结核性中耳乳突炎的临床特征及疗效分析

Analysis of clinical features and treatment outcomes of patients with tuberculous otitis media and mastoiditis

目的 探讨结核性中耳乳突炎的临床特点以及手术疗效.方法 回顾性分析经病理学证实的16例（18耳）结核性中耳乳突炎的临床表现、影像学特征以及治疗方法,并随访其预后.结果 16例（18耳）患者均表现为耳流脓、听力下降,并发重度感音神经性聋患者3例（4耳）,并发周围性面神经麻痹患者3例.16例颞骨高分辨率CT均表现为鼓室、乳突充满软组织密度影,其中骨质破坏11例（12耳）,颞骨内存在死骨7例（7耳）.16例患者中伴发肺结核7例.15例患者接受了手术治疗去除病灶并联合抗结核治疗.除2例患者术前经穿孔的鼓膜取活检明确诊断为结核性中耳乳突炎外,其余14例患者均为术中或者术后确诊.除1例患者失访外其余15例患者均随访1年以上,中耳乳突结核无复发,3例面神经麻痹患者基本恢复正常.结论 对于顽固性耳流脓,影像学提示鼓室、乳突充满软组织密度影且存在骨质破坏或者死骨者,应仔细询问是否有结核病史,以便鉴别结核性中耳乳突炎.手术去除病灶并结合抗结核治疗对该病有较高的治愈率.

Objective To analyze the clinical features and the surgical treatment outcomes of patients with tuberculous otitis media and mastoiditis. Methods The medical records of 16 patients （18 ears） with tuberculous otitis media and mastoiditis, who received surgery in Beijing Tongren hospital,were reviewed. Results The common symptoms were otorrhea and hearing loss, and 3 patients demonstrated severe sensorineural hearing loss. Three patients demonstrated a peripheral-type facial palsy.Temporal bone high resolution CT scans demonstrated the entire tympanum and mastoid air cells were occupied by soft tissue. Eleven patients demonstrated bone destruction and sequestra was found in 7 temporal bones. Contemporary pulmonary tuberculosis were diagnosed in 7 of the 16 patients. Surgical removal of disease lesions in combination with anti-tuberculosis treatment were given to 15 patients. Other than 2 cases of tuberculous otitis media and mastoiditis diagnosed by pre-operational biopsy through the perforated tympanic membrane, the remaining 14 cases were diagnosed intra-oporatively or post-operatively. No relapse of tuberculosis in the middle ear and mastoid were found after follow-up for more than 1 year, except for the one case that was lost to follow-up. The 3 cases of facial nerve palsy almost recovered to normal.Conclusions Clinicians should suspect tuberculous otitis media and mastoiditis if clinical findings include refractory otorrhea, total occupation of the tympanic cavity and mastoid ari cells by soft tissue, and erosion of the bone or sequestra as shown by CT. A history of tuberculosis should be asked carefully in order to differentiate tuberculous otitis media and mastoiditis. The patients who received surgery and anti-tuberculosis chemotherapy achieved more rapid healing of the ear.