Tap ch! Y DUVC hqc - Truimg Bqi hqc Y Dugc Hue- Tqp 6, si 5 - thang 10/2016
DANH GIA KET QUA DIEU TRj VIEM TAI GI&A & DjCH BANG PHUONG PHAP OAT ONG THONG KHf
Hodng Phu&c Minh, Li Thanh Thai Tru&ng Bgi hgc YDugc Hui- Dgi hgc Hui Tdm tat
Mye tigu: Md t i dge diem lam sang, nhT luang, thinh lyc va danh gia k i t qua dieu tq viem tai gi&a & djch bang phuang phap dat dng thdng khi. Ddi tupng va phyang phap nghien cdu: 114 tai eiia 76 bgnh nhan vigm tai gl&a & dieh ed chl djnh dat dng thfing khi. Nghien c&u tien e&u, ed ean thigp lam sang. Kit qua: Nhdm
< 6 tudi gap nhieu nhat (39,5%).Cic trigu eh&ng ca nang thudng ggp nhdm < 6 tudi la nggt mui (73,3%), chiy mui (66,7%); nhdm >6 tudi la ii tai (78,3%), nghe kem (76,1%). Hinh inh mang nhT: day due toan bp (40,4%), ed mdc hai djch (64,1%), co keo (44,7%), mat ndn sing (87,7%). NhT do det (type B) gap nhieu nhat 78,1%.
Thinh lyc do nghe kem dan truyen vdi PTA £ 20 dS 100%. Phau thugt dat dng thdng khi 1 hoge 2 ben tai phdi hpp ngo VA. Thdi gian theo ddi 6 thang, PTA sau khi dieu trj cdn 28,4±1,6 dB. Hau hit cic trudng hpp thinh lyc ting, tai khd, dng thdng khi con tren mang nhT. Biln chdng thudng gap la ehay tai va tut dng thdng khi.
Kit luin: Cic tngu ch&ng viem tai gi&a & djch thudng im lang, khd phat hien die biet d tre nhd. Do nhT lupng ddng vai trd quan trong trong viec chan doin. Dgt dng thdng khi giiip cii thign thinh luc va t i i lip chdc nang tai gi&a.
Tir khda: Viim tai gi&a & dich, ong thong khi Abstract
EVALUATING THE RESULTS OF TREATMENT FOR OTITIS MEDIA WITH EFFUSION BY VENTILATION TUBE INSERTION
Hoang Phuoc Minh, Le Thanh Thai Hue University of Medicine and Pharmacy - Hue University Background: Otitis media \N'\Xh effusion (OME) is a common disease especially in children. Objective: To study clinical, tympanometry, audiometry and the results of ventilati'on tube insertion. Materials and methods:
Prospective study with clinical intervention in 114 ears of 76 pati'ents with OME, Results: The most common age group was S 6 years of age (39.5%). Common symptoms in <6 years of age group are nasal obstruction (73.3%), rhinorrhea (66.7%); in > 6 years of age group are ti'nnitus (78.3%), hearing loss (76.1%). Tympanic membrane findings: completed opaque (40.4%), air-fluid level (64.1%), retraction (44.7%), losing cone of light (87.7%). Tympanograme type B was 78.1%. Audiograme was conductive heanng loss with PTA > 20 db (100%).
Ventilati'on tube insertion one or both side associated with or without adenoideetomy. After 6 months of follow-up, postoperative average PTA was 28.4+1,6 dB. Most of cases have dry ear, hearing improvement, tubes on the tympanic membrane. Common complications were otorrhea and extrusion. Conclusion' OME is asymptomatic especially In children. Tympanograme plays a key role in diagnosis Ventilation tube insertion improves the hearing and restores the normal function of the middle ear.
Key words: Otitis media with effusion, ventilation tube
1. OAT VAN DE nhan ehinh ciia giam s&e nghe t d do inh hudng den Vilm tai gida & djch la tinh trgng tu djch ciia tai qui trinh phat trien ngdn ngd va hoc tap. Tai Viet Nam gi&a phia sau mdt mang nhT ddng kin nhung khdng cd theo thdng ke ciia Nguyen Thi Hoii An ed khoang 8,9%
cac trigu chdng cap tinh nhu sdt, dau tai, kich thieh. tre bi bdnh nay [1]. U'dc ti'nh khoang 90% tre em bi Vilm tai gl&a d djch la mgt trong nh&ng benh ly tai viem tai gi&a d djch d mfit thdi diem nao do trude thudng ggp nhat dtre em v i nlu khdng dupe dieu tri 10 tudi, da sd d dp tudi t& 6 thing tuoi den 4 tudi dung se gay ra cic di chdng ngng n l tren tai gi&a lam [5]. Trieu ch&ng ciia benh nhe nhang, khdng ram rd, giam chuc nang cua mang nhT tai gi&a va la nguyen diln bien ciia benh tiem tang am i nen rat de bi bo
IjO chl lien he Le Thanh Thai email thsiethanhthai@gmaii com
Ngay nhan b ^ ^ ^ ^ ^ ^ ^ ^ v S a n g 15/10^016 Ngdy xuat iifm: 25/10/2016
JOUKNAL OF MEDICINE h>
Tgp chi YDuvc hqc - Tru&ng Dgi hqc Y Duvc Hui- Tqp 6, so 5 - thang 10/2016 sdt khi tham khim. Hien nay, vdi su phat trien ciia y hpe hign dgi, nhieu ky thugt mdi da gdp phan chan doan va dilu tri bgnh viem tai gi&a & djch dac bigt nhT lupng do giup chan doin tinh trgng d djch hdm nhT Nhieu logi dng thdng khi hom nhT dupe tgo ra de din luu djch t d hom nhT ra ngoii. Dat dng thdng khi giiip cii thign ding ke s&e nghe, giam tinh trgng & djch, giim tl lg mac viem tai gi&a d p t i i phit, va tgo cP chl din luu va dieu tq khang sinh tai chd ddi vdi vidm tai giu^ cap keo dii. Tan suat dgt dng thdng nhT, chl djnh phlu thugt can cd bang eh&ng de giOp eho cae bae sT ehi djnh dung ddi tupng va theo doi, dinh gJa cham sde sau phiu thugt. Xuat phat t d nh&ng van de neu tren, de gdp phan ehan doan cung nhU dieu tri bgnh viem tai gi&a & djch, de tai dupc tiln hinh nham:
"Odnh gid kit qud dieu tti viem tai giiJXi & dich bhng phirang phdp ddt dng thbng khi" vdi 2 myc tiiu sau:
1. Nghiin c&u dgc diem Idm sdng, cqn Idm sdng benh viim tai gi&a & dich.
2. Ddnh gid kit qud dieu tri viim tai giu'a & dich bang phuang phdp dgt dng thbng khi.
2. Ddi TirgrNG VA PHirCTNG PHAP NGHIEN COU 2.1. Ddi tuang nghien c&u: 114 tai eiia 76 bgnh nhan dupc chan doin viem tai gi&a & djch den kham va dieu tri bang phuang phip dat dng thdng khi tai Bgnh vign Trung UOng Hui v i Benh vign Trudng Dai hpc Y Dupe Hui t d 03/2014 din 01/2016.
2.2. Phuang phap nghiin c&u: Nghien c&u tien c&u, cd ean thigp lam sang.
- Cic tigu chi nghign c&u, tudi, gidi, tri§u ch&ng ca nang, hinh anh mang nhT, thinh luc dd, nhT lupng dd, phuang phip phlu thugt, kit qua dilu tn dgt dng thdng khi.
- Phuang ti'en nghign c&u: Miy ngi soi ghi hinh, kinh hien vi phiu thuit, may do thinh lyc v i nhT lupng, dng thdng khi (OTK),
- Cic budc tien hanh nghign c&u; Trudc md tiln hanh hoi bgnh, kham ghi hinh mang nhT, do nhT lupng, do thinh lyc cho tre Idn hpp tic tdt va bgnh nhan Idn tudi. Tiln hinh dat OTK ed ket hop vdi ngo V.A nlu ed ehi djnh. Sau md dinh gia ket qua dilu trj sau 3 thing, 6 thing.
- Bd m? benh nhan nhd tudi va bgnh nhan Idn tudi ddng y tham gia nghidn e&u.
- Nhgp va xd ly sd lieu bang phan mem thdng kl yhoc SPSS 18.0,
3. KET QUA
3.1. D^c diem lam sang, cgn l i m sang 3.1.1. Dgc diim chung
- Tudi v i gidi: nhdm tudi ggp nhieu nhat la S6 tudi cd 30 bn (39,5%), dd tudi trung binh la 19,5±2,3.
Dp tudi trong nghiin c&u ciia ehiing tdi cd sy chlnh Igch rat ldn, trudng hpp nho tudi nhat la 1 tudi va idn nhat la 84 tudi. Ty I I mac bgnh ciia nam la 52,6%
(40/76 bn), ciia n& la 47,4% (36/76 bn).
- Sd tai benh. Cd 38 bgnh nhan bj bgnh 2 tai ehiem 50%, da sd trong nhdm <6 tudi vdi 21 bn.
3.1.2. Triiu ch&ng cff ndng Bang 3.1. Cac trigu ehdng ca nang
Nhom tuoi
56 tuoi (30 BN)
>6tu6i (46 BN)
T6ng (76 BN)
n
%
n
%
n
%
Ngat mui 22 73,3
18 39,1
40 52,6
Trifu ctni-ng CO" nang Cliav
mui 20 66,7
13 39,1
38 50,0
U tai 7 23,3
36 78,3
43 56,6
IMglie l<em 13 56,7
35 76,1
48 63,2
Ngil ng^y 16 53,3 14 30,4 30 39,5
Cli|m n6i 10 33,3
2 4,4 12 15,8
Dau tai
7 23,3
16 34,8
23 30,3
dc
0 0 6 13,1
6 7,9
thinii 0 0 8 17,4
8 10,5 Tren nhdm bgnh nhan £6 tudi eic tngu eh&ng
ngoai tai ndi bat nhu nggt mui (73,3%) va ehay mui (66,7%) do lien quan nhieu din V.A. Ngupc Igi tren nhdm bgnh nhan >6 tudi (n=46) cd kha ning nhgn
|82 lOURNALOFMPn,,,... . . , „ . . . , .
bilt va giao tiep tdt eic trigu chdng hay gap nhat la il tai (78,3%) ggp d 36/46 bn va nghe kem (76,1%) ggp d 35/46 bn. Cd 8/46 bn cd trigu chdng t y thinh va 6/46 bn cd trigu ch&ng dc ich trong tai.
Tqp chiYDugc hgc - Tru&ng Bgi hgc Y Dugc Hui- Tgp 6, so 5 - thdng 10/2016
3.1.3. Triiu ch&ng t / i y c thi thdm khdm mdng nhT
Bang 3.2. K i t qua hinh anh t h a m k h a m m a n g nhT (n=114) Trigu ch&ng t h u c the
D f i m d d u e
M d e h a i dich
M i u sae
Hinh t h a i vj t r i
D g d i d d n g
Ndn sang
Binh t h u d n g D y e m f i t phan D y e t g a n b g Tdng Khdng Cd Tdng Trang x i m Vang m p t p h a n V i n g t g a n bd Tdng Binh t h u d n g Co keo Phang H o i p h d n g P h d n g t o a n b p Tdng Binh t h u d n g G i a m d i d f i n g K h d n g d i d d n g Tong Blnh t h u d n g G i a m / m a t Tdng
n 25 43 46 114 41 73 114
23 64 27 114 4 51
1 47 11 114 27 74 13 114 14 100 114
T ' y l g % 21,9 37,7 40,4 100,0 35,9 6 4 , 1 100,0 20,2 5 6 , 1 23,7 100,0
3,5 44,7 0,9 41,2 9,7 100,0 23,7 64,9 11,4 100,0 12,3 87,7 100,0 3.1.4. Kit qud do nhT lug'ng
Bang 3.3. H Hinh dang Dang d e t D g n g v d m Dang t h i n g chech t r i i
Tdng
n h d a n g nhT l u p n g d o t r e n s d t a i b g n h ( n - 1 1 4 ) S d t a i
92 19 3 114
T ^ l e % 80,7 16,7 2,6 100,0 NhT l u a n g d o d a n g d e t c h i l m d a so 8 0 , 7 % ( 9 2 / 1 1 4 ) .
B i n g 3.4. M d c d o cua d f i t h d n g t h u g n t r U d c d i e u t r i t r g n s d tai b e n h (n=114) Mii'c d p d d t h d n g t h u a n
>0,2 m m Ho
<0,2 m m Ho Tdng
S d t a i 25 89 114
T ^ | g % 21,9
7 8 , 1 100,0
Trung binh ( m m H o ) 0,12+0,16
(0;0,7)
83 I
Tap chi Y Buvc hqc - Tru&ng Dgi hqc Y Dugc Hui- Tgp 6, so 5- thdng 10/2016
Dg thdng thuan thap (S0,2 mmHo) ehiem ty Ig rat eao (78,1%), trung binh l i 0,12±0,16 mmHo, thap nhat la 0 mmHo, Idn nhat la 0,7 mmHo.
3.1.5. Kit qud do thinh l&c
Bang 3.5. Ngudng nghe trung blnh trude va sau dgt dng thdng khi 6 thing (n=78) Ngudng nghe TB (dB)
Trung binh Tdi thieu Tdi da
Trudc dieu trj 39,2±1,4
21,7 75,1
Sau 6 thing 28,4±1,6
15,3 68,9
p<0,01
Cd 78/114 tai do dupc thinh lyc trudc va sau dat OTK 6 thing. Ngudng nghe trung binh khi tai khim I:
28,4+1,6 dB, ed giam so vdi trude dieu tri, p<0,01.
3.2. Dinh gia ket qui dilu tri viem tai gl&a & djch bang phUPng phap dgt dng thdng khf.
3.2.1. Cdc phuang phdp diiu tri
Bing 3.6. Cic phuang phip dieu tn trdn bgnh nhan (n=76) Phuang phip dilu trj
Dit OTK mdt ben dan thuan Dat OTK hai ben Dat OTK mpt bgn + ngo VA Dat OTK hai bgn + ngo VA
Tong
Phan bd bgnh nhan n
31 9 7 29 76
T'y'lg%
40,8 11,8 9,2 38,2 100,0 Dgt dng thdng khi mpt bdn dan thuan ehilm ty le eao nhat 31/76 BN (40,8%). Tiep den la dgt OTK hai bin + nao VA 29/76 BN (38,2%)
3.2.2. Kit qud sau dieu trj dqt dng thdng khi 3 vd 6 thdng
Bing 3.7. Kit qui sau dilu tri dgt dng thdng khi 3 va 6 thing
^~~~~--^^ Tho'i gian K^t qud ^ " " " " ^ - - - ^ Tot
Tyt ong Tac ong Chay tai Nhilm trung
Tong so (n)
3 thang 95
5 3 11 0 114
%
83,3 4,4 2,6 9,7 0,0 100
6 thang 65 20 6 16
2 109
%
59,6 18,3 5,5 14,7
1,9 100 Sau 3 thing dgt OTK bien ch&ng chay tai chllm
ty le cao nhat (9,7%). Sau 6 thing thi biln ch&ng tyt dng chilm ty le cao nhit vdi 18,3%.
4. BAN LUAN
4.1. Dgc diem lim sing, can lam sing 4.1.1. Ddc diim chung
Theo nghien e&u eiia chiing tdi benh vigm tai gi&a & djch xuat hien d mgi l&a tudi, dg tudi trung binh la 19,45+2,3, l&a tudi trude khi den trudng (t&
0 din 6 tudi) ehiem ty Ig eao nhat 39,5%. Cic tic
gia nudc ngoai nhgn xet rang vigm tai gi&a & djch thudng xuat hign d tre dudi 6 tudi [3], [6], nghidn edu cua chung tdi ty lg nay thap han, trong khi dd t\/ Ig t r i Idn v i ngudi Idn lai eao, cd the do cd mlu nghien c&u eua ehiing tdi chua dii ldn, lly mau trgn thang dp tudi rdng, cung cd the vl trigu eh&ng d djch d tre em khd nhgn bilt nen cha mp thudng hay bd qua hogc nham lin vdi eie bgnh ly khic.
4.1.2. Trieu ch&ng Cff ndng
Cac bieu hign d nhdm <6 tudi thydng la cie trigu ch&ng ngoai tai, dupc phat hien tinh cd khi bd m?
Is. lOUHNAL OF MEDICINE M
Tgp chi Y Duqc hqc - Truimg Oqi bqc Y Dugc Hui -Tgp 6, so 5- thdng 10/2016 dua di kham vi eic trigu ch&ng mui hong, do phit
hien nghe kem gian tilp qua cic dau higu chim ndi, gpi khdng d i p dng hogc ddi vdi l&a tudi di hpc thi hpc hanh sa sut, khdng nghe bii giing. Trong Bang 3.1, 73,3% tre b] ngat mui, 66,7% tre bj chay mOl trong hogc nhly dye. 6 nhdm bgnh nhan >6 tudi cd kha ning giao tilp va t y nhgn biet cac trigu ch&ng tdt thi trigu eh&ng thudng ggp nhat la LI tai (78,3%) va nghe kem (76,1%). Cung d nhdm bgnh nhan niy cd the khai thic cie trigu ch&ng t y thinh (17,4%) va dc ich trong tai (13,1%).
4.1.3. Triqu ch&ng thi^ the
Theo Bang 3.2, hinh anh ming nhTco keo chiem ty le 44,7%, v i cd m&c hPi djch ehiem 64,1%. Ngoai ra mau sac mang nhT vang mpt phan ehiem 56,1% va dye toan bp chiem 40,4%. Cie ket qua niy tuang t y vdi ket qua nghien c&u eua Nguyin Thi Hoii An va DoanDieuVi[l], [2].
4.1.4. Kit qua do nhT lu&ng
Hinh anh nhT luang dd dgng d?t ehiem ty le cao 80,7% tuang &ng vdi type B phii hpp vdi dac diem nhT lupng dd trong vigm tai gi&a & djch va eiing phii hpp vdi nhgn dmh eiia Doan Digu Vi [2]. Theo Bang 3.4 dd thdng thuan thap (50,2 mmHo) chiem ty le rat cao (78,1%), trung blnh la 0,12±0,16 mmHo. NhT lupng dd la phuang phip dinh gii khich quan chdc nang tai gi&a ngay ca ddi vdi cac bgnh nhan nhd tudi.
Tuy nhien can loai tr& eae yeu td gay duang ti'nh gia nhu thiing mang nhT hoie riy tai bit tac dng tai.
4.1.5. Kit qua do thinh l&c
Chung tdi da do thinh lyc duyc 78 tai d nhdng tre Idn va ngudi Idn hpp tie tdt. Ket qua la 100% tai bj nghe kem dan truyen cd PTA >20 dB. Nghien c&u ciia Robin T. Cotton cung eho thay nghe kem trong viem tai gi&a & djch la nghe kem din truyen, s&c nghe giam t d 15 din 45 dB [5]. Dieu nay eho thay viem tai gi&a & djch anh hudng ding k l den s&c nghe. Theo Bang 3.5, PTA khi tai kham la 28,4+1,6 dB, cd giam so vdi trudc dieu tn cd y nghTa thdng k l vdi p<0,01 cho thiy lpi ich ciia vige dgt OTK de din luu djch, can bang ap suit ben ngoai va ben trong hdm nhT.
4.2. Oanh gia ket q u i dieu trj viem tai giii'a &
djch bang phUPng phip dgt dng thdng khi 4.2.1. Cdc phuffng phdp dieu tri
Dgt OTK la mdt trong eic phiu thugt gay me toan than phd biln nhat b tre em, l i lya ehpn dau tien trong cie trudng hpp viim tai gi&a & djch can can thigp phiu thuit. Theo Robin T. Cotton chl djnh dgt OTK khi benh nhan bj viem tai gi&a & djch mgn tinh vdi thinh lyc mat tren 15 dB, b| viem tai gi&a tai dien nhieu dpt khdng dip &ng dilu tr;, vilm tai gi&a dinh, xep nhT cd tui eo keo, tre ed cac trigu eh&ng
ram rg [5]. Trong nghien c&u nay chung tdi dgt OTK dudi gay me toan than vdi bgnh nhin nhd tudi, eae benh nhin Idn tudi hpp t i e tdt chung tdi dgt OTK gay te tai chd bang kinh hiin vl phlu thugt hoae npi soi.
Phan Idn logi dng thdng khi sddyng la loal Grommet (dng thdng khi thdi gian ngan < 1 nam), rieng m$t sd trudng hpp cd hign tuang xep nhT ehiing tdi phii dimg dng ch&T (T-Tube: dng thdng khi thdi gian dai) dung ehi djnh va de dat kit qua tdt nhat. Theo Bang 3.6, phuang phap d i t OTK ket hpp nao VA chilm 38,2%. Cie nghien c&u ciia Nguyin Thi Hoai An va Chantal Boonaeker deu nhgn xet viec kit hpp ngo VA vdi dgt OTK cd higu qua tdt, phuc hdi nhanh ch&c nang tai gl&a trong viem tai gl&a & djch [1], [3].
4.2.2. Kit qua sau dieu trj ddt dng thong khi 3 vd 6 thdng
Theo kit qua Bang 3.7, eho thay hau het tai khd, OTK cdn nam t r i n mang nhT. Bien ch&ng hay ggp nhat la chay tai, tyt dng, trong nghign e&u nay sau 3 thing ed 11/114 tai bl chiy tai (9,7%) va 5/114 trudng hpp tyt dng (4,4%). Sau 6 thing ti Ig chay tai la 16/109 tai va tyt dng l i 20/109 tai (18,3%). Ty Ig ehay tai ciia tie gia Mohammad Yousaf la 13,6% [6].
Nh&ng trudng hpp nay deu dupc ehung tdi xd tri kjp thdi, bgnh nhin dupe vg sinh hiit rira lam sgch tai, nhd khing sinh khing viem vio tai Cac trudng hpp OTK bj day ra sdm, tai bgnh nhan bi & djch trd lai, ehiing tdi tien hanh dgt lgi OTK va theo doi benh nhan. Oa sd eic trudng hpp OTK t y day ra mang nhT deu ddng kin, ed 1 trudng hpp cd Id thung mang nhTkhdng ddng kin keo dii chdng tdi tien hanh va nhT bjt kin id thiing.
Theo Yousaf v i Nurliza ti le mang nhT khdng ddng kin la 2,3% [6], [7].
5. K^T LUiBiN
Dgc dilm lam sang, cgn lam sang Dpc diim chung: Viem tai gi&a & djch xuat hign d mgi l&a tudi, dg tudi trung blnh la 19,45±2,3, l&a tudi trude khi den trudng (td 0 den 6 tudi) ehiem ty Ig eao nhit 39,5%.
7r(|u ch&ng cff ndng: Cac bieu hign d nhdm
^6 tudi thudng la cic trieu ch&ng ngoai tai, duqc phat hign tinh ed khi bd me dua dl kham vi cac trigu eh&ng mui hpng, phat hign nghe kem giin tiep qua cic dau higu chgm ndi, gpi khdng dap &ng. Cd 73,3%
tre bj nggt mui, 66,7% tre bj chay mui trong hogc nhay dye. 6 nhdm bgnh nhan >6 tudi ed kha nang giao tilp va t y nhin biet eae tngu ch&ng tdt thi trigu ch&ng thypng ggp nhat l i LI tai (78,3%) v i nghe kem (75,1%).
Triiu ch&ng thi/c thi: Hinh anh ming nhTco keo chiem ty Ig 44,7%, va ed m&c hal djch chiem 64,1%.
Ngoai ra mau sae mang nhT vang mdt phan chiem
lOUR'^AL OF MEDICINE Al 85|
Tgp ch! Y DUVC hgc - Tru&ng Ogi hgc Y Dugc Hui- Tgp 6, so 5- tbdng 10/2016
5 6 , 1 % v i d y e t o a n b d ehiem 40,4%.
Kit qud do nhT luffng: Hinh anh nhT l u p n g d o dang d e t chiem t y Ig eao 8 0 , 7 % t U P n g &ng v d i t y p e B p h i i h p p v d i dgc d i l m nhT l u p n g d d t r o n g v i e m tai gi&a & dich, d p t h d n g t h u a n t h a p (£0,2 m m H o ) c h l l m t y Ig rat cao (78,1%), t r u n g b l n h la 0,12+0,16 m m H o .
Kit qud do thinh l&c: Chung t d i da d o t h i n h l y e d u p e 78 tai d n h & n g t r e Idn v i n g u d i l d n h p p t i c t d t . K i t qua la 100% tai bj nghe kem d i n t r u y e n cd PTA >20 dB.
D i n h gia k i t qua dieu trj v i l m t a i gi&a & djch bang p h u a n g p h i p d a t dng thdng khf
Cdc phuffng phdp dieu tri: Trong nghien c&u nay c h i i n g t d i d g t OTK d u d i gay m l t o i n t h i n v d i
b g n h nhan n h d t u d i , eae b e n h n h a n I d n t u d i h p p t a c t d t c h i i n g t d i d a t OTK gay t g tgi c h d b a n g kinh hien vi p h l u t h u a t hogc npi soi. Phan l d n logi ong t h d n g k h i s d d y n g la logi G r o m m e t ( d n g t h d n g khi t h d i gian ngan < 1 n a m ) , rieng m p t s d t r u d n g h p p cd hign t u p n g xep nhT c h i i n g t f i i phai d t i n g d n g eh& T (T-Tube: d n g t h d n g k h i t h d i gian dai) d i i n g chl dinh va d e d g t k i t q u a t d t n h a t . D g t OTK ket h p p ngo VA c h i e m 38,2%.
Kit qud sau dieu trj dgt dng tbdng khi 3 vd 6 thdng: Cho t h a y hau h i t tai k h d , OTK cdn n a m t r g n m i n g nhT. B l l n c h & n g hay ggp nhat la ehay t a i , t u t d n g , sau 3 t h i n g cd 1 1 / 1 1 4 tai bj chay tai (9,7%) va 5 / 1 1 4 t r u d n g h a p t u t d n g (4,4%). Sau 6 t h i n g ti lg ehay t a i la 1 6 / 1 0 9 tai v i t y t d n g la 2 0 / 1 0 9 tai (18,3%).
TAI U l u T H A M KHAO
1. Nguyin Thi Hoai An (2002), Nghiin c&u dgc diem dich ti hgc viem tai gi&a & dich & tre em phu&ng Trung Tuvd mgt vdi phudng khac thugc Hd Ngi, Luan an tien sTY hpc, Trudng Dgi hgc Y khoa H i Ngi
2. Doan Di^u Vi (2014), Nghiin c&u dgc diem Idm sdng, cgn Idm sdng va kit qud dieu tri viim tai gi&a & dich, Lugn van tot nghigp bac sy ngi tru, TruPng Dgi hgc Y Dupc Hue.
3. Chantal W/B Boonaeker (2014), Adenoideetomy with or without grommets for children with otitis media: an individual patient data meta-analysis. Health Technology Assessment, National Institute for Healtii Research, UK,
4. Cummings et al (2015), Acute Otitis Media and Otitis Media with Effusion, Otolaryngo logy-Head and Neck Surgery, Elsevier, USA, pp.3021-3040.
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