隐匿性中耳炎的诊断与治疗

Diagnosis and treatment of latent otitis media

目的探讨隐匿性中耳炎的诊断及治疗方法,提高隐匿性中耳炎的诊治效果。方法回顾性分析我院1994年1月～2005年12月经手术治疗和病理证实的15例隐匿性中耳炎患者的临床资料,总结其病因及临床特点。结果所有病例无明显耳漏病史,鼓膜和外耳道局部无明显阳性体征发现,3例急性发作时有鼓膜充血,1例伴鼓膜穿孔及脓液搏动。听力损失多为传导性聋。颞骨CT扫描示病变主要集中在上鼓室和鼓窦,4例病变充满乳突气房及鼓室、鼓窦。主要症状为听力渐进性下降、头闷痛、耳闷堵塞感及耳鸣等。术中探查中耳气房内有肉芽组织10例,其中4例伴有积液及胆固醇肉芽肿;另2例为胆脂瘤病变。手术主要是清除病变,解除引流通道的阻塞并一期行鼓室成形术。术后随访6个月～5年,病变无复发,听力平均提高16.3dB。结论应提高对隐匿性中耳炎的认识,对不明原因的听力下降及局部胀痛不适者应行纯音听力测试、声导抗检查及高分辨率颞骨CT扫描。高分辨率颞骨CT扫描可作为诊断隐匿性中耳炎的主要手段,手术是有效的治疗方法。

OBJECTIVE To investigate the diagnosis and treatment of latent otitis media. METHODS The clinical data of 15 cases （16 ears） with latent otitis media from Jan. 1994 to Dec. 2005 were studied retrospectively. RESULTS All of the15 cases had no past history of otorrhea. All cases were free of pathologic changes in the tympanic membrane and external acoustic meatus. Most of the patients showed conductive deafness. The pathologic changes in the epitympanum and mastoid antrum were evident on temporal bones CT scan. The predominant finding at mastoidectomy was granulation tissue filling the mastoid cavity and antrum. Operation focused on eradicating lesions and improving middle ear ventilation. During 0.5 to 5 years follow up, no recurrences were found. The air hearing threshold in all cases was improved in an average of 16.3dB. CONCLUSION It is important to disseminate the knowledge of latent otitits media. Temporal bone CT scans is a valuable method for diagnosing latent otitis media and operation is the effective way for treating latent otitis media.