误诊为其他耳科疾病的分泌性中耳炎临床分析  

Clinical Analysis of Secretory Otitis Media Misdiagnosed as Other Ear Diseases

作　　者：陈旎珺[1] 孙星梅[1] 汪姬婵[1] CHEN Nijun;SUN Xingmei;WANG Jichan(Department of Otolaryngology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院耳鼻咽喉科,上海200025

出　　处：《临床误诊误治》2025年第7期1-7,共7页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析分泌性中耳炎的误诊原因,并探讨如何通过优化诊断流程降低误诊率,提高临床诊断的准确性。方法选择2021年2月至2023年2月初诊时被误诊为其他耳科疾病的分泌性中耳炎患者12例,对其临床资料进行回顾性分析,重点关注症状表现、初诊误诊情况、检查手段及确诊过程,并针对其临床表现与其他耳科疾病进行鉴别诊断。结果12例患者中,4例因耳堵感、耳鸣、听力下降等症状被误诊为突发性聋-低频型,3例因耳痛及耳堵感等症状被误诊为感音神经性聋,5例因耳闷胀感和低频耳鸣而被误诊为急性中耳炎。耳镜检查显示4例患者鼓膜内陷或混浊。12例患者接受初步治疗后症状未见明显改善,转诊后经耳镜复查、声导抗测试(均为B型图)及鼓膜穿刺检查确诊为分泌性中耳炎,误诊时间1~6(3.26±1.05)周。患者确诊后均接受鼓膜穿刺、鼻腔黏膜收缩剂、抗生素及改善中耳腔通气功能等对症治疗,症状得到明显改善,听力恢复。随访6个月均未复发。结论分泌性中耳炎症状多样,易与其他耳科疾病混淆。加强对该病的认识、改进诊断方法,尤其是结合声导抗测试和鼓膜穿刺检查,有助于提高本病诊断准确性,减少误诊的发生。Objective To analyze the causes of misdiagnosis of secretory otitis media(SOM),and to explore how to reduce the misdiagnosis rate and improve the accuracy of clinical diagnosis by optimizing the diagnostic process.Methods From February 2021 to February 2023,12 patients with SOM who were misdiagnosed as other otological diseases at initial di⁃agnosis were selected.Their clinical data were retrospectively analyzed,focusing on the symptoms and manifestations,misdi⁃agnosis at initial diagnosis,examination methods and diagnosis process,and the differential diagnosis was made according to their clinical manifestations and other otological diseases.Results Among the 12 patients,4 patients were misdiagnosed as low⁃frequency sudden hearing loss due to symptoms such as ear blocking sensation,tinnitus,and hearing loss,3 patients were misdiagnosed as sensorineural hearing loss due to symptoms such as otalgia and ear blocking sensation,and 5 patients were misdiagnosed as acute otitis media due to ear fullness sensation and low⁃frequency tinnitus.Otoscopy showed that 4 patients had sunken or cloudy eardrums.The symptoms of the 12 patients were not significantly improved after initial treatment.After referral,the patient was diagnosed with SOM by otoscope review,acoustic immittance test(all B type)and tympanic mem⁃brane puncture.The duration of diagnosis was 1~6(3.26±1.05)weeks.All the 12 patients received symptomatic treat⁃ment,including tympanic membrane puncture,nasal decongestant,antibiotics and improving the ventilation function of the middle ear cavity.The symptoms were significantly improved and the hearing was restored.There was no recurrence during 6 months of follow⁃up.Conclusion SOM has various symptoms and is easily confused with other otological diseases.Strengthening the understanding of the disease and improving the diagnostic methods,especially in combination with acoustic immittance test and tympanocentesis,will help to improve the diagnostic accuracy of the disease and reduce the occurrence of m

关 键 词：分泌性中耳炎 误诊 突发性聋 感音神经性聋 急性中耳炎 耳镜 声导抗 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]