鼓膜造口管置入的常见适应症

K. Outhoff
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引用次数: 1

摘要

7岁以下的儿童患中耳炎的风险增加,因为他们的免疫系统不成熟,耳咽管功能不佳,正常情况下,耳咽管会给中耳空间通风,使压力与外部环境平衡。超过80%的儿童在3岁之前至少有一次急性中耳炎(AOM)发作,40%的儿童在7岁之前有6次或更多的复发。到3岁时,大约7%的儿童因一系列中耳炎问题接受鼓膜造瘘管插入手术,最常见的是慢性中耳炎伴积液(OME)、复发性急性中耳炎和尽管抗生素治疗仍持续存在的急性中耳炎。2然而,鼓膜造瘘管置入与风险相关,并且仍然是一种有争议的做法,特别是对于持续时间小于3个月的OME儿童和复发性AOM儿童。与鼓膜造瘘管置入相关的不良反应包括与麻醉及其并发症(喉痉挛、支气管痉挛)相关的不良反应,以及与管相关的后遗症,如复发性(7%)或持续性(16-26%)耳漏、管腔阻塞(7%)、肉芽组织(4%)、管过早挤出(4%)、鼓膜移位至中耳(0.5%)和持续性鼓膜穿孔(1%-6%)。这篇文章为希望优化可能需要鼓室造瘘置管儿童健康结果的家庭医生提供了指导。
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Grommets - an update on common indications for tympanostomy tube placement
Children younger than 7 years are at increased risk of otitis media because of their immature immune systems and poorly functioning eustachian tubes that normally ventilate the middle ear space and equalize pressure with the external environment. More than 80% of children have at least one episode of acute otitis media (AOM) before the age of 3 years and 40% experience six or more recurrences by the time they are 7 years old. 1 By the age of 3 years, approximately 7% of children undergo surgery for tympanostomy tube insertion for a range of otitis media issues, most commonly for chronic otitis media with effusion (OME), recurrent acute AOM, and acute otitis media that persists despite antibiotic therapy. 2 However, tympanostomy tube insertion is associated with risks and remains a controversial practice especially in children with OME of less than three months’ duration and in children with recurrent AOM. Adverse effects associated with tympanostomy tube insertion include those associated with anaesthesia and its complications (laryngospasm, bronchospasm), as well as tube related sequelae such as recurrent (7%) or persistent (16–26%) otorrhoea, blockage of the tube lumen (7%), granulation tissue (4%), premature extrusion of the tube (4%), tympanostomy tube displacement into the middle ear (0.5%) and persistent perforation of the tympanic membrane (1%–6%). 3 This article offers guidance for family practitioners wishing to optimize health outcomes in children potentially requiring tympanostomy tube placement.
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