坏死性外耳道炎23例临床分析  

A retrospective clinical analysis of 23 cases of necrotizing otitis externa

作　　者：陈明林 李慎玲[2] 王国鹏[1] 谢静[1] 宋跃帅 赵鹏飞[3] 李小帅 龚树生[1] Chen Minglin;Li Shenling;Wang Guopeng;Xie Jing;Song Yueshuai;Zhao Pengfei;Li Xiaoshuai;Gong Shusheng(Otorhinolaryngology Head and Neck Surgery Center,Beijing Friendship Hospital,Capital Medical University,Clinical Center for Hearing Loss,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉头颈外科中心、首都医科大学耳聋疾病临床诊疗与研究中心,北京100050 [2]青岛大学附属医院耳鼻咽喉头颈外科,青岛266003 [3]首都医科大学附属北京友谊医院放射科,北京100050

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第11期1086-1092,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析坏死性外耳道炎患者的临床特点,探讨其临床分期及治疗措施。方法回顾性分析2015年6月至2021年12月于首都医科大学附属北京友谊医院耳鼻咽喉头颈外科中心住院治疗的坏死性外耳道炎患者的临床资料,共23例(23耳),其中男19例、女4例,年龄32~85岁(中位数68岁)。分析总结本组患者的主要症状与体征、实验室检查、影像学检查、治疗方案及预后情况。使用Microsoft Excel 2019建立数据库进行资料的收集与整理。结果23例患者均有不同程度的各种合并症,其中合并2型糖尿病19例,贫血5例,低白蛋白血症3例,慢性肾功能不全2例,尿毒症1例。患者入院时的临床症状主要为耳痛、耳流脓、听力下降、口角歪斜、张口受限、吞咽困难及声音嘶哑。查体可见外耳道肿胀、外耳道肉芽组织、外耳道稀薄脓性分泌物、面神经麻痹、张口受限、声带运动减弱等。病原学检查结果提示铜绿假单胞菌15例,金黄色葡萄球菌5例,真菌3例。影像学主要表现为外耳道及中耳鼓室异常软组织影,根据病变侵袭方向不同可见颞下颌关节、咽旁间隙、颅底及颅内等邻近结构受累。根据本组患者特点我们总结了相应的诊断标准及临床分期。所有患者均进行系统性抗感染、手术及对症支持治疗。截至2022年1月30日,有4例患者已死亡,其中1例因坏死性外耳道炎导致的颅内广泛感染去世,3例在患耳痊愈出院后死于其他系统疾病。其余19例患者患耳痊愈,耳痛、耳流脓等症状消失,术腔上皮化良好。结论坏死性外耳道炎临床表现缺乏特异性,诊断需根据病史、体格检查及辅助检查综合判断。可根据不同临床分期制定相应的治疗措施。治疗以多学科综合治疗为基础,以手术治疗为主。尽早干预预后较好,但合并多组颅神经损伤及颅内感染的患者预后不佳。Objective To analyze the clinical characteristics of necrotizing otitis externa(NOE)and to discuss its clinical staging and treatment.Methods A retrospective case series study was conducted in the Otorhinolaryngology Head and Neck Surgery Center of Beijing Friendship Hospital.Patients hospitalized in our department with diagnosis of NOE between June 2015 to December 2021 were included.There were 23 patients(23 affected ears),with 19 males and 4 females,aged 32-85 years(the median age was 68 years old).We analyzed and summarized the main symptoms and signs,laboratory examinations,imaging examinations,treatments and prognosis of the patients,and established a database for data collection and sorting.Results All the 23 patients had various complications.There were 19 cases of type 2 diabetes,5 cases of anemia,3 cases of hypoalbuminemia,2 cases of chronic renal insufficiency,and 1 case of uremia.The main symptoms on admission were otalgia,otorrhea,hearing loss,angular deviation,limited mouth opening,dysphagia and hoarseness.Physical examination showed swelling of the external ear canal(EEC),granulation tissue of the EEC,thin purulent secretion of the EEC,facial paralysis,restricted mouth opening,and decreased vocal cord movement.Etiological results showed 15 cases of Pseudomonas aeruginosa,5 cases of Staphylococci and 3 cases of Aspergillus fumigatus.Imaging mainly showed abnormal soft tissue shadows of the EEC and middle ear,and temporomandibular joint,parapharyngeal space,skull base,intracranial and other adjacent structures were involved according to the different invasion directions of the lesions.According to the characteristics of these patients,we summarized a diagnostic criteria and clinical staging.All patients received systematic anti-infection,surgery and symptomatic support treatment.Until January 30,2022,4 patients died,including 1 case of extensive intracranial infection caused by NOE,and 3 cases of other systemic diseases after the affected ears were recovered and discharged from hospital.The other 19

关 键 词：坏死性外耳道炎 颅底骨髓炎 糖尿病 假单胞菌 铜绿 多学科治疗 

分 类 号：R764.11[医药卫生—耳鼻咽喉科]