本文關(guān)鍵詞： 腺樣體肥大 中耳咽鼓管功能障礙 分泌性中耳炎 純音測聽 聲導(dǎo)抗 電子鼻咽鏡　出處：《山西醫(yī)科大學(xué)》2011年碩士論文　論文類型：學(xué)位論文

【摘要】：目的腺樣體肥大是兒童常見病和多發(fā)病,是引起小兒分泌性中耳炎的重要病因。腺樣體肥大患兒年齡小,不善于表述耳鳴、耳聾等不適。家長也不易發(fā)現(xiàn)患兒聽力下降。一旦引起聽力明顯下降時再就醫(yī),治療起來就很困難,而兒童時期是語言、心理等發(fā)育的關(guān)鍵時期,聽力下降勢必影響其發(fā)育,所以,及早發(fā)現(xiàn)腺樣體肥大患者咽鼓管功能和中耳傳音功能異常,對于挽救兒童聽力損失具有非常重要的意義。腺樣體是位于鼻咽頂后壁的淋巴組織,在解剖學(xué)上是咽淋巴環(huán)的一部分,出生后即發(fā)育成熟,在兒童和青少年時期腺樣體體積最大,以后逐漸縮小,腺樣體是人體的免疫器官,它含有各個發(fā)育階段的淋巴細(xì)胞。肥大的腺樣體一直被認(rèn)為是引起兒童分泌性中耳炎的重要原因,本文通過探討兒童腺樣體肥大與中耳咽鼓管功能相關(guān)性,為臨床防止腺樣體肥大引起聽力障礙提供依據(jù)。 方法回顧性分析2008年10月至2011年2月在長治醫(yī)學(xué)院附屬和濟醫(yī)院、和平醫(yī)院耳鼻喉科己進(jìn)行鼻咽X線側(cè)位片檢查診斷為腺樣體肥大的98例患者,并選取30例正常兒童作為對照,根據(jù)所有患者鼻咽X線側(cè)位片A/N比值的結(jié)果將全部病例按腺樣體肥大程度分為腺樣體正常組、中度肥大組和病理性肥大組,所有兒童均接受常規(guī)耳鏡檢查、純音聽閾測定、聲導(dǎo)抗測試和電子鼻咽鏡檢查,記錄相關(guān)數(shù)據(jù),進(jìn)行統(tǒng)計分析,腺樣體肥大組行腺樣體切除術(shù),術(shù)后半年復(fù)查耳鏡檢查、純音聽閾測定、聲導(dǎo)抗測試和電子鼻咽鏡檢查,記錄相關(guān)數(shù)據(jù)與術(shù)前相對比,進(jìn)行統(tǒng)計分析。將負(fù)壓水平超過200daPa的C型和所有B型曲線者診斷為合并分泌性中耳炎,負(fù)壓水平?jīng)]有超過-200daPa的C型和所有A型曲線者則診斷為沒有合并分泌性中耳炎,統(tǒng)計分析腺樣體大小對分泌性中耳炎發(fā)病的影響。 結(jié)果腺樣體中度肥大組、病理性肥大組耳鏡檢查、純音聽閾測定、聲導(dǎo)抗測試和電子鼻咽鏡檢查與正常兒童組相比,差異均有統(tǒng)計學(xué)意義(P0.05)。腺樣體肥大組行腺樣體切除術(shù),術(shù)后半年復(fù)查耳鏡檢查、純音聽閾測定、聲導(dǎo)抗測試和電子鼻咽鏡檢查,與術(shù)前相對比差異均有統(tǒng)計學(xué)意義(P0.05)。各組分泌性中耳炎發(fā)生率差異有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論1.兒童腺樣體肥大會造成中耳咽鼓管功能障礙。2.腺樣體體積越大,分泌性中耳炎發(fā)病幾率越高。3.腺樣體切除術(shù)可改善中耳咽鼓管功能,有利于兒童分泌性中耳炎治療。
[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.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R764.2

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