儿童阻塞性睡眠呼吸暂停伴无症状分泌性中耳炎的治疗路径选择OA

OBJECTIVE To explore the treatment strategies for children with asymptomatic otitis media with effusion(OME)complicated by obstructive sleep apnea(OSA)and provide clinical treatment guidance.METHODS In this study,selected patients from the Department of Otolaryngology Head and Neck Surgery,Beijing Children's Hospital between April 2023 and May 2024,74 children(107 ears)with asymptomatic OME were screened out from cases initially diagnosed with pediatric OSA and scheduled for surgical treatment.They were randomly divided into three groups using the random number sorting method in Excel:Group A with 27 children(37 ears),Group B with 26 children(38 ears),and Group C with 21 children(32 ears).All children in the three groups underwent tonsillectomy and/or adenoidectomy.Among them,Group A did not receive ear intervention,Group B received myringotomy under otoscopy,and Group C received tympanostomy tube insertion under endoscopic.The children were followed up for 12 months after surgery.Through the analysis of time effect,between-group effect,and time-group interaction effect,we compared the hearing prognosis,clinical efficacy,recurrence,and complication status of children in each group at different follow-up time points before and after surgery.RESULTS 1.Hearing comparison:At 1,3,and 6 months after surgery,the hearing thresholds of the groups with otoscopic surgical intervention(Group B and Group C)were lower than those of the observation group(Group A)(P<0.05),and the hearing threshold of Group C was lower than that of Group B.At 12 months after surgery,there was no significant difference among the three groups(P=0.585).There were significant time effects,inter-group effects,and time-inter-group interaction effects among the three groups(P<0.05).The hearing improvement in Group C occurred the earliest,followed by Group B,and then Group A.2.Clinical efficacy evaluation:At 1,3,and 6 months after surgery,there were significant differences in clinical efficacy among the three groups of children(P<0.001).The cure rate was in the order of Group C>Group B>Group A(P<0.05).At 12 months after surgery,there was no significant difference in clinical efficacy among the three groups of children(P>0.05).3.Recurrence:During the follow-up period,there was no significant difference in the recurrence rate among the three groups of children(χ2=1.846,P=0.643).4.Complications:There was no significant difference in the incidence of complications among the three groups of children(χ2=2.231,P=0.328).CONCLUSION For pediatric patients with OSA combined with asymptomatic OME,synchronous intervention during OSA surgery is recommended.Tonsillectomy and/or Adenoidectomy combined with tympanostomy tube placement yields superior clinical efficacy,characterized by faster and more significant improvement in hearing thresholds.