耳源性脑脓肿105例临床分析

目的 本文的目的为探讨耳源性脑脓肿的发生、诊断和治疗。方法 对1952～2002年治疗的105例耳源性脑脓肿患者(颞叶66例,小脑38例),对疾病的发生、诊断和治疗方式进行回顾性分析,特别是手术所见、诊断方法、治疗方法和结果。结果本组中发病年龄主要在10～30岁,10岁以内和更高的年龄组较少见。头痛(99.05％)、淡漠和昏迷(91.43％)是较常见的症状。105例中神经系统检查异常者78例。23例经CT诊断。经乳突腔穿刺抽脓者63例,外科钻颅穿刺抽脓26例,脓肿切除17例。死亡15例,其中66例颞叶脓肿中11例死亡,38例小脑脓肿中3例,脓肿部位不明者1例。结论 正确掌握经乳突腔穿刺抽脓的适应证对耳源性脑脓肿的治疗十分重要。颅骨钻孔穿刺引流和脑室引流是脑疝的有效的紧急处理措施。自CT用于耳源性脑脓肿的诊断和随访以来,死亡率明显下降。     

耳源性小脑脓肿2例并文献复习

目的 探讨耳源性小脑脓肿的临床特点,提高此类疾病的诊治水平。方法 回顾性分析2例耳源性小脑脓肿患者的病历资料,复习相关文献。结果 2例均有慢性耳流脓史,中耳胆脂瘤,入院时表情淡漠,无中枢神经系统体征。患者一在乳突根治后经乳突入路行小脑脓肿穿刺抽脓而治愈;患者二先行乙状窦后入路桥小脑角脑脓肿切除,半个月后再行改良乳突根治而治愈。随访3~6年,均无复发。结论 耳源性小脑脓肿并不多见,容易漏诊,处理不当易致死亡,诊断主要依据增强CT及MRI检查。治疗应首选在积极抗感染的基础上,防止颅内压增高,尽早行根治性乳突病灶清除,确保术腔引流通畅,同时尽可能行经乳突入路穿刺抽脓;若患者病情危急,可先行钻颅抽脓,同时行乳突切开引流以提高抗生素的抗菌效果;若多发脓肿者,应先行开颅脓肿切除或与乳突根治同期手术。抗生素敏感、脓肿较小者,有条件的医院可在加强抗感染下先行乳突病灶根治,MRI定期检查随访。彻底清除乳突病灶及选择敏感抗生素是减少耳源性小脑脓肿复发的两个关键因素。     

经乳突腔填塞引流法治疗耳源性脑脓肿30例报告

采用经乳突填塞引流法治疗耳源性脑脓肿３０例，治愈２６例，占８４．１％，随访１－１０年无复发。认为，此法适用于大多数耳源性脑脓肿。脓腔在有效的监视下闭合，引流充分，不易复发。文中还对术中和术后的并发症及有关问题进行讨论。     

耳源性脑脓肿治疗之进展

耳源性脑脓肿治疗的进展可以分为三个时期: 一、普通外科时期: 从古代到中世纪均认为中耳感染是由脑部病变引起。外科学家Ambrose Pare提出:“要很好地知晓脑脓肿的存在”并建议采用钻颅术切开硬脑膜排出“脑实质及脓液”。Morand(1752)首次手术治愈耳源性脑脓肿.他先作乳突引流而后在腐骨上钻洞放出脓液,每天用肠线插入脓腔引流,14天后作硬脑膜“十”字形切开,用手指挖出脓肿,并将大麦水(barley water)注入腔内     

耳源性脑脓肿14例临床分析

目的　探讨耳源性脑脓肿的临床特点及治疗。方法　回顾性分析2011年8月～2017年9月于中国医科大学附属第一医院收治的耳源性脑脓肿患者的临床病例资料，总结其临床特点及治疗。结果　所有患者中3例脑脓肿经抗炎治疗治愈，8例行开颅脑脓肿切除术，3例行钻孔引流术。13例行耳部手术。14例患者中13例患者治愈，治愈率2.9%，随访10个月～3年，未出现脑脓肿及耳部疾病复发。1例患者脑脓肿术后病情加重转回当地治疗失访。结论　耳源性脑脓肿好发于颞骨胆脂瘤。对于有中耳炎急性发作病史，持续头痛，影像学提示骨质破坏的病例应高度怀疑脑脓肿等颅内并发症的可能。尽早发现脑脓肿并针对性的治疗是治愈的关键。     

耳源性脑疝治愈1例

耳源性脑疝绝大多数继发于耳源性脑脓肿，是脑脓肿最危险的并发症之一，死亡率高。我院1971年6月～1987年6月，共收治耳源性脑脓肿6例，其中五例并发脑疲幸喜治愈。现报道如下。患者，男，27岁。因右耳反复流脓20余年，右耳疼20d，头疼7d，以“胆脂瘤型中耳炎并颅内感染”于1987年5月10日入院。入院第2d行右耳乳突根治术，术中见乳突已自然根治，腔内充满胆脂瘤及脓液，天盖及乙状窦板完整，但骨质疏松易出血。凿开天盖，硬脑膜色淡红，无搏动，张力不大。术后第Zd再次手术凿开乙状窦板，穿刺小脑及颔叶，本抽出脓液。入院第14d中午，患者…     

耳源性脑脓肿14例临床分析CSCD

目的探讨耳源性脑脓肿的临床特点及治疗。方法回顾性分析2011年8月~2017年9月于中国医科大学附属第一医院收治的耳源性脑脓肿患者的临床病例资料,总结其临床特点及治疗。结果所有患者中3例脑脓肿经抗炎治疗治愈,8例行开颅脑脓肿切除术,3例行钻孔引流术。13例行耳部手术。14例患者中13例患者治愈,治愈率92.9%,随访10个月~3年,未出现脑脓肿及耳部疾病复发。1例患者脑脓肿术后病情加重转回当地治疗失访。结论耳源性脑脓肿好发于颞骨胆脂瘤。对于有中耳炎急性发作病史,持续头痛,影像学提示骨质破坏的病例应高度怀疑脑脓肿等颅内并发症的可能。尽早发现脑脓肿并针对性的治疗是治愈的关键。     

耳源性颅内并发症临床特点分析

目的 探讨近25年来耳源性颅内并发症的临床特点和诊治措施.方法 采用回顾性分析方法 ,对1982至1987年和1997年至2006年北京协和医院耳鼻咽喉科收治的耳源性颅内并发症患者的临床资料进行总结.14例患者中,男10例,女4例,发病年龄12～62岁,平均32.1岁;颅内病变与耳部病变均为同侧.耳部病变中,中耳胆脂瘤12例,非胆脂瘤性慢性化脓性中耳炎2例.颅内并发症中,大脑颞叶脓肿6例次、小脑脓肿4例次、乙状窦周围脓肿3例次、乙状窦血栓性静脉炎和脑膜炎2例次,硬脑膜外脓肿1例次.入院主诉中,头痛13例次、高热11例次和恶心呕吐10例次.所有患者均有耳道溢脓.脓液培养结果 显示,变形杆菌(5例次)、表皮葡萄球菌(3例次)和绿脓杆菌(2例次)最多见.所有患者均急诊行乳突单凿术或乳突根治术.采用抗生素+甘露醇联合方案者12例,单独使用抗生素治疗者2例.结果 14例患者均临床治愈后出院,治愈率100%.1982至1987年间的4例患者出院后失随访,可以随访到的5例患者中,目前情况良好者4例(随诊时间为22.5至24.4年,平均23.8年);死亡1例(出院后19.2年死于心脑血管疾病).1997至2006年间的5例患者中,其中1例因乙状窦周围脓肿入院行乳突根治术和抗感染治疗,假性治愈出院后第24天突发高热、恶心和意识障碍,经MRI证实为颞叶脓肿,再次入院治疗,治愈后出院;所有这5例患者随访至今情况良好,随访时间1.5～10.6年,平均6.5年.结论 耳源性颅内并发症更好发于男性、年轻患者,颅内并发症以大脑脓肿、小脑脓肿和脑膜炎最为多见,不同文献报道的菌培养结果 各异.随着时间的推移,致病菌、并发症的类型和选用的抗生素均有演变,及时的乳突手术脓腔开放引流和药物联合治疗有效地提高了本病的治愈率.CT、MRI对耳源性颅内并发症的诊断具有重要价值,MRI的应用可以弥补CT的不足.     

儿童耳源性脑脓肿

作者经治10例儿童耳源性脑脓肿(男2,女8,6～15岁)。病因:急性化脓性中耳炎1例,慢性化脓性中耳炎9例,其中胆脂瘤型2例,骨疡型1例,胆脂瘤型+骨疡型6例。并发症种类:小脑脓肿8例,颞叶脓肿2例。合并其他并发症:乳突炎及乳突脓肿3例,硬膜外脓肿2例,脑积水1例。诊断检查方法:CT检查8例,脑血管造影2例。乳突手术术式:改良乳突根治术2例。乳突根治术5例。颅脑手术术式:颅骨穿刺抽吸术2例,颅骨穿刺+开颅术5例。隐匿型脑脓肿4例、小脑脓肿、颞叶脓肿各2例,术前无任何神经系统症状,均在乳突术后一周内出现神经系统症状和体     

乳突根治术后并术腔脑膜脑膨出2例报告

乳突根治术后并术腔脑膜脑膨出２例报告黄方１乳突根治术后并发术腔脑膜脑膨出少见，在１９７３～１９９５年施行的８４０耳乳突根治术（其中经乳突腔行脑脓肿穿刺或切开引流术６５例）中，仅出现２例，报道如下。１临床资料例１，男，１５岁，以右耳反复溢清液发热头痛１...     

Pediatric lateral sinus thrombosis: retrospective case series and literature review

OBJECTIVE: A comparison between the literature and our management of pediatric patients presenting with otogenic lateral sinus thrombosis. DESIGN: A retrospective case series of five pediatric patients. SETTING: Four patients were treated at BC Children's Hospital, whereas the fifth patient was treated in New Westminster, BC. All were treated between 1994 and 2001. METHODS: A retrospective chart review was conducted with a literature review for otogenic lateral sinus thrombosis. MAIN OUTCOME MEASURES: Treatment success was based on resolution of acute infection and neurologic symptoms. RESULTS: Five patients, four males and one female, aged 2 to 14 years were reviewed. Three patients were treated successfully without mastoidectomy. One patient received a mastoidectomy that yielded no pus or granulation tissue within the mastoid cavity. One patient required a mastoidectomy after failure to respond to bilateral myringotomy and tympanostomy tube insertion. Although no pus was seen in the mastoid cavity, perisinus pus was found after unroofing the sigmoid sinus plate; free flow of blood was obtained on needle aspiration of the sinus, and the sinus was not surgically opened. CONCLUSION: The current literature states that the management of otogenic lateral sinus thrombosis includes high-dose intravenous antibiotics with a mastoidectomy and possible opening of the sinus. In our retrospective case series, three of five patients recovered completely without mastoidectomy, and a fourth had a mastoidectomy deemed to have been unnecessary. We conclude that intravenous antibiotics and insertion of a tympanostomy tube are sufficient treatment for selected cases of otogenic lateral sinus thrombosis. Mastoidectomy with possible opening of the sinus should be reserved for patients refractory to the above conservative treatment.     

Otogenic intracranial complications: a review of 28 cases

CONCLUSIONS: Antibiotic treatment does not absolutely prevent the development of otogenic intracranial complications (ICC); however, their incidence is relatively low (0.36%).Various pathogens can be isolated in cultures of patients with these complications, but combinations of third- or fourth-generation cephalosporins with chloramphenicol, vancomycin, metronidazole or aminoglycosides can provide good results. Underlying cholesteatoma is common and is usually associated with intracranial abscess or sinus thrombosis. High morbidity rates warrant long-term follow-up. OBJECTIVE: To evaluate the cause and nature of otogenic ICC in patients treated at 1 medical center over an 18-year period. MATERIAL AND METHODS: This was a retrospective chart review of 28 patients admitted to Sheba Medical Center, Israel with otogenic ICC between 1984 and 2002. RESULTS: Meningitis was the commonest complication (46.4%), followed by brain abscess, epidural abscess, sigmoid sinus thrombosis, subdural empyema, perisinus abscess and transverse and cavernous sinus thrombosis. Twelve patients (42.9%) had received antibiotic treatment prior to admission. Chronic otitis media, cholesteatoma and brain abscess were diagnosed mainly in adults, while acute otitis media and epidural abscess were more frequent in children. Twenty-one patients underwent mastoidectomy to eradicate the source of infection. The commonest finding at surgery was granulations (81%). Cholesteatoma was seen in 38.1% of cases. Cholesteatoma and brain abscess were usually associated with Gram-negative bacterial infection. Meningitis, however, was caused by Streptococcus pneumoniae in 40% of cases. CT showed a sensitivity of 92.75% for diagnosing otogenic ICC. There was no mortality. The morbidity rate was high (71.4%) and included hearing impairment, hemiparesis, hydrocephalus, mental retardation, polyneuropathy and epilepsy.     

Type I hair cell regeneration induced by Math1 gene transfer following neomycin ototoxicity in rat vestibular sensory epithelium

Conclusions. Antibiotic treatment does not absolutely prevent the development of otogenic intracranial complications (ICC); however, their incidence is relatively low (0.36%).Various pathogens can be isolated in cultures of patients with these complications, but combinations of third- or fourth-generation cephalosporins with chloramphenicol, vancomycin, metronidazole or aminoglycosides can provide good results. Underlying cholesteatoma is common and is usually associated with intracranial abscess or sinus thrombosis. High morbidity rates warrant long-term follow-up. Objective. To evaluate the cause and nature of otogenic ICC in patients treated at 1 medical center over an 18-year period. Material and methods. This was a retrospective chart review of 28 patients admitted to Sheba Medical Center, Israel with otogenic ICC between 1984 and 2002. Results. Meningitis was the commonest complication (46.4%), followed by brain abscess, epidural abscess, sigmoid sinus thrombosis, subdural empyema, perisinus abscess and transverse and cavernous sinus thrombosis. Twelve patients (42.9%) had received antibiotic treatment prior to admission. Chronic otitis media, cholesteatoma and brain abscess were diagnosed mainly in adults, while acute otitis media and epidural abscess were more frequent in children. Twenty-one patients underwent mastoidectomy to eradicate the source of infection. The commonest finding at surgery was granulations (81%). Cholesteatoma was seen in 38.1% of cases. Cholesteatoma and brain abscess were usually associated with Gram-negative bacterial infection. Meningitis, however, was caused by Streptococcus pneumoniae in 40% of cases. CT showed a sensitivity of 92.75% for diagnosing otogenic ICC. There was no mortality. The morbidity rate was high (71.4%) and included hearing impairment, hemiparesis, hydrocephalus, mental retardation, polyneuropathy and epilepsy.     

Otogenic brain abscess in childhood

Brain abscesses are quite rare complications of middle ear infections. Although temporal lobe abscesses are more common than cerebellar abscesses, the converse was found to be true in our series of 10 cases. Eight cases of cerebellar abscess and 2 cases of temporal lobe abscess in the paediatric age group were reported including 4 cases of latent brain abscesses which manifested themselves after mastoidectomy for middle ear infection. Brain abscess is by far the most serious of otogenic complications.     

Otogenic cerebellar abscess - two case histories

OBJECTIVE: The otogenic brain abscess remains a serious intracranial complication of otitis media despite advantages in diagnostics and antibiotic treatment during the last decades. We discuss the clinical picture and the possible ways of treatment by the example of two case histories. CASE HISTORIES: Case 1: We report about a 38-year-old man, who was suffering in cholsteatoma since 30 years. The surgical revision was restricted by the patient since this time. The acute symptoms of meningitis were caused by intracranial involvement and cerebellar abscess due to cholesteatoma. After surgical revision we observed a period of clinical improvement. A repeated surgery became necessary because of renewed brain abscess at the cerebellar region five weeks after primary operation. Case 2: A 6-year-old girl was already treated with antibiotics because of subacute mastoiditis since three weeks. She was entering the ENT department because of headache and otorrhoea. During mastoidectomy the bone destruction leads to a cerebellar abscess. The neurological symptoms were regredient immediately after the surgical revision. CONCLUSION: Both case histories underline the importance of cerebellar abscess as an intracranial complication of chronic otitis media. The neurologic symptoms and the CT-scan were essential for the exact diagnosis. The following treatment includes the surgical revision of the middle ear, the abscess-drainage as well as the lavage of the cavity with antibiotics.     

Postauricular needle aspiration of subperiosteal abscess in acute mastoiditis

To test the hypothesis that subperiosteal abscess, a complication of acute mastoiditis, can be treated equally well by needle aspiration as by cortical mastoidectomy, we performed a retrospective analysis of 78 pediatric patients hospitalized between 1995 and 2003 and performed an analysis of published data on types and outcomes of treatment approaches for acute mastoiditis. Postauricular pus aspiration resolved the subperiosteal abscess in 14 of 17 patients. The length of the hospital stay of patients who underwent aspiration was shorter than that of patients who underwent cortical mastoidectomy. We conclude that postauricular pus aspiration, a simple and minimally invasive procedure, is an effective treatment modality for subperiosteal abscess. Mastoidectomy should be reserved for nonresponsive cases or those with more serious complications. Broad-spectrum antibiotics, myringotomy with daily toilet of the ear, and postauricular aspiration, when required, minimize the indications for surgery and reduce the hospital stay.     

Surgical management of intracranial complications of otogenic infection

We conducted a prospective study of 24 patients to evaluate the evolution of intracranial complications resulting from otogenic infection and to correlate the course of the disease with surgical treatment. Almost half of the patients were younger than 18 years, and most were male. The most common intracranial complication was brain abscess, followed by meningitis, lateral sinus thrombosis, and extradural abscess. Cholesteatoma was found in 14 patients. After the complications were confirmed by computed tomography, initial treatment consisted of intravenous systemic antibiotics followed by mastoid surgery. The surgical approach was determined by the type of ear disease, not by the type of neurologic complication. Modified radical mastoidectomy was performed in 16 patients, tympanomastoidectomy in 6, and myringotomy in 2. No significant morbidity, mortality, recurrence, or residual neurologic deficit was observed at the 6-month follow-up. Early surgical intervention is important in achieving positive outcomes in patients with such intracranial complications.     

Otogenic intracranial abscesses. Description of 6 cases

We are reporting 6 clinical cases corresponding to admitted patients with intracranial abscesses (4 in brain and 2 in cerebellum) due to chronic otogenic pathology. Five were men and one woman with ages between 25 and 74 years. We have analysed in each case the initial symptoms, otoscopic exam, the otic and cranial CT informed, diagnosis, treatment and evolution. In all of them, it was performed a drainage of the abscess by Neurosurgery and Radical mastoidectomy by our Service with positive result. Although it is an uncommon complication nowdays, the abscesses of otological cause must be always suspected in uncontrolled chronic otitis or poor response to medical treatment. Symptoms can be no characteristics and must be asked for a CT or IRM in case of doubt.