经乳突腔穿刺抽脓在耳源性脑脓肿治疗中的应用

目的总结经乳突腔穿刺抽脓治疗耳源性脑脓肿的方法和效果。方法回顾性分析在乳突根治术中经乳突腔穿刺抽脓治疗76例耳源性脑脓肿的方法及效果。结果76例患者中，治愈72例，3例死亡，1例穿刺未愈．转神经外科开颅行脓肿切除治愈。结论经乳突腔穿刺抽脓是一种治疗耳源性脑脓肿的简单、有效的方法。     

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。     

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     

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.     

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     

急性中耳乳突炎并发耳源性颅内并发症

目的探讨急性中耳乳突炎并发耳源性颅内并发症的诊断和治疗.方法回顾4例急性中耳乳突炎引起的颅内并发症患者,耳源性乙状窦血栓性静脉炎1例,耳源性脑膜炎2例,耳源性硬脑膜外脓肿1例.结果4位患者经乳突凿开术,配合有效的抗生素治疗,二期行乳突根治术,均获痊愈.结论急性中耳乳突炎患者一经诊断或怀疑颅内并发症者应立即行扩大乳突凿开术,通畅引流,应用有效抗生素,这是挽救患者生命的关键.     

耳源性脑脓肿术后并发癫痫（摘要）

耳源性脑脓肿术后并发癫痫（摘要）郝敬忠１９８０年～１９９２年间住院治疗的耳源性脑脓肿６９例，随访６４例（５例失访），发现了８例患者术后有不同程度的癫痫发作，全部为颞叶脓肿患者。小脑脓肿术后无癫痫发作病例。６４例耳源性脑脓肿发病部位：颞叶脓肿４８例，术...     

咽旁脓肿引发下行性坏死性纵隔炎1例

颈部及牙原性感染引起的急性纵隔感染又称下行性坏死性纵隔炎(descending necrotizingmediastintis,DNM),临床上罕见,如诊断不及时、未及时经颈或经胸引流,可能会导致死亡.2010年1月,我们采用咽旁脓肿切开、经颈纵隔引流和B超引导下颈部多脓肿穿刺抽脓的联合治疗方法,治愈咽旁脓肿引发DNM患者1例,报告如下.     

耳源性脑脓肿一例并文献复习

耳源性脑脓肿作为耳科感染最严重的危及生命的并发症之一,故汇报我科近来收治的耳源性脑脓肿病例并复习文献,描述常见的临床体征和症状、细菌学、位置、治疗方案,分享相关体会。耳源性脑脓肿患病率低,但死亡率高。大多有化脓性中耳炎病史或中耳胆脂瘤,脓肿多位于颞叶,其次为小脑。常见症状是发热、头痛、精神状态改变、恶心、视乳头水肿和脑膜刺激征。常见培养细菌种类是变异形杆菌、链球菌、葡萄球菌。大多采用穿刺抽吸后置管引流并根据药敏继续静脉抗生素治疗。对于有慢性耳部疾病病史突然新发出现发热、头痛和恶心、精神状态改变等新症状的患者,耳鼻喉科医生应提高警惕,采取迅速、精准的诊断和治疗可以尽量降低患者的并发症和死亡率。     

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 brain abscesses in a patient sample of the otolaryngology clinic of the Poznan Medical Academy 1953-1984

Between 1953-1984 we treated 64 otogenic brain abscesses (44 of the temporal lobe and 20 of the cerebellum). This material included 2 cerebral abscesses and 1 cerebellum abscess in children. In 3 cases the abscess was a complication of acute otitis media. 84% of patients with a temporal lobe abscess and 85% with a cerebellar abscess recovered. Treatment consisted of removal of the inflammatory process in the middle or inner ear with subsequent puncture of the abscess and replacement of the pus by antibiotic solution. Otologic, neurologic, ophthalmolgic, EEG and CT examinations were performed on 50 patients. Residual signs of epilepsy were found in 6 patients. Forty one patients resumed work or study. The merit of computer tomography (CT) in diagnosing brain abscesses is emphasized. Since CT has been used a successful outcome has been obtained in 8 cases and a fatal result in 1.     

Role of non-spore-forming anaerobic microflora in the onset and development of otogenic abscesses of the brain and cerebellum]

The role of non-spore-forming anaerobic microflora in development of otogenic cerebral and cerebellar abscesses was studied in 49 patients with brain abscesses. Microfloral study of the middle ear discharge and content of cerebral abscess demonstrates that at present the role of pathogenic pyogenic staphylococci, streptococci and other kinds of purulent infection is lower than that of previously unreported non-spore-forming anaerobs in the pus of otogenic brain abscesses. It means that urgent sanation of the primary focus and cerebral abscesses should be supplemented with targeted combined antibacterial conservative therapy.     

Intracranial abscesses associated with chronic suppurative otitis media

Intracranial abscesses are serious complications of chronic suppurative otitis media (COM). This study included 32 patients presenting with intracranial abscesses from 780 patients hospitalized for treatment of COM. The 32 patients had 59 intracranial complications. Perisinus abscess (13 of 32) was the most common intracranial abscess, followed by temporal lobe abscess (8 of 32), epidural abscess (7 of 32), cerebellar abscess (6 of 32) and subdural empyema (2 of 32). Headache (93%), fever (87%) and altered mental status (62%) were the most common presenting symptoms and signs, along with symptoms of COM. All patients were treated with intravenous antibiotics and canal wall down mastoidectomy. Cholesteatoma with granulation tissue and bony defects at the sinus plate and/or dural plate were seen in most of the patients. Gram negative bacilli and anaerobes were the most common organisms cultured from the abscesses. Three patients had neurological sequels. One patient died. The early diagnosis of these complications requires a high index of suspicion and imaging studies. A multidisciplinary and coordinated approach is important for the management of these patients.The authors did not receive any financial support for the present study.     

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.     

Drainage of cerebral and cerebellar abscesses with "cigar"-shape draining tampon

The treatment was given to 95 patients aged 5 to 63 years with temporal (n = 86) and cerebellar abscesses (n = 9). Most of the patients were hospitalized after home treatment with antibiotics which complicated the diagnosis because of atypical course of the disease induced by them. The "cigar" tampon was used for draining brain abscess. The cover of the tampon was made not of the glove rubber but of a baby's rubber dummy and a rubber pipette cap. Holes were cut in the walls of the latter and gauze turundas inserted. The results of such manipulation were favourable. Therefore, it is recommended to use a modified "cigar" tampon-drain in the treatment of otogenic abscesses of the brain and cerebellum.     

Otogenic cerebellar abscesses (in the light of 10-year observation materials at the ENT clinic at the Tashkent institute of continuing education of physicians)

In 1989-1998 ENT specialists of the Tashkent Institute of Postgraduate Medical Education treated 109 patients with otogenic intracranial complications. 13 (11.9%) of them had cerebellar abscess. Clinical symptoms of the abscesses were obscure or absent. Head ache was the leading symptom. Other hypertensive symptoms presented with nausea, (n = 2), vomiting (n = 5), bradycardia (n = 7). Changes on the fundus of the eye were not registered in 6 patients. Defective coordination of movements, scanning speech were observed in 11 and 3 patients, respectively. Large-swinging, mixed horizontal nystagmus was truncal, in 11 patients it was directed to the side of the abscess, in 2 patients--in both directions. Symptoms of the secondary meningitis arose in 12 patients. The patients underwent surgical cleaning of the middle ear and opening cerebellar abscess under drug therapy. One patient died of purulent ventriculitis (lethality 7.6%). It is inferred that cerebellar abscesses often run with mild symptoms. This creates diagnostic difficulties.     

Posterior cranial fossa abscess secondary to cholesteatoma

OBJECTIVE: The intra cranial complications of chronic ear disease continue to pose a challenge in Senegal, despite advances in anti microbial therapy. Posterior cranial fossa abscesses are rare and continue to be associated with significant morbidity and mortality rates. We describe the presentation and management of a large cerebellar abscess secondary to cholesteatoma. METHODS AND RESULTS: A 11-year-old female presented with an inflammed fluctuant swelling of the right temporal region with ipsilateral otorrhoea. Examination demonstrated an auto atticotomy, large marginal perforation of the tympanic membrane associated with polyp. A diagnosis of otomastoiditis secondary to cholesteatoma was made. The abscess of the right temporal region was incised and drained and the patient was commenced on broad spectrum antibiotics. However the patients clinical status did not improve and there was a deterioration in her neurological status. CT brain and temporal bones demonstrated a large abscess in the cerebellum. 30 CC of pus were drained through a posterior fossa burr hole by the neurosurgeons. A radical mastoidectomy for extensive cholesteatoma of the right ear was subsequently carried out when the patients condition improved. CONCLUSION: Cerebellar abscess is a life threathning condition. In the presence of complicated chronic ear disease, clinical suspicion must be high as early symptoms and signs may be misleading. A low threshold for the performance of brain imagining will aid early diagnosis and allow prompt definitive treatment.