儿童及青少年慢性化脓性中耳炎临床特点

目的 回顾性总结儿童及青少年慢性化脓性中耳炎的临床特点,为儿童及青少年慢性化脓性中耳炎的临床早期诊断和早期干预提供思路.方法 比较儿童及成人慢性化脓性中耳炎在临床特征方面的异同.对105例（116耳）儿童及青少年和108例（112耳）成人慢性化脓性中耳炎患者的术中听骨链损伤程度及病变范围进行总结和比较.结果 儿童及青少...     

慢性化脓性中耳炎病原菌分析及临床意义

目的分析慢性化脓性中耳炎患者病原菌群分布及对抗生素的耐药性，指导临床用药。方法对收治的163例慢性化脓性中耳炎患者中耳分泌物进行细菌及真菌分离培养和药物敏感试验。结果163例患者中，有136例检出病原菌，检出率为83.4％。以金黄色葡萄球菌(42株)、铜绿假单胞菌(29株)和肺炎克雷伯菌（22株）为主,真菌6株。结论慢性化脓性中耳炎患者感染病原菌中以金黄色葡萄球菌多见，不同病原菌对药物的耐药性不同，临床使用抗生素时应行细菌培养及药物敏感试验，使用敏感抗生素治疗。     

慢性化脓性中耳炎病原菌分析

目的探讨慢性化脓性中耳炎病原菌临床分布特征。方法纳入自2017年1月至2020年3月我院确诊并收治住院的304例慢性化脓性中耳炎患者为研究对象,对外耳道和鼓室的脓性分泌物进行药敏试验、细菌培养及真菌培养。结果304例慢性化脓性中耳炎患者中,288例患者培养出病原菌(344株),真菌60例(19.7%)、细菌172例(56.6%),细菌与真菌共存56例(18.4%);无菌生长16例(5.3%)。344株培养出的病原菌中,革兰氏阳性菌有158株(45.9%),以金黄色葡萄球菌为主;培育出的真菌116株(33.7%),主要为黄曲霉菌;培育出的革兰氏阴性菌70株(20.3%),其中铜绿假单胞杆菌居多。结论慢性化脓性中耳炎患者感染病原菌以金黄色葡萄球菌(革兰氏阳性菌)、黄曲霉菌(真菌)、铜绿假单胞杆菌(革兰氏阴性菌)多见,临床可以根据药敏结果针对性给与抗菌药物治疗,能有效提高疾病治愈率,临床值得推广。     

Labyrinthine fistula: a complication of chronic suppurative otitis media

A labyrinthine fistula is a frequent complication of long-standing unsafe chronic suppurative otitis media. It is characterized by a slowly progressive erosion of the bony labyrinth. In this paper we present our observations regarding the diagnosis and management in 50 patients with unsafe chronic suppurative otitis media with labyrinthine fistula.     

慢性化脓性中耳炎病原学研究及其临床应用

目的：分析慢性化脓性中耳炎的致病菌种类及其药物敏感性。方法：取108例慢性化脓性中耳炎的外耳道深部或中耳脓液作细菌培养及药敏试验。结果：108例中培养分离出9 种细菌,其中铜绿假单胞菌占26.85%，金黄色葡萄球菌23.15%, 变形杆菌20.37%, 其他25.92%，混合感染2.78%。铜绿假单胞菌感染的病例中,亚胺培南和多粘菌素敏感试验均为阳性。结论：为避免产生耐药菌株，应根据药敏试验结果合理应用抗生素。     

Assessment of immune disorders in patients presenting with various forms of chronic suppurative otitis media in the postoperative period

The present study was designed for immunological examination of 46 patients presenting with various forms of chronic suppurative otitis media. All the patients underwent surgical intervention on mastoid process (processus mastoideus). It was shown that exacerbation of catarrhal inflammation provoked a significant decrease of the total lymphocyte, T-helpers, and B-lymphocyte (CD22) count whereas the concentration of T-suppressors increased. In patients with the distractive form of chronic suppurative otitis media, the absolute number of total lymphocytes, T-lymphocytes, T-helpers, and B-lymphocytes was also reduced while the concentration of IgG was elevated. The level of serum cytokines (IL-1-beta, IL-6, TNF-alpha) increased in both forms of the disease although the rise in case of catarrhal inflammation was much more pronounced. These data suggest beneficial effect of supplemental corrective immunotherapy.     

高分辨率CT对慢性化脓性中耳炎和胆脂瘤中耳炎软组织分型的诊断价值

目的 探讨高分辨率CT(high-resolution CT,HRCT)检查在慢性化脓性中耳炎及胆脂瘤中耳炎软组织分型中的诊断价值.方法 对120例153耳慢性化脓性中耳炎和胆脂瘤中耳炎患者行HRCT检查,以原始轴位图像为基础,分别行轴位、冠状位多平面重建(multiplanar reconstructtion,MPR)及最大密度投影(maximum intensity projiection,MIP),观察软组织生长特点、窗宽窗位对软组织显影的影响、邻近主要解剖结构改变情况并与手术结果进行对比.结果 120例153耳中经HRCT诊断为胆脂瘤中耳炎109耳,其中27耳合并肉芽组织;慢性化脓性中耳炎44耳,其中合并肉芽组织形成33耳,仅有分泌物11耳.术后诊断为胆脂瘤中耳炎107耳,其中25耳合并肉芽组织;慢性化脓性中耳炎46耳,其中35耳合并肉芽组织,仅有分泌物11耳.HRCT诊断胆脂瘤中耳炎和慢性化脓性中耳炎的符合率为98.6%,对胆脂瘤、肉芽组织、分泌物诊断的约登指数分别为0.98、0.98、1.00.结论 HRCT轴位、冠状位MPR及MIP图像相结合对慢性化脓性中耳炎软组织诊断分型具有重要的价值,可常规应用于慢性化脓性中耳炎及胆脂瘤中耳炎的鉴别诊断,并制定相应手术计划.

Abstract：

Objective To evalute the efficacy of high-resolution CT(HRCT) in differential diagnosis and treatment of chronic suppurative otitis media and cholesteatoma otitis media by soft-tissue shadows. Methods HRCT scanning was performed in 120 cases, 153 ears, with chronic otitis suppurative media and cholesteatoma otitis media, of which original data were processed with multi-planar reconstructtion (MPR) and maximum intensity projection ( MIP) , the characteristics of the soft-tissue shadows' growth, window width or window leveling and bony destruction were respectively observed, as well as compared with the surgery findings. Results In 120 patients (133 ears), 109 ears were diagnosed as cholesteatoma otitis media, and 44 ears were diagnosed as chronic suppurative otitis media, among which 33 ears had granulation tissue and 11 ears had secretion. One hundred and seven ears were postoperatively diagnosed as cholesteatoma otitis media, among which 25 ears had granulation tissue. Among 46 ears of chronic suppurative otitis media, 35 ears had granulation tissue, and only 11 ears had secretion. A 98. 6% diagnostic accuracy can be reached with HRCT in diagnosing cholesteatoma otitis media and chronic suppurative otitis media. The Youden's index was 0. 98, 0. 98 and 1. 00 respectively with HRCT in diagnosing cholesteatoma, granulation tissue and secretion. Conclusions Combination of the three different imaging methods, axial images, coronal MPR images and MIP images, can improve the efficacy of the HRCT diagnosis and definite chronic otitis media, which can be routinely used for surgery plan.     

Middle ear and eustachian tube lining in chronic otitis media.

By means of histological observations we have tried to find morphological data on which to classify non-suppurative and suppurative chronic otitis media. There was also evidence of pathophysiological features which may have direct influence upon the development and behaviour of chronic inflammations of the tympanic cleft, such as disorders of ventilation and reaction of the mucoperiosteal layer. Local defence mechanisms, the species and virulence of infection also play an important role. It appears that the Eustachian tube is a very effective mechanical and immunological barrier against ascending infection which may perhaps be assisted by antibiotic treatment. Certainly non-suppurative chronic otitis media is more frequent now than in pre-antibiotic days.     

Middle ear and Eustachian tube lining in chronic otitis media*

By means of histological observations we have tried to find morphological data on which to classify non-suppurative and suppurative chronic otitis media. There was also evidence of pathophysiological features which may have direct influence upon the development and behaviour of chronic inflammations of the tympanic cleft, such as disorders of ventilation and reaction of the mucoperiosteal layer. Local defence mechanisms, the species and virulence of infection also play an important role. It appears that the Eustachian tube is a very effective mechanical and immunological barrier against ascending infection which may perhaps be assisted by antibiotic treatment. Certainly non-suppurative chronic otitis media is more frequent now than in pre-antibiotic days.     

慢性化脓性中耳炎伴蛛网膜下腔出血病例分析

1病例资料患者,女,45岁。因低热伴头晕1周,加重1d,左耳流脓1d入院。患者1周前无明显诱因出现发热,T 37.5℃,觉头晕,无明显头痛,无恶心、呕吐、耳痛及耳鸣。在当地医院门诊输液(阿莫西林)6d,头晕无明显好转,发热停止。近1天觉头晕明     

老年慢性化脓性中耳炎患者听力学分析

目的 探讨老年慢性化脓性中耳炎患者的听力学特点。方法 回顾性分析68例≥60岁单侧慢性化脓性中耳炎患者的语频（0.5、1.0、2.0、4.0kHz）纯音测听结果、术中所见中耳病变组织特点和听骨链病变情况、病变组织病理检查结果。结果 语频范围内,患耳气导、除4kHz外的骨导阈值均高于对侧耳;胆脂瘤患者与非胆脂瘤患者的气、骨导阈无明显差异;听骨链完好者与破坏者（中断或固定）的气导、2kHz骨导阈值差异具有统计学意义,0.5、1.0、4.0kHz骨导阈值差异不显著。结论 老年慢性化脓性中耳炎患者的听力改变有其独特性,掌握老年慢性化脓性中耳炎患者的听力学特征有助于疾病的诊治。     

颞骨高分辨率CT在中、内耳手术中的应用

目的分析颞骨高分辨率CT在中、内耳手术中的应用。方法回顾分析近3年的600例中、内耳手术前颞骨CT和术中病变情况。结果术前CT诊断慢性化脓性中耳炎、中耳胆脂瘤、中耳炎后遗症(包括鼓膜穿孔、粘连性中耳炎、鼓室硬化症)、耳硬化症和中耳畸形及恶性肿瘤的符合率分别为98.7%(221/224耳)、94.4%(319/302耳)、94.1%(32/38耳)、66.7%(16/24耳)和100%(12/12耳)。结论颞骨CT提供了大量关于中、内耳的信息,临床医师术前应该认真阅读分析颞骨CT片,充分利用CT提供的信息,做好手术的个体化设计,提高治疗质量。     

慢性化脓性中耳炎病原菌及耐药性分析

目的研究慢性化脓性中耳炎的主要病原菌种类及对抗生寨的耐药情况。方法对132例慢性化脓性中耳炎患者的脓性分泌物进行细菌培养并对分离的病原菌进行药物敏感试验。结果分离出病原菌152株,以金黄色葡萄球菌（49株）和铜绿假单胞菌（25株）为主,真菌5株。金黄色葡萄球菌对喹诺酮类敏感,敏感率为79．6％。铜绿假单胞菌对头孢他啶和喹诺酮类敏感,敏感率分别为84％和64％。结论金黄色葡萄球菌和铜绿假单胞菌是聊城地区慢性化脓性中耳炎主要致病菌,二者均对喹诺酮类敏感,铜绿假单胞菌亦对三代头孢类的头孢他啶敏感。临床医师在对慢性化脓性中耳炎患者治疗时应根据细菌培养和药敏结果用药,准确有效的治疗,以防耐药菌株的发生。真菌在慢性化脓性中耳炎致病菌中不容忽视。     

慢性化脓性中耳炎的咽鼓管功能对手术疗效的影响

目的探讨慢性化脓性中耳炎咽鼓管功能改变对手术疗效的影响.方法分析40耳行鼓室成形术的慢性化脓性中耳炎的咽鼓管功能与手术疗效的关系.咽鼓管功能检查用正-负压试验、TTAG法及音响法,咽鼓管鼓室口及咽口的观察分别用鼓室镜及鼻窦镜,对比分析咽鼓管功能改变与病变部位的关系,并比较鼓室成形术后咽鼓管功能正常耳与异常耳的鼓膜生长及听力变化情况.结果慢性化脓性中耳炎的咽鼓管功能与鼓室口病变程度相关,鼓室口病变轻者,咽鼓管功能良好;而鼓室口病变重者咽鼓管功能不良.40耳鼓室成形术后咽鼓管功能良好耳鼓膜生长良好,咽鼓管功能不良耳鼓膜生长欠佳;两者均有统计学意义.结论慢性化脓性中耳炎咽鼓管功能与鼓室成形术效果关系密切,咽鼓管功能障碍可能是导致手术失败的重要因素之一.     

结核性中耳乳突炎的误诊原因探讨

目的：探讨结核性中耳乳突炎的临床特征并分析其误诊原因。方法：回顾分析9例结核中耳乳突炎的临床资料。结果：9例患者仅1例在术前明确为结核中耳乳突炎,其余8例术前误诊为慢性中耳乳突炎,术后病检才确诊为结核中耳乳突炎。结论：结核性中耳乳突炎临床特征与慢性化脓性中耳乳突炎相似,临床上易混淆。临床医生应重视此病,结合病史、影像学检查、病理检查及其他特殊检查以明确诊断,减少误诊。     

Panel discussion: Pathogenesis of otitis media. Current treatment of otitis media based on pathogenesis studies

Studies of pathogenesis of otitis media indicate clear cut categories including POM (acute purulent otitis media), SOM (serous otitis media), MOM (mucoid or secretory otitis media), COM (chronic suppurative otitis media) and sequellae with frequent overlap of types. One type of otitis media can lead to another type along a continuum. In this paper our concepts of treatment based on laboratory studies and clinical observation, both medical and surgical, are documented.     

慢性化脓性中耳炎分泌物的细菌培养及药敏试验

目的 :了解慢性化脓性中耳炎 (CSOM )患耳脓性分泌物的细菌分布及药物敏感性 ,以指导临床用药。方法 :采集 92例武汉地区CSOM患者手术中的中耳炎性分泌物 ,分别进行需氧菌、厌氧菌培养及药物敏感试验。结果 :需氧菌培养阳性者 75例 ,阳性率 81.5 % ,主要致病菌为绿脓杆菌、金黄色葡萄球菌和变形杆菌。 3种致病菌均对环丙沙星敏感 (敏感率为 89.0 %、88.2 %和 85 .0 % )。厌氧菌培养阳性者 10例 ,阳性率 10 .9%。结论 :绿脓杆菌、金黄色葡萄球菌和变形杆菌是武汉地区CSOM的主要致病菌 ,三者对环丙沙星类抗生素的敏感率均较高。厌氧菌在CSOM的发病中起着重要的作用。     

耳部炎性疾病的细菌学及药物敏感性分析

目的了解慢性化脓性中耳炎及外耳道炎主要病原菌的分布及药物敏感性,用以指导临床用药。方法取238例慢性化脓性中耳炎及外耳道炎患者外耳道深部或鼓室内脓性分泌物,行细菌及霉菌培养和药物敏感试验。结果分离出病原菌206株,包括金黄色葡萄球菌 （34.95％）、耐甲氧西林凝固酶阴性葡萄球菌（20.38％）、绿脓杆菌（7.28％）、真菌 （18.45％）。药物敏感性因菌种而异。结论慢性化脓性中耳炎及外耳道炎的病原菌以金黄色葡萄球菌为主,耐甲氧西林凝固酶阴性葡萄球菌次之,真菌比例明显增高。不同病原菌对药物的敏感性及耐药性不同,对临床常用抗生素存在耐药性。对耳部炎性疾病应行分泌物培养及药物敏感试验,以便采取针对性治疗。     

探讨健康教育护理路径干预在对慢性化脓性中耳炎患者睡眠质量和护理满意度的影响

目的分析健康教育护理路径干预在对慢性化脓性中耳炎患者睡眠质量和护理满意度的影响。方法此次研究对象为我院2019年4月~2020年4月期间收治的58例慢性化脓性中耳炎患者,以随机数字表法分对照组和观察组,每组29例,观察两组睡眠质量与护理满意度。与本研究,按照护理方法的差异将其分为对照组与观察组,每组39例,对两组护理前后的心理状态进行比较。结果护理后,观察组匹茨堡睡眠质量指数量表(PSQI)评分低于对照组,且护理满意度高于对照组(P<0.05)。结论在慢性化脓性中耳炎患者中实施健康教育护理路径干预,可促进患者睡眠质量与护理满意度的提升。     

Peculiarities of the treatment of patients presenting with chronic suppurative otitis media associated with Gram-negative microorganisms

The objective of the present study was to determine the absolute and relative numbers of T-lymphocytes, B-lymphocytes, T-suppressors, T-helpers, phagocytes, immunoglobulins A, M, and G in blood sera of patients presenting with chronic suppurative otitis media who had undergone sanation surgery. The study included tests for the evaluation of immunological efficiency of combined treatment with imunofan and myelopid in 89 patients divided into two groups. Pretreatment immunological status of all patients was characterized by reduced B-lymphocyte, T-helper, and phagocyte counts coupled to the elevated levels of IgM and T-suppressors. Patients of group 1 received conventional antibacterial therapy, those in group 2 were treated with a combination of imunofan and myelopid. Conventional therapy failed to correct immune deficiency. Additional treatment with a combination of imunofan and myelopid following sanation surgery proved to be much more efficacious. This observation was confirmed by the results of clinical, cytological, and immunological studies.