7例(8.4%)、耳硬化症2例(2.4%)。患儿多无自觉性听力下降。其中,通过耳内镜可作出诊断的有50例(50/83),通过颞骨CT可作出诊断的有61例(61/83),组间比较两者之间无明显统计学差异(P>0.05);11例(11/83)耳内镜首诊为"分泌性中耳炎"而延迟诊断,最终通过颞骨CT确诊,从疾病首诊到确诊病程平均(14.4±11.8)个月。患儿均接受手术治疗,35例患儿术后听力较前明显提高,其中外伤性听骨链中断患儿的术后听力提高有效率最高,差异具有统计学意义(P=0.000)。结论儿童非分泌性中耳炎的鼓膜完整的传导性聋,前三位:先天性中耳胆脂瘤、粘连性中耳炎、先天性听骨链畸形;听力损失以轻中度为主。此类疾病患儿诊断较为困难,耳内镜及术前颞骨CT有助于疾病判断,是早期诊断的关键诊疗步骤,利于在疾病早期进行干预治疗。
Objective To report characteristics of non-OME conductive hearing loss in children with intact tympanic membrane and authors’experiences in its diagnosis and treatment.Methods Clinical data of 83 children with conductive hearing loss and intact tympanic membrane seen at the department of otorhinolaryngology head and neck surgery,Beijing Children's Hospital,from January 2013 to December 2019,were reviewed,including history,clinical manifestations,ear examination,audiological characteristics,temporal bone CT,intraoperative findings and diagnosis and treatment paths.Results Hearing loss was mainly mild to moderate with an average air conduction threshold at 46.2±14.9 dB HL.Etiologies included congenital cholesteatoma(n=52,63.7%),adhesive otitis media(n=13,15.7%),ossicular chain interruption following trauma(n=9,10.8%)and ossicular chain deformity(n=7,8.4%).Most of these children were not aware of their hearing loss.Diagnosis was made by otoendoscopy in 50 cases and by CT in 61 cases,with no significant difference between the two groups(P>0.05).Eleven cases were initially diagnosed as OME by otoendoscopy,but later correctly diagnosed by CT.The average course of disease was 14.4±11.8 months.All the children were treated with surgery.Hearing was significantly improved in 35 cases,with best results seen in children with traumatic ossicular chain interruption(P=0.000).Conclusion Tte top three etiologies for non-OME conductive hearing loss in children with intact tympanic membrane are congenital cholesteatoma,adhesive otitis media and congenital ossicular chain malformation,resulting in mainly mild to moderate hearing loss.Diagnosis may be difficult in children and may require both otoendoscopy and temporal bone CT can to help identify the underlying disease,which is conducive to early intervention.
作者
张晓
陈敏
刘薇
杨扬
邵剑波
郝津生
刘冰
马宁
张杰
ZHANG Xiao;CHEN Min;LIU Wei;YANG Yang;SHAO Jianbo;HAO Jinsheng;LIU Bing;MA Ning;ZHANG Jie(Department of Otolaryngology Head and Neck Surgery,Beijing Children’s Hospital,Capital Medical University;National Center for Children's Health,Beijing,PR China,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery,Beijing,100045)
出处
《中华耳科学杂志》
CSCD
北大核心
2020年第6期1002-1006,共5页
Chinese Journal of Otology
基金
北京市医院管理中心儿科学科协同发展中心专项经费资助,编号XTYB201828
北京市医院管理中心“登峰”计划专项经费资助,编号:DFL20191201。
关键词
鼓膜完整
传导性聋
病例特点
诊疗策略
Intact tympanic membrane
Conductive deafness
Clinical manifestations
Treatment strategy
