山东大学耳鼻喉眼学报 ›› 2015, Vol. 29 ›› Issue (4): 11-14.doi: 10.6040/j.issn.1673-3770.0.2014.291

• 论著 • 上一篇    下一篇

双耳感音神经性聋患儿合并分泌性中耳炎的临床诊治

孙昌志, 刘文龙, 李琰, 罗仁忠   

  1. 广州市妇女儿童医疗中心耳鼻喉科, 广东 广州 510623
  • 收稿日期:2014-08-31 修回日期:2015-06-30 出版日期:2015-08-16 发布日期:2015-08-16
  • 通讯作者: 罗仁忠。E-mail:luorenzhong@21cn.com E-mail:luorenzhong@21cn.com
  • 作者简介:孙昌志。E-mail:sunchzhent@126.com

Diagnosis and treatment of otitis media with effusion in children with bilateral sensorineural deafness.

SUN Changzhi, LIU Wenlong, LI Yan, LUO Renzhong   

  1. Department of Otolaryngology, Guangzhou Women and Children's Hospital, Guangzhou 510623, Guangdong, China
  • Received:2014-08-31 Revised:2015-06-30 Online:2015-08-16 Published:2015-08-16

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摘要： 目的 探讨双耳感音神经性聋并发分泌性中耳炎患儿的症状特点, 为及时诊治此类患者提供临床依据。方法 收集经手术治疗的双耳感音神经性聋并发分泌性中耳炎患儿(A组)17例(34耳)的病历资料, 分析其误诊原因、临床特点及并发症发生率, 并与同期行手术治疗的单纯双耳单纯分泌性中耳炎患儿(B组)17例(34耳)进行鼓室粘连发生率的比较。手术前后应用听性脑干反应(ABR)检查随诊听力变化。结果 A组均以家属发现听力下降为首诊症状, 在当地首诊曾诊断为突发性聋7例, 耳闷塞感、耳鸣、耳痛等症状叙述不清, 均无法采集到确切的分泌性中耳炎发病时间;行双耳鼓膜置管时发现中耳粘连5例(7耳), 手术前后ABR检查Ⅴ波阈值改善0～30 dB nHL, 平均17.3 dB nHL, 手术前后Ⅴ波阈值改善, 差异有统计学意义(P < 0.05)。B组患儿无1例误诊, 首诊诉耳痛或耳鸣、耳闷塞感等耳部不适症状15例, 发病时间明确, 首诊诉听力下降2例, 鼓膜置管时中耳粘连1例(1耳)。A组并发症发生率高于B组, 差异有统计学意义(P < 0.05)。结论 双耳感音神经性聋并发分泌性中耳炎患儿临床病史采集困难, 易误诊, 临床并发症发生率高, 应及时干预;鼓膜置管对听力改善效果明显。

关键词: 误诊, 分泌性中耳炎, 儿童, 感音神经性聋

Abstract: Objective To explore the clinical characteristics of otitis media with effusion (OME) in children with bilateral sensorineural deafness. Methods Clinical data of 17 pediatric OME patients (34 ears) with bilateral sensorineural deafness (Group A) and another 17 pediatric patients (34 ears) with simple OME (Group B) were reviewed. Incidences of middle air adhesion, and changes of auditory brainstem response (ABR) before and after operation were compared. Results In Group A, the primary symptom was hearing loss; 7 cases were misdiagnosed as sudden deafness, and 5 cases (7 ears) had middle ear adhesion; the response threshold of wave Ⅴ of ABR was improved from 0 to 30 dB nHL (average 17.3 dB nHL) after tympanostomy tube and the improvement had significant difference (P<0.05). In Group B, the primary symptoms included ear discomfort (15 cases) and hearing loss (2 cases), and 1 patient (1 ear) had middle ear adhesion. There was statistical difference between the two groups in the incidence of middle ear adhesion (P<0.05). Conclusion It is difficult to collect the history of pediatric patients with OME and bilateral sensorineural deafness, which is often misdiagnosed. Surgical intervention should be taken timely to prevent complications. Tympanostomy tube can effectively improve hearing in these patients.

Key words: Sensorineural deafness, Otitis media with effusion, Children, Misdiagnosis

中图分类号: 

  • R764.43
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