婴幼儿挠耳的病因调查及分析

Etiological investigation and analysis of ear scratching in infants and young children

摘要:

目的 本研究旨在调查因有挠耳习惯而就诊或被转诊到耳鼻咽喉科的婴幼儿的病因并对常见诊断作相关因素分析。方法 纳入2019年1月—2021年12月主诉为“挠耳现象”而就诊的86例婴幼儿，对所有的婴幼儿进行家庭访谈，询问并记录所有婴幼儿挠耳的频率、发生时间、季节以及既往有无已知的皮肤病和食物过敏史。进行耳科检查，对耳科检查异常的患儿作出诊断分类，而对耳科检查结果正常的婴幼儿请儿童发育专家衡量其发育情况，拟找出除了一些家长可发现的耳部疾病之外所隐藏的婴幼儿挠耳的病因，发现其中对健康危害较大的疾病。根据“挠耳现象”出现的时间和频率，分为3类：日间数次、整日连续不断、仅睡眠时；并划分春、夏、秋、冬4个季节，以此来研究婴幼儿挠耳行为发生的时间及频率、季节分布与常见诊断之间的关系。结果 37.2%的婴幼儿耳部检查正常，发育量表评估也并未发现存在发育迟缓的病例。耳部异常的诊断按例数多少依次为耵聍栓塞(33.7%)、分泌性中耳炎(OME)(23.3%)、外耳道湿疹(4.7%)、红耳综合征(1.2%)。耵聍栓塞患儿挠耳更多出现在夏季，OME患儿挠耳更多出现在冬季。日间数次挠耳婴幼儿中诊断耵聍栓塞较多而正常较少；整日连续不断挠耳患儿中诊断OME较多而正常较少；仅睡眠时挠耳的患儿，耳部检查多为正常。结论 存在挠耳行为的婴幼儿中多数耳部检查结果正常，且“挠耳现象”与婴幼儿发育情况之间无明确相关性，在病因学上可能存在其他一些不同的因素，需要进一步的研究。耳部异常的因素中，除了耵聍栓塞外，OME诊断率较高，考虑到OME对婴幼儿的负面影响，重视“挠耳现象”，从中诊断出OME变得极其重要。

Abstract:

Objective To investigate the etiology and to analyze the factors associated with common diagnoses in infants and young children who were referred to the otolaryngology department for ear scratching habits.Methods This prospective study included 86 infants and young children who were admitted to January 2019 to December 2021 with complaints of “ear scratching”. Home interviews were conducted with all cases, and the frequency, timing and season of ear scratching, and history of known skin diseases and food allergies were asked and recorded. Ear examination was performed on all infants and young children. And diagnostic classification was made for the cases with abnormal results of ear examination. For infants and young children with normal ear examination results, child development experts were invited to measure the development of infants and young children, to find out the hidden causes of ear-scratching in addition to some obvious ear diseases (parents can find), and to find out the diseases that were more harmful to the health of infants and young children. According to the timing and frequency of ear scratching, it was divided into three categories: several times during the day, continuous throughout the day, only sleeping time.In addition, spring, summer, autumn and winter were divided into four periods. Then, it was studied for the relationship between the timing, frequency, seasonal distribution and common diagnosis of ear scratching behavior in infants and young children.To study the relationship between the time, frequency and seasonal distribution of infant scratching behavior and common diagnosis.Results The ear examination of 37.2% cases was normal. And no cases of developmental delay were found in the development scale assessment. According to the number of cases diagnosed with ear abnormalities, they were cerumen embolism(33.7%), otitis media with effusion(OME)(23.3%), eczema of external auditory canal(4.7%), and red-ear syndrome (1.2%). Infants and young children with cerumen embolism had more ear scratching in summer, while those with OME had more ear scratching in winter. Cerumen embolism was more diagnosed in infants and young children who scratched their ears several times during the day and was less diagnosed as normal. The diagnosis of OME was more in the infants and young children who continuously scratched their ears all day longand and and was less diagnosed as normal. In infants and young children who only scratched their ears during sleep, their ear examination was mostly normal.Conclusions The results of ear examination in most infants and young children with scratching behavior are normal, and there is no clear correlation between “scratching phenomenon” and the growth and development status of infants and young children. There may be some other etiological factors, which need further study. Among the abnormal results of ear examination, except cerumen embolism, the diagnosis rate of OME is high. Considering the negative effects of OME on infants and young children, it is extremely important to pay attention to “ear scratching” and diagnose OME from it.