儿童中耳炎合并颅内外并发症的临床分析  

Clinical Analysis of Otitis Media Combined with Intracranial and Extracranial Complications in Children

作　　者：钟玲玲 孙序元 刘广平[1] 龚广港 沈蓓[1] ZHONG Lingling;SUN Xuyuan;LIU Guangping;GONG Guanggang;SHEN Bei(Department of Otolayngology,Head&Neck Surgery,Tianjin Children’s Hospital/Tianjin University Children’s Hospital,Hospital,Tianjin 300143)

机构地区：[1]天津市儿童医院/天津大学儿童医院耳鼻咽喉头颈外科,天津300143

出　　处：《中华耳科学杂志》2022年第4期538-542,共5页Chinese Journal of Otology

基　　金：天津市自然科学基金青年项目(20JCQNJC01800)。

摘　　要：目的分析儿童中耳炎引起颅内外并发症的临床特征,提高对该类疾病的认识。方法回顾性分析2011年3月-2020年2月天津市儿童医院诊断的31例儿童耳源性颅内外并发症的临床资料,总结并发症的种类、临床表现、细菌学特点、治疗方法及预后情况。结果31例患儿中,单项并发症27例,其中骨膜下脓肿最为常见,其它并发症发病率由高到低依次为周围性面瘫、脑膜炎、硬膜外脓肿、岩尖炎及颈部脓肿。2项以上并发症共4例,其中2例中耳炎患儿合并骨膜下脓肿及硬膜外脓肿,2例合并脑膜炎及周围性面瘫。31例患儿中均从脓肿切开处收集脓液进行培养,阳性检出率仅为58.06%(18/31),致病菌主要是变形杆菌38.89%(7/18)、金黄色葡萄球菌27.78%(5/18),其它病原体33.33%(6/18),无细菌生长41.94%(18/31)。31例患儿均予以抗感染治疗,其中14例通过抗感染治疗获得痊愈,其余17例患儿通过不同的外科手段进行干预。结论抗生素是治疗儿童中耳炎颅内外并发症的基础。骨膜下脓肿是儿童中耳炎最为常见的并发症,通过脓肿引流术±鼓膜切开置管术能取得较满意的治疗效果。周围性面瘫患儿通过积极抗感染及抗炎治疗通常能够获得较为满意的恢复。儿童中耳炎合并颅内外并发症在保守治疗无效时应积极行手术治疗。Objective To report clinical characteristics of otitis media combined with intracranial and extracranial complications in children for improving the understanding of these conditions.Methods Data from 31 pediatric cases of otogenic intracranial and extracranial complications treated between March 2011 and February 2020 at Tianjin Children’s Hospital were retrospectively reviewed and analyzed,including types of complications,clinical manifestations,bacteriological findings,treatment and outcomes.Results Among the 31 children,27 had one complication.The most common complication was subperiosteal abscess.Others included peripheral facial paralysis,meningitis,epidural abscess,petropitis,and neck abscess.Four children had more than two complications,including 2 subperiosteal abscess combined with epidural abscess,and 2 meningitis combined with peripheral facial paralysis.In all the 31 cases,pus was collected from abscess drainage for culture with a positive rate at 58.06%(18/31),involving proteus(7/18,38.89%),S.pneumoniae(5/18,27.78%)and other pathogens(6/18,33.33%).All the 31 cases were treated with intravenous antibiotics.Complications resolved from conservative treatment in 14 cases,while the remaining 17 required surgical interventions.Conclusion Antibiotics are the basis for the treatment of intracranial and extracranial complications in otitis media in children.Subperiosteal abscess is the most common and can be successfully managed with abscess drainage±tympanostomy tube placement.Recovery from facial paralysis is usually satisfactory through active anti-infection and anti-inflammatory treatment when occurring as the sole complication.Surgery should be aggressively considered if conservative treatments are ineffective.

关 键 词：儿童 中耳炎 并发症 颅外 颅内 手术 

分 类 号：R764[医药卫生—耳鼻咽喉科]