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目的 探讨分泌性中耳炎(otitismediawitheffusion,OME)复发相关的影响因素。方法 分析经鼓膜切开置管术治疗的255例慢性分泌性中耳炎患者的临床资料,其中取出通气管后一年内复发者85例,未复发者170例。对与分泌性中耳炎复发相关的可能因素包括年龄、性别、病程、吸烟环境、反复呼吸道感染、慢性鼻-鼻窦炎、鼻腔结构异常、腺样体肥大/鼻咽淋巴组织增生、乳突气化情况、既往置管手术史、中耳通气管留置时间等进行单因素分析及多因素Logistic回归分析。结果单因素分析发现,年龄、反复呼吸道感染(χ2=22.546,犘=0.000)、慢性鼻-鼻窦炎(χ2=5.211,犘=0.023)、腺样体肥大/鼻咽淋巴组织增生(χ2=10.338,犘=0.002)、乳突气化不良(χ2=15.196,犘=0.000)、通气管留置时间(3~6月)(χ2=11.347,犘=0.001)对分泌性中耳炎复发的影响有统计学意义。Logistic回归分析显示,小龄、反复呼吸道感染(犘=0.001,OR=2.992)、腺样体肥大/鼻咽淋巴组织增生(犘=0.021,OR=2.198)、乳突气化不良(犘=0.000,OR=3.433)、通气管留置时间(3~6m)(犘=0.010,OR=2.237)5个因素对分泌性中耳炎复发的影响有统计学意义。反复呼吸道感染对学龄前、学龄期儿童和青少年复发性分泌性中耳炎影响有显著意义,腺样体肥大/鼻咽淋巴组织增生对学龄前儿童OME复发的影响有显著意义(犘<0.05)。结论 小龄、反复呼吸道感染、慢性鼻-鼻窦炎、腺样体肥大/鼻咽淋巴组织增生、乳突气化不良、通气管留置时间较短可能是导致分泌性中耳炎复发的主要因素。反复呼吸道感染对学龄前、学龄期儿童和青少年的影响较成人更为显著,腺样体肥大对学龄前儿童的影响最为明显。
Objective To investigate the influencing factors of the recurrence of otitis mediaicheffusion (OME). Methods The clinical data of 255 cases of chronic otitis media with effusion treated by tympanotomy were analyzed. Among them, 85 cases recovered within one year and 170 cases did not. Potential factors associated with the recurrence of secretory otitis media include age, sex, duration, smoking environment, recurrent respiratory infections, chronic rhinosinusitis, nasal structural abnormalities, adenoid hypertrophy / nasopharyngeal lymphoid hyperplasia, mastoid gasification , Previous catheterization history, middle ear ventilation tube indwelling time and other univariate analysis and multivariate logistic regression analysis. Results Univariate analysis showed that age, recurrent respiratory infections (χ2 = 22.546, 犘 = 0.000), chronic rhinosinusitis (χ2 = 5.211, 犘 = 0.023), adenoid hypertrophy / nasopharyngeal lymphoid hyperplasia (χ2 = 10.338 (Χ2 = 15.196, 犘 = 0.000), ventilation tube indwelling time (March-June) (χ2 = 11.347, 犘 = 0.001) had statistical significance on the recurrence of secretory otitis media significance. Logistic regression analysis showed that age, recurrent respiratory tract infection (犘 = 0.001, OR = 2.992), adenoid hypertrophy / nasopharyngeal lymphoid hyperplasia (犘 = 0.021, OR = 2.198) , OR = 3.433), ventilation tube indwelling time (3 ~ 6m) (犘 = 0.010, OR = 2.237) had a significant effect on the recurrence of secretory otitis media. Recurrent respiratory tract infections have significant effects on recurrent secretory otitis media in preschool, school-age children and adolescents. Adenoid hypertrophy / nasopharyngeal lymph node hyperplasia has a significant effect on OME recurrence in preschool children (犘 <0.05). Conclusions The main causes of the recurrence of otitis media with secretory otitis media may be small age, recurrent respiratory tract infection, chronic rhinosinusitis, adenoid hypertrophy / nasopharyngeal lymphoid tissue hyperplasia, poor mastodermal gasification and short ventilation tube indwelling time. Repeated respiratory infections on preschool, school-age children and adolescents more significantly than adults, adenoid hypertrophy on the most significant impact on preschool children.