小児難治性反復性中耳炎に対する長期鼓膜換気チューブ留置術の有効性について

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  • Effects of long-term tympanostomy tubes in children with intractable otitis media

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We evaluated the effectiveness of long-term tympanostomy tubes in children with intractable repeated otitis media. 954 children (1744 ears) with intractable otitis media underwent insertion of Koken B type tympanostomy tube, and followed up until the removal of the tubein our hospital between September 1995 and August 2005. The following results were obtained.<BR>1. The patients developed acute otitis media in a mean of 5.1 times/year before operation. However, after operation, the mean number of episodes per year decreased to 0.7 in patientswith a good course and to 3.1 in those with persisting otorrhea. Good results wereobtained in more than 95% of the patients.<BR>2. The mean number of antimicrobial administration days/month was 23.4 before operation but markedly decreased to 2.1 in the patients with a good course and to 8.2 in those with a poor course. In particular, in the patients with a good course, the number of antimicrobial administration days significantly decreased because of a decrease in the risk of acute otitis media in the presence of purulent otorrhea<BR>3. After removal of the tube, the mean number of episodes of otitis media/year was0.06 in the patients with a good course during the, use of the tube, 2 in those with a poor course, and 0.14 in all patients, showing a significant decrease from the preoperative number (5.1) in the patients with a poor course.<BR>4. Concerning complications, perforation of the tympanic membrane developed in 1.9% of all patients and 11.4% of those with a poor course. Tympanosclerotic lesions were observed in 3.3% of all patients and 5.7% of thosewith a poor course. Since perforation of the tympanic membrane closed in a long periodof time after removal of the tube in some patients, immediate myringoplasty may not be necessary.<BR>5. A tympanostomy tube was re-inserted in 1.5% of all patients and 22.9%(about 1/5) of those with a poor course. Re-insertion of the tube was performed in patients who underwent initial tympanostomy tube insertion at the age of<2 years and those who underwent removal of the tube due to a poor course at the age of<2 years. In patients who underwent insertion of a long-term tympanostomy tube, the evaluation of the timing of the removal of the tube may be important.

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