Objective:To compare adenoidectomy combined tympanocentesis, CO₂ laser tympanostomy and grommet insertion in the treatment for secretory otitis media (SOM) in children, and to provide basis for selection of surgical treatments. Method: Four hundred and twenty-six ears in 244 children with adenoid hypertrophy and SOM were divided into 3 groups which were: group A, 80 cases (142 ears) were treated with adenoidectomy combined with tympanocentesis; group B, 86 cases (145 ears) were treated with adenoidectomy combined with CO₂ laser tympanostomy; group C, 78 cases (139 ears) were treated with adenoidectomy combined with grommet insertion. Endotoscopy, tympanometry and PTA (or ABR) were conducted. Based on the characters of the middle ear effusion in operation, each ear were divided into two groups: Serous group and Mucus group. All patients conducted PTA (or ABR) 6 months after surgery and they were followed up until 1 year after surgery. The efficacy and postoperative complications and recurrence rate were compared among 3 groups, the prognosis of both serous group and mucus group were analyzed. Result:The effective rate of 3 groups at 6 months postoperative were 89.44%, 90.34% and 96.40% respectively, which showed no statistical difference among 3 groups and statistical difference between group C and group A, B was found. No statistical difference was found among 3 groups in serous group. The effective rate of group C was higher than that of group A and group B, with statistical difference. The rate of postoperative complications (permanent tympanic membrane perforation, middle ear infection postoperative, tympanic tube blockage or detachment, etc.) during 1 year postoperative in 3 groups were: 16.20%, 13.10%, 33.81%, respectively. The recurrence rates were: 11.02%, 12.98%, 3.73%, respectively, and the reoperation rate in all 3 groups were 0. Conclusion:In the treatment for SOM in children with adenoid hypertrophy, adenoidectomy combined with tympanocentesis or combined with CO₂ laser tympanostomy showed a similar effects, which was slightly lower than adenoidectomy combined with gromment insertion. Considering the complications postoperative and recurrence rates of different operations, tympanocentesis or CO₂ laser tympanostomy is recommended to be conducted as routine, and grommet insertion is recommended to be conducted when mucus-like middle ear effusion is found during surgery.
目的：比较腺样体切除术联合鼓膜穿刺、CO₂激光鼓膜打孔或鼓膜置管治疗儿童腺样体肥大合并分泌性中耳炎（SOM）的疗效，为临床治疗儿童腺样体肥大合并SOM的术式选择提供参考。方法：将腺样体肥大合并SOM的患儿244例（426耳）随机分为3组：腺样体切除+鼓膜穿刺组（A组）80例（142耳）；腺样体切除+CO₂激光鼓膜打孔组（B组）86例（145耳）；腺样体切除+鼓膜置管组（C组）78例（139耳）。所有患儿术前行耳内镜检查、鼓室声导抗及纯音测听（或听觉脑干诱发电位）。术中评估每例鼓室内积液性状，将患耳分为浆液型积液及黏液型积液两型，术后6个月复查纯音测听并随访至术后1年。对3组的疗效、并发症、复发率以及浆液型、黏液型积液的预后情况进行比较。结果：术后6个月，A、B、C三组的有效率分别为89.44%、90.34%、96.40%，A、B两组差异无统计学意义，A、B组与C组间差异均有统计学意义。浆液型积液的患耳在A、B、C三组间的有效率差异无统计学意义；黏液型积液患耳中，C组有效率均显著高于A、B两组。术后1年内，A、B、C三组出现穿孔不愈合、术后中耳感染、通气管堵塞或脱落等并发症发生率分别为16.20%、13.10%、33.81%；A、B、C三组的复发率分别为11.02%（14/127）、12.98%（17/131）、3.73%（5/134）。3组患者无一例再次手术。结论：对于腺样体肥大合并SOM的患儿，腺样体切除术合并鼓膜穿刺或CO₂激光鼓膜打孔的疗效相当，鼓膜置管术可能更有优势。考虑到3种术式的并发症及复发率，建议可常规行CO₂激光鼓膜打孔术或鼓膜穿刺术，对术中发现中耳黏液型积液者进行鼓膜置管术。.
Keywords: CO₂ laser tympanostomy; adenoid hypertrophy; grommet insertion; secretory otitis media; tympanocentesis.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.