发生颅脑并发症的鼓膜完整的中耳病变分析  

Analyses of chronic otitis media with intact tympanic membrane concurrent with intracranial complication

作　　者：王晓茜[1] 吴佩娜[1] 黄宏明[1] 傅敏[1] 葛润梅[1] 

机构地区：[1]广东省人民医院广东省医学科学院耳鼻咽喉科,广州510080

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第5期343-347,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广东省科技计划项目（20128031800408）

摘　　要：目的 探讨鼓膜完整的中耳慢性炎症的临床特征和影像学特点.方法 回顾性分析2006年12月至2015年1月广东省人民医院收治的资料齐全的鼓膜完整的中耳慢性炎症患者10例,总结其临床症状、听力学和影像学特点.结果 所有病例分两组：以颅内并发症为首发表现的颅脑并发症组和以听力下降为主要表现的听力下降组.颅脑并发症组5例：包括小脑脓肿1例、脑膜炎3例、脑膜脑炎1例;听力表现全聋2例,混合性聋2例,听力正常1例.听力下降组5例：包括混合性聋3例,传导性聋2例.术前高分辨率CT（high-resolution computed tomography,HRCT）扫描全部病例均有阳性改变.颅脑并发症组除提示颅脑改变外,还存在中耳乳突病变,包括局限软组织影4例,广泛软组织影合并颅底骨破坏1例.听力下降组HRCT表现为单纯上鼓室鼓窦局限软组织影3例,单纯听骨部分缺如2例.术后病理：颅脑并发症组中胆固醇肉芽肿1例,炎性肉芽4例;听力下降组中胆固醇肉芽肿1例,胆脂瘤4例.结论 发生于鼓膜完整的中耳慢性炎症,病灶隐匿,它可以突发颅内并发症为首发症状,危及生命.HRCT和听力学检查对于早期诊断具有重要意义.Objective To investigate the clinical and imaging characteristics of chronic otitis media with intact tympanic membrane.Method Ten patients were retrospective studied in the department of otorhinolaryngology of Guangdong general hospital from December 2006 to January 2015.The clinical characteristics of their manifestations,audiology and imaging examinations were analyzed.Results All the cases could be divided into two groups：the intracranial complication group who was primarily diagnosed as intracranial complications,and the hearing loss group who primarily complained of hearing loss.Five cases belonged to the first group,which include 1 cerebellar abscess,3 meningitis and 1 meningoencephalitis,2 of them were profound hearing loss,2 were mixed hearing loss,and 1 was normal hearing.The other 5 cases belonged to the hearing loss group,3 were mixed deafness,2 were conductive deafness.All the case showed positive high-resolution computed tomography （HRCT） features.In the first group,four cases showed the soft tissue shadow in tympanic antrum/superior tympanic pouch and 1 case showed a wide damage of skull base,in addition to intracranial complications.In the second group,five cases showed soft tissue imaging in tympanic antrum/superior tympanic pouch.Pathology showed that 2 cases were cholesterol granuloma （one was in the first group and the other was in the second group）,4 were intracranial inflammatory （the first group） and 4 were cholesteatoma （the seond group）.Conclusions In chronic otitis media with intact tympanic membrane,intracranial complications may be the primarily diagnosis,which should be paid much attention by multidisciplinary team.HRCT and audiology were valuable for early diagnosis.

关 键 词：中耳炎 颅内并发症 诊断 治疗结果 

分 类 号：R764.2[医药卫生—耳鼻咽喉科]