儿童腺样体肥大对中耳咽鼓管功能的影响

发布时间：2018-02-12 00:43

本文关键词： 腺样体肥大中耳咽鼓管功能障碍分泌性中耳炎纯音测听声导抗电子鼻咽镜　出处：《山西医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的腺样体肥大是儿童常见病和多发病,是引起小儿分泌性中耳炎的重要病因。腺样体肥大患儿年龄小,不善于表述耳鸣、耳聋等不适。家长也不易发现患儿听力下降。一旦引起听力明显下降时再就医,治疗起来就很困难,而儿童时期是语言、心理等发育的关键时期,听力下降势必影响其发育,所以,及早发现腺样体肥大患者咽鼓管功能和中耳传音功能异常,对于挽救儿童听力损失具有非常重要的意义。腺样体是位于鼻咽顶后壁的淋巴组织,在解剖学上是咽淋巴环的一部分,出生后即发育成熟,在儿童和青少年时期腺样体体积最大,以后逐渐缩小,腺样体是人体的免疫器官,它含有各个发育阶段的淋巴细胞。肥大的腺样体一直被认为是引起儿童分泌性中耳炎的重要原因,本文通过探讨儿童腺样体肥大与中耳咽鼓管功能相关性,为临床防止腺样体肥大引起听力障碍提供依据。方法回顾性分析2008年10月至2011年2月在长治医学院附属和济医院、和平医院耳鼻喉科己进行鼻咽X线侧位片检查诊断为腺样体肥大的98例患者,并选取30例正常儿童作为对照,根据所有患者鼻咽X线侧位片A/N比值的结果将全部病例按腺样体肥大程度分为腺样体正常组、中度肥大组和病理性肥大组,所有儿童均接受常规耳镜检查、纯音听阈测定、声导抗测试和电子鼻咽镜检查,记录相关数据,进行统计分析,腺样体肥大组行腺样体切除术,术后半年复查耳镜检查、纯音听阈测定、声导抗测试和电子鼻咽镜检查,记录相关数据与术前相对比,进行统计分析。将负压水平超过200daPa的C型和所有B型曲线者诊断为合并分泌性中耳炎,负压水平没有超过-200daPa的C型和所有A型曲线者则诊断为没有合并分泌性中耳炎,统计分析腺样体大小对分泌性中耳炎发病的影响。结果腺样体中度肥大组、病理性肥大组耳镜检查、纯音听阈测定、声导抗测试和电子鼻咽镜检查与正常儿童组相比,差异均有统计学意义(P0.05)。腺样体肥大组行腺样体切除术,术后半年复查耳镜检查、纯音听阈测定、声导抗测试和电子鼻咽镜检查,与术前相对比差异均有统计学意义(P0.05)。各组分泌性中耳炎发生率差异有统计学意义(P0.05)。结论1.儿童腺样体肥大会造成中耳咽鼓管功能障碍。2.腺样体体积越大,分泌性中耳炎发病几率越高。3.腺样体切除术可改善中耳咽鼓管功能,有利于儿童分泌性中耳炎治疗。
[Abstract]:The purpose of adenoid hypertrophy is a common and frequently occurring disease in children, is the most important cause of secretory otitis media in children with adenoid hypertrophy. The age of small, not good at expression of tinnitus, deafness and discomfort. Parents are not easy to find in children with hearing loss caused by hearing decreased. Once again when it was very difficult for medicine. The treatment, and childhood is a critical period of language, mental development, hearing loss is bound to affect its development, therefore, early detection of patients with adenoid hypertrophy of eustachian tube function and middle ear conduction dysfunction, to save the children with hearing loss is very important. The adenoids are located in the lymphoid tissue of the posterior wall of nasopharynx top. And in anatomy is a part of Waldeyer's ring, born after that mature, the largest in childhood and adolescence adenoid volume, after adenoidectomy is reduced gradually, the immune organ of human body, it contains various developmental Stage lymphocytes. Hypertrophic adenoids have been considered to be important causes of secretory otitis media in children. This article discusses the correlation between adenoidal hypertrophy and middle ear eustachian tube function in children, so as to provide evidence for clinical prevention of hearing loss caused by adenoidal hypertrophy.
Methods a retrospective analysis from October 2008 to February 2011 in the Department of ENT of Heping Hospital affiliated Heji Hospital of Changzhi Medical College, has carried out nasopharyngeal lateral X-ray examination in the diagnosis of 98 cases with adenoidal hypertrophy, 30 cases of normal children were selected as control, according to all patients with nasopharyngeal lateral radiographs of A/N ratio will result in all cases with adenoid hypertrophy divided into adenoid hypertrophy group and normal group, moderate hypertrophy group. All children underwent routine otoscopy, pure tone audiometry, tympanometry and electronic epipharyngoscope examination, record data, statistical analysis, adenoid hypertrophy group underwent adenoidectomy, six months after operation otoscopes check, pure tone audiometry, tympanometry and electronic epipharyngoscope examination, record related data and preoperative contrast, were analyzed. The negative pressure level more than C 200daPa and all B The curve was diagnosed as having otitis media with secretory otitis media. The negative pressure level did not exceed -200daPa of C and all A curves were diagnosed as no secretory otitis media. The effect of adenoid size on the incidence of secretory otitis media was statistically analyzed.
Results adenoid moderate hypertrophy group, hypertrophy group otoscopy, pure tone audiometry, tympanometry and electronic epipharyngoscope examination compared with the normal children, the differences were statistically significant (P0.05). Adenoid hypertrophy group underwent adenoidectomy, six months after operation of ear endoscopy, pure tone audiometry determination of tympanometry and electronic epipharyngoscope examination before operation, and compared the differences were statistically significant (P0.05). Each group of secretory otitis media occurs there was statistically significant difference (P0.05).
Conclusion 1. children's adenomatoid fat meeting causes the eustachian tube dysfunction. The greater the adenoid volume of.2. is, the higher the incidence of secretory otitis media..3. adenoidectomy can improve the function of eustachian tube in the middle ear, and is beneficial to the treatment of children with secretory otitis media.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764.2

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