以遠距鏡錄影系統來偵測小兒積液性中耳炎

Detection of Otitis Media with Effusion in Children Using Videotelescopy

郭淵進(Yuan-Ching Guo) ； 杜宗陽(Tzong-Yang Tu) ； 廖文輝(Wen-Huei Liao) ； 蕭安穗(An-Suey Shiao)

《中華民國耳鼻喉科醫學雜誌》 37卷2期 (2002/03) Pp. 113-118

https://doi.org/10.6286/2002.37.2.113

摘要

背景：小兒積液性中耳炎的診斷相當重要，較常用的方法包括：氣式耳鏡、鼓室圖、聲反射檢查（acoustic reflectometry）及鼓膜切開術等。近年來由於光學儀器及錄影系統的進步，遠距鏡錄影系統（videotelescopy）被應用於耳科疾病的診斷，但至今並沒有該檢查對於診斷小兒積液性中耳炎準確率的相關研究報告。
方法：採用前瞻性的研究方法，從1999年11月至2001年7月間收集需要住院接受放置中耳通氣管或其他手術的小孩，在手術前2天內進行聲反射檢查、鼓室圖、氣式耳鏡及遠距鏡錄影系統檢查。遠距鏡錄影系統檢查時病患可採坐姿或站姿，檢查者將病患耳郭向後輕拉，再將遠距鏡經由外耳道放至鼓膜前，在監視器上取得清晰且放大影像。最後再以鼓膜切開術或鼓膜抽吸術來確定是否有中耳積液的情形，並比較前述各種方法在診斷積液性中耳炎的準確率。
結果：共收集89名病患，其中經鼓膜切開術或鼓膜抽吸術確定有中耳積液者有125耳，沒有中耳積液者有47耳。遠距鏡錄影系統檢查的敏感性與特異性分別為98.4%、100%，是所有檢查中最高的，準確率高達98.8%，與其他檢查比較具有顯著的統計意義。
結論：遠距鏡錄影系統似乎可做為門診評估小兒積液性中耳炎的標準，對於小兒積液性中耳炎的治療及教學也有相當的幫助。

關鍵字

遠距鏡錄影系統 ； 聲反射檢查 ； 積液性中耳炎 ； 氣式耳鏡 ； 鼓室圖

並列摘要

BACKGROUND: Diagnosis otitis media with effusion (OME) in children is very important. The commonly used diagnostic methods are pneumatic otoscopy, tympanometry, acoustic reflectometry, and myringotomy. Due to technological advances with video-optical techniques in recent years, videotelescopy has become available for the diagnosis of otological diseases. To the best of our knowledge, there have been no reports concerning the accuracy of videotelescopy for the diagnosis of OME in children.
METHODS: Between November 1999 and July 2001, a prospective study of diagnostic methods for OME on children was conducted. These children were candidates for ventilation tube insertions or other ENT surgeries. All tests, including acoustic reflectometry, tympanometry, pneumatic otoscopy, and videotelescopy were performed in the two days preceding surgery. Myringotomy or tympanic aspiration was then performed to confirm the presence or absence of OME. During the videotelescopy examination, the children were in either a sitting or a standing position; the pinna was retracted backwards, and the telescope was advanced medially to the tympanic membrane, thereby achieving a clear view on a video monitor.
RESULTS: Eighty-nine children (58 males and 31 females), ranging in age from 1 to 13 years, participated in the study. Of 172 ears assessed in the study, middle ear effusion was detected in 125; the remaining 47 ears were found to be dry at myringotomy or tympanic aspiration. The sensitivity and specificity of videotelescopy were 98.4% and 100%, respectively. The accuracy of videotelescopy reached 98.8%, significantly better than the other methods used in this study.
CONCLUSONS: Videotelescopy has a potential to become golden standard for the diagnosis of OME in children in outpatient clinics. It is also of use in the treatment of OME and for otoscopic training.

並列關鍵字

videotelescopy ； acoustic reflectometry ； otitis media with effusion ； pneumatic otoscopy ； tympanometry