曲安奈德益康唑乳膏局部涂布治疗外耳道真菌病

目的 探讨曲安奈德益康唑乳膏局部涂布治疗外耳道真菌病的有效性.方法 回顾总结132例(178耳)曲安奈德益康唑乳膏局部涂布治疗外耳道真菌病的临床资料.结果曲安奈德益康唑乳膏局部涂布治疗外耳道真菌病治愈率81.46%、好转率17.42%,总有效率98.88%.结论 曲安奈德益康唑乳膏局部涂布治疗外耳道真菌病方法合理,疗效肯定,简便易行且安全、经济.     

曲安奈德益康唑乳膏不同用药方法治疗耳部真菌病

目的　探讨曲安奈德益康唑乳膏不同用药方法对耳部真菌病的临床治疗效果。方法　选择经涂片及镜检确诊的伴鼓膜穿孔的耳部真菌病86例,随机分为观察 组和对照组,各43例。观察组耳内镜下清除外耳道真菌及分泌物后将曲安奈德益康唑乳膏置于明胶海绵上,再均匀贴于真菌感染的外耳道或残余鼓膜表面;对照组嘱患者将曲安奈德益康唑乳膏在家自行涂抹于相应部位,每日2次。两组患者每3日来院门诊复查。均治疗2周后,随访３个月,比较各组临床疗效。结果　观察组治愈39例（90.7%）,有效2例（4.7%）,无效2例（4.7%）,总有效率95.3%,随访3个月复发1例（2.4%）。对照组治愈26例（60.5%）,有效1例（2.3%）,无效16例（37.2%）;总有效率62.8%。随访3个月治疗有效的患者复发9例（31.0%）。观察组疗效显著高于对照组（χ2=14.508,P＜0.05）。结论　耳内镜下仔细清理外耳道真菌及分泌物,并准确放置涂有曲安奈德益康唑乳膏的明胶海绵,对伴有鼓膜穿孔的耳部真菌感染,疗效确切。     

复方硝酸益康唑乳膏治疗耳真菌病疗效观察

我科自 2 0 0 0年 2月～ 5月应用复方硝酸益康唑乳膏治疗耳真菌病 46例 ,取得了满意疗效 ,现报告如下。1　资料与方法1 .1 　 临床资料本组 46例均为门诊患者。其中男 2 0例 ,女 2 6例 ;年龄 1 7～ 70岁 ,平均 3 6 .2岁。病程 1 0 d～ 1 5年 ,平均 2 6个月。外耳道真菌病 3 4例 ,慢性化脓性中耳炎并外耳道真菌病 5例 ,乳突根治术后术腔真菌感染 7例 ,3例合并其他部位真菌病。全部患者均有外耳道瘙痒或奇痒 ,胀闷或阻塞感 2 8例 ,耳漏 2 4例 ,耳鸣 1 6例 ,耳痛 9例。检查 :外耳道见灰白色、土黄色或黑色点状、粉末状或绒毛状霉苔 ,或呈筒状薄…     

哌瑞松霜治疗外耳道真菌病的临床观察

外耳道真菌病系指霉菌引起的外耳道炎症，多为麴霉菌感染，可单纯局限于外耳道，严重者可穿透鼓膜进入鼓室或乳突腔。治疗方法有口服咪唑类广谱抗真菌药物，耳内涂用抗霉菌的二性霉素B、克霉唑软膏、达克宁霜等。临床上我们曾用克霉唑软膏及达克宁霜治疗本病。我们从2000年7月～2001年12月用哌瑞松霜治疗本科门诊55例病例进行总结和讨论，并与既往所使用药物进行对照。     

Topical treatment of acute otitis externa: clinical comparison of an antibiotics ointment alone or in combination with hydrocortisone acetate

The study was designed to investigate the potential contribution of hydrocortisone acetate to the efficacy and safety of an antibiotics ointment in the treatment of acute otitis externa (AOE). In a double-blind study 151 patients with a unilateral acute bacterial otitis externa were randomized either to receive an ointment with polymyxin-B sulfate (7,500 I.E./g) + bacitracin (300 I.E./g) alone (AB) or the same antibiotic ointment with 10 mg hydrocortisone acetate/g ointment (AB + HC). Primary efficacy endpoint was the change of an aggregate clinical symptom score (CSS) (subscores: redness, swelling, pain and secretion) found at Visit 2 versus baseline (Visit 1). Secondary outcome parameters were the change of the CSS from Visit 1 to the study termination, and the changes in the subscores and of a visual analog scale for pain. In the group treated with AB + HC, significantly more patients with severe redness [14 (56%) vs. 7 (28%), P = 0.045] or severe secretion [23 (70%) vs. 10 (40%), P = 0.024] at inclusion were symptom-free at the last visit. Fewer pain-relieving tablets (1.1 ± 2.2 vs. 2.3 ± 4.6 paracetamol tablets) were used in the AB + HC-group. In the steroid group there was a slightly larger though not significant reduction in CSS at Visit 2 and Visit 3 versus baseline. Similar results were documented for redness, pain and secretion. No serious adverse events occurred. Both ointments are effective and safe in the topical treatment of AOE. Hydrocortisone acetate combined with the antibiotics improved individual symptoms better as did the steroid-free ointment.     

早期激光联合曲安奈德治疗视网膜颞上支静脉阻塞继发黄斑水肿

目的 探讨早期激光联合曲安奈德治疗视网膜颞上支静脉阻塞继发黄斑水肿的临床疗效。方法 经FFA、OCT检查确诊为视网膜颞上支静脉阻塞继发黄斑水肿的患者42例(42眼),经球旁注射曲安奈德及倍频YAG532激光机进行早期视网膜激光光凝,光凝术后1、3、6个月观察视力、眼压、FFA、黄斑中心凹视网膜厚度。结果 治疗后6个月视力增加37例,不变4例,减退1例。治疗前最佳矫正视力>0.3者11例,治疗后23例。治疗前CMT为(561±104)μm,治疗后6个月为(349±93)μm,差异有统计学意义(P＜0.01)。球周注射曲安奈德后1、3、6个月分别有2、6、1眼眼压增高,滴用降眼压药水后均能控制。结论 早期激光联合球周注射曲安奈德可安全有效地治疗视网膜颞上支静脉阻塞继发黄斑水肿 。     

Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists

Introduction: Necrotising otitis externa (NOE) is a rare infection causing skull base osteomyelitis. The evidence regarding NOE consists mostly of case series. Hence, there is a limited evidence base to guide decision-making. This survey aims to report the experience of 221 otolaryngologists in this condition.

Materials and methods: Internet survey administered to the membership of the British Association of Otorhinolaryngology – Head and Neck Surgery (ENT UK).

Results: Respondents’ detailed replies on diagnosis, treatment and follow up are presented. One third of respondents reported increasing incidence of NOE. Over 80% diagnosed NOE based on pre-existing risk factors, severe pain, non-resolution of infection and CT scan. Most respondents managed NOE with intravenous antibiotics (90%) and blood sugar control (82%). There was less agreement in certain aspects of management including the role of surgery and the nature and duration of follow up.

Conclusions: Our survey provides a picture of NOE management in the UK. While there is consensus in some aspects of NOE management, other aspects attract widely differing answers. This may reflect the lack of strong evidence in the literature. Future work should aim to address this.     

A randomised controlled trial comparing Triadcortyl® with 10% glycerine–ichthammol in the initial treatment of severe acute otitis externa

Acute otitis externa is a common clinical condition accounting for a large proportion of patients attending the otolaryngology department, although milder cases are often managed in primary care. Treatment of the most severe forms of otitis externa involves aural toilet, followed by the application of a topical preparation, commonly in the form of an ear canal dressing. A prospective single-blind randomized controlled trial was performed to compare the efficacy of 10% glycerine-ichthammol (GI) solution and Triadcortyl((R)) (TAC) ointment, both applied as ear canal dressings, in the initial management of severe acute otitis externa. A total of 64 patients were studied. Both treatment modalities were proven efficacious in the treatment of severe acute otitis externa. Although there was a statistically significant improvement of pain parameters in the TAC group, we found no significant differences in clinical findings between the two groups. Therefore, it is recommended that GI dressing can be used instead of an antibiotic dressing as an initial treatment of severe acute otitis externa on the basis of cost, avoidance of resistance and toxicity.     

曲安奈德联合微脉冲激光治疗糖尿病性黄斑水肿

目的〓〖HTK〗观察曲安奈德联合微脉冲激光治疗糖尿病性黄斑水肿的疗效和安全性。〖HTW〗方法〓〖HTK〗据眼底血管造影,对36例（40眼）糖尿病性黄斑水肿患者行黄斑区微脉冲激光治疗,玻璃体腔注射曲安奈德0.1mL(4mg)。随访3个月,观察视力、眼压、前房反应、晶状体及眼底改变,并行荧光素眼底血管造影及干涉光断层扫描仪检查。〖HTW〗结果〓〖HTK〗所有患者视力均提高,其中1例病史3年的患者从0.1提高到0.5,3例出现眼压升高,2例局部滴降眼压药,1例加用口服药后控制。1例出现假性眼内炎。黄斑水肿均减轻。〖HTW〗结论〓〖HTK〗曲安奈德联合微脉冲激光治疗糖尿病性黄斑水肿安全有效。     

A clinical comparison of hydrocortisone butyrate with oxytetracycline/hydrocortisone acetate -polymyxin B in the local treatment of acute external otitis

Summary In a single blind, randomized study, 46 patients with acute external otitis were treated with either oxytetracycline/hydrocortisone with polymyxin B (TPB) or hydrocortisone-17-alpha-butyrate eardrops for 7 days. Pseudomonas pyocyanea, Staphylococcus epidermidis and Staph. aureus were the microorganisms most frequently found in the ear canal. Fungi were not found in any culture. The overall cure rate was 80%. No significant difference in therapeutic efficacy was noted between the preparations except regarding Staph. aureus, which was cultured from 17% of the patients. Although the butyrate solution did not contain any antibiotic supplement, it seemed to be more effective than TPB in treating the staphylococcal infections. These findings suggest that such other factors as the hydrogen ion concentration, the steroid potency or the vehicle per se are of importance for the successful treatment of acute external otitis.offprint requests to: M. Ruth     

混合氧联合药物治疗突发性聋

目的 :探讨混合氧联合药物治疗突发性聋的临床疗效及其可能的治疗机制。方法 :将 5 2例突发性聋患者随机分为混合氧联合药物治疗与单纯药物治疗两组 ,各 2 6例。混合氧治疗为常压下吸入 5 %CO2 和 95 %O2 的混和气体 ,每次吸入 30min后休息 30min ,然后再吸入 30min ,每日如此循环 2次 ,配合使用类固醇激素及扩血管营养神经药物 ;对照组单纯使用上述同类药物治疗 ;比较两组疗效。结果 :治疗组总有效率 76 .9% ,听力开始恢复时间在治疗后 3～ 14d ;对照组总有效率 5 0 .0 % ,听力开始恢复时间在治疗后 6～ 2 3d ,两组总有效率差异有统计学意义 (P <0 .0 5 ) ,听力开始恢复时间差异无统计学意义。结论 :混合氧联合药物治疗突发性聋疗效优于单纯药物治疗     

自体血清联合糖皮质激素眼膏治疗非感染性角膜疾病的疗效观察

目的观察自体血清联合糖皮质激素眼膏治疗非感染性角膜疾病的疗效。方法分析本院2017年10月至2019年5月诊断为非感染性角膜病变患者51例(60只眼)的临床资料及治疗后随访情况。结果自体血清联合糖皮质激素眼膏治疗组中,治疗1周后27例患者眼部症状均明显改善,17例患者角膜荧光素染色阴性,占62.96%,其余10例患者2周后复查,行角膜荧光素染色结果为阴性。自体血清治疗组中,治疗1周24例患者症状改善,13例患者角膜荧光素染色阴性,占54.17%,余11例患者2~3周后复查角膜荧光素染色阴性。以上治疗维持时间均为3周,病情稳定,未见继发感染病例。结论自体血清联合糖皮质激素眼膏治疗非感染性角膜疾病的疗效优于单纯使用自体血清组。     

软骨鼓膜修补联合Ⅲ型鼓室成形治疗粘连性中耳炎

目的探讨软骨鼓膜修补联合Ⅲ型鼓室成形治疗粘连性中耳炎的疗效。方法回顾性分析5 1例接受手术治疗的粘连性中耳炎患者,术中切除粘连的鼓膜及瘢痕组织,去除锤骨、砧骨,行Ⅲ型听力重建,穿孔的鼓膜用全厚耳屏软骨修补。结果5 1例患者均于术后4～6周干耳,鼓膜解剖形态基本正常,但稍厚,活动差。术后3个月纯音测听（0.2 5,0.5,1,2,4 kHz）骨气导差（ABG）为2 3.8 dB,提高了1 8.1 dB。术后1年为1 3.4 dB,提高了2 8.5 dB。随访1年以上,稍厚的软骨鼓膜变薄,活动能力好,无1例穿孔,声导抗测试鼓室图全为As型曲线。结论软骨鼓膜修补联合Ⅲ型鼓室成形治疗粘连性中耳炎效果显著,有临床应用价值。     

完壁式乳突切开联合面隐窝开放治疗儿童分泌性中耳炎

目的 探讨完壁式乳突切开联合面隐窝开放在治疗儿童分泌性中耳炎中的临床价值.方法 回顾性分析2005年6月至2007年6月中山大学附属第二医院耳鼻咽喉头颈外科收治的17例(19耳)反复发作,行鼓膜置管3次以上无效的儿童分泌性中耳炎患者的临床资料,19耳均接受完壁式乳突切开联合面隐窝开放术治疗,其中7耳术中探杳咽鼓管欠通畅,同期行鼓膜置管术,置管后1～3个月拔管.结果 19耳中耳乳突炎性组织的病理检杳结果显示,9耳为中耳胆固醇肉芽肿,10耳为炎性肉芽.术后19耳均获痊愈,鼓膜形态正常.鼓室压图为A型曲线者16耳,C型曲线者3耳,且负压均在150 mm H2O(1 cm H2O=O.098 kPa)内.术后3个月纯音测听骨气导差均在15 dB以内,随访2～3年无复发.结论 儿童分泌性中耳炎如果反复发作,在多次行鼓膜置管无效的情况下,可考虑采用完壁式乳突切开联合面隐窝开放术式彻底清除病灶,从而建立长期有效的咽鼓管、鼓室、鼓窦、乳突的通气引流,该术式有效.