OSAHS患儿术前及术后听觉功能变化的临床研究
赵斯君,张梦萍,黄 敏,彭湘粤,赵东吉慧,陶礼华

湖南省儿童医院耳鼻咽喉-头颈外科(湖南省长沙市, 410007)

儿童; 睡眠呼吸暂停, 阻塞性; 听功能

Clinical study of auditory function for children with obstructive sleep apnea-hypopnea syndrome before and after adenotonsillectomy.
Zhao Sijun,Zhang Mengping,Huang Min,Peng Xiangyue,Zhao Dongji Hui,Tao Lihua.

Department of Otolaryngology,Hunan Children's Hospital,Changsha 410007,China.Corresponding author:Zhao Sijun,Email:zhaosj3991@sohu.com

Child; Sleep Apnea,Obstructive; Function of Auditory

DOI: 10.3969/j.issn.1671— 6353.2018.09.009

备注

目的 了解4～7岁阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿听觉功能的变化状况,分析双侧扁桃体切除术联合鼻内镜下腺样体消融手术后中、重度OSAHS患儿听功能的变化。方法 2016年3月至6月,笔者采用病例抽样的方法抽取就诊于湖南省儿童医院耳鼻咽喉-头颈外科门诊的4～7岁OSAHS患儿,按病情轻、中、重度分组,并选择健康儿童作为对照组。各组均行多导睡眠仪监测(PSG)、纯音测听(PTA)、听性脑干反应(ABR)检测、畸变产物耳声发射(DPOAE)。其中,中、重度OSAHS组分别于术后半年复查1次PSG、PTA、DPOAE及ABR检查,对照组行ABR、DPOAE和ABR检查。结果 中、重度OSAHS儿童PTA、ABR、DPOAE结果较轻度OSAHS及对照组均有统计学差异(P<0.05),轻度OSAHS及对照组儿童PTA、ABR、DPOAE无统计学差异(P>0.05)。结论 中、重度OSAHS可引起4～7岁儿童听功能受损,主要表现为中、高频听力受损,且OSAHS病情程度越重,听功能受影响越严重。双侧扁桃体切除术联合鼻内镜下腺样体消融术对腺样体肥大合并扁桃体肥大的OSAHS儿童治疗效果好,手术有助于耳蜗功能的部分改善。
Objective To explore the changes of auditory function in children aged from 4 to 7 years with obstructive sleep apnea hypopnea syndrome(OSAHS)and examine the influence of auditory function on children with medium-severe OSAHS after bilateral amygdala resection plus adenoidectomy under endoscopic ablation. Methods Children of varying degrees of OSAHS aged from 4 to 7 years were selected as research subjects.They were divided into mild,medium and severe OSAHS groups according to the results of polysomnography(PSG,n=40 each).Three groups were monitored by PSG for at least 7h and those with medium-severe OSAHS were re-operated under general anesthesia.The healthy control group was made up of 40 healthy children and their parents confirmed having no snoring or hearing-related history.The study group received PSG,pure tone audiometry(PTA),auditory brainstem response(ABR)and distortion product otoacoustic emission(DPOAE).Cases of medium-severe OSAHS were re-examined by PSG,PTA,DPOAE and ABR for 6 months post-operation while healthy control group repeated ABR,DPOA and ABR.Multifactorial variance analysis was used for comparing the experimental data between groups.And t test was performed for the same group at pre and post-operation. Results Significant differences existed in PTA,ABR and DPOAE in cases of moderate-severe OSAHS(P<0.05).And significant differences existed between mild OSAHS and healthy controls.No significant difference existed between PTA,ABR and DPOAE in those with mild OSAHS and healthy controls(P>0.05). Conclusion Medium-severe OSAHS can impair listening function of children aged 4 to 7 years with middle and high-frequency hearing loss.The more advanced degree of OSAHS,the more severe listening function impairment.Bilateral amygdala resection plus adenoidectomy under endoscopic ablation of adenoid hypertrophy is efficacious for children with OSAHS and tonsil hypertrophy.It may improve cochlear function partially.