儿童急性中耳炎和面瘫:系统回顾和手术算法的建议

IF 2.1 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY
Piergabriele Fichera, Luca Bruschini, Stefano Berrettini, Silvia Capobianco, Giacomo Fiacchini
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引用次数: 0

摘要

急性中耳炎(AOM)是儿童最常见的耳鼻喉疾病之一。在抗生素/后抗生素时代,面瘫是一种非常罕见的AOM并发症(0.004-0.005%)。尽管这种并发症很少见,但所有的医生都应该知道正确的治疗方法,以避免严重的后遗症。这篇综述的目的是在现有文献的基础上提供一个管理指南。材料与方法:选取2000 - 2022年间发表的15项研究,包括120例患者(62 M/58 F),平均年龄4.96岁(范围= 4个月- 16岁;SD: 4.2)。麻痹经常突然发作,严重程度(发作时House-Brackmann (HB)评分中等:4.68;SD: 0.5);然而,大多数患者几乎完全恢复(随访时HB 1为88.49%)。结果:其一线治疗必须以抗生素(内酰胺类抗生素如青霉素类或头孢菌素类)的使用为基础。皮质类固醇应同时使用,以发挥其抗炎和神经保护作用;然而,作者之间对其应用并没有达成一致意见。鼓膜完好的病例需要行鼓膜切开术,不论是否插入通气管。其他类型的手术只能在AOM症状恶化或HB评分恶化的患者中进行,即使经过临床治疗。结论:所获资料显示,保守治疗可使大多数患者完全康复,首选保守治疗作为一线治疗。乳突切除术应仅在急性乳突炎患者和保守入路后症状没有改善的情况下进行。对于需要行乳突切除术联合面神经减压的患者,目前文献资料不足,无法提供明确的选择标准。这种治疗的选择是基于个别中心的专业知识。需要进一步的研究来阐明皮质类固醇的作用和面神经减压在这种临床情况下的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm
Acute otitis media (AOM) is one of the most common ENT diseases in children. In the antibiotic/post-antibiotic era, facial paralysis is a very rare complication of AOM (0.004–0.005%). Despite the rarity of this complication, it should be known by all physicians for proper therapeutic management to avoid serious sequelae. The aim of this review is to provide a management guide based on the current literature. Materials and Methods: Fifteen studies published between 2000 and 2022 were selected, including 120 patients (62 M/58 F) with an average age of 4.96 years old (range = 4 months–16 years; SD: 4.2). The paralysis frequently has a sudden onset and is of a severe grade (medium House–Brackmann (HB) score at onset: 4.68; SD: 0.5); however, it tends to have an almost complete recovery in most patients (88.49% HB 1 at follow-up). Results: Its first-line treatment must be based on the use of antibiotics (beta-lactam antibiotics as penicillins or cephalosporins). Corticosteroids should be used concomitantly for their anti-inflammatory and neuroprotective actions; however, there is no unanimity between authors about their application. Myringotomy, with or without ventilation tube insertion, is indicated in cases where the tympanic membrane is intact. Other kinds of surgery should be performed only in patients who have a worsening of their AOM symptoms or a worsening in HB score even with clinical treatment. Conclusions: The obtained data show that a conservative treatment can be sufficient for complete recovery in most patients, and it is preferred as the first-line therapy. Mastoidectomy should be performed only in patients with acute mastoiditis and without symptom improvement after a conservative approach. There are insufficient data in the current literature to provide clear selection criteria for patients who need to undergo mastoidectomy with facial nerve decompression. The choice of this treatment is based on an individual center expertise. Further studies are needed to clarify the role of corticosteroids and the role of facial nerve decompression in this clinical scenario.
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来源期刊
Audiology Research
Audiology Research AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-
CiteScore
2.30
自引率
23.50%
发文量
56
审稿时长
11 weeks
期刊介绍: The mission of Audiology Research is to publish contemporary, ethical, clinically relevant scientific researches related to the basic science and clinical aspects of the auditory and vestibular system and diseases of the ear that can be used by clinicians, scientists and specialists to improve understanding and treatment of patients with audiological and neurotological disorders.
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