| Objective:To explore the relationship between secretory otitis media(SOM)and adenoid hypertrophy and chronic sinusitis in children by Cone Beam Computed Tomography(CBCT)and analyze the characteristics of the basic structure of the eustachian tube in the diseased lateral,such as the pharyngeal orifice,the tympanic orifice,the cartilaginous portion,the bony portion and so on,when children have SOM.This study provides a theoretical basis for correct understanding of the significance of eustachian tube disease in the prevention and treatment of SOM.Methods:A retrospective analysis was performed on 52 patients aged 0～12 who were clinically diagnosed as adenoid hypertrophy from January 2017 to July 2018 in the department of otolaryngology head and neck surgery.①According to the diagnostic criteria of SOM[1],26 cases were the combined SOM group and 26 cases were not combined SOM group.Each patient was measured with A/N[2],the anterior and posterior diameter value of the effective airways of the nasopharyngeal airway D and the effective section area of the nasopharyngeal airway(Sn).we compared the results and the incidence of chronic sinusitis of the two groups;②According to whether each patient’s ear was associated with SOM,41 ears were the combined SOM ear group and 63 ears were not combined SOM ear group.We measured the data related to the basic structure of each eustachian tube,such as the trans diameters of the pharyngeal orifice,the superior-inferior diameters of the pharyngeal orifice,the angles from sagittal plane,the trans diameters of the tympanic orifice,the superior-inferior diameters of the tympanic orifice,the lengths of the cartilaginous portion,the lengths of the bony portion,the angle between the bony portion and the cartilaginous portion and so on.Finally,we analyzed and compared the imaging difference of the eustachian tube between the two groups.Results:①The A/N in the combined SOM group and the not combined SOM group were 0.72(0.67,0.84)and 0.68(0.63,0.75),and the Sn were 73.81(39.55,125.15)mm2和 131.00(82.95,168.20)mm2,and the D were 4.39 ± 1.88mm 和 5.69 ±2.48mm.,respectively.There was significant difference in the groups(P<0.05).The number and proportion of cases with chronic maxillary sinusitis,frontal sinusitis,ethmoid sinusitis and sphenoid sinusitis in combined SOM group were 21(80.8%)、15(57.7%)、22(84.6%)、21(80.8%)、20(76.9%),and in not combined SOM group the number and proportion were 11(42.3%)、4(15.4%)、6(23.1%)、5(19.2%)、17(65.4%).There was significant difference in the groups(P<0.05);②The trans diameters of the pharyngeal orifice in the combined SOM ear group and not combined SOM ear group were 2.30± 0.74mm 和 2.72 ± 0.81mm,and the trans diameters of the tympanic orifice were 3.03±0.69mm 和 3.39±0.72mm,and the superior-inferior diameters of the pharyngeal orifice were 3.03± 1.07mm 和 3.74±1.40mm.There was significant difference in the groups(P<0.05).The lengths of the cartilaginous portion in the combined SOM ear group and not combined SOM ear group were 29.39 ± 8.37mm 和 28.65 ± 7.27mm,and the lengths of the bony portion were 9.20±2.27mm 和 9.57±2.29mm,and the angle between the bony portion and the cartilaginous portion were 43.70 ± 9.87°和 41.66 ± 11.85°,and the superior-inferior diameters of the tympanic orifice were 3.03 ±0.61 mm 和 3.30±0.72mm,respectively.There was no significant difference in the groups(P>0.05).Conclusion:1.Adenoid hypertrophy leads to SOM and the size of adenoid is positively correlated with the incidence of SOM.2.Sn may be a more sensitive indicator of nasopharyngeal airway obstruction.3.SOM is closely related to adenoid hypertrophy and chronic sinusitis.4.The superior-inferior diameters of the pharyngeal orifice,the trans diameters of the pharyngeal orifice and the trans diameters of the tympanic orifice of the eustachian tube was smaller on the diseased side than on the undiseased side obviously.5.When the trans diameters of the pharyngeal orifice<2.62mm or the superior-inferior diameters of the pharyngeal orifice<3.82mm,the possibility of developing SOM is high and early intervention should be made. |
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