成人慢性鼻竇炎合併中耳積液與否之臨床症狀比較

Clinical Severity Adult Chronic Rhinosinusitis with Otitis Media with Effusion

游士杰(Shih-Chien Yu) ； 黃威雄(Wei-Hsiung Huang)

《台灣耳鼻喉頭頸外科雜誌》 48卷4期 (2013/12) Pp. 294-301

https://doi.org/10.6286/2013.48.4.294

摘要

背景：臨床上發現有部份的成人慢性鼻竇炎患者會合併有中耳積液，而這群患者在鼻竇炎的嚴重度和治療效果似乎都較一般鼻竇炎患者來的差，本研究目的為證實中耳積液是較嚴重的成人慢性鼻竇炎的指標。方法：病歷回顧2000年到2010年因鼻竇炎在嘉義基督教醫院接受鼻竇內視鏡手術的成人，找出同時合併有中耳積液的患者28名，定義為實驗組，根據實驗組患者的性別及年齡，從沒有中耳積液的患者中選出另外28名為對照組，比較兩組的術前電腦斷層分數、術後內視鏡評估分數、鼻竇手術後是否殘留感染發炎現象未癒、是否必須進行第二次手術、是否術後必須使用口服類固醇、是否術後1個月仍必須使用抗生素、手術治療結果、手術後回診頻率以及是否有合併氣喘或慢性阻塞性肺疾。結果：實驗組有較高的術前電腦斷層分數、較高的術後內視鏡評估分數、術後較容易殘留感染或發炎現象、較高的二次手術比例、較需要術後使用口服類固醇、術後1個月仍使用抗生素的比例較高、較差的手術治療結果及較頻繁的術後回診率，但在是否有合併氣喘或慢性阻塞性肺疾並未達統計意義。結論：成人慢性鼻竇炎合併有中耳積液確實比沒有中耳積液來的嚴重，治療效果也較差。

關鍵字

成人慢性鼻竇炎(adult rhinosinusitis) ； 中耳積液(otitis media with effusion) ； 過敏(allergy) ； 嚴重度(severity) ； 手術後評估(postoperative evaluation)

並列摘要

BACKGROUND: It is not uncommon to find that adult chronic rhinosinusitis (CRS) patients also suffer from otitis media with effusion (OME). Our clinical observation shows that these patients seem to present more severity and worse prognosis in comparison with those without OME. Thus, the purpose of this study is to test the hypothesis that adult CRS patients with OME show more disease burden and worse surgical prognosis than those without OME.METHODS: This study is a retrospective chart review with case control. We reviewed the charts of the patients who had CRS and underwent endoscopic sinus surgery from 2000 through 2010. In the study group, there are 28 eligible CRS patients with OME who had adequate chart records that met our study criteria. Other 28 CRS patients without OME, who matched the study group in age and gender, were selected as control group. We compared the 2 groups in the following items: preoperative sinus CT score, postoperative sinoscopic score, postoperative residual disease, revised operation, oral steroid use, antibiotics use since one month after operation, surgical results, post-operative hospital visit, and asthma or chronic obstructive pulmonary disease.RESULTS: The study group showed higher CT score, higher postoperative sinoscopic score, more frequent postoperative residual disease, more revised operations, more oral steroid use, more antibiotics use since one month after operation, worse surgical results, and more frequent post-operative hospital visit than control group. But there were no difference in the frequency of asthma or chronic obstructive pulmonary disease in both groups.CONCLUSIONS: Adult CRS patients with OME present more severity and worse surgical prognosis than those without OME.