胆脂瘤型中耳炎颅内外并发症的临床分析

Clinical analysis of extracranial and intracranial complications of choleseatoma otitis media

目的 探讨胆脂瘤性中耳炎引起颅内外并发症的临床特点和处理方法。方法 1992年 1月— 2 0 0 2年 12月解放军总医院耳鼻咽喉 头颈外科共收治胆脂瘤型中耳炎患者 5 76例 ,其中出现颅内外并发症 78例 ,对其临床资料进行回顾性分析。结果 78例患者中单项并发症者 5 6例(71 8% ) ,2项以上并发症者 2 2例 (2 8 2 % )。总计 92例次 :其中周围性面瘫 2 4例 ,迷路炎 16例 ;脑膜炎 12例 ;耳周围脓肿 11例 ;硬膜外脓肿 9例 ;脑脓肿 9例 ;乙状窦病变者 6例 ,颈部脓肿 5例。 2 4例面瘫患者中的 15例面神经连续性存在行面神经减压 ,其中 11例明显恢复 (73 3% ) ,面神经功能由Ⅳ级恢复到Ⅱ级 ,其余 4例术后无明显恢复 ;9例术中面神经已离断 ,行面神经吻合术 4例 ,耳大神经移植术 3例 ,舌下神经吻合术 2例 ,面神经功能均由Ⅴ～Ⅵ分级恢复到Ⅱ～Ⅲ。耳周围脓肿、硬膜外脓肿、脑脓肿、乙状窦病变、颈部脓肿经过手术一期处理均治愈 ,无死亡病例。结论 虽然胆脂瘤型中耳炎颅内外并发症的患病率和严重并发症较前已明显下降 ,但临床上仍不少见 ,而且并发症的种类分布出现变化 ,以面瘫和迷路瘘管居多 ;颞骨CT检查是颅内外并发症重要的诊断依据 ;外科手术是主要的治疗方法 。

Objective To study the clinical feature of extracranial and intracranial complications caused by choleseatoma otitis media.Methods A retrospective study as made of 78 patients with extracranial and intracranial complications caused by suppurative otitis media between January 1992 and December 2002 was conducted.Results Fifty six of the 78 patients had one complication and the other 22 patients had two or more complications among them. In this series,24 cases had facial paralysis,16 cases with suppurative labyrinthitis, 12 cases with meningitis, 11 cases with periauricular abscess, 9 cases with extradural abscess, 9 case with otogenic meningitis brain abscess, 6 case with lesion of sigmoid sinus and 5 cases with Bezold abscess. Of the 24 patients with facial paralysis, 15 with continued nerves had obtained omatomic preservation of the facial nerves, The nerve function of 11 patients recovered from House Brackmann grade Ⅳ to grade Ⅱ, the rest 4 patients didn′t regain after operation. Four of the 9 patients with their facial nerves broken received anostomosi of the facial nerves, three cases received transplantation of the nervus auricularis magnus, and two received anostomosis to nervus auricularis magnus. The nerve function recovered from House Brackmann grade Ⅴ Ⅳ to grade Ⅲ. Conclusions Even though the incidence of the complications has been low down in past years, there are still some serious complications. Temporal bone CT scan plays an important role in the diagnosis of extracranial and intracranial complications of choleseatoma otitis media. The most reliable method to diagnosis and treat the complications is surgery.