A secretion of otitis media (OME) is a non -purulent disease with a complete middle ear with a complete tympanic membrane. The main characteristics are the accumulation of the medium ear, the hearing decrease, and the ears.
Through research, 80%of children have OME medical history and even recur, but because children are not sensitive to some symptoms and are not described in uncomfortable symptoms, they have caused neglect of patients’ families.
The cause of the disease of children’s OME may be transition from acute otitis media, sinusitis, allergic rhinitis, and upper respiratory tract infections.
AH can squeeze the round pillow to make the pharyngeal tube blocked and poor drainage, which leads to negative pressure in the drum chamber. The vein of the middle ear mucosa is expanded, and the permeability of the vascular wall is increased., Finally, the indoor effusion gathered to produce OME.
Even if the glandular sample does not reach the degree of nostrils or affect the drainage of the eustachian tube, the hidden nest of the glandular sample can become the savings pool of bacteria to gather various bacteria. When the bacteria exist for a long time, the glandular sample can be released.The inflammatory medium leads to the edema of the eustachian tube, which indirectly affects the function of the eustachian tube.
Because AH’s typical symptoms are sleep snoring, breathing, etc., this bad sleep habit can affect the shape of children’s maxillofacial facial parts in growth and development, produce adenoid decent capacity, and affect the appearance. At this time, it will attract the attention of parents of patients.
In addition, patients with AH can also be accompanied by symptoms such as nasal congestion, runny nose, etc. These symptoms are more likely to attract the attention of patients with patients. Omes that have not yet shown symptoms can be found during the consultation, so that OME can be discovered and treated early.
In addition to the appearance, patients with adenoid hypertrophy may occur in long -term chronic hypoxia may have problems such as slow growth, dynamic disease, inconsistent attention, slow reaction and intelligence, poor learning ability, etc., and secretion otitis media can also cause dizziness by affecting vestibular functions.Feelings and reduce patient learning ability, so in recent years, it has continuously attracted the attention of scholars at home and abroad.
Combined with the cause of OME, the main method of treatment is to relieve mechanical blockage of pharyngeal tube pharyngeal, strengthen the sector drainage of indoor indoor, and reduce the possibility of middle ear infection.
The current commonly used surgical methods are glandular sample resection and hypogonal tubal puncture or tube tube surgery. According to previous clinical experience, although this method is always effective, there is still a part of the existence of part of it.Patients do not heal, which increases the possibility of progress in stubborn secretion of otitis media. The lesions can even accumulate mastoids, produce chronic tractitis, and eventually lead to the occurrence of intermediate otitis media.
The sequelae of otitis media can occur at any age group. It is divided into iliac cholesterol granuloma, adhesive otitis media, drum room sclerosis, and concealment of otitis media.Mainly.
Cholesterol granuloma (CG) is a proliferative granulation tissue with cholesterol crystals and giant cells inside.Drum rooms and other places, Middle ear CG is usually considered as advanced lesions of secretion otitis media.
The clinical research on middle -ear CG is mainly aimed at adults, but in recent years, with the incidence of adenoid hypertrophy gradually increased, OME’s incidence is also increasing. Clinically, otitis media caused by stubborn secretion of otitis media causedThe sequelae can also occur in children.
In terms of treatment, referring to adult treatment plans should be based on individualized surgical treatment. For patients with exhaustion of mastoid, feasible mastoid root treatment combined with drum rooms, and according to the results of electricity testing and the listening small bones seen during the surgery, the listening small bones seen during the surgery, the listening small bones seen during the surgery.The damage is given the drum room forming, but most of the children are younger in age and cannot cooperate with the electric hearing inspection. It is difficult to evaluate the condition of the bone chain before surgery.Essence
Before surgery, it can be performed to improve the diagnosis of OME and the scope of its diseased diseases and the scope of its disease.
Nong Guotian found that 120 patients with CG patients found that there were typical lesions characteristics, that is, a complete drum membrane, and 104 cases with blue or brown black (86.7%).120 patients’ vocalist anti -examination was type B.Therefore, carefully check the physical examination before surgery, and combined with the MRI results, the diagnosis can be preliminarily clear
Although both adults and children can occur, the reasons are not exactly the same, and the proportion of children’s disease is higher than that of adults.About 50%-90%of preschool children have OME history, of which 30%-40%of patients have refractory OME.
Due to the short and straight pharyngeal tube of the child, the lumen is large, and the angle of the horizontal plane is small. When AH occurs, its orange petal -like appearance is more likely to accumulate bacteria from nasal and nasopharynx, upper respiratory tract infection, etc.The increase in the number of bacteria at the physiological structure of the drums makes bacteria easier to enter the drum room.
If AH occurs, on the one hand, the hypertrophic gland sample can be squeezed by squeezing the pillow, which blocks the pharyngeal tube and throat, which causes the swallow tube drainage ability to decrease, thereby forming negative pressure in the drum room, increasing the formation of the indoor effusion;On the other hand, AH can block the posterior nostrils, so that the pressure of the nasopharynx is elevated when swallowing, and the secretions in the pharynx are easier to flow into the drum room, which can also become the source of bacteria that cause OME.
The tissue structure on the surface of the hypertrophic gland will also change, that is, the ciliated cylindrical epithelium is degenerated as a squamous epithelium and a fiber connective tissue, which reduces the efficiency of the pharyngeal tube and the ciliac ciliated ciliac fur flow system, and the drainage of the indoor effusion of the drum chamberreduce.In addition, the pediatric eustachian tube is still in the developmental stage, the sails are weak, and the elastichus of the pharyngeal tube has poor elasticity, which can easily lead to stenosis or occlusion of the lumen, which can also cause negative pressure on the drum chamber.
Whether the function of the eustachian tube is normal is another important factor in children’s OME.When AH is accumulated more, the adenoid experience will release the inflammatory medium that causes the throat and pharyngeal mucosal edema, but the scope of edema may not be limited.serious.
Some studies have also proved that because children have not yet been improved, they are prone to poor pharyngeal tube duct function and immune system defects, which is also the main cause of the high incidence of children in children.
AH is one of the main causes of children’s OME. Therefore, cutting hypertrophic gland samples to relieve the blockage of pharyngeal tubes, and removing a series of risk factor for OME is a necessary treatment method.
Although many children have no obvious complaints of AH -related symptoms when they are clinic, in this study, through the CT examination of the nasopharynal nasopharynx before surgery, it was found that the glandular samples were squeezed to the patient’s round pillow.Removal gland sample is helpful for the treatment of children’s OME.
There are also other studies in China that for children with OME for children, although the glandular sample does not cause the nasopharynx to block and produce corresponding symptoms, it will still affect the normal function of the eustachian tube.
In 2021, children’s secretion of otitis media guide mentioned that although the tympanic membrane puncture can quickly discharge the drum room effusion and have a certain treatment effect on the children’s OME, the puncture channel has a short retention time.-In the 10th, it is not recommended for conventional use for the treatment of children’s OME.
Some studies also believe that for patients with short -disease and drums with thin spots, adenoid resection combined with drum membrane puncture treatment for children OME can achieve the treatment effect similar to the tympanic membrane tube.The total efficiency is for patients with a thicker accumulation in the group, and the patients are given the drum membrane in accordance with the guidelines.
Foreign scholars believe that the basic treatment of children’s OME is AT+T. This method can help patients to quickly recover hearing and prevent the occurrence of omitic chilotoma and CG.
The guide published in 2016 pointed out that after the gonad -sample resection, the possibility of children’s OME delay can be reduced by reducing the chance of upper respiratory tract infection and controlling allergic rhinitis. ThereforeThe surgical plan should be AT+T.
There is META analysis and forward -looking studies that AT can increase the efficacy of hearing improvement after the tympanic membrane tube, and reduce the risk of repeated replacement of the middle ear -passing duct, which can significantly improve the efficacy after surgery and reduce the production of the medium effusion.
Through research, although the course of the disease for more than 3 months is the surgical indicator of the tympanic diaphragm tube, the effect of postoperative postoperative effect is not unchanged, but as the course of the disease is prolonged and the curative effect gradually decreases.The tympanic membrane is performed as soon as possible to achieve the purpose of healing as soon as possible.
In terms of medication, although experiments have proved the effects of antibiotics of large circles of venelin on OME, anti -inflammatory and antibacterial effects, in view of premature use of antibiotics, it will produce drug resistance and coexist in advantages and disadvantages.Use antibiotics.
It is found in clinical observations that after AT, the mucosa around the throat and the surrounding cymbals will have edema, and it will last for a period of time. This will lead to the improvement of the drainage function within a period of time after surgery.Hormones are conducive to quickly reducing the edema of the nasopharynx and better restoration of the drainage function.
Some studies have also found that nasal injection hormones can inhibit the synthesis of peanitic acid (AA) and other inflammatory medias, and reduce the hyperplasia around the lymphatic tissue around the eustachian tube, improve the secretion state of surface active substances, reduce the viscosity after the production of the middle ear accumulation,The combination of patients in the study combined with the use of mucus promotion agents is more conducive to discharge the residual and newly generated medium -ear accumulation after surgery, improve the cure rate of children’s OME, and improve the prognosis effect.
With the continuous improvement of AH’s cognition of the public, the detection rate of children’s OME is also increasing. Many patients can find diseases and deal with them accordingly without obvious symptoms in the early days.However, there are still patients with early treatment of patients, and even multiple times are invalid, and the progress is stubborn OME.
It is found in clinical work that although it will be actively treated when children’s OME is discovered, it will not heal for a long time, and the lesion may progress further and affect the mastoid. This part of the lesion may be secondary inflammatory granulous tissue, cholesterol granoma, medium medium, and medium.Ear adhesion, drum hardening and other lesions, there is no new creature in the mastoid in patients, only chronic habitis caused by the inadequate drainage.
At present, the occurrence of refractory OME is related to the obstruction of the eustachian tube and functional disorders, infection, and immune response. These factors can increase the middle ear to increase the pressure of the middle ear by promoting the production of mucus, increased blood flow, and stimulating small blood vessel expansion.Large, when it reaches to a certain degree, it will inhibit cilia, further increase the negative pressure of the middle ear, and form a vicious circle.
Due to the higher the degree of gas gasification, the lower the incidence of stubborn secretion of otitis media, many scholars suggest that in the mastoid surgery of the middle ear.Although the patients in the study are younger, there are history of drum membrane control surgery, and OMEs are still delayed after the tube falling off, and gradually evolved into chronic secretion of otitis media with chronic tractitis.
Because the internal disease of the mastoid can affect the gasification and development of the mastoid, and the possibility of refractory secretion of otitis media in patients with refractory secretions can be thoroughly relieved, and the course of shortening the disease should be used as a choice.Mid -ear CG is considered to be a advanced lesion of OME, and the cause of the occurrence is not unreasonable.
No matter which part of the pharyngeal tube, the drum chamber, or the mastoid cavity, it will cause negative pressure and oxygen in the middle ear, causing the mucosa blood vessels to break and bleed.For the ingredients, the foreign body reaction caused by these ingredients will gradually form a CG, and CG will increase the possibility of bleeding and continue to promote the formation of CG.
CG has the characteristics of difficulty governance and recurrence, and general inflammatory granulation tissues have a low recurrence rate after improvement of medium -ear drainage.
CG grows in different positions will have different aggression. Compared with CG growing in the drum chamber and the mastoid, the Iwian CG has a strong invasion, but the middle ear CG still has the possibility of cochlear infringement, which will affect children’s children.Hearing development, so you need to deal with otin lesions as soon as possible.
At this time, the simple tympanic membrane tube does not disappear the new creatures in the mastoid. Some scholars believe that the treatment of wall -type mastoid root treatment can achieve a smooth drainage, but some scholars hold different views that they believe that open mastours is opened.The effect is better after treatment.
Open dystrophic root treatment can not only contour in mastoid, completely remove CG crystals, prevent it from continuing to stimulate the body to produce crystallization, but also connects with the outside world by opening the back wall of the outer ear canal, to achieve the purpose of completely eliminating the middle ear.
Even if the irreversible pathogenic obstruction of the drum sinus entrance, drums, and bone chain areas cannot be completely solved, it cannot completely solve the problem of reduced the function of swallowing tube drainage. After the back wall of the outer ear canal, it can improve the drainage efficiency for a period of time after surgery.It is particularly important to extend the high drainage state after the tympanic tube for a period of time after surgery.
In the early stage after surgery, there were increased edema and secretions in the lateral ear, and the drum membrane was used to promote the early recovery of the middle ear function.
1. The shorter the course of the child OME, the more significant the efficacy of the drum film.
2. When the children’s OME is delayed, the lesions can gradually affect the mastoid. At this time, the mastoid root treatment combined with the tube of the drum is more conducive to strengthening the drum-drum-sinus-mastoid drainage and improve the prognosis.