易漏诊的隐匿性中耳炎

Missed Diagnostic Masked Otitis Media and Mastoiditis

目的探讨隐匿性中耳炎的临床特点,避免误诊。方法回顾分析13例隐匿性中耳炎患者的临床资料,从病史、鼓膜检查、听功能检测、颞骨CT及手术所见等方面总结分析其特征。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,均以听力下降、耳闷、耳鸣、耳痛等症状就诊,病程8天～2个月;纯音听阈显示4耳为传导性听力损失,9耳为混合性听力损失,0.5～4kHz气导平均听阈为44.15±4.50dB HL;鼓室导抗图B型12耳,C型1耳;颞骨CT显示鼓窦、乳突区密度增高;术中见2耳上鼓室有包裹性积液及肉芽,9耳上鼓室、鼓窦、乳突腔有肉芽组织,部分听骨链中断,2耳乳突腔见胆脂瘤。手术清除病变,解除引流通道的阻塞,13例均治愈,随访6个月至3年,无复发。结论易漏诊的隐匿性中耳炎无明显临床症状,对于有反复原因不明的耳痛、耳闷感、耳鸣、听力下降等症状者,无论鼓膜完整与否,均应早期行听力及高分辨率颞骨CT扫描等检查以确诊;手术是该病有效的治疗方法。

Objective To investigate the clinical characteristics of masked otitis media and mastoiditis and to avoid misdiagnosis. Methods The clinical data of 13 cases with masked otitis media and mastoiditis were studied retrospectively. Results All of the 13 cases had no past history of otorrhea.All cases were free of pathologic changes in the tympanic membrane and external acoustic meatus.Hearing loss,ear stuffiness,tinnitus and earache were the main symptoms.The course of disease was from eight days to two months.Pure tone test results showed four ears with conductive hearing loss and 9 ears with mixed hearing loss,the average hearing threshold of air conduction were 44.15 ± 4.50 dB HL for 0.5 ~ 4 kHz.Twelve ears had type B and 1 ear had type C tympanogram.The CT scan showed increased density in mastoid antrum and mastoid.Effusion and granulation were found in epitympanum in 2 ears,granulation were found in epitympanum,mastoid antrum and mastoid cavity in 9 ears and the part of the ossicular chain were disrupted.In addition,cholesteatoma were found in 2 ears.Surgery focused on eradicating irreversible lesions and improving middle era ventilation.During the 6 months to 3 years follow-up,no relapse was observed. Conclusion The cases with the masked otitis media and mastoiditis lacked of obvious clinic symptoms.If the patient have the unexplained symptoms of earache,ear stuffiness,tinnitus and hearing loss,regardless of the tympanic membrane integrity or not,CT is valuable for the earlier diagnosis and surgely is an effective way for treating of masked otitis media and mastoiditis.