N g h i e n c m i Y h p c V H p c T P . H o C h i M i n h * P h u B a n T a p 1 9 * S o 5 * 2015
KHAO SAT DAC DIEM VIEM TAI GI0A TIET DICH KEM QUA PHAT VA O TRE EM
Huynh Thi My Hten *, Cao Minh Thie*, Nguyen Dinh Chuong*
T O M T A T
Muc tieu: Nido sdt mot so'dgc diem ldm sdng vd can ldm sdng ciia binh nhi co VTGTD kem qud plidt VA.
Phuang phdp niiien ctiu: Nghien a'eu mo td hdng loqt ca tieii hdnh tren 33 bath nhi co VTGTD kem qud phdt VA ti-ong thdi gian 10/2014 deh 08/2015 tgi Berdi vien Nhi D'ong 2.
Kft qua: Nhi lirgng do dqng B la thudng gap nlidi chian 83,3°/a. Trong n^ien ahi cua dtiing toi ghi nhgn CO su khdc biet ii le bqdi cau da nhan di toan (BCDNAT) trong djch tai giUa a nhimg benh nhdn VTGTD cd Hnh trqng di img z'd khdng cd tinh trqng di iJnig. Khong co ste tiecmg quan giiia ti li BCDNAT trong djch tai guia va BCDNAT ti-ong mdu a benh nhdn VTGTD (R - -0,236, p = 0,114).
Kei ludn: Di ieng la yeii t6'thuqn lgi gay ra nhifng binh ly viim nhiim d zmng mili hgng, dnh hudng dai chiec ndng vdi nhi vd tai giiea Do do nhieng binh nlian co bieu hien di img can dieac kian tra tai ddphdt hien vd dieu tli sdm tinh trgng znem tai giUa.
Tif khoa: Viem tai giOa tiei dich, nqo VA A B S T R A C T
INVESTIGATION OTIHS M E D M WITH EFFUSION AND ADENOID HYPERTROPHY CHARACTERISTICS JN CHILDREN
H u y n h Thi M y H i e n , C a o M i n h Thuc, N g u y e n D i n h C h u o i ^
• Y H o c TP. H o Chi M i n h * S u p p l e m e n t of Vol. 19 - N o 5 - 2015:114 -117
Objectives: To report some clinical characteristics and laboratory studies cf otitis media with effusion and adaioid hypertrophy.
Method: A case series stiidy zvas performed on 33 cases cf otitis media zoith effusion and adenoid hypertrophy in Children's Hospital 2 fi-om 10/2014 io 08/2015.
Results: The most common type of tympaiwmetiy results was type B (83.3%). This study reported no difference zvho's eosinophils in the middle ear effiision in patients with allergies and no allergies. Eosinophils in middle ear effusion aren't significantly assodated with eosinophils in the blood in the diildren with otitis media (R
=-0.216, p = 0.114).
Conclusion: Allergies are riskfactors cause infiammation in the nose and throat, affecting thefundion ofthe middle ear and Eustadiian tiibe. Therefore patiaits zoith allergic mani^tations should be tested ear for detection and early treatment of middle ear infiammation.
Keywords: Otitis media zoith effiision (OME), aderwidedomy.
GAT V A N D E the gidi cho t h a y t r o n g h a u het cac n g u y e n nhan v r n T i l i t^r,!, h-™™ • J- 1. • ._• — 1 ' ^ ^ VTGTD, rdi loan c h u c n a n g vdi n h i va roi V H J I U la tinh t r a n g u dich cua tai giua phia , » ^ , , , „ ° sau m p t m a n g n h i n g u y e n v?n va k h o n g co cac ' ? ^ , * ! " ^"^ ^^ = ^ ' ' ^ ^ ^ * " « ^ ^ " * ' " " 8 trieu Chung viem cfp tinh Cac n g h i e n c u u tren ' ™ ' ' f h " ^ n a n g c h m h cua tai giOa la t m y e n cac r u n g d p n g s o n g a m tir k h o n g khi vao chat dich 6
*Benh vien Khi Dong 2.
Tdc ^ lien lgc. Bs Huynh Tin iM> Hien DT: 0948898450 Email: myhiengsmall.a,m.
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Y Hpc TP. Ho Chi Minh * Phu Ban Tap 19 * So 5 * 2015 Nghien cuu Y hpc
tai trong. Qua trinh nay php thuoc vao su rung dpng ciia mang nhi. 6 tinh trang binh thuong, SU chenh lech ap suat giiJa tai giiia va moi truong xung quanh dieu hoa nho vao hoat dong dong mo co tinh chu ky cua voi nhi. Do do, voi nhi dong vai tro can b3ng ap suat giua tai giiia va hpng miii thong qua dieu hoa luong khi vao taigiija.
Nhiing benh ly anh huong den su thong khi binh thuong ciia voi nhi (nhu nhiem khuah, di ung hay qua phat VA), lam giam lupng khi cho tai giija va/hoac lam tang lupng mau den tai giiia do qua trinh viem, lam giam khi trong tai giiia, tao ra ap suat am. Tinh trang ap luc am trong tai giiia keo dai se dan den VTGTD thong qua CO che thoat nuoc tu long mach.P)
VTGTD o tre em thuong khong co trieu chung, benh keo dai se de lai cac di chung nang ne 6 tai va lam suy giam chuc nang ng^e anh huong den qua trinh hinh thanh ngon ngii cung nhu kha nang giao tiep va hpc tap ciia tre. Do do, viec chah doan sonv tim va giai quyet nguyen nhan la van de can thiet. Dieu nay thiic day chiing toi thuc hien nghien cuu "Khao sat dac diem viem tai giiia tiet dich kem qua phat VA 6 tre em"
Mvc tieu nghien cun
Khao sat mpt so dac diem lam sang va can lam sang ciia benh nhi co VTGTD kem qua phat VA.
DdlTUONG-PHU'ONG PHAPNGHIENCUlJ Nghien cuu mo ta hang loat ca tien hanh tren 33 b^nh nhi co VTGTD kem qua phat VA trong thoi gian 10/2014 den 08/2015 tai Benh vien Nhi Dong 2.
P h u o n g p h a p tieh hanh
Nghien a i u tien hanh tren cac benh nhi co chi dinh trich rach nhi hoac dat ong thong nhi voi chan doan viem tai giira tiet dich bang cac trifu chung nghe kem, u tai, cam giac day nang tai, npi soi tai va nhi luong do kem qua phat VA dupc chah doan bing noi soi mui.
Khai thac va thu thap thong tin theo benh an nghien ciiu mau.
Tridi rach mang nhi o V* truoc duoi hoac Vi truoc fren bang dao la liia.
Dung ong hiit co he thong thu nhan dich (dung cu Juhn Tym Taps - Xomed Products) dua vao hom nhi qua 16 rach mang nhi de hut dich tu hom nhi. Benh p h ^ duoc pha loang va dupc dua tdi phong xel nghiem trong 30 phiit.
NaoVA.
KET QUA VA BAN LUAN 5 1 . TricH chimg co ndng Trieu chi>ng
So luong (n=33) n i e
Nghe kem 27 81,8
U t a 19 57,6
Cam giac 6Ay n^ng tai 3 9,1
Ket qua tuong tu voi nghien cuu ciia tac gia Nguyin Tuong Thi <=>. Nghe kem la mpt trong nhiing trieu chung co nang de phat Men benh. Tuy nhien, trieu chung nay co the khong ghi nhan dupc neu tre qua nho do ngon ngu chua hoan thi|n. De khong bo qua trieu chiing nay, khi tiep xuc voi tre can danh thoi gian tro chuyen cimg cha me de danh gia gian tiep tinh trang nghe kem thong qua viec tre dap iing kem voi tieng on, khong quay dau hoac khong tra loi khi dupc goi, ket qua hoc tap kem, khi xem ti vi thuong ngoi sat man hinh va chinh am luong rat toP>.
Bdng 2. Ddc dian mang nhi tren ngi soi
Vj tri m a n g nhT
Mau sac many nhT
E)acdiem S6 tai (n= 48
tai)
• n i # ( % } D|ic iJem S 6 t a i ( n = 4 8
tai) T i l # ( % )
Pilfing 0 0 % Tring
22 45,8%
Trung t i n h 27 56.2%
Vang h6 phach
22 45,8%
L o m 21 43,8%
Trang aye
4 8,4%
Ket qua nghien ciiu ciia chiing toi ciing gan giong nghien ciiu ciia Sahikh va cong su''"'. Ong ghi nhan ket qua mang nhi qua 945 hinh anh noi soi chah doan VTGTD. Trong do mang nhi md due, thay doi mau sac, mang nhi lom, mang nhi do chiem ti le ^ lupt 97%, 57%, 58% va 22%.
C h u y e n D e Ngoai Nhi
Nghien cuu Y hpc Y Hoc TP. Ho Chl M i n h ' Phu Ban Tap 19 * So 5 ^ 201S
Mang nhi phong ^ nhan trong 93% truang hpp bi VTG cap, ti-ong 3% VTGTD. Trong do, dau hieu mang nhi do ma khong co bat thuong gi khac gap trong 13 truong hop, chii yeu d nhdm khong cd benh. Mang nhi dd, kem ttiem nhiing bat thudng khac nhung khong phong co the gap d tre viem tai gjiia tiet dich va tre binh thudng chiem ti le 87%.
Bdng 3. NhT lugng 3d
NhTliFongdd S6tai{n=48tal)
T i l e ( % )
D?ngA 0 0%
D^ngB 40 8 3 , 3 %
[J^ngC 8 1 6 , 7 %
Nhi lupng do co vai trd quan trpng trong chain doan benh ly tai giiia vi day la mot thii nghiem khach quan cd dp nhay va dp dac hieu cao. Trong mau nghien cuu aia chiing tdi nhi lupng do dang B la thuong gap nhat chiem 83,3%. Ket qua nay cung phii hop vdi nghien cuu ciia Babonis (1991) chiing td day la dang dac trung cho su ton tai dich trong tai giiia'*>. Tat ca cac trudng hpp trong mau nghien ciiu ciia chiing tdi khi trich rach mang nhi deu co dich, Bdng 4. Tinh chdi dich tai giua
Tinh c h i t S^ tai (n=4e tai)
•nie(%) Mu
4 8,3%
Keo 17 35,4%
Thanh djch 27 56,3%
Ket qua nay kha tuong dong vdi ket qua ciia tac gia Chui Kwon va cpng su khi ong so sanh h^n 370 benh nhan bi VTGTD sau 2 tuan dieu tin khang sinh va tiep tpc sau 2-3 thang theo ddi ^K Tac gia ghi nhan tiianh dich chiem ti le cao nhat (50,2%), tiep theo la dich keo (34,9%) va dich mii (14,9%). Dong thdi, dng ding ghi nhan ti le benh nhan viem mui di iing va hen trong nhdm thanh dich cao hon so vdi nhdm dich keo. Mat khac vi khuah duoc phan lap d nhdm dich mu cao hon la nhdm thanh dich hay dich keo. Tu dd dng ket luan VTGTD the thanh dich co lien quan tdi linh tirang di iing trong khi VTGTD the dich mii cd lien quan tinh trang nhiem trimg hon la di itng.
Trong nghien cuu nay, chiing toi ghi nhan cd 8,3% boidng hpp cd dich mii. Day la mpt dang viem tai kha dac biet ma nhieu tac gia nhu Sade, Hurst,... ciing md ta «'. Dang nay thudng gap d
nhung tre em bi viem tai giua cap tai di tai lai tren nen mot viem tai giua tiet dich lam cho dich tiiudng xu%'en u dong trong tai giua.
Bdtig 5 Tl lc BCDNTT vd BCDNAT tivng djch tai giiia 6 benh nhi \n'GTD cb hogc kJwng co tinh tiang
1
Djch tai giQs BCDNTT
BCDNAT
Co tinh trang dj img 52,97 ± SEM
5,80 6,30 + S E M 0,53
Khong co tinh trang d j i m g 4 9 , 8 4 ± S E M 4 , 8 0
2,36 ± SEM 0,56 P
0.05
0,05
Trong ngliien oiu cua chung toi ghi nhan khong CO 50 khac biet ti le BCDNTT va co sit khac biet ti le BCDNAT trong dich tai giiia o nhung benli nhan XTGTD co tinh tiang di ung va khong cd tinh tiang di iing.
Cho toi nav, nguoi ta chua thay ro rang vai trd cua BCDNTT trong benh tai giua, chi thay rang BCDNTT thudng hien dien o benh nhan VTGTD mu '^'. Theo Hurst \'a ^'enge '"' ghi nhan BCDNTT duoc hoat hoa nhieu ngay ca VTGTD giai doan man. Ong ghi nhan d nhung benh nhan co tinh trang di ung cd tang nong do MPO (myeloperoxidase- glycoprotein duoc tie't ra hi BCDNTT) va ECP (eosinophil cahonic protein- protein duoc tiet ra tu BCDNAT) tiong dich tai giiJa, mac dii nhung benh nhan nay khdng co tinh trang nhiem triing cap nhung d nhiing benh nhan viem tai giiia mu thi cd tang ca 2 hoa chat trung gian tren nhung tang khdng tuong xung vdl MPO nhieu hon, Dieu dang luu y la trong viem tai giua mil khdng tha'y su hoat ddng cua duong bao (mast cell) Do \'a\' su tang hoat dong cua ca BCDNAT va BCDNTT deu la nhung thanh ph'an khdng the thie'u tiong dich tai giua.
Bdtig 6. Tumig quan giiea li le eosinophils trong didi tai glim va trong mdu
TiFong quan ti le eosinophils trong dich tai giCia va trong mau
R (he sd Pearson)
0,114;
0.05 Trong mau nghien cuu, chiing tdi ghi nhan khong CO su tuong quan giua ti le eosinophils trong dich tai giira \'a eosinophils tiong mau o
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Y Hpc TP. Ho Chi Minh * Phu B ^ Tap 19 * So 5 * 2015 Nghien cmi Y hpc
benh nhan VTGTD (he sd tiiong quan R = -0,216, p = 0,114 > 0,05). Bernstein va cdng svP' da ghi nhan cd 16/35 trudng hpp cd IgE fa-ong dich tai giua d benh nhan VTGTD. Trong do, cd 8 benh nhan cd nong dp IgE ti-ong dich tai giiia cao hon trong mau. Do do, dng cho rang IgE toan phan trong dich tai giOa dupc tao ra rieng biet vdi IgE d mioi va ciing khong do su trao ngupc dam nhay tir vimg miii hong di qua vdi nhi vao tai giiia. Ngoai ra, Sanz va cpng su*'' ciing bao cao ti le tie cd tinh tiang di iing tirong 20 tie bi VTGTD la 30%. Trong dd, 5/7 trudng hpp la cd tang nong dp IgE toan phan trong dich tai giiia (80 lU/mL) so vdi tiong mau (45 lU/mL). Do dd, nhdm nghien ciiu ciing cho rang IgE dupc tao ra tai niem mac tai giiia d nhiing benh nhan cd finh trang di ung.
Hurst va cpng su<*' bao cao kha nang IgE trong dich tai giiia la do dich tham tir huyet thanh hay la do phan iing tai chd ciia tai giiia bang each so sanh timg cap IgE trong dich tai giiia va huyet thanh aia 18 benh nhan co finh trang di ung vdi 12 di nguyen. Tac gia cho ring neu tai la mpt trong nhijng co quan ciia di iing thi nong dp IgE dac hieu vdi timg di nguyen tiong dich tai giiia se khac vdi nong dp d trong huyet tuong. Trong nhiing benh nhan VTGTD cd finh trang di ung, tac gia chiing minh khdng cd moi lien quan giiJa nong dp IgE trong dich tai gjiia va huyet tuong. Do do, ho ket Iuan rang IgE tiong dich tai giiia khong phai do tham ma la do qua trinh phan ung tai chd d nhiing benh nhan diiing.
KET LUAN
Nhu vay di iing la yeu to thugn lpi gay ra nhiing benh ly viem nhilm d vimg miii hong
anh hudng den chiic nang vdi nhi va tai giiia. Do do nhung benh nhan cd bieu liien di iing c ^ dupc kiem tra tai de phat hien va dieu tr| sdm linh trang viem tai giiia.
TAI LIEU THAM KHAO
1 Babonis TR., W a r MR, and Kell}' PC (1991), "Impedaroe tympanometry and acousdc rdectometry at mjiingotomy", Pediatrics. 87(4), pp. ¥75-80.
' Bernstein JM (1996), "Role of a l l e i ^ in eustachian lube blockage and ohiis media with effusion: a review", Otolan-ngol Head Neck Surg 114(4), pp. 562-8
3 Hurst DS (19%), "Assodation of otihs media with effusion and allergy as demonstrated by mtrademial s b n testing and eosmophil catiorac protein levds m both middle ear effuaons and mucosal biopsies", Laryngoseopa 106(9 Pt 1), pp, 1128-37 4 Hurst DS, Voige P (19%), 'Levels of eosinophil cabonic protem
and myeloperoxidase from chronic middle ear effusion in pabents with allerg)' and/or acute infection", Ololaryngol Head Neck Surg. 114(4), p p 5 3 1 - t i
5 Kawana M, et al (1993), "Polymorphonuclear leukoeyles contribute inSammatoiy metabolic products in the nnddle ear during expenmental otitis media", in l i m , D and Bluestone; C Editor^ Recent advances in otihs media, BC Decker. New York, p p 202-4.
6 Kwon C, et al (2013), "Allergic diseases in childrai with ohtis media with effusion", Int J Pediatr Otorhinolaryngol, 77(2), pp 158-61
7 Le Minh Himg (2006), 'Tvlghien o h i ve djch te' hpc ciia b^nh viem tai gjua bel dich 6 tre 4-6 tuen tgi cac truong mam non thupc quan 8", Luan van Thac sy Y hpc
S Nguyin Tuong Thi, Pham Nggc Chat (2014), "Khao sat vi khuan trong' viem tai giiia tiet djch 6 tre em", Luan an chuyen khoa cap Q.
9 Sanz ML, et al (1986), "Local and senmi IgE in patients affected by otitis media with effusion", Allei^ol Immunopathol (Madr) 14(6), pp 483-7.
10. Shaikh \ ' , el al (2011)> "Otoscopic a g n s of ohlis media", Pediatr InfidDi^l 30(10), p p 822-6-
Ngiy nhgn hdi bdo 06/08/2015 Ngdy phdn bien nhdn xet bdi bdo: 07/08/2015 Ngdy bdi bdo dieac dang: 01/10/2015
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