Clinical Effect Analysis Of Adenoidectomy Combined With Tympanotomy In The Treatment Of Children With Adenoidal Hypertrophy Accompanied By Secretory Otitis Media

ObjectiveTo investigate the short-term efficacy of adenoidectomy combined with tympanotomy in the treatment of children with secretory otitis media(SOM)with adenoidectomy compared with simple adenoidectomy.To analyze the contributing factors of the outcome of two surgical methods of otitis media with secretory secretion,and to provide clinical reference for the treatment of children with adenoid hypertrophy with otitis media with secretory secretion.MethodThis study collected and analyzed clinical data of 99 children aged between 2 to 12with SOM from September 2018 to March 2021.Patients were divided into 2 groups including adenoidectomy combined tympanotomy group(the experimental group.AT+M)and simple adenoidectomy group(the control group.AT group),postoperative follow up regularly for children,in postoperative 3M,6M review acoustic immittance and electronic otoscope.The therapeutic effect was divided into curative effect,effective effect and ineffective effect according to the therapeutic effect evaluation criteria of secretory otitis media in children.After the above clinical data collection,statistical analysis:(1)comparing the AT+M group and the group AT 3months and 6 months after surgery of curative effects,(2)in children with preoperative observation adenoidectomy under electronic nose throat mirror type,factors such as gender,age,whether combined allergic rhinitis,3 months and 6 months after analysis,the factors associated with SOM curative effect,(3)compare the postoperative 3months and 6 months,the factors associated with SOM curative effect if there are different,and reading.SPSS22.0 software was used for statistical analysis,and P<0.05was considered statistically significant.Result1、The general characteristics of AT and AT+M groups were compared,and the results showed that the general characteristics of the two groups were comparable.2、Analysis of SOM cure rate AT 3 months:31 patients(51 cases)in AT+M group,24 cases were cured,19 cases were effective,8 cases were ineffective,and the effective rate was 84.31%.In the AT group,there were 68 patients(103 cases),of which 26 cases were cured,42 cases were effective,and 35 cases were ineffective.The effective rate was 66.02%,and the difference between the two groups was statistically significant(X~2=5.672,P=0.017).Single factor comparison shows that the efficacy of AT+M may be better than AT in children withⅣadenoid hypertrophy,allergic rhinitis and pre-school age.Logistic analysis showed that AT+M/AT(P=0.006,OR=4.084),allergic rhinitis(P=0.015,OR=7.140),age(P=0.004,OR=3.515)and adenoidⅣhypertrophy(P=0.000,OR=6.913)had significant effects on the prognosis of SOM,while gender had no significant statistical difference in the prognosis of SOM.3、Analysis of SOM cure rate AT 6 months:A total of 31 patients(51 cases)in AT+M group were cured in 31 cases,effective in 14 cases and ineffective in 6 cases,with a total effective rate of 88.24%;In the AT group,there were 68 patients(103cases),40 of them were cured,37 of them were effective,and 26 of them were ineffective.The total effective rate was 74.75%,and there was no statistical difference in the effective rate between the two groups(X~2=3.764,P=0.052).Single factor comparison shows that AT+M may have better efficacy than AT in children withⅣadenoid hypertrophy,allergic rhinitis and pre-school age.Logistic analysis showed that AT+M/AT(P=0.020,OR=3.699),age(P=0.011,OR=3.281),adenoidⅣhypertrophy(P<0.001,OR=9.684)had significant effects on the prognosis of SOM,and the differences were statistically significant.Gender(P=0.275,OR=1.884)and sinusitis(P=0.086,OR=4.010)had no statistically significant difference in the prognosis 6 months after SOM.Stepwise multivariate logistic regression found that there was no statistical difference in the prognosis of SOM children with or without allergic rhinitis 6 months after surgery.Conclusion1、There was a statistical difference between AT+M and AT in the treatment of children with AH and SOM AT the first third months,but there was no statistical difference AT the sixth month.2、AT+M in the treatment of AH with SOM in children in preschool,allergic rhinitis,adenoidectomyⅣdegree of hypertrophy group curative effect is better than that of the AT,difference have statistical significance;In the preschool years,no allergic rhinitis and adenoidectomyⅢdegree AT+M in children with hypertrophy group,and the AT curative effect is no statistical difference.3、Adenoid size,age,and operation type(AT+M vs.AT)were independent influencing factors for postoperative prognosis of SOM.