儿童分泌性中耳炎诊的治.ppt

儿童分泌性中耳炎的诊治;分泌性中耳炎（OME）是以鼓室积液和传导性听力下降为主要特征的中耳非化脓性炎症 Catarrhal inflammation of middle ear cleft that characterized by middle ear effusion and conductive hearing loss. 无急性炎症表现（耳痛、发热、鼓膜充血肿胀）的中耳积液，但可源于急性中耳炎 OME is defined as MEE without signs and symptoms of acute inflammation (otalgia, irritability, and fever; bulging of the tympanic membrane) ;;Various factors interact in the pathogenesis of otitis media ;咽鼓管 (ET)-中耳 (ME)-乳突 (mast) 通气系统在OME发病中的作用. The three physiologic functions of the eustachian tube are (1) pressure regulation (ventilation), (2) protection, and (3) clearance (drainage). Of these, pressure regulation is the most important A, Pressure regulation function is related to active dilation of the tube by contraction of the tensor veli palatini muscle (TVP). ;以往认为，咽鼓管功能不良是OME发生的始发及主要因素 儿童、婴幼儿咽鼓管较成人短、宽、平，更易患OME，7岁以后渐接近成人，OME发生率明显下降;中耳积液的细菌学研究 Comparison of distribution of isolates in 2807 effusions from patients with acute otitis media (AOM) and 4589 effusions from patients with otitis media with effusion (OME) at the Pittsburgh Otitis Media Research Center, 1980 to 1989. Total percentages are greater than 100% because of multiple organisms ; 现有研究认为: OME可能起源于慢性感染 Secretory changes in the middle ear in COME are most likely due to chronic infection 多数患者以急性感染起病 The majority of cases begin as acute infection of the middle ear 咽鼓管及中耳粘膜的炎症后反应导致持续性鼓室积液 Postinflammatory alteration in the middle ear mucosa and eustachian tube (e.g., goblet cell metaplasia and hypersecretion) lead to persistence of effusion 咽鼓管功能不良是疾病发生、发展的重要环节 Dysfunction of the eustachian tube is an important part of the process. ;症状 耳闷、听力下降、耳鸣以及自听过显 听力下降是儿童就诊的首要原因 体格检查 听力学测试 影像学检查：不作常规 ;体检 Physical examination 耳科检查 头颈检查：很重要，可发现OME易患因素，如：颅面畸形、腭裂、鼻腔和鼻咽部异常.;听力学检查 Hearing Tests 听阈评价：轻~中度传导性听力损失 行为测听：视觉强化测听(2岁)，游戏测听(2岁)，纯音测听(5岁) ABR：不能配合行为测听者，但不能真实反映外周听力 声导抗（需外耳道通畅）： 很好反映中耳功能状态，可用于OME动态随访和筛查 OME：鼓室图B或C型，提示中耳积液或负压;治 疗 Management;一. 观察随访 watchful waiting;抗生素 急性中耳炎：阿莫西林40 mg/kg/day，7-10