目的:探讨鼻内镜下腺样体切除术联合鼓膜置管术对分泌性中耳炎(SOM)患儿血清炎症因子和T细胞亚群的影响.方法:选取2016年8月～2018年12月期间我院收治的SOM患儿113例,上述患儿根据随机数字表法分为对照组(n=56)和研究组(n=57),对照组患儿予以鼓膜置管术治疗,研究组则在对照组的基础上联合鼻内镜下腺样体切除术治疗,比较两组患儿疗效、血清炎症因子、T细胞亚群、中耳积液时间、语频区气导平均听阀及并发症.结果:研究组术后3个月的临床总有效率为94.74％(54/57),高于对照组的75.00％(42/56)(P＜0.05).两组术后3个月血清白介素-2(IL-2)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平均下降,且研究组低于对照组(P＜0.05).两组术后3个月CD8+下降,且研究组低于对照组(P＜0.05);CD4+、CD4+/CD8+升高,且研究组高于对照组(P＜0.05).研究组中耳积液时间短于对照组,语频区气导平均听阀高于对照组(P＜0.05).两组术后并发症发生率比较无差异(P＞0.05).结论:鼻内镜下腺样体切除术联合鼓膜置管术治疗SOM患儿,疗效显著,可有效改善血清炎症因子、T细胞亚群、中耳积液时间及语频区气导平均听阀,且安全性较好,临床应用价值较高.

目的分析高危新生儿听力筛查结果及高危因素.方法选择2019年8月～2019年12月我院NICU就诊的339例高危新生儿(出生48～72 h)作为观察组,均接受瞬态声诱发耳声发射(TEOAE)联合自动听性脑千反应(AABR)听力筛查,并选择同期分娩的1000例正常新生儿作为对照1组,选择同期分娩的1000例早产儿作为对照2组,对其筛查结果与高危因素进行分析.结果观察组、对照2组的听力联合筛查初筛未通过率为7.37％、6.1％,显著高于对照1组的联合筛查初筛未通过率1.2％(P＜0.05).高危新生儿听力联合筛查初筛未通过率为7.37％(25/339)、复筛未通过率为3.13％(10/320),其中TEOAE筛查初筛未通过率为20.35％(69/339)、复筛未通过率为6.88％(22/320),AABR筛查初筛未通过率为18.88％(64/339)、复筛未通过率为5.93％(19/320).新生儿听力障碍高危因素依次是:听力障碍家族史、母孕期用耳毒性药物、两种以上高危因素、NICU住院≥5 d、重度窒息、宫内感染、高胆红素血症、出生体重1500 g以下.结论TEOAE与AABR联合筛查危新生儿听力障碍,可有效减少漏诊与误诊,有利于早发现、早诊断、早治疗.

Objective To evaluate the audiological results of referral infants for failed secondary hearing screening.Methods The audiological results of 210 ears were analyzed.All the referral infants received audiological evaluationin cluding auditory brainstem response (ABR),auditory steady-state response (ASSR),distortion product otoacoustic emission(DPOAE),40 Hz auditory event-related potentials and acoustic impedance.Results Of all the 210 ears,143 were confirmed to have hearing loss with adetection rate of 68.10％ (143/210).Of the confirmed 143 ears,62 ears (43.36％) were conductive and 81 ears (56.64％) were sensorineural.Large vestibular aqueduct syndrome(LVAS) was diagnosed in 16 ears with an incidence of 7.62％ (16/210).Auditory neuropathy spectrum disorder was confirmed in 6 ears with an incidence of 2.85％ (6/210).Conclusions The detection rate of hearing loss is high in infants who have failed secondary hearing screening.We should pay more attention to carry out dynamic follow-up for hearing in infants with high risk factors.Accurate and comprehensive audiological evaluations should be conducted combined with the physiological characteristics of infants.

Objective:To investigate the effects of transient evoked otoacoustic emission (TEOAE) combined with automatic auditory brainstem response (AABR) in high risk newborns hearing screening.Methods:A total of 326 cases of high-risk newborn hearing were examined with TEOAE combined with AABR in NICU,children did not pass by hearing screening were examined with AI,OAE,ABR,40 Hz auditory event related potential(40 Hz AERP).Results:In 21 cases(28 ears) hearing impaired children,TEOAE combined with AABR discovered 16 ears,AABR discovered 18 ears and TEOAE discovered 10 ears.Conclusion:TEOAE combined with AABR in high-risk newborns is more beneficial to early detection of hearing impaired children.

Objective:To investigate the hearing information for low months infants failing in auditory brainstem response (ABR).Methods:Twenty-one infants with totally 42 ears after screen failed,without ABR but normal 1000 Hz probe tone tympanometry results were studied.The evaluations of auditory steady state response(ASSR) and 40 Hz auditory event related potential (40 Hz-AERP) in twenty-one infants were tested.Results:The hearing thresholds were elicited by measurement of ASSR in 45.29％,61.90％,66.67％ and 80.95％ of the children at 500,1000,2000 and 4000 Hz.Prevalence of 40 Hz-AERP at 500 Hz was 52.38％.Conclusion:It is insufficient to evaluate the hearing of infants with ABR only,ASSR combine with 40 Hz-AERP may provide additional audiometric information for accurately evaluating the hearing.

目的:对151例听力筛查未通过的低月龄婴儿进行客观听力结果分析.方法:通过听性脑干反应(ABR),40 Hz听觉相关电位(40 Hz-AERP),多频稳态听觉诱发反应(ASSR),畸变产物耳声发射(DPOAE)、声导抗(AI)等检查对151例婴儿进行客观听力学评估.结果:151例低龄婴儿中双耳听力正常57例(37.7％);听力损失94例(62.3％).轻度听力损失24例(15.9％);中度8例(5.3％);重度4例(2.0％);极重度16例(10.6％).听力损失儿中复查率为21.2％.结论:不能配合主观行为测听的低月龄儿,用客观听力学检查可以评估听力水平,为听力损失儿的早期诊断干预提供依据.

<正>突发性耳聋(sudden deafness,SD),是指瞬间或几小时或几天内突然发生原因不明的一种感音神经性聋。近年采用高压氧(hyperbaric oxygen,HBO)辅助治疗SD取得一定疗效,现综述如下。1 HBO治疗SD的机制目前SD的发病机制仍备受国内外专家的关注,其中以病毒感染,内耳血供障碍为多数学者认可[1]。因此改善内耳血液循环是治疗SD的主要措施,HBO在以下方面对SD起到辅助治疗作用。1.1迅速改善内耳的缺氧及微循环:突发性耳聋蜗底缺氧受损较为严重,高压氧治疗能明显改善受损的内耳供氧与微

<正>患者,男,59岁,因左侧鼻腔出血6h于2010年11月5日急诊入院。患者既往有高血压、糖尿病、乙型肝炎、肝硬化病史。入院前4个月右眼外展受限,枕后头颈深部痛明显。专科检查:抽取鼻腔填塞物后见双下鼻甲稍大,鼻中隔向左偏曲,双侧鼻腔内未见异常分泌物及新生物。因患者头痛

Objective To study whether removal of the horizontal part of the middle turbinate base has an effect on post-operative middle turbinate drifting synechia.Methods 110 cases of bilateral sinusitis and nasal polyps were enrolled in this study,with removal of parts of the middle tuebinate base due to diseases on one side and integrity of it on the other side.By self-control of the patients,incidence of bilateral post-operative middle turbinate drifting synechia in six months after surgery was observed.Results Post-operative middle turbinate drifting synechia occurred on 19 sides(17.8%) with removal and on 7 sides(6.4%) without removal in 110 cases.Conclusion To reserve the horizontal part of the middle turbinate base has clinical significance for maintaining the middle turbinate fixed and preventing post-operative middle turbinate drifting synechia and to reserve it as completely as possible during surgery is recommended.