难治性中耳真菌感染的诊治分析

Clinical features and treatment of refractory mycotic otitis media

目的探讨难治性中耳真菌感染的临床特征及治疗方法。方法回顾分析2005年2月～2009年2月难治性中耳真菌感染62例患者(62耳)的临床特征、菌群分布,并将患者随机分为口服伊曲康唑胶囊组(31耳)和涂用硝酸咪康唑乳膏组(31耳)进行疗效对比。结果真菌培养阳性34株,阳性率54.8%(34/62)。真菌培养多为曲霉菌24/34(70.6%)。治疗2周后,涂用硝酸咪康唑乳膏组痊愈21耳,显效2耳,无效8耳,总有效率为74.2%;口服伊曲康唑胶囊组痊愈29例,显效1例,无效1例,总有效率为96.8%。结论难治性中耳炎合并中耳真菌感染属深部真菌感染,主要致病真菌是曲霉菌,口服伊曲康唑胶囊组疗效明显优于涂用硝酸咪康唑乳膏组。

OBJECTIVE To study the clinical features and the treatment of refractory mycotic otitis media. METHODS From February 2005 to February 2009, 62 cases diagnosed as refractory mycotic otitis media were randomly divided into two groups. One group was 31 cases treated with local daubing Miconazole Nitrate Cream and another group was 31 cases treated with oral Itraconazole. The clinical features and fungi of distribution were retrospectively analyzed. RESULTSAspergillus was the most common fungi（70.6%）. After two weeks treatment, 29 cases were cured in the group of Itraconazole, while 21 cases were cured in the group of Miconazole Nitrate Cream. CONCLUSIONRefractory mycotic otitis media is deep-seated mycotic infection and the primary pathomycete was aspergillus. The curative effect with oral Itraconazole was significantly better than that with local daubing Miconazole Nitrate Cream.