无明显耳漏症状的胆脂瘤型中耳炎17例临床分析

Clinical analysis of 17 cases with cholesteatomatous otitis media without obvious otorrhea

目的 探讨无明显耳漏症状的胆脂瘤型中耳炎临床特征 ,提高诊断水平。方法 回顾性分析 17例(17耳 )经手术及病理证实的本病临床资料。结果 17例中 12例无耳漏史 ,3例幼年时及 2例发病早期曾有短时耳漏。鼓膜看不到穿孔 4例 ,松弛部及紧张部后上方有轻微体征 13例 ,其中瘢痕及内陷囊袋各 3例 ,上皮痂、耵聍覆盖 5例 ,针尖样穿孔 2例。听力下降以轻、中度传导性聋为主。鼓室导抗图为B型。CT诊断符合率为 76 .5 %(13/17)。结论 无明显耳漏症状的胆脂型中耳炎常以无明显耳漏 ,轻、中度听力下降及鼓膜体征轻微为主要临床特征 ,易发生漏诊、误诊。轻、中度听力下降可为其唯一症状 ,也是诊断的重要线索。仔细检查鼓膜并结合影像学资料综合分析才可减少漏诊 。

Objective To investigate the clinical features of cholesteatomatous otitis media without obvious otorrhea and to improve diagnosis. Methods The clinical data of 17 cases (17 ears) were analysed without obvious otorrhea proved cholesteatomatous otitis media by surgery and pathology. Result Of the 17 patients, 12 had no obvious otorrhea, 3 otorrhea in their childhood and 2 only in the early term of the disease for a short time. There were no perforation of tympanic membrane in 4 cases, only slight findings such as attic retraction, ear wax covered or tiny perforation in the pars flaccide or the superior and posterior pars tens in 13 cases. The hearing loss was slight or medium conductive deafness. Tympanogram was type B. The diagnosis rate of CT was only (76.5%) (13/17). Conclusion The patients with the cholesteatomatous otitis media without obvious otorrhea are easily to be misdiagnosed because of obvious otorrhea lacked, slight or medium hearing loss and slight signs of tympanic membrane. Slight or medium hearing loss may be the only clinical symptom and also an important cluc to the diagnosis. Combining careful examination of tympanic membrane and CT scan or MRI is of importance to avoid misdiagnosis and otogenic complications.