结核性中耳乳突炎13例临床分析并文献复习

目的：探讨结核性中耳乳突炎的临床特点及治疗方法。方法：回顾性分析13例结核性中耳乳突炎患者的l‰眯资料。治疗方法采取单纯手术治疗l例．单纯抗结核治疗l例．手术结合抗结卡囊治疗11例。结果：l例行单纯于术患者在术后7个月复发,行抗结核药物治疗后随访7个月未J见复发;余12例未虬复发。结论：对于结中蔓性中耳乳突炎,正规抗结核治疗足最基本的治疗方法,手术町清除中耳内炎性肉芽组织及死骨．缩钮痫狂。     

结核性中耳乳突炎的临床特征及疗效分析

目的 探讨结核性中耳乳突炎的临床特点以及手术疗效.方法 回顾性分析经病理学证实的16例(18耳)结核性中耳乳突炎的临床表现、影像学特征以及治疗方法,并随访其预后.结果 16例(18耳)患者均表现为耳流脓、听力下降,并发重度感音神经性聋患者3例(4耳),并发周围性面神经麻痹患者3例.16例颞骨高分辨率CT均表现为鼓室、乳突充满软组织密度影,其中骨质破坏11例(12耳),颞骨内存在死骨7例(7耳).16例患者中伴发肺结核7例.15例患者接受了手术治疗去除病灶并联合抗结核治疗.除2例患者术前经穿孔的鼓膜取活检明确诊断为结核性中耳乳突炎外,其余14例患者均为术中或者术后确诊.除1例患者失访外其余15例患者均随访1年以上,中耳乳突结核无复发,3例面神经麻痹患者基本恢复正常.结论 对于顽固性耳流脓,影像学提示鼓室、乳突充满软组织密度影且存在骨质破坏或者死骨者,应仔细询问是否有结核病史,以便鉴别结核性中耳乳突炎.手术去除病灶并结合抗结核治疗对该病有较高的治愈率.     

结核性中耳乳突炎

3例耳结核病人,均为白人女性,年龄不超过33岁,来自贫困的挪威地区,都没有结核接触史,仅1人有头、颈部表现。据该国家结核病登记处统计,1979～1988年间报道有3 273例结核病人,结核性淋巴结炎占4.8%,无淋巴结核的耳鼻咽喉侵害仅占0.33%(11例)。复习20世纪英文文献,有320例结核性中耳炎或中耳乳突炎,其中93例是1986～1990年中报道,其中83%(77例)来自贫困的非洲地区,至少     

胆固醇肉芽肿性中耳乳突炎

为了探讨对胆固醇肉芽肿性中耳乳突炎的及时诊断和正确处理，回顾性分析了经手术和病理证实的胆固醇肉芽肿性中耳乳突炎６例患者的临床资料。６例中均有长期或既往中耳炎病史，其中２例呈典型慢性分泌性中耳炎病史，２例为特发性蓝色鼓膜改变，另２例则表现为似原发中耳占位病变。对６例患者均采用了手术治疗，包括鼓室探查及中耳置管、或联合鼓窦开放、单纯乳突切除或根治性乳突切除术，术后追踪１～７年无复发，其中５例术后听力有提高。久治不愈的分泌性中耳炎及蓝色鼓膜是临床诊断的主要依据，对该症应积极采取手术治疗，清除病变建立鼓室乳突的通气引流     

中耳乳突炎性病变的人工耳蜗植入术

目的探索双侧重度感音神经性聋合并中耳乳突炎性病变人工耳蜗植入手术方法.方法 29例不同类型中耳乳突炎患者行人工耳蜗植入手术,根据炎症病变程度采用Ⅰ期手术26例,分期手术3例.非化脓性及慢性中耳炎静止期者,行完壁式乳突根治术,清除病灶,保留骨性外耳道,同期行人工耳蜗植入;化脓性中耳炎者,行完壁式或开放式乳突根治术,清除病灶保留骨性外耳道或重建外耳道后上壁,获得干耳后,Ⅱ期行人工耳蜗植入.结果 29例中耳乳突不同炎症病变患者经Ⅰ期或分期手术,人工耳蜗电极均顺利植入.随访2～8年,无炎症病变复发,开机后人工耳蜗工作正常,无电极裸露、脱出.结论中耳乳突炎性病变经正确的手术措施干预后,可行人工耳蜗植入.强调依据病变程度和范围个性化处理.     

隐匿性中耳及乳突炎的手术治疗

隐匿性中耳及乳突炎是指具有完整鼓膜的中耳慢性炎症，中耳内存在肉芽组织、胆固醇肉芽肿等病变，由于无鼓膜穿孔和耳流脓病史，病变发展隐匿，患者忽视未及时就诊，临床上常常漏诊。疾病进一步发展常引起听力下降。为了提高对隐匿性中耳及乳突炎的认识，对我科收治的23例（27耳）隐匿性中耳及乳突炎的病例资料进行回顾性分析，报道如下。     

慢性中耳乳突炎手术的医源性并发症

对有经验的耳科医师,慢性中耳乳突炎手术常见并发症的发生率低于1％。本文重点讨论面神经损伤,其次为血管损伤,鼓室与鼓窦盖损伤,半规管损伤及迷路窗损伤。不包括中耳手术所致的颅内感染,脑水肿及其他脑神经损伤。     

慢性化脓性中耳乳突炎的手术治疗

既往治疗慢性化脓性中耳乳突炎首先考虑的是彻底清除病灶,对听力能否提高关注不够,尤其是青少年患者.现在的要求是在彻底清除病灶的同时,要提高听力、干耳率.     

会厌结核误诊原因分析

会厌结核临床较少见 ,常易引起误诊。 1 995～2 0 0 0年我科共收治 8例会厌结核 ,均经病理证实。入院前 6例存在一定程度的误诊。现报道如下。1　临床资料8例患者中 ,男 5例 ,女 3例 ;年龄 2 8～ 75岁 ,平均 45 .3岁。主诉为咽痛、吞咽障碍或异物感、进食有呛咳等 ,无明显声嘶。门诊初诊为急性会厌炎4例而予抗生素、激素治疗无效 ,另有 2例考虑为会厌癌可能性大而收治入院。胸片示 4例肺部有结核改变。全部患者在间接喉镜或直接喉镜下行会厌部活检 ,病理见典型的肉芽肿结核结节 ,诊断明确后均转内科进行正规的抗结核治疗。2 　 讨论会厌结核…     

结核性中耳炎12例临床观察

目的探讨结核性中耳炎的临床特点及治疗方法.方法回顾性分析从1998年至今诊治的12例结核性中耳炎患者的临床资料.结果 12例患者中,10例经手术＋抗痨治疗、2例经抗痨治疗治愈,随访6月～5年无复发.结论对长期慢性无痛性中耳流脓患者应警惕结核性中耳炎,并给予及时诊断及治疗.     

中耳乳突结核7例临床分析

我科自1990～1998年共收治7例（8耳）中耳乳突结核患者,临床表现为耳漏,中耳胶粘膜苍白肉芽。术前明确诊断结核2耳,术前诊断为急性中耳乳突炎2耳,慢性化脓性中耳炎3耳,乳突根治术后感染1耳,此6耳经术后病理证实为结核病变。8耳均行乳突根治术清除病灶结合抗痨治疗,随访2月～2年,局部病变无复发。文中对中耳乳突结核的病因、诊断、鉴别诊断及治疗方法进行了讨论。     

Intratemporal complications of otitis media

Otitis media (OM) is considered a potentially severe disease due to the risk of complications.ObjectiveTo establish the annual incidence of intratemporal complications (ITC) resulting from OM and to prospectively assess patients for epidemiological and clinical factors.MethodThis prospective cohort study included patients admitted during one year at a university hospital diagnosed with intratemporal complications of OM. Patients were analyzed for age, gender, type of intratemporal complication, treatment, and clinical outcome. The overall incidence of complications and the specific incidence rates of each type of complication were determined.Results1,816 patients were diagnosed with OM; 592 (33%) had chronic OM; 1224 (67%) had acute OM. Fifteen patients were diagnosed with OM ITC, adding up to an annual incidence of 0.8%. Nineteen diagnoses of ITC were made in 15 patients. Seven (36.8%) patients were diagnosed with labyrinthine fistula, five (26.3%) with mastoiditis, four (21.1%) with peripheral facial palsy, and three (15.8%) with labyrinthitis.ConclusionThe incidence of intratemporal complications remains significant when compared to the rates seen in developed countries. Chronic cholesteatomatous otitis media is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.     

Early onset otitis media: risk factors and effects on the outcome of chronic suppurative otitis media

The onset of early otitis media (EOM), in the first few months of life has been reported to predict later chronic otitis media (CSOM), although the prevalence rates are increasing little is known about specific risk factors. In this survey we examined the hypothesis that higher risk factors is associated with the development of OM within 1 year compared to later onset and early onset otitis media (OM) has potential for negative outcome of CSOM. This is a survey of the age at onset of otorrhoea and associated risk factors in children with CSOM, in five sites spread in two sub-urban cities in two states in Nigeria. Questionnaires were administered on the informants followed by examination of the children. EOM was seen in 136/189 (70%) with CSOM, the age range was 1-150 months, mean of 59.25 (SD = 44.55). Of the 85 CSOM subjects with hearing loss, EOM accounted for 49 (57.7%) while 36 (42.4%) was later onset, On multivariate analysis (OR = 0.276, CI = 0.133-0.572, P = 0.001) revealing EOM was significant in the development of hearing loss however there was no correlation with the frequency of attack of otorrhoea (OR = 1.025, CI = 0.88-1.19, P = 0.75). Low socioeconomic status seen in 110/136 EOM (P = 0.000), allergy (P = 0.030) and number of people >10 in household (OR = 4.13, CI = 1.81-9.39, P = 0.001) constituted the significant risk for EOM compared to later onset. Bottlefeeding, adenoiditis/adenoid hypertrophy, indoor cooking and upper respiratory infection were not found to have statistical significance in early onset OM compared to later onset OM. This study found correlation between EOM and hearing loss and identified allergy, low social status and chronic exposure to overcrowding through increased number of children in the household significant risk factors for future research focus. This may help in controlling the prevalence of hearing loss accompanying CSOM.     

Genetic background and the risk of otitis media

Objective

Otitis media is a multifactorial disease where genetic background may have an important role. For genome-wide association studies, it is important to understand the degree of heritability. The objective of this study was to estimate the heritability of recurrent acute otitis media and chronic otitis media with effusion.

Methods

Children operated because of recurrent or chronic otitis media at the Helsinki University Central Hospital, Finland, as well as their families were recruited during 2008-2009. A cohort of 2436 subjects was enrolled consisting of 1279 children and their parents. The study subjects answered a questionnaire concerning their otitis media history and treatment, as well as tobacco exposure, allergy and asthma history. Heritability estimates were calculated for recurrent acute, chronic and any episodes of otitis media using software especially designed for estimating heritability in family cohorts.

Results

Altogether 901 subjects suffered from recurrent otitis media and 559 from chronic otitis media with effusion. The heritability estimates in our cohort were 38.5% for recurrent (P = 7.3 × 10⁻⁹), 22.1% for chronic (P = 4.6 × 10⁻³) and 47.8% for any otitis media (P = 1.5 × 10⁻¹¹).

Conclusions

Our results demonstrate a moderately strong and statistically significant genetic component for both recurrent acute otitis media and chronic otitis media with effusion. These results highlight the importance of unraveling the genetic factors for otitis media that are still poorly known.     

Bilateral chronic otitis media

Summary We have compared the clinical presentations and results of operative treatment in 86 patients with bilateral chronic otitis media with findings in 641 patients with unilateral disease. Concomitant conditions such as cleft palate, rhinitis and chronic adenotonsillitis were found significantly more frequently in those patients with bilateral chronic otitis media than in the patients with unilateral disease. Additionally, cholesteatomas in the cases in which both ears were involved were larger than in those cases which only one ear was involved. The overall results of surgery were similar in the bilateral and unilateral cases. The timing of operation in cases of bilateral chronic otitis media and the special problems of operation on an only hearing ear are discussed.     

The changing pattern of otitis media in Korea

From a nationwide survey of otitis media in Korea, 44.52% of the population were found to have some type of otitis media or its sequelae. A high prevalence rate was seen in the age group over 41 years. This finding suggests a strong relationship between socioeconomic status and incidence of otitis media. From a clinical study of surgical cases of otitis media seen in the past 10 years, we have found that the prevalence of chronic otitis media is decreasing every year. However, severity and pathological findings of otitis media were reflected remarkably in a decreased incidence of acute purulent otitis media and an increased incidence of middle ear effusion in children. In recent years our efforts to control chronic otitis media in children have focused on the treatment of chronic middle ear effusion. To prevent the latter condition, it is strongly emphasized that pediatricians and primary care physicians should be competent in diagnosing otitis media as early as possible, and that they should refer appropriate patients to otolaryngologists for further evaluation and management.     

Expression of aquaporins mRNAs in patients with otitis media

Objective: This study analyzed the associations between measured levels of aquaporin (AQP) mRNAs and clinical manifestations in patients with various types of otitis media (OM).

Methods: AQP1, 2, 3, 4, 5, 6, 8, and 10 mRNA levels were assayed by real-time PCR from 57 patients with chronic otitis media (COM), 24 patients with cholesteatomatous otitis media (choleOM), and 82 patients with otitis media with effusion (OME). The relationships of these mRNA levels with the presence of bacteria, the type of hearing loss, and clinical manifestations of OM types were evaluated.

Results: All eight AQP mRNAs were expressed in inflammatory tissue, chole matrix, and effusion fluid obtained from all 163 patients with OM. The levels in OME of AQP2, 4, 6, and 10 mRNA; and the levels in choleOM of AQP1, 3, 4, and 10 mRNA were elevated significantly compared to the corresponding levels in COM (p?p?Conclusions: The levels of expression of AQP mRNA are associated with the pathophysiology of OM.     

Cochlear implantation in patients with chronic otitis media

Objective

Patients with complications of otitis media present a significant challenge to safe cochlear implantation. We describe our experience of cochlear implantation in patients with chronic ear disease, and propose management principles according to the presenting status of the ear.

Methods

Cochlear implantations were performed as treatment for complications of otitis media in seven patients. They consisted of four patients with adhesive otitis media, two patients with an open cavity after surgery for otitis media and one patient with eosinophilic otitis media.The electrodes were inserted by an approach via the external auditory canal in patients with poor growth of the mastoid antrum or adhesion of the tympanum. For the patients with an open cavity, we created a posterior wall for the external auditory canal and perform the mastoid obliteration. Modified Rambo's technique with blind sac closure of the external auditory canal was performed for the case of eosinophilic otitis media as a single-stage procedure.

Results

The post-operative courses were good. However, a post-operative infection developed in one patient who had previously undergone radiation therapy following surgical excision of a cerebellar tumor.

Conclusion

Transcanal approach is effective in a poorly pneumatized mastoid or severe adhesive otitis media.A decision whether implantation as a single-stage or multiple stages depends on the condition of each cases. But there is a possibility of infection even if we selected a stage operation.