CAJ | 학술논문

目的：探讨腭裂伴中耳功能异常的综合评估策略，优化诊治程序，进一步提高腭裂的综合治疗效果。方法对腭裂患者中耳功能异常的469侧患耳进行声导抗测试，对中耳积液与鼓室图、鼓室压及听力的关系进行统计分析。对其中62例唇腭裂患儿的124侧患耳鼓室图变化进行为期1年的动态监测。结果鼓室图为B、C、异型者积液率分别为50.3%（97/193）、34.8%（8/23）和20.9%（53/253）。异型积液患耳的鼓室压与无积液患耳的鼓室压之间差异无统计学意义（P>0.05）。B型且有积液的患耳听力损失高于无积液患耳（P=0.001），异型鼓室图患耳积液与听力损失不相关（P>0.05）。唇腭裂患者在唇裂修复术至腭裂整复术期间，其中耳各型鼓室图构成比无差异（P>0.05）。结论各型异常鼓室图积液率不同。鼓室压低于-150?dapa的异常鼓室图患耳应穿刺排查。B型鼓室图且有积液的患耳很可能影响听力，应在腭裂整复术中同期行鼓膜切开置管术；异型鼓室图患耳，即使有积液，也可暂保守治疗，暂不置管，但需密切随访。选择在腭裂整复术时置管并不会延误治疗时机。
목적：탐토악렬반중이공능이상적종합평고책략，우화진치정서，진일보제고악렬적종합치료효과。방법대악렬환자중이공능이상적469측환이진행성도항측시，대중이적액여고실도、고실압급은력적관계진행통계분석。대기중62례진악렬환인적124측환이고실도변화진행위기1년적동태감측。결과고실도위B、C、이형자적액솔분별위50.3%（97/193）、34.8%（8/23）화20.9%（53/253）。이형적액환이적고실압여무적액환이적고실압지간차이무통계학의의（P>0.05）。B형차유적액적환이은력손실고우무적액환이（P=0.001），이형고실도환이적액여은력손실불상관（P>0.05）。진악렬환자재진렬수복술지악렬정복술기간，기중이각형고실도구성비무차이（P>0.05）。결론각형이상고실도적액솔불동。고실압저우-150?dapa적이상고실도환이응천자배사。B형고실도차유적액적환이흔가능영향은력，응재악렬정복술중동기행고막절개치관술；이형고실도환이，즉사유적액，야가잠보수치료，잠불치관，단수밀절수방。선택재악렬정복술시치관병불회연오치료시궤。
ObjectiveTo?explore?evaluation?strategies?for?middle?ear?dysfunction?in?cleft?palate?patients,?to?optimize?the?diagnosis?and?treatment?of?this?dysfunction,?and?ultimately?to?improve?the?comprehensive?treatment?of?cleft?palate.?Methods?The?relationship?among?abnormal?tympanic?types?(B,?C,?and?Anomaly),?effusion?rate,?tympanic?pressure,?and?hearing?loss?were?analyzed.?We?collected?relevant?information?on?469?ears?of?cleft?palate?patients?and?traced?one-year?longitudinal?changes?in?the?tympana?of?124?ears?from?62?patients?with?both?cleft?lip?and?cleft?palate.?Results???The?effusion?rates?of?cleft?palate?patients?with?type?B,?type?C,?and?type?Anomaly?were?50.3%?(97/193),?34.8%?(8/23),?and?20.9%?(53/253),?respectively.?The?tympanic?pressure?of?the?ears?with?and?without?effusion?showed?no?significant?difference?(P>0.05).?The?hearing?loss?in?type?B?cleft?palate?patients?with?middle?ear?effusion?was?worse?than?that?in?patients?without?effusion?(P=0.001). However, the hearing?loss?in?type?Anomaly?showed?no?difference?(P>0.05).?The?constituent?ratio?of?each?tympanic?type?remained?constant?during?the?period?between?cheiloplasty?and?palatoplasty?for?cleft?lip?and?palate?patients?(P>0.05).?Conclusion???Cleft?palate?patients?of?all?tympanic?types?may?all?suffer?from?middle?ear?effusion?at?different?rates.?Examination?by?centesis?is?suggested?for?ears?with?abnormal?tympanic?types.?Early?aggressive?therapy?is?essential?for?type?B?cleft?palate?patients?with?middle?ear?effusion?to?avoid?hearing?loss.?However,?catheterization?may?be?not?necessary?for?type?Anomaly?patients,?and?conservative?observation?should?be?performed?instead.?Myringotomy?with?grommet?insertion?during?palatoplasty?does?not?delay?treatment?timing?for?patients?with?both?cleft?lip?and?cleft?palateg.