中耳炎并发耳后骨膜下脓肿临床诊疗探讨  

Clinical Diagnosis and Treatment of Subperiosteal Abscess in Patients with Suppurative Otitis Media

作　　者：黄何森 林昶[1] 张榕[1] 许元腾[1] 肖恒[1] 舒博[1] 林伟[1] 叶胜难[1] HUANG Hesen;LIN Chang;ZHANG Rong;XU Yuanteng;XIAO Heng;SHU Bo;LIN Wei;YE Shengnan(The First Affiliated Hospital of Fujian Medical University,Department of Otorhinolaryngology Head and Neck Surgery,Fuzhou 350005;Xiang'an Hospital,Xiamen University,Department of Otorhinolaryngology Head and Neck Surgery,Xiamen 361101)

机构地区：[1]福建医科大学附属第一医院耳鼻咽喉头颈外科,福州350005 [2]厦门大学附属翔安医院耳鼻咽喉头颈外科,厦门361101

出　　处：《中华耳科学杂志》2019年第5期699-704,共6页Chinese Journal of Otology

基　　金：CD133与相关信号通路在胆脂瘤形成中的作用国家自然科学基金项目81371083~~

摘　　要：目的探讨化脓性中耳炎并发耳后骨膜下脓肿临床特征和治疗方案。方法对2005年1月至2018年6月就诊于我科的中耳炎并发耳后骨膜下脓肿的45例患者进行回顾性分析,通过对治疗结果及随访情况进行分析,探讨最佳治疗方案,并对特殊病例及其他并发症诊疗要点进行分析。45例患者中,急性化脓性中耳炎23例,慢性化脓性中耳炎22例,其中合并颧弓根脓肿4例,乙状窦血栓性静脉炎4例。保守治疗8例,手术治疗37例。手术组骨质破坏位于筛区19例,非筛区乳突骨皮质13例,筛区及其他部位乳突骨皮质共5例。结果保守治疗组8例随访均获干耳,无中耳炎及脓肿复发,无其他并发症状;手术治疗组25例随访无中耳炎及脓肿复发,干耳18例,湿耳7例,2例术后头晕,2例听力下降。结论急慢性化脓性中耳炎并发耳后骨膜下脓肿好发于婴幼儿和青少年,需完善影像学检查明确病变范围,排除其他颅内外并发症,并根据细菌培养及药敏选择合适抗生素。病程较短,无颅内并发症,可先以抗生素治疗,或联合脓肿针吸、鼓膜穿刺等保守方案。对于保守治疗无效、胆脂瘤或伴随其他颅内外并发症的,应及时行乳突手术治疗。Objective To report clinical characteristics and treatment of suppurative otitis media with subperiosteal abscess.Methods Data from 45 patients with otitis media complicated with retroauricular subperiosteal abscess treated from January 2005 to June 2008 were retrospectively analyzed,including results of treatment and follow-up,for best possible treatment schemes and a discussion over key diagnosis and treatment points in unique cases and other complications.Among the 45 patients,23 had acute suppurative otitis media and 22 had chronic suppurative otitis media,including 4 with zygomatic arch root abscess and 4 with sigmoid sinus thrombophlebitis.Conservative treatments were provided in 8 cases and surgical treatment in 37 cases.In surgically treated patients,bone erosions were located in the ethmoid region in 19 cases,in non-ethmoidal regions in 13 cases,and in the ethmoidal region and other regions in 5 cases.Results In patients receiving conservative treatments,8 were achieved dry ears during follow up,with no recurrence of otitis media,abscess or other complications.In surgically treated patients,25 showed no recurrent otitis media or abscess during follow up,with dry ear in 18 cases,wet ear in 7 cases,dizziness in 2 cases and hearing loss in 2 cases.Conclusion Acute or chronic suppurative otitis media complicated with subperiosteal abscess often occurs in infants and adolescents.It is necessary to clarify the scope of lesions and exclude other intracranial and extracranial complications using imaging examination,and select appropriate antibiotics according to bacterial culture and drug sensitivity test.If disease course is short with no intracranial complications,antibiotic therapies or conservative treatments combined with abscess needle aspiration and tympanic membrane puncture can be appropriate.When conservative treatments are ineffective,especially when facing cholesteatoma or other intracranial and extracranial complications,mastoidectomy should be performed promptly.

关 键 词：耳后骨膜下脓肿 中耳炎 临床特征 治疗 

分 类 号：R764[医药卫生—耳鼻咽喉科]