成人分泌性中耳炎临床误诊分析  

Clinical Misdiagnosis of Adult Secretory Otitis Media

作　　者：廖旭[1] 李天明[1] LIAO Xu;LI Tianming(Department of Otolaryngology Head and Neck Surgery,the People's Hospital of Santai County,Santai,Sichuan 621100,China)

机构地区：[1]三台县人民医院耳鼻咽喉头颈外科,四川三台621100

出　　处：《临床误诊误治》2023年第9期34-37,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的 分析成人分泌性中耳炎的误诊原因。方法 选取2021年3月—2022年9月收治的成人分泌性中耳炎误诊患者16例,分析其诊治经过。结果 16例中,14例发病前半个月有上呼吸道感染史,2例有化脓性上颌窦炎史,2例有噪声接触史。16例均以患耳闭塞感、耳鸣(低音调)、听力下降为主诉就诊,4例伴轻微耳痛;耳镜检查示:16例鼓膜混浊内陷,呈琥珀色或淡黄色,均未见液平线及气泡影。初步诊断为感音神经性耳聋2例,突发性聋14例,予相应治疗后症状无好转。后结合相关病史和耳镜检查结果,加行鼓室声导抗测试(均为B型鼓室导抗图)及鼓室穿刺术(均抽出淡黄色黏稠液体),最终确诊为分泌性中耳炎。误诊时间7~52 d。经耳鼓膜穿刺抽液和鼻腔收缩剂等治疗痊愈。结论 成人分泌性中耳炎以轻度耳痛、听力下降、耳闷胀和闭塞感、耳鸣为主要症状,与多种中耳疾病症状相似;对以听力突然下降、耳闭塞感、耳鸣为主要症状就诊者,应详细询问相关病史,仔细观察鼓膜变化及有无鼓室积液,及早行声导抗检查及鼓室穿刺术,以早期确诊。Objective To analyze the causes of misdiagnosis of adult secretory otitis media(SOM).Methods A total of 16 adult patients with SOM misdiagnosed from March 2021 to September 2022 were selected and the process of diagnosis and treatment was analyzed.Results Among the 16 cases,14 patients had a history of upper respiratory tract infection at 15 d before onset,2 had a history of suppurative maxillary sinusitis,and 2 had a history of noise exposure.All 16 cases presented with ear occlusion,tinnitus(low pitch),hearing loss as the main complaint,and 4 cases were accompanied by mild earache.Otoscopy showed that 16 had tympanic membrane opacity and invagination,which was amber or light yellow in color,and no liquid flat line or bubble was found.The initial diagnosis was sensorineural deafness in 2 cases and sudden deafness in 14 cases.The symptoms did not improve after corresponding treatment.Combined with relevant medical history and otoscopy results,tympanic sound immittance test(B-type tympanic immittance map)and tympanocentesis(yellowish viscous fluid was extracted)were performed to confirm SOM.Misdiagnosis lasted from 7 to 52 d.The patient was cured after treatment,including tympanic membrane puncture,and nasal contraction agent.Conclusion The main symptoms of adult SOM are mild ear pain,hearing loss,ear distension,occlusive feeling and tinnitus,which are similar to many middle ear diseases.For patients with sudden hearing loss,ear occlusion,and tinnitus as the main symptoms,the relevant medical history should be inquired in detail,the tympanic membrane changes and tympanic effusion should be carefully observed,and the acoustic immittance examination and tympanocentesis should be performed as soon as possible for early diagnosis.

关 键 词：伴渗出液中耳炎 成人 误诊 听觉丧失 感音神经性 突发性聋 呼吸道感染 声导抗检查 中耳通气 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]