Long-term Tympanic Membrane Pathology Dynamics and Spontaneous Healing in Chronic Suppurative Otitis Media
Long-term Tympanic Membrane Pathology Dynamics and Spontaneous Healing in Chronic Suppurative Otitis Media
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DOI：
10.1097/inf.0b013e318238c0a4
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发表时间：
2012-02-01
影响因子：
3.6
通讯作者：
Homoe, Preben
中科院分区：
文献类型：
--
作者：
Jensen, Ramon Gordon;Koch, Anders;Homoe, Preben
背景：发展中国家的儿童慢性化脓性中耳炎(CSOM)的患病率很高。据估计，全世界有6500万至3.3亿人患有CSOM，但人们对这种疾病的自然病程知之甚少。北极地区的因纽特人是CSOM患病率最高的人群之一。本研究的目的是检测格陵兰因纽特青少年自童年以来鼓膜的长期变化，并估计受CSO影响的个体的比例。方法：对1993-1994年间最初检查的591名3-8岁儿童进行跟踪研究(2009)。对仍生活在这些地区的348人进行了跟踪调查。采用视频耳镜检查和鼓室导纳测量。结果：在226名参与者中(65%的接触者，中位年龄22岁)，28人(12%)存在CSOM或接受过手术治疗。11例是1993至1994年间未见的CSOM新病例。在最初研究中患有CSOM的患者中，39%的患者自发愈合。在最初的研究中，自然愈合的比例不受CSOM诊断年龄的影响。39人(17%)在最初的研究或随访中患有CSOM。在这些患者中，2人从未接受过中耳炎的抗生素治疗，15人接受过少于3次的治疗。有80例患者(35%)接受过耳部手术，或有环状萎缩或脊髓硬化的后遗症。结论：CSOM的自愈率和新发病例的发现表明，CSOM在个体和人群水平上都是一种动态疾病。在随访中，每三分之一的参与者都有复发或持续穿孔的穿孔或后遗症，这表明中耳炎的疾病负担比横断面研究中可以估计的更大。在这一人群中有可能增加对中耳炎的治疗，这需要提高人们对这种疾病的认识，并制定针对格陵兰岛条件定制的指南。
Background: Children in the developing parts of the world have a high prevalence of chronic suppurative otitis media (CSOM). It is estimated that 65 to 330 million people worldwide have CSOM, yet very little is known about the natural course of the disease. The Inuit population of the Arctic regions is among those with the highest prevalences of CSOM. The aim of this study was to examine the long-term tympanic membrane changes since childhood among Inuit adolescents in Greenland and estimate the proportion of individuals affected by CSOM.Methods: Follow-up study (2009) on a population-based cohort of 591 children originally examined during 1993 to 1994 at 3 to 8 years of age. Follow-up was attempted among 348 individuals still living in the areas. Video otoscopy and tympanometry were used. Data on otologic disease, ear surgery, and antibiotic use for otitis media were collected from medical records.Results: Of 226 participants (65% of those contacted; median age, 22 years), 28 (12%) had present CSOM or had been surgically treated. Eleven were new cases of CSOM not seen between 1993 and 1994. Of those with CSOM in the initial study, 39% had healed spontaneously. The proportion of spontaneous healing was not influenced by the age at which CSOM was diagnosed in the initial study. Thirty-nine individuals (17%) had CSOM in either the initial study or at follow-up. Of these, 2 had never received antibiotic treatment for otitis media, and 15 had been treated less than 3 times. Eighty individuals (35%) at follow-up had CSOM, had undergone ear surgery, or had sequelae in the form of circular atrophy or myringosclerosis.Conclusions: The proportion of spontaneous healing and the findings of new cases show that CSOM is a dynamic disease both on the individual as well as on the population level. Every third participant at follow-up had a perforation or sequelae from recurrent or long-lasting perforations, indicating a burden of disease from otitis media larger than what can be estimated in cross-sectional studies. There is a potential for increased treatment of otitis media in this population, which requires raised awareness of the disease in the population and the creation of guidelines customized to conditions in Greenland.