| Objective To explore its important role in the pathogenesis of adenoid hypertrophy combined with secretory otitis media in children by studying the correlation between laryngeal reflux and adenoid hypertrophy combined with secretory otitis media in children.The accuracy of the Throat Reflux Symptom Index Scale(RSI)and Throat Reflux Signs Scale(RFS)for the initial screening of children was verified by adenoid tissue pepsin detection.The effect of nasopharyngeal microenvironment changes caused by laryngeal reflux on the distribution of microflora was clarified.Methods A total of 80 children requiring surgery due to adenoid hypertrophy were included in this study,and all of them completed RSI and RFS scale questionnaire scores before surgery.During the operation,the bacterial culture of nasopharyngeal secretions and adenoid tissue were retained under direct nasal endoscopic vision,and the adenoid tissue was stained by pepsin immunohistochemical staining after surgery.According to whether the patients had secretory otitis media,they were divided into A and B groups,and the reflux-related indexes(RFS,RSI,positive area ratio and H-SCORE)between the two groups were compared,and the accuracy of RFS and RSI scales was analyzed according to the results of pepsin staining.According to whether the bacterial culture results were positive,they were divided into two groups,C and D,and the semi-quantitative results of pepsin staining(positive area ratio and H-SCORE)between the groups were compared.Results There were 31 cases of adenoid hypertrophy with secretory otitis media in group A and 49 cases of adenoid hypertrophy without secretory otitis media in group B,and the differences in RFS score(~2=20.804,P<0.001)and RSI score(~2=6.104,P=0.013)between the two groups were statistically significant.Taking pepsin immunohistochemistry as the reference standard,the sensitivities of RSI,RFS,RSI combined with RFS were 42.42%,69.70%and 61.11%,respectively,and the positive predictive values of the three were 50.00%,67.65%and 61.11%,respectively.That is,RFS and RSI combined with RFS for the diagnosis of laryngeal reflux have high authenticity and diagnostic value.According to Kappa consensus analysis RFS(k=0.461,P<0.001)and RSI combined with RFS(k=0.417,P=0.02),the diagnosis of laryngeal reflux had high consistency.3.The positive area ratio and H-SCORE of pepsin expression in group A were significantly higher than those in group B,and the difference was statistically significant(P<0.001);the positive area ratio of pepsin expression between groups A and B(r=0.526,P<0.001)and H-SCORE(r=0.548,P<0.001)were statistically significant,that is,there was a correlation between laryngeal reflux and adenoid hypertrophy combined with secretory otitis media.4.After comparison,there was no significant difference in general clinical data and laryngeal reflux-related indicators between the two groups C and D(P>0.05),that is,there was no correlation between the distribution of nasopharyngeal flora and laryngeal reflux.Conclusion There is a correlation between adenoid hypertrophy and secretory otitis media in children and laryngeal reflux,RFS and RSI combined with RFS are more accurate in the diagnosis of laryngeal reflux than the RSI scale alone,and the distribution of nasopharyngeal flora is not related to laryngeal reflux.Objective By exploring the distribution of pathogenic bacteria and related risk factors in children with adenoid hypertrophy,this paper aims to provide reliable guidance for the prevention and treatment of bacterial infection in children with adenoid hypertrophy.Methods The clinical data of 405 children who underwent adenoidectomy in the Department of Otorhinolaryngology,Head and Neck Surgery of the Affiliated Hospital of Qingdao University from October 2021 to April 2022 were retrospectively analyzed.All patients included in this study were retained for bacterial culture with adenoid surface secretions and part of adenoid tissue.According to the bacterial culture results,405patients with adenoid hypertrophy were divided into positive and negative bacterial culture groups.Among them,69 cases were in the positive group and 336 cases were in the negative group.Univariate analysis was used to analyze the gender,age stratification,birth history,birth history,birth mode,feeding mode,disease course,adenoid size,tonsil size,whether secretory otitis media,history of chronic sinusitis,and tobacco exposure history of the two groups were used to screen out meaningful correlation variables,and the screened related variables were included in the binary logistic regression model for multivariate analysis.Results Univariate analysis showed that there was a significant difference between the two groups in terms of adenoid size,whether it was complicated with secretory otitis media,whether there was a history of chronic sinusitis,and whether there was a history of tobacco exposure(P<0.1).A history of chronic sinusitis and tobacco exposure are risk factors for positive results of pathogenic bacteria in nasopharyngeal conditions in children with adenoid hypertrophy.The three pathogenic strains of nasopharynx in children with adenoid hypertrophy were Staphylococcus aureus(41.18%),Streptococcus pyogenes(27.45%),and Streptococcus pneumoniae(15.38%).Conclusion In children with adenoid hypertrophy,bacterial culture of nasopharyngeal secretions should be obtained as soon as possible for children with secretory otitis media,a history of chronic sinusitis,and a history of tobacco exposure to determine whether pathogenic bacteria are infected and anti-infective therapy should be given as soon as possible.The main conditional pathogenic bacteria in the nasopharynx of children with adenoid hypertrophy are Staphylococcus aureus,Streptococcus pyogenes and Streptococcus pneumoniae are all gram-positive cocci,and children with adenoid hypertrophy and infection with unyielded bacterial culture results can refer to the results of this study and use antibiotics for anti-infective treatment. |
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