目的 分析采用耳内镜下鼓膜置管联合电动切割器切除腺样体治疗小儿分泌性中耳炎55例的疗效.方法 采用耳内镜下鼓膜置管并电动切割器切除腺样体治疗小儿分泌性中耳炎55例(64耳),观察术后中耳积液的平均时间,以及通气管脱落或取出后随访的结果,如听力变化、疗效、复发率和并发症情况.结果 55例术后纯音听力均提高,在0.5、1.0、2.0 KHz的测听中,听阈平均提高23.4 dB,术后耳积液平均时间为(8.7±1.4)d,治愈42耳(65.6%),好转19耳(29.7%),无效3耳(4.7%);在通气管取出3个月后分泌性中耳炎复发3耳,其中有1耳并发感染;并发症主要有脱管5耳、耳漏2耳、膜穿孔不愈合2耳,1耳发生鼓膜钙化.结论 耳内镜下鼓膜置管术联合电动切割器切除腺样体法治疗儿童分泌性中耳炎安全有效,不仅提高患儿的听力,还能缩短中耳积液时间,降低复发率及感染的发生率,值得推广应用.%Objective To explore the effect of tympanostomy tube insertion under endotoscopy combined with adenoidectomy with electro-cautery in treatment of secretive otitis media ( SOM ) in 55 childish patients. Methods The general situation of children after treatment has been recorded, such as average duration of middle ear fluid retention, changes in hearing, complications, recurrence rate following removal or extrusion of tube and middle ear infection rate. Results The hearing ability is recovered in all 55 cases, and audibility threshold increased by 23. 4 dB at 0.5,1.0 and 2.0 kⅡz of pure tone test. The average duration for middle ear fluid retention after operation was 8.7 ±1.4 days, 42 ears ( 65. 6% ) cured, 19 ears ( 29.1% ) improved and 3 ears (4.7% ) failed. Three months after ventilation tube removed, secretive otitis media recurred in 3 ears including 1 ear complicated with infection. The complications mainly manifested as detachment of tube in 5 ears, otorrhea in 2 ears, unhealed membrane perforation in 2 ears and calcification of tympanic membrane in 1 ear. Conclusion Tympanostomy tube insertion under endotoscopy combined with adenoidectomy by electrocautery is effective in treatment of childish patients with SOM. The hearing ability of children has been improved, the duration of middle ear effusion is also shortened, and the relapse rate and infection rate are reduced. This kind of therapeutic procedures can be applied for treatment of childish patients with secretive otitis media.
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