结核性中耳乳突炎的临床特征分析

目的 探讨结核性中耳乳突炎的临床特征及治疗措施,提高对该病的认识,从而减少误诊.方法 回顾分析9例（9耳）结核性中耳乳突炎患者的临床表现、影像学特征及治疗方法.结果 9例患者均有耳漏病史,6例有大量粘稠脓性分泌物,8例听力下降,1例患几年龄小未测,2例周围性面瘫.9例颞骨高分辨CT均表现鼓室、鼓窦、乳突软组织密度影,其中明显骨质破坏6例,颞骨内存在死骨1例,2例有结核病史.8例接收手术治疗去除病灶,并联合抗结核治疗;1例有急性粟粒性肺结核未手术行单纯药物治疗.除1例术前取耳道分泌物镜检证实为结核性中耳乳突炎外,其余均为术后病检确诊.9例患者随访6个月～15年症状均消失,无复发.结论 结核性中耳乳突炎是一种少见疾病,其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,避免误诊.手术去除病灶并结合抗结核治疗对该病有较高的治愈率.

Analysis of the clinical features of nine cases of tuberculous otitis media and mastioditis

Objective To analyze of the clinical features and treatment outcomes patients of tuberculous otitis media and mastioditis,and increase awareness of the disease and reduce misdiagnosis.Methods The clinical data of 9 cases （9 ears）with tubercular otitis media and mastoiditis were reviewed.Results Nine patients had otorrhea history.8 patients demonstrated hearing loss and 2 patients demonstrated a peripheral-type facial palsy.Temporal bone high-resolution CT scans demonstrated the entire tympoanum and mastoid air cells were occupied by soft tissue,six patients demonstrated bone destruction and one sequestra was found.Two cases （2 ears） have a history of tuberculosis.Surgical removal of disease lesions in combination with anti-tuberculousis treatment were given to 8 patients.One patients acute miliary tuberculosis-line drug therapy alone without surgery.Other than 1 cases of tuberculous otitis media and mastoiditis diagnosed by the ear canal secretions microscopy,the remaining 8 cases wered diagnosed post-operatively.Nine patients were followed up for 6 months-15 symptoms disappeared and no recurrence.Conclusion Tuberculous otitis media and mastioditis is a rare disease.The clinical features of tubercular otitis media and mastoiditis was similar easily confused with chronic suppurative otitis media.