Endoscopic Adenoidectomy in Children With Otitis Media With Effusion and Mild Hearing Loss.
Endoscopic Adenoidectomy in Children With Otitis Media With Effusion and Mild Hearing Loss.
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DOI：
10.21053/ceo.2016.9.1.33
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发表时间：
2016-03
影响因子：
3
通讯作者：
Pignataro L
中科院分区：
文献类型：
--
作者：
Capaccio P;Torretta S;Marciante GA;Marchisio P;Forti S;Pignataro L
慢性渗出性中耳炎（OME）儿童的手术治疗包括鼓膜置管或腺样体切除术，单独或鼓膜切开术和置管。本研究的目的是比较经口吸切器内镜辅助腺样体切除术（TOMEA）和传统腺样体切除术在治疗OME和慢性腺样体炎所致轻度听力损失儿童中的有效性。这项前瞻性、双盲和对照研究纳入了120名年龄在4-12岁之间的连续患者，他们以1：1的比例随机接受全麻下的TOMEA或传统腺样体切除术。所有患者在入组时以及术后3个月和9个月进行了完整的耳鼻喉科检查，包括鼻咽纤维内窥镜（NFE）、充气耳镜、耳显微镜、鼓室导抗和阈上音调测听。TOMEA组（平均年龄，4.9±1.1岁; 53.3%为男性）和传统腺样体切除术组（平均年龄，5.3±0.9岁; 56.7%为男性）之间的年龄或性别分布无统计学显著差异。两种手术均导致术后3个月和9个月后鼻孔通畅率（P <0.01）以及所有耳科和听力学参数（P<0.01）的显著改善，尽管术后NFE显示TOMEA组中残留后鼻孔阻塞的平均百分比显著更低（P=0.02）。鼓膜变化的儿童百分比在组间无显著差异，但TOMEA组术后B型鼓室导抗图儿童的患病率在术后3个月显著降低。（15.0%与31.7%，P=0.05）和9个月轻度传导性听力损失儿童分别为3.3%和8.3%（P <0.01）。虽然TOMEA和传统腺样体切除术均能有效治疗腺样体肥大和OME引起的轻度听力损失儿童，但前者能更大程度地减少残留腺样体肥大，并获得更好的听力学结果。
Surgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis. This prospective, double-blind and controlled study involved 120 consecutive patients aged 4–12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively. There were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01). Although both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes.