结核性中耳乳突炎的临床特征分析  

Analysis of the clinical features of nine cases of tuberculous otitis media and mastioditis

作　　者：李志勇[1] 刘世喜[1] 邹剑[1] 黄石[1] 

机构地区：[1]四川大学华西医院耳鼻咽喉头颈外科,四川成都610041

出　　处：《西部医学》2013年第11期1653-1655,1659,共4页Medical Journal of West China

摘　　要：目的 探讨结核性中耳乳突炎的临床特征及治疗措施,提高对该病的认识,从而减少误诊.方法 回顾分析9例（9耳）结核性中耳乳突炎患者的临床表现、影像学特征及治疗方法.结果 9例患者均有耳漏病史,6例有大量粘稠脓性分泌物,8例听力下降,1例患几年龄小未测,2例周围性面瘫.9例颞骨高分辨CT均表现鼓室、鼓窦、乳突软组织密度影,其中明显骨质破坏6例,颞骨内存在死骨1例,2例有结核病史.8例接收手术治疗去除病灶,并联合抗结核治疗;1例有急性粟粒性肺结核未手术行单纯药物治疗.除1例术前取耳道分泌物镜检证实为结核性中耳乳突炎外,其余均为术后病检确诊.9例患者随访6个月～15年症状均消失,无复发.结论 结核性中耳乳突炎是一种少见疾病,其临床特征与慢性化脓性中耳乳突炎相似,临床上易混淆.临床医生应重视此病,避免误诊.手术去除病灶并结合抗结核治疗对该病有较高的治愈率.Objective To analyze of the clinical features and treatment outcomes patients of tuberculous otitis media and mastioditis,and increase awareness of the disease and reduce misdiagnosis.Methods The clinical data of 9 cases （9 ears）with tubercular otitis media and mastoiditis were reviewed.Results Nine patients had otorrhea history.8 patients demonstrated hearing loss and 2 patients demonstrated a peripheral-type facial palsy.Temporal bone high-resolution CT scans demonstrated the entire tympoanum and mastoid air cells were occupied by soft tissue,six patients demonstrated bone destruction and one sequestra was found.Two cases （2 ears） have a history of tuberculosis.Surgical removal of disease lesions in combination with anti-tuberculousis treatment were given to 8 patients.One patients acute miliary tuberculosis-line drug therapy alone without surgery.Other than 1 cases of tuberculous otitis media and mastoiditis diagnosed by the ear canal secretions microscopy,the remaining 8 cases wered diagnosed post-operatively.Nine patients were followed up for 6 months-15 symptoms disappeared and no recurrence.Conclusion Tuberculous otitis media and mastioditis is a rare disease.The clinical features of tubercular otitis media and mastoiditis was similar easily confused with chronic suppurative otitis media.

关 键 词：结核 中耳乳突炎 临床特征 治疗措施 

分 类 号：R764.22[医药卫生—耳鼻咽喉科]