分(fen)泌性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)是(shi)以中(zhong)(zhong)(zhong)(zhong)耳(er)(er)積液(ye)及聽(ting)(ting)力(li)下降為特(te)征的(de)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)非(fei)化(hua)膿性(xing)(xing)炎(yan)(yan)(yan)(yan)(yan)性(xing)(xing)疾病(bing)(bing)(bing)(bing),又稱為滲出(chu)性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)、非(fei)化(hua)膿性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)、黏液(ye)性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)、卡(ka)他(ta)性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)、鼓室積液(ye)、漿(jiang)液(ye)性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)、漿(jiang)液(ye)-黏液(ye)性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)、無菌性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)。為耳(er)(er)鼻(bi)(bi)喉常(chang)見(jian)疾病(bing)(bing)(bing)(bing)之一。兒童多(duo)見(jian)。在(zai)上呼吸道感染后以耳(er)(er)悶脹(zhang)感和聽(ting)(ting)力(li)減退為主要癥狀。由于耳(er)(er)痛不明顯,兒童主訴不清,在(zai)小兒聽(ting)(ting)力(li)受到影(ying)響(xiang)時(shi)(shi)家長才發(fa)現就診(zhen),常(chang)常(chang)延(yan)誤診(zhen)斷和治療。分(fen)泌性(xing)(xing)中(zhong)(zhong)(zhong)(zhong)耳(er)(er)炎(yan)(yan)(yan)(yan)(yan)可造(zao)成兒童的(de)聽(ting)(ting)力(li)損(sun)失,影(ying)響(xiang)語言發(fa)育,應(ying)高(gao)度警惕(ti)和及時(shi)(shi)觀(guan)察治療。對于成人單側病(bing)(bing)(bing)(bing)變者,應(ying)盡(jin)(jin)早(zao)明確病(bing)(bing)(bing)(bing)因,排除鼻(bi)(bi)咽(yan)部及其周圍間隙(xi)的(de)占位性(xing)(xing)腫瘤,盡(jin)(jin)早(zao)緩解(jie)癥狀、改善生(sheng)活質量。
對于(yu)正(zheng)常鼓(gu)(gu)膜患者,咽(yan)鼓(gu)(gu)管是中(zhong)耳與外(wai)界環境(jing)溝(gou)通(tong)(tong)的(de)惟(wei)一管道。咽(yan)鼓(gu)(gu)管阻塞(sai)是造成分泌性中(zhong)耳炎的(de)重(zhong)要原因。正(zheng)常情況下(xia),中(zhong)耳內、外(wai)的(de)氣(qi)壓基(ji)本相(xiang)等。當咽(yan)鼓(gu)(gu)管由于(yu)各(ge)種(zhong)原因出(chu)現(xian)通(tong)(tong)氣(qi)功(gong)(gong)能(neng)障(zhang)礙(ai)(ai)時,中(zhong)耳的(de)氣(qi)體(ti)被黏膜吸收(shou),中(zhong)耳出(chu)現(xian)負壓從而導(dao)致中(zhong)耳黏膜的(de)靜脈擴(kuo)張(zhang),通(tong)(tong)透性增加(jia),血清漏(lou)出(chu)聚積于(yu)中(zhong)耳,從而形成中(zhong)耳積液(ye)。咽(yan)鼓(gu)(gu)管通(tong)(tong)氣(qi)功(gong)(gong)能(neng)障(zhang)礙(ai)(ai)又分為(wei)機械性功(gong)(gong)能(neng)障(zhang)礙(ai)(ai)和功(gong)(gong)能(neng)性功(gong)(gong)能(neng)障(zhang)礙(ai)(ai)兩種(zhong)。
1.機械性阻塞
鼻(bi)(bi)咽(yan)(yan)(yan)部各種(zhong)良性或惡性占位性病變(如:腺樣體肥大(da)、鼻(bi)(bi)咽(yan)(yan)(yan)癌、鼻(bi)(bi)咽(yan)(yan)(yan)纖維血管(guan)瘤等),鼻(bi)(bi)腔(qiang)(qiang)和鼻(bi)(bi)竇疾病(如:慢(man)性鼻(bi)(bi)竇炎(yan)、巨(ju)大(da)鼻(bi)(bi)息肉、肥厚性鼻(bi)(bi)炎(yan)、鼻(bi)(bi)中隔(ge)偏曲(qu)等),長期的(de)(de)鼻(bi)(bi)咽(yan)(yan)(yan)腔(qiang)(qiang)填塞,咽(yan)(yan)(yan)鼓管(guan)咽(yan)(yan)(yan)口粘連,代(dai)謝(xie)障(zhang)礙性疾病(如:甲狀腺功能減退(tui)等),以及很少見的(de)(de)鼻(bi)(bi)咽(yan)(yan)(yan)白喉、結核、梅毒和艾滋病等特殊(shu)感染(ran)均(jun)可(ke)因直接壓迫、堵塞咽(yan)(yan)(yan)口或影響(xiang)淋巴回(hui)流(liu),造成咽(yan)(yan)(yan)鼓管(guan)管(guan)腔(qiang)(qiang)黏膜腫脹(zhang)等從而引起本病。
2.功能性(xing)通氣功能障(zhang)礙
小兒的(de)腭(e)(e)帆張肌、腭(e)(e)帆提肌和咽(yan)(yan)鼓(gu)(gu)管(guan)(guan)(guan)(guan)咽(yan)(yan)肌等肌肉薄弱,收縮無(wu)力(li),加之(zhi)咽(yan)(yan)鼓(gu)(gu)管(guan)(guan)(guan)(guan)軟骨(gu)發育不(bu)夠(gou)成熟,彈性(xing)(xing)(xing)較差(cha),當咽(yan)(yan)鼓(gu)(gu)管(guan)(guan)(guan)(guan)處于負壓(ya)狀態時,軟骨(gu)段的(de)管(guan)(guan)(guan)(guan)壁(bi)甚易發生(sheng)塌陷,導致中耳(er)負壓(ya)。細菌病(bing)毒感染、放射性(xing)(xing)(xing)損(sun)傷(shang)、先天(tian)性(xing)(xing)(xing)呼吸道黏膜纖毛運動不(bu)良(liang)、原發性(xing)(xing)(xing)纖毛運動障礙等原因(yin)(yin),引(yin)(yin)起咽(yan)(yan)鼓(gu)(gu)管(guan)(guan)(guan)(guan)表面(mian)活性(xing)(xing)(xing)物(wu)質減(jian)少,從而致咽(yan)(yan)鼓(gu)(gu)管(guan)(guan)(guan)(guan)開(kai)放阻力(li)加大,也(ye)被(bei)認為(wei)是分泌性(xing)(xing)(xing)耳(er)炎的(de)原因(yin)(yin)之(zhi)一。此外(wai)Ⅰ、Ⅲ型變態反(fan)應均可能(neng)引(yin)(yin)起分泌性(xing)(xing)(xing)中耳(er)炎,可能(neng)與過敏(min)引(yin)(yin)起的(de)咽(yan)(yan)鼓(gu)(gu)管(guan)(guan)(guan)(guan)黏膜水腫,管(guan)(guan)(guan)(guan)腔閉塞有(you)關。
嬰幼兒(er)易(yi)患分泌性中(zhong)耳炎(yan)(yan)(yan)與嬰幼兒(er)特(te)殊的解剖結構有關。新生兒(er)的咽鼓管短、寬而平(ping)直,鼻咽部的分泌物易(yi)經咽鼓管進入(ru)(ru)中(zhong)耳引(yin)起(qi)炎(yan)(yan)(yan)癥(zheng)。分娩(mian)時(shi)難(nan)產(chan)、臀位、室息時(shi)作過人(ren)工呼吸的新生兒(er),羊(yang)(yang)水常(chang)易(yi)進入(ru)(ru)中(zhong)耳內(nei)。母體患妊娠中(zhong)毒癥(zheng)、先(xian)兆子癇或產(chan)前出血者(zhe)(zhe),羊(yang)(yang)水也(ye)易(yi)進入(ru)(ru)中(zhong)耳發生感染引(yin)起(qi)中(zhong)耳炎(yan)(yan)(yan)。新生兒(er)哺乳不當容易(yi)逆乳,特(te)別是取平(ping)仰(yang)臥(wo)位用(yong)奶瓶人(ren)工哺養者(zhe)(zhe),逆乳時(shi)乳汁潴(zhu)積(ji)于鼻咽腔,經咽鼓管進入(ru)(ru)中(zhong)耳引(yin)起(qi)中(zhong)耳炎(yan)(yan)(yan)。
分泌(mi)性(xing)中耳炎的臨(lin)床(chuang)表現主要為聽(ting)力下降,可(ke)隨(sui)體位(wei)變(bian)化(hua)而變(bian)化(hua),輕微的耳痛、耳鳴(ming)、耳悶脹和閉(bi)塞感,搖頭可(ke)聽(ting)見水聲。耳科(ke)專科(ke)檢查可(ke)見鼓(gu)(gu)膜內陷(xian),呈琥珀色或色澤發暗,亦(yi)可(ke)見氣液平面或氣泡,鼓(gu)(gu)膜活動度降低(di)。
嬰(ying)幼兒則(ze)表現為(wei)對周(zhou)圍(wei)聲(sheng)音(yin)反(fan)應差,抓耳(er)(er),睡眠易醒,易激惹。嬰(ying)兒對周(zhou)圍(wei)的(de)聲(sheng)音(yin)沒(mei)有反(fan)應,不(bu)能(neng)將頭準確地轉(zhuan)向聲(sheng)源(yuan);即使患(huan)兒沒(mei)有主訴(su)聽(ting)(ting)力(li)下(xia)降(jiang),家人(ren)則(ze)發(fa)現患(huan)兒漫(man)不(bu)經心、行為(wei)改變、對正常(chang)對話(hua)無(wu)反(fan)應、在看電(dian)視或使用聽(ting)(ting)力(li)設備時總是將聲(sheng)音(yin)開(kai)得很(hen)大;對于反(fan)復發(fa)作(zuo)的(de)急性中(zhong)耳(er)(er)炎,應警(jing)惕在發(fa)作(zuo)間(jian)歇期(qi)可能(neng)持續的(de)分(fen)泌性中(zhong)耳(er)(er)炎;學(xue)習成績差;平衡能(neng)力(li)差,不(bu)明原因(yin)的(de)笨(ben)拙;語(yu)言(yan)發(fa)育遲緩。
1.鼓氣耳鏡(jing)檢查或顯微(wei)鏡(jing)檢查
鼓氣耳(er)鏡(jing)檢查方便易行,是分泌性中耳(er)炎(yan)的主要診斷(duan)方法,也是社(she)區檢查鼓膜的首選方法。它可以改變外耳(er)道的氣壓,觀(guan)察鼓膜的活動(dong)情(qing)況。如發現(xian)鼓膜動(dong)度減低,同時(shi)伴(ban)有鼓膜內(nei)陷、色澤由正常(chang)的灰(hui)白色半透明狀改變為橘黃色或琥珀色,見到氣液(ye)平面或氣泡即可診斷(duan)。與普(pu)通耳(er)鏡(jing)相比較,鼓氣耳(er)鏡(jing)有著更高的敏感(gan)度和特異度。
2.聲導抗測試
聲導(dao)抗(kang)(kang)測試是反映中耳功能的(de)(de)快速、有效的(de)(de)客(ke)觀測聽(ting)方法。由于鼓(gu)(gu)(gu)(gu)(gu)氣耳鏡對(dui)于2歲以下兒童的(de)(de)鼓(gu)(gu)(gu)(gu)(gu)膜和(he)中耳情況判斷困難,聲導(dao)抗(kang)(kang)則(ze)提供了(le)方便的(de)(de)測試。聲導(dao)抗(kang)(kang)的(de)(de)鼓(gu)(gu)(gu)(gu)(gu)室(shi)(shi)壓(ya)圖(tu)可呈(cheng)B型(xing)(xing)和(he)C型(xing)(xing)。開始時咽(yan)鼓(gu)(gu)(gu)(gu)(gu)管(guan)功能不良或(huo)堵塞,中耳氣體被(bei)吸(xi)收形成負壓(ya),鼓(gu)(gu)(gu)(gu)(gu)膜內(nei)陷,鼓(gu)(gu)(gu)(gu)(gu)室(shi)(shi)壓(ya)峰(feng)壓(ya)點(dian)向(xiang)負壓(ya)側位(wei)移,以C型(xing)(xing)曲線多見。當病變(bian)逐漸(jian)進(jin)展,鼓(gu)(gu)(gu)(gu)(gu)膜更(geng)加(jia)內(nei)陷,出現鼓(gu)(gu)(gu)(gu)(gu)室(shi)(shi)積液,傳音結(jie)構質量增(zeng)加(jia)而使聲導(dao)抗(kang)(kang)進(jin)一步增(zeng)加(jia),鼓(gu)(gu)(gu)(gu)(gu)室(shi)(shi)勁度加(jia)大,鼓(gu)(gu)(gu)(gu)(gu)膜和(he)聽(ting)骨鏈(lian)活動(dong)降低,峰(feng)壓(ya)點(dian)就越偏向(xiang)負值,當聲順減(jian)弱(ruo)或(huo)無變(bian)化時則(ze)成為(wei)無峰(feng)的(de)(de)B型(xing)(xing)圖(tu)。
一(yi)般認(ren)為(wei),如鼓(gu)(gu)室導抗圖(tu)為(wei)B型(xing),結(jie)合臨(lin)床可診斷為(wei)分泌性(xing)中(zhong)耳(er)(er)(er)炎(yan)。但是(shi),新(xin)生(sheng)(sheng)(sheng)(sheng)兒(er)(er)(er)和(he)(he)嬰兒(er)(er)(er)出生(sheng)(sheng)(sheng)(sheng)后(hou)(hou)外(wai)耳(er)(er)(er)和(he)(he)中(zhong)耳(er)(er)(er)結(jie)構發(fa)生(sheng)(sheng)(sheng)(sheng)了一(yi)系列的(de)(de)(de)(de)改變,如1歲以內嬰兒(er)(er)(er)外(wai)耳(er)(er)(er)道大(da)小和(he)(he)直徑的(de)(de)(de)(de)增加(jia)(jia),使其(qi)順應性(xing)也發(fa)生(sheng)(sheng)(sheng)(sheng)變化(hua),導致外(wai)耳(er)(er)(er)道共振增益和(he)(he)共振頻(pin)率發(fa)生(sheng)(sheng)(sheng)(sheng)改變;隨著生(sheng)(sheng)(sheng)(sheng)后(hou)(hou)6個(ge)(ge)月(yue)(yue)內鼓(gu)(gu)膜到(dao)鐙(deng)(deng)骨底(di)板距離的(de)(de)(de)(de)增長,增加(jia)(jia)了中(zhong)耳(er)(er)(er)含氣(qi)腔(qiang),擴大(da)了中(zhong)耳(er)(er)(er)腔(qiang)的(de)(de)(de)(de)容(rong)積,此(ci)時乳突(tu)氣(qi)化(hua)也增加(jia)(jia),中(zhong)耳(er)(er)(er)腔(qiang)容(rong)積增加(jia)(jia)使鼓(gu)(gu)膜的(de)(de)(de)(de)順應性(xing)和(he)(he)控制低頻(pin)傳(chuan)導方面受到(dao)重要影響;此(ci)外(wai),中(zhong)耳(er)(er)(er)腔(qiang)中(zhong)存在(zai)的(de)(de)(de)(de)羊水和(he)(he)間(jian)葉(xie)細胞逐漸消失(可持續到(dao)生(sheng)(sheng)(sheng)(sheng)后(hou)(hou)5個(ge)(ge)月(yue)(yue)),也使得中(zhong)耳(er)(er)(er)總(zong)質(zhi)量減(jian)少(shao)(shao);鐙(deng)(deng)骨密(mi)度降低,質(zhi)量減(jian)少(shao)(shao);聽骨鏈關節之間(jian)和(he)(he)鐙(deng)(deng)骨底(di)板附著到(dao)卵圓窗上的(de)(de)(de)(de)緊(jin)密(mi)程度也在(zai)改變,這些都減(jian)少(shao)(shao)了抵抗成分。因此(ci),常規的(de)(de)(de)(de)226Hz探測(ce)(ce)音(yin)測(ce)(ce)試的(de)(de)(de)(de)鼓(gu)(gu)室圖(tu)不能真實地反映6個(ge)(ge)月(yue)(yue)以內嬰幼兒(er)(er)(er)中(zhong)耳(er)(er)(er)有無病變和(he)(he)中(zhong)耳(er)(er)(er)功(gong)能。因此(ci)大(da)于(yu)4個(ge)(ge)月(yue)(yue)患(huan)(huan)兒(er)(er)(er)使用226HZ的(de)(de)(de)(de)探測(ce)(ce)音(yin),小于(yu)4個(ge)(ge)月(yue)(yue)的(de)(de)(de)(de)患(huan)(huan)兒(er)(er)(er)使用高頻(pin)率的(de)(de)(de)(de)探測(ce)(ce)音(yin)(1000Hz)。這樣(yang)可使檢查結(jie)果更加(jia)(jia)準確。
3.鼓膜穿刺(ci)或鼓膜切開(kai)術
在耳(er)顯微鏡或(huo)內(nei)鏡下,于鼓(gu)膜前下方(fang)進行穿刺或(huo)切開(kai),若有(you)(you)漿液樣或(huo)黏液樣液體流出則可(ke)(ke)證實分泌性(xing)(xing)中耳(er)炎的存在。其為一(yi)種有(you)(you)創性(xing)(xing)診斷(duan)方(fang)式,不(bu)但(dan)可(ke)(ke)以明(ming)確診斷(duan),同(tong)時可(ke)(ke)以達到治療目(mu)的。
4.鼻咽部檢查
成人(ren)患者,用鼻(bi)(bi)(bi)內(nei)鏡或多功能纖維鼻(bi)(bi)(bi)咽(yan)(yan)鏡直接(jie)觀察鼻(bi)(bi)(bi)咽(yan)(yan)部及咽(yan)(yan)鼓管咽(yan)(yan)口(kou)情況(kuang)。排除鼻(bi)(bi)(bi)咽(yan)(yan)部占位性病變。
5.顳骨高分(fen)辨率(lv)薄層CT
單側頑固性(xing)分泌性(xing)中(zhong)耳炎,經過治(zhi)療無效,應警惕(ti)黏膜下型鼻咽(yan)(yan)癌累及咽(yan)(yan)旁(pang)間(jian)隙(xi),壓迫咽(yan)(yan)鼓管。如鑒別診斷需要,或需要排(pai)除鼻咽(yan)(yan)部(bu)和(he)咽(yan)(yan)旁(pang)間(jian)隙(xi)占位者,顳骨高(gao)分辨率薄(bo)層CT可了解中(zhong)耳情況,將(jiang)CT片調到軟組織窗時可觀察(cha)咽(yan)(yan)旁(pang)間(jian)隙(xi)有(you)無占位。必要時需進行增強(qiang)掃描。
根(gen)據病史及(ji)專科檢查(cha),結合鼓(gu)室導抗圖和聲(sheng)反射、耳顯微鏡或內鏡檢查(cha),鼓(gu)膜穿刺或切開術等可以明確診斷(duan)。
1.急性中耳炎
嬰(ying)幼兒及兒童分(fen)泌性(xing)(xing)中耳(er)(er)炎應與急性(xing)(xing)中耳(er)(er)炎相鑒(jian)別。急性(xing)(xing)中耳(er)(er)炎治(zhi)療不(bu)(bu)徹底或(huo)遷延(yan)不(bu)(bu)愈可(ke)轉換為分(fen)泌性(xing)(xing)中耳(er)(er)炎。多病程(cheng)較(jiao)短,患者(zhe)可(ke)有劇烈(lie)耳(er)(er)痛(tong)、耳(er)(er)流膿(nong)等癥狀,分(fen)泌性(xing)(xing)中耳(er)(er)炎多病程(cheng)較(jiao)長,多以耳(er)(er)悶為主(zhu)要癥狀,耳(er)(er)痛(tong)呈間斷性(xing)(xing),較(jiao)輕,甚至無耳(er)(er)痛(tong)表現。
2.鼻咽(yan)癌或(huo)鼻咽(yan)部占位性病變
典型的鼻(bi)咽癌早期癥(zheng)狀可為涕中帶血、頸部(bu)包塊。但(dan)有(you)些患(huan)者耳(er)部(bu)癥(zheng)狀先于上述癥(zheng)狀,癌腫在鼻(bi)咽部(bu)的黏膜(mo)下潛行,鼻(bi)內(nei)鏡(jing)檢查在早期不易發(fa)現。對(dui)于單耳(er)分(fen)泌性中耳(er)炎(yan),特(te)殊地區(qu)患(huan)者,應(ying)高度警惕。
3.慢(man)性化膿性中耳炎合并中耳膽(dan)脂瘤
松弛部穿孔被痂皮覆(fu)蓋,耳(er)鼓(gu)膜緊(jin)張部顯示鼓(gu)室積液,此類(lei)患(huan)者應仔細檢(jian)查松弛部,必要時行顳骨的高(gao)分辨率CT,以除外中(zhong)耳(er)膽脂(zhi)瘤。
4.粘連性中耳(er)炎
主訴為聽力減退和悶(men)脹(zhang)感,檢(jian)查鼓膜與鼓岬粘連(lian)以資鑒別。
5.鼓室硬化
屬慢性中耳炎的(de)后遺病變。主(zhu)訴聽力下降和(he)耳悶脹感。一般(ban)病史較長(chang),有中耳炎病史。鼓(gu)膜可以(yi)(yi)完整,鼓(gu)室內大(da)量硬化癥包裹(guo)聽骨鏈(lian),影響(xiang)聲能傳導。顳骨CT或手術探查(cha)可以(yi)(yi)明確診斷。
6.膽固(gu)醇肉芽腫
患者主訴聽(ting)力減退和(he)耳悶脹感。但耳科(ke)檢(jian)查可(ke)(ke)見鼓(gu)膜呈藍(lan)色,顳骨CT提(ti)示(shi)鼓(gu)竇入口狹(xia)窄,可(ke)(ke)有骨質破壞。手(shou)術(shu)探(tan)查及病(bing)例檢(jian)查可(ke)(ke)以(yi)明確診(zhen)斷(duan)。
7.先天(tian)性或后天(tian)性中(zhong)耳膽脂(zhi)瘤
對于鼓(gu)膜(mo)(mo)完整的(de)中耳膽脂瘤,主訴(su)聽(ting)力(li)下降,檢查鼓(gu)膜(mo)(mo)完整,透(tou)光(guang)度(du)(du)差,聽(ting)力(li)圖(tu)顯示為傳導性聽(ting)力(li)損(sun)失(shi),容易混(hun)淆。但鼓(gu)室積液征(zheng)不明顯,鼓(gu)膜(mo)(mo)透(tou)光(guang)度(du)(du)差,可(ke)透(tou)過鼓(gu)膜(mo)(mo)見到白色的(de)實性團塊樣物位(wei)于鼓(gu)膜(mo)(mo)內側的(de)鼓(gu)室內。
8.自發性(xing)(xing)或外(wai)傷(shang)性(xing)(xing)腦脊液耳漏
可(ke)主訴患側反復發生腦膜炎,檢(jian)查(cha)(cha)顯(xian)示鼓室內液(ye)體積聚。年(nian)輕患者,根據病史、查(cha)(cha)體及影像學檢(jian)查(cha)(cha)可(ke)以確診(zhen)。外(wai)傷性者則(ze)有明確的外(wai)傷史。
9.外淋巴漏
兩窗(chuang)破裂(lie)和(he)先天(tian)性裂(lie)隙(xi),造成(cheng)外淋巴(ba)液(ye)漏至中耳(er)鼓(gu)室腔。可表現為鼓(gu)室積液(ye),但患者有眩暈病史,遇強聲刺激可誘(you)發眩暈。聽力圖(tu)提示感音(yin)神經(jing)性耳(er)聾。
10.Wergerner肉芽腫(zhong)
雖然屬于少(shao)見病(bing),但疾病(bing)初期容易(yi)誤診(zhen)為分(fen)泌性(xing)中耳(er)(er)炎(yan)。雙(shuang)耳(er)(er)發病(bing),病(bing)程(cheng)遷(qian)延和頑固,伴有(you)全身發熱、肺部及腎臟(zang)病(bing)變,ANCA等抗體陽(yang)性(xing),對糖皮質激素治療有(you)效,應高度警惕(ti)該病(bing)。
11.其他
當咽鼓(gu)管功能不良或耳(er)硬化癥,聽(ting)力曲(qu)線為(wei)傳(chuan)導性聾,另外,內耳(er)的(de)病(bing)變如梅(mei)尼埃病(bing)、上半(ban)規管裂綜合征等,可表(biao)現為(wei)耳(er)悶脹感,尤其(qi)是聽(ting)力曲(qu)線上顯示有骨氣導間距時(shi)則容易混淆(xiao)。但(dan)鼓(gu)膜檢(jian)查無積(ji)液(ye)征,聲導抗圖顯示為(wei)A型圖或C型圖,而非B型圖;內耳(er)病(bing)變以(yi)感音(yin)神經性聾為(wei)其(qi)主要(yao)特征,以(yi)資鑒別。
分泌性中耳(er)炎可發(fa)展(zhan)為粘(zhan)連性中耳(er)炎、鼓室硬(ying)化癥、膽(dan)固醇肉芽腫和后天(tian)原發(fa)性膽(dan)脂瘤等,這些病變如不及時治療,可引起嚴重聽力減退(tui)和引起一系列并發(fa)癥。長期鼓室置管可能遺留鼓膜(mo)穿孔(kong),等待觀(guan)察至成年(nian)后可考慮鼓膜(mo)修補(bu)手(shou)術。
治療原(yuan)則為積極治療原(yuan)發病及鄰近(jin)病灶(zao),去(qu)除病因(yin),改善咽鼓(gu)管的(de)通氣功能,平(ping)衡和消除中耳(er)鼓(gu)室內的(de)負壓狀況,通暢引流鼓(gu)室內的(de)積液(ye),防(fang)止鼓(gu)室粘連和中耳(er)膽脂(zhi)瘤及膽固(gu)醇肉芽腫的(de)發生。
1.成人分泌性中耳炎的治(zhi)療
(1)保守治療(liao)①鼻(bi)腔(qiang)(qiang)收縮(suo)劑 改善咽鼓(gu)管(guan)通(tong)氣功(gong)能(neng)(neng),常用(yong)藥(yao)(yao)物(wu)(wu)為麻黃素(su)(su)(su)制(zhi)劑、鹽(yan)(yan)酸羥甲唑(zuo)啉(lin)等藥(yao)(yao)物(wu)(wu),但(dan)是使用(yong)此(ci)藥(yao)(yao)物(wu)(wu)要(yao)注(zhu)意防止藥(yao)(yao)物(wu)(wu)依賴,一般療(liao)程不(bu)超(chao)過1周,若(ruo)頻繁過量使用(yong)易(yi)引(yin)(yin)起藥(yao)(yao)物(wu)(wu)性(xing)(xing)鼻(bi)炎(yan)(yan)。麻黃素(su)(su)(su)類鼻(bi)腔(qiang)(qiang)收縮(suo)劑可(ke)升高血(xue)壓,老(lao)年(nian)人用(yong)藥(yao)(yao)后應(ying)觀察血(xue)壓變化。②黏(nian)液(ye)促(cu)排(pai)劑 可(ke)調節咽鼓(gu)管(guan)及鼓(gu)室(shi)內黏(nian)膜生(sheng)理功(gong)能(neng)(neng),促(cu)進鼓(gu)室(shi)內積(ji)液(ye)排(pai)除,改善黏(nian)膜黏(nian)液(ye)毯的(de)(de)清理作(zuo)用(yong),常用(yong)藥(yao)(yao)物(wu)(wu)有(you)(you):鹽(yan)(yan)酸氨溴索等藥(yao)(yao)物(wu)(wu)。③抗(kang)生(sheng)素(su)(su)(su) 在(zai)急(ji)性(xing)(xing)期內,可(ke)短期內使用(yong)敏感抗(kang)生(sheng)素(su)(su)(su)。④口服糖(tang)皮質(zhi)(zhi)激(ji)(ji)素(su)(su)(su) 對(dui)于無糖(tang)尿病(bing)等禁(jin)忌證的(de)(de)患者(zhe),可(ke)使用(yong)糖(tang)皮質(zhi)(zhi)激(ji)(ji)素(su)(su)(su)類藥(yao)(yao)物(wu)(wu)如潑尼(ni)松(song)等口服,但(dan)只(zhi)可(ke)作(zuo)短期治療(liao),不(bu)宜長期使用(yong)。⑤鼻(bi)用(yong)糖(tang)皮質(zhi)(zhi)激(ji)(ji)素(su)(su)(su) 改善鼻(bi)腔(qiang)(qiang)炎(yan)(yan)癥(zheng)狀態,消除炎(yan)(yan)癥(zheng)介(jie)質(zhi)(zhi),且相對(dui)口服糖(tang)皮質(zhi)(zhi)激(ji)(ji)素(su)(su)(su)更為安全(quan),局部作(zuo)用(yong)于鼻(bi)腔(qiang)(qiang)、鼻(bi)咽、咽鼓(gu)管(guan),全(quan)身(shen)副作(zuo)用(yong)小。⑥咽鼓(gu)管(guan)吹張(zhang) 可(ke)采用(yong)咽鼓(gu)管(guan)吹張(zhang)器、捏鼻(bi)鼓(gu)氣法、波氏球法或導管(guan)法促(cu)使咽鼓(gu)管(guan)通(tong)暢(chang)(chang),還可(ke)經導管(guan)向咽鼓(gu)管(guan)咽口吹入潑尼(ni)松(song)龍,達到通(tong)暢(chang)(chang)和引(yin)(yin)流的(de)(de)目的(de)(de)。但(dan)應(ying)用(yong)此(ci)方法時(shi)須注(zhu)意鼻(bi)腔(qiang)(qiang)不(bu)能(neng)(neng)有(you)(you)鼻(bi)涕(ti),不(bu)然(ran)容(rong)易(yi)將鼻(bi)涕(ti)吹入鼓(gu)室(shi),引(yin)(yin)起急(ji)性(xing)(xing)化膿(nong)性(xing)(xing)中耳(er)炎(yan)(yan)。
(2)手術(shu)治療(liao)①鼓(gu)(gu)(gu)(gu)膜(mo)穿刺(ci)抽液(ye)(ye) 可(ke)同時(shi)作為(wei)診斷(duan)方(fang)法(fa)及治療(liao)方(fang)法(fa),可(ke)有(you)(you)效清除中耳(er)積液(ye)(ye),改善(shan)(shan)中耳(er)通(tong)氣(qi)(qi)(qi)。必(bi)要時(shi)可(ke)重復(fu)(fu)(fu)(fu)穿刺(ci),或抽液(ye)(ye)后(hou)(hou)注入(ru)糖皮質激(ji)(ji)素類(lei)藥物。②鼓(gu)(gu)(gu)(gu)膜(mo)切(qie)開術(shu) 適(shi)用(yong)于(yu)分(fen)(fen)泌(mi)的(de)液(ye)(ye)體(ti)較(jiao)黏稠,鼓(gu)(gu)(gu)(gu)膜(mo)穿刺(ci)不(bu)能(neng)(neng)吸盡者(zhe)。不(bu)合作的(de)小兒可(ke)于(yu)全麻下進(jin)行(xing)(xing)。需要注意保護(hu)鼓(gu)(gu)(gu)(gu)室內壁黏膜(mo),鼓(gu)(gu)(gu)(gu)膜(mo)切(qie)開后(hou)(hou)應將鼓(gu)(gu)(gu)(gu)室內液(ye)(ye)體(ti)全部(bu)吸盡。③鼓(gu)(gu)(gu)(gu)室置(zhi)管(guan)(guan)術(shu) 適(shi)用(yong)于(yu)病情遷延不(bu)愈,或反(fan)復(fu)(fu)(fu)(fu)發(fa)(fa)(fa)作,頭部(bu)放(fang)療(liao)后(hou)(hou),咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)功(gong)能(neng)(neng)短期內難以(yi)恢(hui)復(fu)(fu)(fu)(fu)正常者(zhe),目(mu)的(de)是改善(shan)(shan)通(tong)氣(qi)(qi)(qi)引流,促使咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)恢(hui)復(fu)(fu)(fu)(fu)功(gong)能(neng)(neng)。通(tong)氣(qi)(qi)(qi)管(guan)(guan)留置(zhi)時(shi)間一般(ban)為(wei)3~6個月,最長可(ke)達6個月~1年(nian)(nian)。可(ke)在咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)功(gong)能(neng)(neng)恢(hui)復(fu)(fu)(fu)(fu)后(hou)(hou)取(qu)出通(tong)氣(qi)(qi)(qi)管(guan)(guan),有(you)(you)部(bu)分(fen)(fen)患(huan)者(zhe)可(ke)自行(xing)(xing)將通(tong)氣(qi)(qi)(qi)管(guan)(guan)排出于(yu)外耳(er)道內。④對于(yu)頑固性分(fen)(fen)泌(mi)性中耳(er)炎(yan)一直缺(que)乏(fa)有(you)(you)效的(de)治療(liao)措(cuo)施(shi),目(mu)前咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)激(ji)(ji)光(guang)成形術(shu)和咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)球(qiu)(qiu)囊(nang)擴(kuo)張(zhang)術(shu)為(wei)該類(lei)患(huan)者(zhe)帶來一線希望。對于(yu)反(fan)復(fu)(fu)(fu)(fu)發(fa)(fa)(fa)作的(de),病程大于(yu)3個月以(yi)上的(de)慢性分(fen)(fen)泌(mi)性中耳(er)炎(yan)患(huan)者(zhe),可(ke)采用(yong)此類(lei)方(fang)法(fa),改善(shan)(shan)咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)通(tong)氣(qi)(qi)(qi)功(gong)能(neng)(neng)。⑤激(ji)(ji)光(guang)咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)成形術(shu) 應用(yong)半導體(ti)激(ji)(ji)光(guang)、CO2光(guang)纖激(ji)(ji)光(guang)、KTP激(ji)(ji)光(guang)燈等軟管(guan)(guan)激(ji)(ji)光(guang),對咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)圓枕后(hou)(hou)唇部(bu)分(fen)(fen)進(jin)行(xing)(xing)消(xiao)融,國外在近兩(liang)年(nian)(nian)的(de)臨床研究發(fa)(fa)(fa)現其有(you)(you)效率(lv)達到(dao)90%以(yi)上。球(qiu)(qiu)囊(nang)擴(kuo)張(zhang)咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)成形術(shu):應用(yong)球(qiu)(qiu)囊(nang)置(zhi)入(ru)咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)咽(yan)(yan)(yan)口(kou),對咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)軟骨部(bu)進(jin)行(xing)(xing)擴(kuo)張(zhang),提(ti)高咽(yan)(yan)(yan)鼓(gu)(gu)(gu)(gu)管(guan)(guan)軟骨部(bu)開放(fang)功(gong)能(neng)(neng),達到(dao)治療(liao)分(fen)(fen)泌(mi)性中耳(er)炎(yan)的(de)目(mu)的(de)。⑥懷(huai)疑鼓(gu)(gu)(gu)(gu)峽阻塞、鼓(gu)(gu)(gu)(gu)竇入(ru)口(kou)有(you)(you)肉(rou)芽(ya)組(zu)織阻塞的(de)頑固性分(fen)(fen)泌(mi)性中耳(er)炎(yan)患(huan)者(zhe) 可(ke)考慮單純乳突切(qie)開術(shu)及鼓(gu)(gu)(gu)(gu)室探查手術(shu),同時(shi)行(xing)(xing)鼓(gu)(gu)(gu)(gu)膜(mo)置(zhi)管(guan)(guan)術(shu)。對將要發(fa)(fa)(fa)生(sheng)粘連性中耳(er)炎(yan)及內陷囊(nang)袋者(zhe),應該盡早進(jin)行(xing)(xing)手術(shu)治療(liao),以(yi)防(fang)止并發(fa)(fa)(fa)癥。
2.兒童及嬰幼兒分泌性中耳炎的治療
(1)密切觀察和隨診 因為分(fen)(fen)泌(mi)(mi)性中(zhong)耳(er)(er)(er)炎(yan)為自(zi)限性疾(ji)病(bing)(bing),有(you)一定的自(zi)愈(yu)(yu)率,在(zai)給予有(you)創治療前患(huan)(huan)(huan)者(zhe)應(ying)該嚴(yan)密觀察3個(ge)月。分(fen)(fen)泌(mi)(mi)性中(zhong)耳(er)(er)(er)炎(yan)是否自(zi)愈(yu)(yu)取(qu)決于病(bing)(bing)因及(ji)積液時間的長短。由急性中(zhong)耳(er)(er)(er)炎(yan)遺留的分(fen)(fen)泌(mi)(mi)性中(zhong)耳(er)(er)(er)炎(yan)患(huan)(huan)(huan)者(zhe),約(yue)(yue)(yue)75%~90%在(zai)3個(ge)月時可以自(zi)愈(yu)(yu),鼓室壓圖由B轉(zhuan)為A、C型。約(yue)(yue)(yue)55%分(fen)(fen)泌(mi)(mi)性中(zhong)耳(er)(er)(er)炎(yan)患(huan)(huan)(huan)者(zhe)可在(zai)3個(ge)月時自(zi)愈(yu)(yu),但是,約(yue)(yue)(yue)1/3的患(huan)(huan)(huan)兒(er)(er)可能(neng)加重。在(zai)起病(bing)(bing)時間不(bu)祥的2~4歲(sui)的患(huan)(huan)(huan)兒(er)(er)中(zhong),約(yue)(yue)(yue)25%的患(huan)(huan)(huan)兒(er)(er)自(zi)愈(yu)(yu)時間為3個(ge)月。嬰兒(er)(er)和小(xiao)小(xiao)兒(er)(er)的自(zi)愈(yu)(yu)率更高(gao)。2歲(sui)以上雙耳(er)(er)(er)分(fen)(fen)泌(mi)(mi)性中(zhong)耳(er)(er)(er)炎(yan)、病(bing)(bing)程在(zai)3月以上患(huan)(huan)(huan)兒(er)(er),在(zai)6~l2個(ge)月時其自(zi)愈(yu)(yu)者(zhe)約(yue)(yue)(yue)為30%。
對于處(chu)于觀察(cha)階段的非(fei)高(gao)危(wei)患(huan)兒,無論是藥物還是手術干預(yu)則百害而無一利,而觀察(cha)等待對非(fei)高(gao)危(wei)患(huan)兒則無害處(chu);需要告知家人患(huan)兒聽力差,尤其是雙(shuang)耳(er)分(fen)泌性中耳(er)炎患(huan)者(zhe);制定改善患(huan)兒聆聽和學習環境的措施和方案;定期復查(cha),并進行氣壓耳(er)鏡(jing)和鼓室壓圖檢(jian)查(cha)。
改(gai)善聆(ling)聽環境的(de)措施包括(kuo):說(shuo)話(hua)時(shi)(shi)在3英尺(chi)內(nei);將周圍(wei)干擾的(de)聲(sheng)響關掉如電視機(ji)、音(yin)樂(le);面(mian)對(dui)患兒說(shuo)話(hua)時(shi)(shi),做到(dao)口齒清晰(xi),并(bing)應用手(shou)勢和(he)圖(tu)片(pian)等視覺方式作(zuo)為輔助;降低語速、提高音(yin)量、言語清晰(xi);與患兒一起閱讀(du)和(he)講述、解釋圖(tu)片(pian)或提出問(wen)題;注意重復(fu)單詞、詞組或句(ju)子;安排患兒坐在距離(li)老師較近的(de)位置(zhi)上;在教(jiao)室(shi)里使用可調節(jie)音(yin)量的(de)擴音(yin)設備等。
(2)藥物治療(liao) 對于(yu)兒童(tong),藥物療(liao)效短暫而有限,副作(zuo)(zuo)用(yong)(yong)(yong)多,不推薦使(shi)用(yong)(yong)(yong)。不主張長期使(shi)用(yong)(yong)(yong)抗(kang)生素(su)治療(liao)分泌性(xing)中(zhong)耳炎,鼓(gu)膜(mo)充(chong)血不應(ying)該成為(wei)抗(kang)生素(su)應(ying)用(yong)(yong)(yong)的(de)(de)指征,不主張聯合使(shi)用(yong)(yong)(yong)抗(kang)組胺藥及減充(chong)血劑,因(yin)為(wei)他(ta)(ta)們的(de)(de)副作(zuo)(zuo)用(yong)(yong)(yong)明顯。也不主張普遍地長期使(shi)用(yong)(yong)(yong)口服激素(su)治療(liao),除非個(ge)別病例(li)。尚無證據支持咽鼓(gu)管通氣、口服或鼓(gu)室內注射黏(nian)液促排劑及其(qi)他(ta)(ta)藥物的(de)(de)治療(liao)作(zuo)(zuo)用(yong)(yong)(yong)。
(3)手術(shu)治(zhi)療(liao) 選擇手術(shu)時應(ying)該(gai)考慮(lv)的(de)因(yin)素為(wei)聽力水(shui)(shui)平(ping)及伴隨癥狀;是(shi)否存在(zai)影響(言(yan)語語言(yan))發育的(de)高危因(yin)素;分(fen)(fen)(fen)(fen)泌性(xing)(xing)(xing)中(zhong)(zhong)(zhong)耳(er)(er)(er)炎(yan)自愈的(de)可(ke)能性(xing)(xing)(xing)。手術(shu)指征為(wei)分(fen)(fen)(fen)(fen)泌性(xing)(xing)(xing)中(zhong)(zhong)(zhong)耳(er)(er)(er)炎(yan)持續在(zai)4月以上伴有聽力減退(tui)和其他癥狀;持續或復發性(xing)(xing)(xing)分(fen)(fen)(fen)(fen)泌性(xing)(xing)(xing)中(zhong)(zhong)(zhong)耳(er)(er)(er)炎(yan),伴有高危因(yin)素存在(zai)(只要是(shi)高危患兒,無論積液時間長短(duan),都應(ying)該(gai)盡(jin)早手術(shu));鼓膜或中(zhong)(zhong)(zhong)耳(er)(er)(er)結構損害。應(ying)該(gai)綜合(he)基層醫生、耳(er)(er)(er)鼻咽喉科醫生和家人的(de)意見(jian),權衡手術(shu)利(li)弊。隨訪患兒的(de)手術(shu)指征為(wei):較好耳(er)(er)(er)的(de)聽力水(shui)(shui)平(ping)達到40dB或以上;長期分(fen)(fen)(fen)(fen)泌性(xing)(xing)(xing)中(zhong)(zhong)(zhong)耳(er)(er)(er)炎(yan)并出(chu)現了耳(er)(er)(er)痛、不明原因(yin)的(de)睡眠障(zhang)礙和合(he)并急性(xing)(xing)(xing)中(zhong)(zhong)(zhong)耳(er)(er)(er)炎(yan)反復發作(zuo);鼓膜后上方內陷囊袋;聽骨(gu)爛蝕;內陷粘(zhan)連和內陷囊袋內角(jiao)化物的(de)積存。
手術術式包括(kuo)首選鼓(gu)(gu)膜(mo)置管(guan)(guan)術(可(ke)(ke)使中(zhong)耳(er)通氣狀態保持(chi)(chi)12~14個(ge)月);有鼻(bi)堵、慢(man)性鼻(bi)竇(dou)炎(yan)、慢(man)性腺樣(yang)(yang)體(ti)炎(yan)等指征時同時行腺樣(yang)(yang)體(ti)切(qie)(qie)除(chu)術,不(bu)(bu)建(jian)議4歲(sui)以下患兒行腺樣(yang)(yang)體(ti)切(qie)(qie)除(chu)術;再次(ci)手術時可(ke)(ke)行腺樣(yang)(yang)體(ti)切(qie)(qie)除(chu)術和鼓(gu)(gu)膜(mo)切(qie)(qie)開術,同時行鼓(gu)(gu)膜(mo)置管(guan)(guan)或不(bu)(bu)置管(guan)(guan);不(bu)(bu)建(jian)議單獨行鼓(gu)(gu)膜(mo)切(qie)(qie)開術(使中(zhong)耳(er)通氣僅僅保持(chi)(chi)幾天,激光輔助(zhu)鼓(gu)(gu)膜(mo)切(qie)(qie)開也只使中(zhong)耳(er)通氣保持(chi)(chi)幾周)或單獨行扁桃體(ti)切(qie)(qie)除(chu)術治療分泌(mi)性中(zhong)耳(er)炎(yan)(無確切(qie)(qie)療效)。
再次手術問題:在鼓膜置管脫管的患兒中,20%~50%的患兒分泌性中耳炎復發,需要再次手術。建議再次手術時,無論腺樣體大小,都應該行腺樣體切除術(但是腭裂或黏膜下腭裂除外)。因為它使再次手術率降低50%。再次手術的療效好(對于2歲兒童的再手術療效明顯,而對于3歲兒童的再手術療效最明顯)。術式采用鼓膜切開+腺樣體切除(>4歲);鼓膜置管+腺樣體切除(<4歲)。再次手術時,鼓膜置管尤其適合于高危患兒并且必須根治分泌性中耳炎患兒和鼓膜、中耳黏膜有明顯炎癥的患者。
手(shou)術(shu)(shu)(shu)并發癥:急診手(shou)術(shu)(shu)(shu)中(zhong)麻(ma)醉的死(si)亡(wang)率為1:50000或更低(di);小兒在麻(ma)醉中(zhong)較成人更易出(chu)現喉頭和氣管的痙(jing)攣;鼓(gu)膜(mo)穿孔的發生率為2%~17%,需(xu)要修補;腺(xian)樣體切(qie)除術(shu)(shu)(shu)的出(chu)血率為0.2%~0.5%,腭帆功能障礙(ai)為2%,還有鼻咽(yan)部(bu)閉鎖或持(chi)續腭帆功能障礙(ai)(適應證選擇(ze)和手(shou)術(shu)(shu)(shu)技(ji)巧)。
應(ying)該權衡(heng)是觀(guan)(guan)察(cha)隨(sui)訪(fang)還(huan)是手術所(suo)帶來的(de)(de)(de)風(feng)險(xian),并(bing)建議每(mei)3~6月或(huo)更短間期復(fu)查(cha)一次(ci)。在觀(guan)(guan)察(cha)階段不宜繼續觀(guan)(guan)察(cha)等待的(de)(de)(de)患(huan)者有:不能定(ding)期復(fu)查(cha)的(de)(de)(de)患(huan)者;高危患(huan)者或(huo)并(bing)發有其他疾病的(de)(de)(de)患(huan)兒。
3.其他補充治療(liao)手段(duan)
(1)補充或替(ti)(ti)代性(xing)治療(liao) 常見的補充及(ji)替(ti)(ti)代療(liao)法包括推(tui)拿按摩、微波、限制(zhi)飲食(如限制(zhi)奶制(zhi)品(pin))、中草藥(yao)、補品(pin)、針灸、中藥(yao)等療(liao)法。
(2)抗過(guo)敏(min)治(zhi)療 據(ju)報(bao)道,分泌(mi)性中(zhong)耳(er)炎患者中(zhong)存在(zai)過(guo)敏(min)者為10%~80%不(bu)等。長期以來一直懷疑(yi)分泌(mi)性中(zhong)耳(er)炎和(he)過(guo)敏(min)因素兩者間(jian)存在(zai)著某(mou)種(zhong)關系(xi),但循證醫學研(yan)究(jiu)(jiu)認為抗過(guo)敏(min)治(zhi)療分泌(mi)性中(zhong)耳(er)炎的研(yan)究(jiu)(jiu)資料(liao)缺乏(fa)前瞻性、對照研(yan)究(jiu)(jiu)和(he)足夠的證據(ju)。
加強鍛(duan)煉(lian),增強體(ti)質,預防(fang)感冒;避免(mian)(mian)辛辣刺(ci)激性(xing)(xing)(xing)食物和煙(yan)(yan)酒刺(ci)激,避免(mian)(mian)接觸(chu)煙(yan)(yan)霧等(deng)不(bu)良氣體(ti)刺(ci)激呼吸道,保(bao)護和增強上(shang)(shang)呼吸道黏膜的(de)抵抗力;預防(fang)和治療過(guo)敏性(xing)(xing)(xing)疾病(bing),避免(mian)(mian)接觸(chu)過(guo)敏原,飲食上(shang)(shang)應(ying)(ying)避免(mian)(mian)引發(fa)個體(ti)過(guo)敏的(de)食物,如海(hai)鮮食品等(deng);擤(xing)鼻(bi)(bi)涕時(shi)勿(wu)雙手同(tong)時(shi)捏緊(jin)前鼻(bi)(bi)孔用(yong)力擤(xing)鼻(bi)(bi)涕,應(ying)(ying)該按壓一側(ce)鼻(bi)(bi)孔輕輕清理鼻(bi)(bi)腔的(de)分泌(mi)物;嬰幼兒喂奶(nai)時(shi)應(ying)(ying)注意(yi)不(bu)要頭部太低;鼓(gu)膜置(zhi)管期(qi)間(jian)應(ying)(ying)避免(mian)(mian)耳道進水,以防(fang)引發(fa)急(ji)性(xing)(xing)(xing)化膿(nong)性(xing)(xing)(xing)中耳炎(yan)。