结核性中耳乳突炎的CT诊断(附5例报告)

目的 探讨结核性中耳乳突炎的HRCT表现.方法 回顾性分析手术及病理学证实的5例(6耳)结核性中耳乳突炎HRCT表现.结果 结核性中耳乳突炎HRCT表现为软组织密度影及骨质异常,患耳鼓室腔、乳突窦及乳突气房内充满软组织影,病理学证实为大量肉芽组织.患耳骨质异常HRCT表现为乳突气房骨性间隔模糊(3耳)、骨质破坏(6耳)累及鼓室壁、听小骨、岩尖等,不伴骨质硬化以及死骨形成(4耳),分别位于乳突窦、鼓室腔、内耳及岩尖.结论 结核性中耳乳突炎具有一定影像学表现特征,单侧气化型乳突呈广泛炎症改变并伴骨性间隔模糊,特别是发现"死骨"可提示本病诊断.     

HRCT对慢性中耳乳突炎分型诊断的价值

目的探讨CT在慢性中耳乳突炎分型诊断中的价值。方法对35例42耳慢性中耳乳突炎行高分辨CT(HighResolutionCTHRCT)检查,分析影像表现特征。结果脂瘤型中耳乳突炎鼓窦、鼓室区可见块状软组织肿块影。鼓室壁破坏出现率为92%,骨质破坏多累及邻近组织。听小骨消失、病损、硬化出现率为94%。肉芽肿型中耳乳突炎鼓室壁破坏出现率为15%。听骨链破坏出现率为23%。肉芽肿型中耳乳突炎多出现听骨链肉芽包裹。单纯性中耳乳突炎鼓室壁及听骨链周围骨质破坏少见,无软组织肿块。结论HRCT检查的影像特征对慢性中耳乳突炎具有良好的定位、定量、和定性作用。     

HRCT冠、轴位扫描对慢性中耳乳突炎的诊断价值

目的　评价ＨＲＣＴ 冠、轴位扫描对慢性中耳乳突炎的诊断价值。方法　回顾性收集６８ 耳经临床及手术病理证实的慢性中耳乳突炎病例。将术前ＨＲＣＴ 冠、轴位扫描征象与手术病理结果对照分析。结果　６８ 耳中,胆脂瘤型２７ 耳,典型者表现为上鼓室、鼓窦及其入口内团块状软组织影,鼓窦及其入口扩大,鼓室天盖破坏,ｋｒｎｅｒ′ｓ隔消失,大多数为硬化型乳突;肉芽肿型３７ 耳,主要表现为鼓室及鼓窦内软组织影,骨质破坏程度轻,大部分为板障型乳突;单纯型４ 耳表现为中耳腔内积液,以气化型乳突为主。结论　ＨＲＣＴ冠、轴位扫描对慢性中耳乳突炎具有很高的术前诊断价值。     

慢性化脓性中耳乳突炎螺旋CT诊断价值

目的探讨慢性化脓性中耳乳突炎螺旋CT检查的诊断价值。方法对手术及病理证实的48例65耳慢性化脓性中耳乳突炎患者术前进行螺旋CT扫描并与手术及病理结果对照分析。结果48例中,胆脂瘤型32耳,典型者表现为上鼓室、鼓窭及其入口内团块样或弥漫性软组织病灶,边缘见低密度环,骨缘硬化,鼓室扩大,盾板变钝或破坏,听小骨明显破坏;肉芽肿型28耳,主要表现为鼓室及鼓窦内软组织条索及片网影,听小骨破坏较轻;单纯型15耳,表现为中耳腔内黏膜增厚、积液。三维CT听骨链显示情况与手术一致。结论螺旋CT扫描对慢性化脓性中耳乳突炎术前诊断及分型有重要意义,三维CT成像对制定手术方案,提高手术安全性有很大价值。     

中耳乳突根治术不干耳原因分析

中耳乳突根治术是治疗慢性中耳乳突炎(骨疡型或胆脂瘤型)的一种方法，是通过清除中耳乳突病灶，以获得干耳的手术。我科自1985年～2001年共收治16例术后不能获干耳的患者，分析如下：     

乳突根治并鼓室成形术治疗慢性中耳乳突炎156例近期疗效观察

目的 探讨慢性中耳乳突炎乳突根治鼓室成形术及术后配合特定电磁波(TDP)局部照射的疗效.方法 对156例(耳)慢性中耳乳突炎行乳突根治并鼓室成形术,术后配合TDP局部照射.结果 干耳率及鼓膜穿孔愈合率达98％,听力有不同程度的提高.结论 对慢性中耳乳突炎采用乳突根治并鼓室成形术,病变愈单纯,术后听力改善愈佳;凡鼓室成形术,均应行鼓室探查;术后应配合TDP局部照射.     

胆脂瘤型中耳乳突炎的CT诊断价值

耳部结构细微复杂,传统的放射学诊断方法难以清晰显示其细微结构和软组织病灶。特别是耳部显微外科的普及,对耳的解剖及疾病诊断提出了更高的要求。而CT扫描能很好地显示耳的正常解剖结构(图1,2)、病变部位及其累及范围,笔者根据34例国人中耳的CT扫描资料,重点探讨CT在慢性中耳乳突炎合并胆脂瘤形成的诊断及其应用价值。1材料与方法对1999年9月～2003年6月临床拟诊慢性中耳乳突炎的48例患者行CT平扫(未有病例作增强扫描)。其中34例(35耳)经我院手术证实或随访证实合并有胆脂瘤形成。此34例中,男19例,女15例。年龄15～60岁。临床均有外耳…     

36例胆脂瘤型中耳乳突炎的x线与手术对照观察

慢性化脓性中耳乳突炎是耳科常见的疾病,有1/3～1/2并发胆脂瘤。胆脂瘤引起的骨质破坏,促使炎症向邻近组织扩散,导致一系列并发症,甚至危及患者生命,故临床上胆脂瘤型中耳乳突炎又有“危险型”之称。x 线检查是诊断胆脂瘤的有效检查方法。本文收集了     

内镜在鼓室成形术中的辅助应用

目的 探讨耳内镜在鼓室成形术中的作用。方法 2001-2004年慢性化脓性中耳乳突炎患者30例、中耳胆脂瘤患者17例手术中应用耳内镜。结果 术后一期干耳44例，余3例二期探查术后均获干耳；平均语言频率听力提高15dB以上者40耳。结论 耳内镜能够弥补耳显微镜的不足，明显提高中耳病灶清除率及手术成功率。     

慢性中耳乳突炎侵犯鼓室骨壁的HRCT探讨

目的:着重研究慢性中耳乳突炎侵犯鼓室壁的HRCT特征及其临床价值。材料和方法:收集经临床和手术证实的慢性中耳乳突炎28例计32耳,并伴有鼓室壁损害的HRCT资料,回顾性分析影像学表现,评价临床意义。结果:①鼓室盖异常68耳,占25%。其中,骨质疏松2耳,骨壁菲薄1耳,骨壁缺损5耳;②颈动脉管异常6耳,占18.7%。其中,骨质疏松2耳,骨壁缺损1耳;③颈静脉孔壁异常5耳,占15.6%。其中,骨质疏松2耳,骨壁菲薄1耳,骨壁缺损2耳;④乙状窦骨壁异常13耳,占40.6%。其中,乙状窦骨壁缺损3耳,乳突窦骨壁破坏10耳,听小骨糜烂、移位5耳;⑤骨迷路异常7耳,占21.8%。其中,鼓岬缺损1耳,前庭窗模糊1耳,蜗窗缺损2耳,面神经管缺损2耳,外半规管缺损1耳;⑥鼓膜异常21耳,占65.6%。其中,鼓膜缺损7耳,鼓膜增厚7耳,鼓膜内陷5耳,外耳道骨质破坏2耳。结论:运用HRCT扫描横断位和冠状位相结合,除能显示慢性中耳乳突炎病变表现外,还能确定其鼓室各壁的骨质损害部位、程度及与周围结构的关系,对手术处理具有重要意义。     

Otomastoiditis-related facial nerve palsy

A 9-year-old girl with persistent otitis media, despite antibiotic therapy developed a facial nerve palsy. Computed tomography (CT) scan revealed ipsilateral mastoiditis, prompting admission for intravenous antibiotic and steroid therapies. Acute mastoiditis, uncommon in the post-antibiotic era, is usually diagnosed on physical examination findings, but two variants, masked mastoiditis or silent mastoiditis, may be difficult to appreciate clinically. Patients who present with facial nerve palsy in the setting of persistent otitis media should undergo CT scan for evaluation of intracerebral or extracerebral pathology, including mastoiditis. Failure to identify associated concomitant pathology may result in treatment failure or persistent neurological deficit.     

Complication of otitis media leads to opisthotonos in a toddler

Opisthotonos, extreme involuntary neck and back extension, is rarely seen in modern emergency departments. Vaccines have prevented the most common causes of this clinical presentation. Alternatively, otitis media is one of the most common pediatric infections and is characteristically non-invasive and harmless. In exceedingly rare cases, otitis media can develop complications and progress to invasive pneumococcal diseases including mastoiditis and meningitis. Streptococcus pneumoniae accounts for the majority of otitis media infections, however, since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) otitis media and its complications have decreased significantly. The present case reports of a previously healthy and immunized child presenting to a pediatric emergency department (PED) with opisthotonos, and was found to have pneumococcal meningitis, bacteremia and mastoiditis arising from otitis media.     

Complications of otitis media in children

The complications of otitis media are frequently not considered in discussions of the medical or surgical management of this disease. Retrospective review of 135 cases in children treated surgically in an otologic referral practice between 1981 and 1989 revealed that perforation of the eardrum (57 cases) was the most common complication of otitis media, followed by cholesteatoma (54), mastoiditis (16), and atelectasis of the eardrum (eight). Coalescent mastoiditis was most common in children less than 6 years of age, whereas cholesteatoma and ossicular chain destruction occurred more frequently with increasing age. The presenting signs and symptoms of the complications and their management are presented to help alert the practitioner to the potentially severe complications of otitis media.     

亚毫米螺旋CT 0.5mm与1.0mm层厚重建显示慢性中耳乳突炎效果的对照研究

目的 螺旋CT 0.5 mm层厚各向同性数据,对比0.5 mm和1.0 mm等距离横断和冠状重建显示慢性中耳乳突炎病变的效果,探讨0.5 mm重建层厚在显示慢性中耳乳突炎是否有优势.方法 对25例慢性中耳乳突炎患者行颞骨0.5 mm层厚螺旋CT扫描,将其各向同性数据建成0.5 mm和1.0 mm两种等间距图像,并由一位经验丰富的放射医师独立盲法评分,评分间期为两周以消除因记忆产生的误差.对比评分结果,进行Wilcoxon符号配对秩和检验.结果共31侧患耳0.5 mm和1.0 mm等间距重建对照,差异有统计学（P＜0.05）,即0.5 mm层厚各向同性数据以0.5 mm等距离重建横断和冠状图像在显示颞骨炎症侵犯存在优势.结论 与1.0 mm层厚相比较,0.5 mm等距离重建图像显示慢性中耳乳突炎颞骨细微病变更具优势,因此,利用螺旋CT亚毫米各向同性数据薄层重建,为颞骨炎症病变提供了更佳的显示方法,有利于隐匿性细微病变的检出,为临床的早期治疗提供可靠依据.     

Mastoiditis

Mastoiditis still occurs as a nonmeningeal complication of otitis media. Fever, postauricular swelling, tenderness of the ear pinna, severe otalgia and ear drainage are all typical clinical findings. Most commonly, the causative organisms are the same aerobic bacteria that are responsible for otitis media; however, anaerobic organisms must also be considered. Treatment for acute mastoiditis includes appropriate intravenous antibiotics and myringotomy for culture and drainage. Mastoidectomy is indicated if medical therapy fails.     

Mastoiditis with concomitant Lemierre's syndrome

Otalgia with mastoiditis is an infrequently encountered complication of acute otitis media (Pfaff and Moore, 2018). Even more rare is the development of infected jugular venous thrombosis, Lemierre's disease. We present a case of a six year-old girl with otalgia for over two months who presented to our Emergency Department (ED) with clinical mastoiditis, confirmed on CT scan, as well as an incidental diagnosis of complete thrombosis of the internal jugular (IJ) vein, Lemierre's syndrome. The true prevalence of Lemierre's from mastoiditis is difficult to discern. This clinical case highlights the importance of the consideration of these pathologies by the emergency physician.     

Three ‘silent’ mastoid abscesses

Acute mastoiditis with abscess formation is uncommon, its incidence being modified by modern antibiotic usage for acute suppurative otitis media (ASOM). It tends to occur in young children who have no previous history of ear disease. The diagnosis is a clinical one, and treatment requires hospital admission and some form of surgical drainage procedure, in order to prevent intracranial complications, eg, meningitis and intracerebral abscess.     

Three 'silent' mastoid abscesses

Acute mastoiditis with abscess formation is uncommon, its incidence being modified by modern antibiotic usage for acute suppurative otitis media (ASOM). It tends to occur in young children who have no previous history of ear disease. The diagnosis is a clinical one, and treatment requires hospital admission and some form of surgical drainage procedure, in order to prevent intracranial complications, eg, meningitis and intracerebral abscess.     

Otitis externa caused by Malassezia slooffiae complicated with mastoiditis: A case report

Herein, we report a case of otitis externa caused by Malassezia slooffiae complicated with mastoiditis. A 70-year-old male complained of fever and severe otorrhea from left external auditory canal 2 months after undergoing a craniotomy to remove a hematoma. He had right-sided paralysis and undertook bed rest.Brain computed tomography revealed continuous fluid accumulation in the left mastoid air cells and middle ear from left external auditory canal in addition to leukocytosis and increased C-reactive protein level. The tympanic membrane was severely swelling. These results indicated the presence of otitis media and mastoiditis. Otorrhea culture showed large amounts of M. slooffiae. The administration of liposomal amphotericin B (L-AMB), the irrigation of external auditory canal with normal saline, and the application of topical ketoconazole ointment were started. The administration of L-AMB for 8 weeks and voriconazole, which was switched from L-AMB, for 4 weeks ameliorated his infection and he was transferred to another hospital to receive rehabilitation. From these results and his clinical course, the diagnosis of otitis externa caused by Malassezia slooffiae complicated with mastoiditis was made. And the possibility of the contamination by M. slooffiae was very low. Clinicians should be aware that M. slooffiae can provoke otological infections since M. slooffiae is the most common Malassezia sp. in external auditory canal.     

Emergency presentation of coalescent mastoiditis

Since the introduction of sulfonamides in the late 1930s, coalescent mastoiditis is an uncommon complication of otitis media. Swelling, erythema, and tenderness over the mastoid area with associated anterior displacement of the auricle are classic signs and symptoms of coalescent mastoiditis with formation of a subperiosteal abscess. Early recognition of this entity is essential to prevent its complications. Prompt otolaryngologic consultation is indicated and inpatient antibiotic therapy should be begun. Surgical treatment is also needed and may obviate further complications.