| Background:Otitis media with effusion(OME)is a common disease in otolaryngology,and is one of the main causes of hearing loss in children.The incidence of OME in children is much higher than that in adults,and the younger the age,the higher the incidence.Long-term or repeated secretory otitis media will have a great impact on the development of language,speech,cognition,balance and other aspects of children.Therefore,the early discovery and treatment of OME are of great significance to the growth and development of children.Acoustic immitance test is a means to evaluate the function of the middle ear and eustachian tube.In clinical practice,B-type tympanic pressure curve is generally used as the diagnostic criteria for OME,and A-type tympanic pressure curve is used as the standard for normal middle ear function.However,in clinical practice,some children show type A or As tympanic pressure curve accompanied by middle ear effusion.The relevant research data of these children are very limited at home and abroad,so the research on these children is of great significance for the diagnosis and treatment of OME in children.Regarding the treatment of OME in children,relevant domestic and foreign guidelines all believe that the therapeutic effect of oral medicine and nasal spray is uncertain,and many studies have reported the adverse reactions of oral medicine and nasal spray hormone,so the guidelines suggest surgical treatment.But the trauma of surgery and postoperative recurrence have also become the concerns of doctors and parents of children.In addition,traditional Chinese medicine decoction therapy also has disadvantages,that is,long-term medication will affect the liver and kidney function of children,and poor compliance of children will affect the therapeutic effect.After many years of intensive clinical studies under the guidance of the Sun’s Sequential Therapy(SST),the doctor Sun combined the research results of modern medicine with traditional Chinese medicine to summarize a set of characteristic therapy for rhinopathy.The SST mainly uses traditional Chinese medicine for external use,strengthens the local efficacy of the nasal mucosa,avoids the adverse reactions of oral drug therapy,and has the advantages of non-trauma,less pain and high compliance of children.At present,many clinical studies have confirmed the efficacy of SST in children with ear,nose and throat diseases.Objective:To observe the clinical characteristics of type A and type AS tympanic pressure curve in children with OME treated in community and clinic,to explore the risk factors of children with OME,and to observe the effect of SST on children with type A and type AS tympanic pressure curve.Methods:1.Screened 121 cases of children in the community(no complaints),conducted epidemiological investigation on OME for all children with OME management APP,recorded the disease history of OME in children,performed ear endoscopy and permeability examination for children,and recorded the middle ear effusion signs and tympanic membrane abnormalities in the affected children.The tympanic membrane status,middle ear pressure value and static acoustic admittance value were observed in sick children and normal children in community.2.A total of 48 children with ear discomfort symptoms or OME related diseases(such as adenoid hypertrophy,allergic rhinitis,etc.)who were diagnosed as OME by ear endoscopy with tympanic pressure curve of type A and type AS were selected from the otolaryngology clinic.The children OME management APP was used to collect the history of OME related diseases in children.Abnormal tympanic membrane,middle ear pressure and static acoustic admittance were recorded.All the children were classified by syndrome differentiation and treated with SST for 4 weeks.Ear endoscopy and acoustic immittance test were reviewed every 2 weeks to observe the tympanic membrane morphology of the children and the changes in the results of sound transduction examination,so as to evaluate the therapeutic effect of this therapy.Results:1.17 out of 121 children in the community were found to have OME,the prevalence rate was 14.05%,and there was no statistical difference between different genders.Type A tympanic pressure curve and type B tympanic pressure curve were dominant in the community children with OME.There was no significant difference in the proportion of middle ear clear fluid and tympanic membrane color change in the community children with OME.2.Among the children with OME in the community,the first three diseases with the most frequent occurrence in the past history were adenoid hypertrophy,allergic rhinitis and recurrent upper respiratory tract infection.The frequency of adenoid hypertrophy in the community children with OME was significantly higher than that in the normal children in the community(P<0.05).3.Although the tympanic pressure curves of type A and type AS were shown in some communities children with OME,the peak pressure value of the ear was significantly lower than that of normal children in communities,and there was no difference in the sound compliance value between them.4.The average age of the children diagnosed in the outpatient department was 4.26±1.32 years old,most of which were 4 years old.There was no statistical difference in the prevalence rate between different genders.There was no significant difference in the proportion of clear fluid effusion in the middle ear and color change in the tympanic membrane,but the frequency of tympanic membrane inversion and congestion was significantly higher than that of asymptomatic community OME children.5.The most frequent TCM syndrome among children diagnosed in outpatient department was the syndrome of heat accumulated through lung,in which the proportion of ear affected by tympanum pressure curve of type A was significantly higher than that of ear affected by AS tympanum pressure curve(P=0.032<0.05),the syndrome with the lowest frequency was Qi stagnation and blood stasis,and there was no statistical significance in the proportion difference between the two kinds of acoustic conductivity curves.6.The frequency of adenoid hypertrophy was significantly higher than that of other previous histories(72.9%),followed by the history of allergic rhinitis(16.6%).7.The middle ear pressure was significantly higher than that before treatment after 2 weeks of the tympanum pressure curve type A and type AS treated by SST(P=0.041<0.05),the 2week cure rate was 86.3%,and the 4-week cure rate was 98.6%.Conclusion:1.Among the asymptomatic children in the community investigated in this study,the incidence of OME was 14.05%,and among the children with OME in the community,ear with type A tympanic pressure curve accounted for 26.9%and ear with type AS tympanic pressure curve accounted for 11.5%.It can be seen that children’s OME is relatively hidden,which requires guardians and clinicians to raise their vigilance on this disease.Achieve early detection,early intervention,to avoid prolonged disease course caused by hearing loss,and even affect the growth and development of children.2.Through the analysis of the previous history of community children and the medical history of outpatient children,it is found that adenoid hypertrophy is an important risk factor for OME in children.In addition,the incidence of allergic rhinitis and repeated upper respiratory tract infection in children with this disease is also relatively high,which requires high attention from guardians and clinicians.3.The traditional Chinese medicine syndromes of children with tympanic pressure curve of type A and type AS diagnosed in outpatient department are mostly lung meridian solid heat syndrome,and the treatment can mainly consider heat clearing and surface relieving drugs.4.This study found that the efficacy of sequential therapy of traditional Chinese medicine nasal disease in children with OME with tympanic pressure curve type A and type AS is better than that of children with type B and type C,and the treatment applied in this type of children can make the children recover faster.Although it is clinically found that some children with OME present tympanic pressure curves of type A and type AS,it is not clear whether type A and type AS tympanic pressure curves are early manifestations of type B or type C tympanic pressure curves,and further studies are needed.5.The structure of the eustachian tube in children has not been fully developed,and the common clinical acoustic immittance test lacks specificity and sensitivity in the diagnosis of OME in children,so the diagnosis of this disease should be based on ear endoscopy.If the patient turning one ear to the source of sound,or if the patient has a history of OME,an endoscopy should be added to determine whether the child has OME. |
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