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題 名 | 兒童積液性中耳炎接受鼓室通氣管置入術後兩年之追蹤=Tympanostomy Tube Insertion for Otitis Media with Effusion in Children--A Two-Year Follow Up |
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作 者 | 吳昌俊; 林凱南; | 書刊名 | 中華民國耳鼻喉科醫學雜誌 |
卷 期 | 35:1 民89.01-02 |
頁 次 | 頁10-15 |
分類號 | 417.6821 |
關鍵詞 | 積液性中耳炎; 鼓室通氣管; 鼓室硬化症; Otitis media with effusion; Tympanostomy tube; Tympanosclerosis; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:積液性中耳炎是幼兒常見的疾病,鼓室通氣管手術為常用且有效的治療方法。然而近年來,許多研究發現此手術和一些鼓膜的慢性病變有關。本研究之目的在追蹤經鼓室通氣管手術2年以上之兒童,檢查鼓膜之變化。方法:自1994年2月至1996年9月間,於本院接受鼓室通氣管置入手術之16歲以下兒童共131名,其中64名回院追蹤,在顯微鏡下檢查鼓膜及中耳之情況,詳細詢問病史加上問卷調查,並追蹤病歷中手術記錄,聽力檢查結果,及各次門診局部理學所見。結果:去除非首次裝管3名後,共61名進入本研究,男性37名,女性24名。接受手術之年齡平均5歲5個月,術前積液時間平均3個月。總計114耳,左右側各57耳。其中有14耳(12.3%)之後又接受第2次甚至第3次通氣管手術。於顯微鏡下觀察:68耳(59.6%)鼓膜正常,21耳(18.4%)出現鼓室硬化症,在多次裝管組之發生率是單次裝管的4.4倍。7耳(6.1%)鼓膜有局部變薄之退行性變化,4耳(3.5%)發現鼓膜破孔,5耳(4.4%)有中耳積液,7耳(6.1%)鼓膜塌陷,1耳(0.9%)的鼓膜與中耳壁黏著。有1耳(0.9%)在中耳腔出現白色腫塊,懷疑是膽脂瘤。有6耳(5.2%)之通氣管自首次手術後即長期滯留,其餘108耳通氣管之平均留存時間約13.5個月。術前及術後之聽力進步約11dB。在主觀上,61名中有49名(80%)自覺聽力恢復正常,另9名覺得聽力明顯改善,僅有3名(5%)無明顯進步。結論:鼓室通氣管置入手術2年後,8成以上病童聽力回復正常,平均聽力進步約11dB,可知此手術對聽力之改善頗有助益。但發現40.4%的鼓膜出現併發症,其中以鼓室硬化症最常見(18.4%)。且12.3%因復發積液,2年內需再次手術,其長期影響亦不可忽視。術前審慎評估,術後定期追蹤檢查,甚為重要。 |
英文摘要 | BACKGROUND: Otitis media with effusion is a common disease in children. Tympanostomy tube insertion is often the treatment of choice. However, there have been several reports confirming the relationship between this procedure and some subsequent complications. This study evaluated the long-term effects of tympanostomy tube insertion on the tympanic membrane over a two-year period. METHODS: from February 1994 to September 1996, grommet type tympanostomy tubes were inserted in 131 children for OME. Sixty-one of them were followed up from August to September 1998 and enrolled in this study. Their eardrums were carefully examined under microscopy. The medical records and audiometric reports were reviewed. RESULTS: One hundred and fourteen ears were included. The mean duration of effusion before surgery was 3 months. The mean interval between surgery and review was 36 months. Repeated intubation was performed in fourteen ears (12.3%) for recurrence during this period. Normal tympanic membranes were found in 68 ears (59.6%).Tympanosclerosis was observed in 21 ears (18.4%) with the incidence higher in the multi-ple-intubation group (57.1%)than the single-intubation ears (13.0%). Atrophic changes of the tympanic membrane were seen in 7 ears (6.1%). The eardrum was perforated in 4 ears (3.5%). In 6 ears (5.2%), tubes have remained in place for more than 2 years since insertion. The mean duration of the other 108 tubes before extrusion was 13.5 months. Postoperatively, the improvement of hearing was about 11dB on average, 80% of the patients noticed hearing recovery. CONCLUSION: Tympanostomy tube insertion can effectively improve hearing in a large percentage of patients. However, tympanosclerosis was present in 18.4% of ears during the follow-up period; while major complications, such as perforation and cholesteatoma were found in less than 5% of ears. |
本系統中英文摘要資訊取自各篇刊載內容。