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Paying attention to the 'lateral airway' allergic diseases in children
Journal of Otolaryngology and Ophthalmology of Shandong University
2019, 33 (1):
59-62.
DOI: 10.6040/j.issn.1673-3770.1.2018.042
Allergic diseases are autoimmune diseases that involve multi-organ systems producing a variety of clinical manifestations; concurrently, there is an intrinsic and inseparable link between multiple systems and clinical manifestations, producing a variety of manifestations among different age-groups and populations. Focusing on allergic diseases that are associated with the respiratory airway in children is relatively complicated due to the dynamic changes observed with respect to their body structures and immune systems. Allergic rhinitis, allergic asthma, and otitis media with effusion are three examples of allergic respiratory diseases in children that affect the same airway at different anatomical regions, and the correlation between them is receiving greater attention. Whether the upper, lower, and lateral airways could ever truly be in concurrence with each other is worth an in-depth discussion, and thus, we put forward some minor thoughts and suggestions based on the available clinical research and literature.
Fig.1
The relationship among adenoidal hypertrophy (AH), allergic rhinitis (AR) and otitis media with effusion (OME)
Extracts from the Article
我们在2017年的回顾性研究发现,205例腺样体肥大(adenoidal hypertrophy, AH)患儿中,合并OME有66例(32.20%);合并AR有110例(53.66%),其中44例(40.00%)并发OME;未合并AR有95例(46.34%),其中仅有22例(23.16%)并发OME;伴发AR的AH患儿发生OME的风险比不伴AR的AH患儿增加了1.212倍(图1),提示AH引起的咽鼓管阻塞或功能障碍并不是引发OME的惟一因素,而上呼吸道黏膜的过敏性炎症可能参与到OME的发病机制中并起到一定的作用[13]。但是,年龄也是不能忽略的重要因素,以咽鼓管为中心的“侧呼吸道”的生理、病理和发育特点使得低龄儿童出现咽鼓管功能障碍而导致OME的概率最大[14];然而随着年龄增长,儿童发育逐渐完善,腺样体自然萎缩,总的OME发病率呈现逐渐降低的趋势,说明在AH患儿中,咽鼓管机械性阻塞可能是导致OME的主要因素,过敏性炎症则是作为协同因素参与OME发病,在病因上占有一席之地[15]。综上所述,从流行病学角度,OME与AR存在一定的相关性,AH与AR的多因素叠加和内在相互协同作用更能促使OME的发生、发展和迁延。
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