單一劑量Sofradex耳滴劑滴入對預防中耳通氣管置入手術術後早期耳漏之成效

耳膜切開合併中耳通氣管置入手術是治療慢性中耳積液或反覆性中耳炎之常見手術 ; 而術後耳漏是最常見且惱人之併發症，其發生率可高達30%以上，且大部份發生於術後二週內即早期耳漏。因此如何去找尋一個有效之預防方法，是相當重要的話題。 用來預防早期耳漏的方法很多，如外耳道無菌技術、手術期間全身性抗生素投予及術後耳滴劑之使用等，不過預防效果則時有爭議。 本研究收集自1998年10月至2001年09月三年間，診斷為雙側慢性中耳積液(持續性積液大於三個月)或反覆性中耳炎(每年中耳炎發作大於4~6次) ，且首次接受雙側耳膜切開及中耳通氣管置入術，並排除其他系統性疾病或合併其他手術之兒童患者，共計有110人，左、右耳各110耳。 在嚴格控制通氣管規格、外耳道無菌操作技術及由資深醫師執行下，我們選擇術後右耳滴入三滴Sofradex耳滴劑(單一劑量)，列為實驗組，左耳不作處置，列為對照組，並至少追蹤二週，視其預防早期耳漏之成效。 結果顯示，實驗組(右耳)與對照組(左耳)間，在早期耳漏方面無明顯差異。本研究結論為術後單一劑量 Sofradex耳滴劑之使用，無法有效預防早期耳漏之產生。

Myringotomy and ventilation tube insertion is commonly used as a treatment for either persistent otitis media with effusion or recurrent otitis media. The most frequent and bothersome complication, early otorrhea, up to 30 percent in incidence, usually occurs within two weeks of surgery. Therefore, to find an effective prophylactic method is very important. There were many methods recommended to prevent early otorrhea, such as aseptic external canal preparation, perioperative systemic antibiotics, instillation of otic drops, however, are equivocal. From October 1998 to September 2001,children having myringotomy and ventilation tube insertion at this clinic were recruited into this study. All of these patients were otherwise healthy children who were treated for bilateral chronic otitis media with effusion (persistent effusion more than 3 months) or recurrent acute otitis media (greater than 4-6 episodes of acute otitis media per year) and no other concurrent procedures were combined. All children who had previously undergone myringotomy and/or tube insertion were excluded and a total of 110 children,110 right ears and left ears, were enrolled in this study. All procedure were performed by senior surgeon under the aseptic ear canal preparation and the same type of ventilation tubes were used. Three drops of Sofradex were applied into the right ear after tube insertion which served as the experimental group and the left ear served as the control. They were followed postoperatively two weeks at least to see the prophylactic effect for early otorrhea. Results showed that there was no significant difference between these two groups about early otorrhea. We concluded that instillation of single dose Sofradex is not an effective prophylactic procedure for preventing early otorrhea following ventilation tube insertion.