Neonatal middle ear effusion predicts chronic otitis media with effusion
Neonatal middle ear effusion predicts chronic otitis media with effusion
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DOI：
10.1097/00129492-200405000-00020
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发表时间：
2004-05-01
影响因子：
2.1
通讯作者：
Ray, RM
中科院分区：
文献类型：
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作者：
Doyle, KJ;Kong, YY;Ray, RM
假设和目的：本研究的具体目的是确定与没有持续性中耳积液的耳朵相比，在 30 至 48 小时内持续性中耳积液的新生儿耳朵是否更有可能在出生后第一年患上慢性积液性中耳炎。假设中耳积液持续 30 至 48 小时的新生儿更有可能发展为慢性积液中耳炎。研究设计：前瞻性病例对照设计。在新生儿听力筛查时进行放大气动耳镜检查以确定是否存在积液。参加研究的婴儿返回门诊检查。地点：大学医学中心婴儿托儿所和门诊听力学诊所。受试者：从 454 名新生儿中，招募 14 名患有新生儿中耳积液的实验受试者和 15 名无新生儿中耳积液的对照受试者参加研究，并随访 1 年。干预措施：门诊研究测试包括瞬态诱发耳声发射、鼓室导抗测试、气动测试。耳镜检查和视觉强化测听（从 6 个月大）、3、6、9 和 12 个月大。实验（新生儿积液）婴儿从 1 个月大时开始进行随访。对在任何随访检查中发现耳镜有积液的婴儿进行随访，并在 1 个月后进行测试。 主要指标：慢性积液性中耳炎定义为连续三个月检查一侧或双耳气动耳镜检查发现鼓膜活动不足或不动。听力损失定义为大于 25 dB 听力损失视觉强化测听阈值。结果：8 名实验婴儿 (58%) 和 3 名对照婴儿 (20%) 出现慢性渗出性中耳炎 (p < 0.04)。对照组的平均积液次数为 1.27 次，实验婴儿的平均积液次数为 4.14 次（每组在 3、6、9 和 12 个月就诊时的平均积液次数）。实验组的颤音和语音视觉强化听力阈值平均差 3 dB，但这些差异不具有统计学意义。对于对照组，平均视觉强化听力测试阈值从未超过 25 dB 听力损失。实验组在 9 个月时，在 1,000、2,000 和 4,000 Hz 频率下，平均视觉强化测听阈值超过 25 dB 听力损失。结论：大多数在 30 至 48 小时内通过气动耳镜检查发现持续性新生儿中耳积液的婴儿将在生命的第一年发展为慢性积液性中耳炎。然而，慢性渗出性中耳炎在所有婴儿中都很常见（占对照组的 20%），在此期间婴儿经常接受检查和测试。
Hypothesis and Aims: The specific aims of the research are to determine whether newborn ears with persistent middle ear effusion at age 30 to 48 hours are more likely to develop chronic otitis media with effusion over the first year of life when compared with ears without persistent middle ear effusion. The hypothesis is that neonates with middle ear effusion persisting to 30 to 48 hours are more likely to develop chronic otitis media with effusion.Study Design: Prospective, case-control design. Loupe-magni-fied pneumatic otoscopy performed at the time of newborn hear-ing screening determined presence or absence of effusion. Infants enrolled in the study returned for outpatient examinations.Setting: University medical center well-baby nursery and outpatient audiology clinic.Subjects: From 454 neonates, 14 experimental subjects with neonatal middle ear effusions and 15 control subjects free of neonatal effusion were recruited for the study and followed-up for 1 year.Interventions: Outpatient study tests included transient-evoked otoacoustic emissions, tympanometry, pneumatic otoscopy, and visual reinforcement audiometry (starting at age 6 months), at 3, 6, 9, and 12 months of age. Experimental (neonatal effusion) infants were followed-up starting at age 1 month. Infants found at any follow-up examination to have effusion on otoscopy were followed-up and tested 1 month later.Main Outcome Measures: Chronic otitis media with effusion defined as hypomobile or immobile tympanic membrane on pneumatic otoscopy in one or both ears for three consecutive monthly examinations. Hearing loss defined as greater than 25-dB hearing loss visual reinforcement audiometry thresholds.Results: Eight experimental infants (58%) and three control infants (20%) developed chronic otitis media with effusion (p < 0.04). The average number of effusions was 1.27 for control and 4.14 for experimental infants (average number of effusions for each group at 3-, 6-, 9-, and 12-month visits). Warbled tone and speech visual reinforcement audiometry thresholds averaged 3 dB worse in the experimental group, but these differences were not statistically significant. For the control group, mean visual reinforcement audiometry thresholds never exceeded 25 dB hearing loss. For the experimental group, mean visual reinforcement audiometry thresholds exceeded 25 dB hearing loss at 1,000, 2,000, and 4,000 Hz at 9 months.Conclusions: A majority of infants with persistent neonatal middle ear effusion found by pneumatic otoscopy at 30 to 48 hours will develop chronic otitis media with effusion during the first year of life. However, chronic otitis media with effusion is common in all infants (20% of controls), a time during which infants are examined and tested frequently.