摘要
目的本研究旨在分析总结结核性中耳炎的临床特征、诊断方法,以丰富结核性中耳炎的临床实践诊疗经验,减少漏诊误诊,以利于患者得到及时有效的治疗,改善患者的预后。方法本研究回顾性分析2008至2022年在我院耳科住院并接受手术治疗的结核性中耳炎患者的临床资料,记录并分析总结其临床特征、影像学表现、术中所见及治疗效果。结果23例(26耳)结核性中耳炎病例纳入此回顾性分析。本研究中结核性中耳炎最常见的临床症状为耳溢液(稀薄无臭味性液)(100%)及传导性听力下降(100%);伴较高的面瘫发生率(23.1%);部分患者用常规抗生素(如左氧氟沙星)局部治疗可短暂减轻或控制症状(有效率仅为50%),且症状在停药后很快复发。术中可见灰白质韧的肉芽组织增生(100%)伴干酪样坏死(23.1%)。手术治疗目的为清除病变,减少流脓感染复发率,酌情功能修复(听力重建或面神经减压),并可明确诊断以利于进一步治疗。术中送检的肉芽组织病变,石蜡病理回报为典型的肉芽肿性炎以及干酪样坏死,抗酸染色阳性,符合结核。结论结核性中耳炎由于其临床特征的不典型性,很容易被漏诊或误诊。当耳部局部表现严重程度与病程长短明显不匹配;病程早期即出现面瘫或感音神经性听力损失;常规抗生素治疗不能长期有效地控制局部症状;颞骨CT呈现中耳及乳突腔内广泛弥漫性的病变;术中发现广泛的苍白质韧的肉芽增生,伴或不伴干酪样坏死或死骨形成,都应该高度警惕疑似结核性中耳炎。组织病理切片抗酸染色检出阳性抗酸杆菌可明确诊断,同时应尽早综合多种实验室检查手段(如T-spot,PCR)来协助支持诊断。明确诊断后应及早进行全身抗痨治疗。
Objective The purpose of this study was to analyze and summarize the clinical characteristics and diagnostic methods of tuberculous otitis media(TOM),to enrich clinical experience in diagnosis and treatment of tuberculous otitis media,so as to reduce missed diagnosis and misdiagnosis,and facilitate timely and effective therapy for better prognosis.Methods This study retrospectively analyzed the clinical data of patients with tuberculous otitis media who were hospitalized in the Ear ward of our hospital and received surgical treatment from 2008 to 2022.The data of patients'clinical characteristics,radiological examination,intraoperative findings and therapeutic strategies were recorded and summarized.Results A total of 23 cases(26 ears)of tuberculous otitis media were included in this retrospective study.The most common clinical symptoms were otorrhea(thin odorless fluid)(100%)and conductive hearing loss(100%),with a high incidence of facial paralysis(23.1%).It was not sensitive to traditional antibiotic treatment,eg.Levofloxacin(50%effective rate only),and relapsed soon after drug withdrawal.It was revealed that all the surgical views had gray and white tough granulation tissue hyperplasia(100%),and 23.1%with caseous necrosis.The purpose of surgery was to clear the lesion,reduce the recurrence rate of suppurative infection,and repair the function(hearing reconstruction or facial nerve decompression)as appropriate.The paraffin pathology of granulation tissue were reported as typical granulomatous inflammation and caseous necrosis with positive acid-fast staining,which was consistent with tuberculosis.Conclusion It was easily confused by the clinical manifestations of tuberculous otitis media and common chronic suppurative otitis media.When met with the following conditions,we should pay highly attention to suspect tuberculous otitis media:The severity of local manifestations did not match with the length of the disease;with poor tympanic membrane at the early stage with no obvious cholesteatomas,with facial paraly
作者
潘晓丹
赵守琴
李轶
PAN Xiaodan;ZHAO Shouqin;LI Yi(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China)
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2024年第3期240-245,共6页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
结核性中耳炎
临床特征
诊断
抗酸染色
tuberculous otitis media
clinical characteristics
diagnosis
acid-fast staining
