慢性肉芽性鼓膜炎的临床分型与治疗

The Clinical Classification and Treatment of Chronic Granular Myringitis

目的探讨慢性肉芽性鼓膜炎的临床分型及治疗方法。方法应用耳内镜对63例67耳慢性肉芽性鼓膜炎进行检查，根据病变不同特征采用搔刮、钳取或／和化学烧灼。结果耳内镜下分为四型：Ⅰ型，局灶性溃疡型，共40耳（59．7％）；Ⅱ型，局灶性息肉型，共21耳（31．3％）：Ⅲ型，鼓膜弥漫型，共5耳（7．5％）；Ⅳ型，外耳道-鼓膜弥漫型，共1耳（1．5％）。随访1月治愈率达95．5％（64／67），无效3耳（4．5％）中2耳（3％）改手术治疗获痊愈，1耳需超过1月治疗痊愈。随访6个月以上复发率6％（4／67）。结论应用耳内窥镜能提高慢性肉芽性鼓膜炎的诊断率，耳内镜下保守治疗取得良好的疗效，并可进行追踪随访。

Objective To approach the clinical classification and treatment of chronicgranular myringitis （CGM）.Methods 63 cases（67 ears） diagnosed as CGM were detected and treated by oto-endoscope. The different treatment techniques including scoraping , clippering or/and chemical cauterization were employed on the basis of the clinical features. Results Oto-endoscopic findings could be typed into four forms： type Ⅰ focal de-epithelization （in 40 ears）, type Ⅱfocal polypoid granulations （in 21 ears）, type Ⅲdiffuse involvement of the tympanic membrane （in 5 ears） , type IVdiffuse involvement of the auditory canal and the tympanic membrane （in 1 ear）.The cure rate was 95.5% （64/ 67） by follow up 1 month, and altering to operation in 2 ears（3%） after treatment ineffective. Recurrence rate was 6% （4/67） with a follow-up period of more than 6 months. Conclusion Otoendoscopy can elevate the accuracy of diagnosis of CGM. It is convenient and cure rate with expectant treatment under oto-endoscope, is high . It is also helpful for postoperative observation.