鼻窦炎在慢性化脓性中耳炎脓毒症病程中的角色分析

Role of sinusitis as focus of sepsis in the patients with tubotympanic type of chronic suppurative otitis media

目的观察研究鼻窦炎在咽鼓管鼓室型慢性化脓性中耳炎患者病程中的作用。方法回顾性分析2014年1月至2015年12月间本院收治的700例咽鼓管鼓室型慢性化脓性中耳炎患者的临床资料。所有患者年龄20~40岁,耳道分泌物外流>2个月伴听力降低25~40 db。口服抗生素治疗后,X射线确诊乳突炎患者继续行鼻内镜和鼻旁窦计算机断层扫描。结果700例咽鼓管鼓室型慢性化脓性中耳炎患者中,280例(40%)患者鼻中隔偏曲,其中380例(54.28%)患者耳道分泌物类型为黏脓性分泌物。鼻旁窦CT扫描显示:340例(48.57%)为Ⅰ期鼻窦炎,160例(32.86%)为Ⅱ期鼻窦炎,380例(54.28%)患者鼓膜中央大穿孔。结论鼻中隔偏曲、鼻甲肥大、鼻窦内侧钩状病变是咽鼓管鼓室型慢性化脓性中耳炎发展的易感因素。

]Objective To investigate the role of sinusitis as focus of sepsis in the patients with tubotympanic type of chronic suppurative otitis media （ CSOM）. Methods A retrospective research was made on the clinical data of 700 patients with tubotympanic type of chronic suppurative otitis media who were hospitalized from January 2014 to December 2015. All the patients with an age range from 20 to 40 had ear canal discharge for over 2 months complicated with a hearing loss of 25 - 40 db. After antibiotic treatment, the patients who were diagnosed with confirmed mastoiditis by X - ray continued to have nasal endoscopy and computed tomography of para-nasal sinuses. Results Of the 700 cases of CSOM, 280 were patients with deviated nasal septum （40% ） , with 380 cases （54.2 8 % ） having mucopurulent type of ear discharge. Paranasal sinuses CT scanning revealed that 340 cases （48. 5 7 % ）had stage I paranasal sinu-ses, 380 cases （54.28% ）had large central perforation and 460 cases had （65.7 1 % ） edema of middle ear mucosa. Conclusion Devia-ted nasal septum, enlarged middle turbinate and medialised uncinate associated with sinusitis were predisposing factors in the develop-ment of CSOM. For this reason, assessment of sinusitis should be a routine practice in the treatment of CSOM.