216例外耳道真菌病病例诊断与治疗

Diagnosis and Treatment of Otitis Externa Mycotica: Experiences with 216 Cases

目的分析216例外耳道真菌病病例,为外耳道真菌病的诊断及治疗提供帮助。方法收集2013年8月至2017年9月间我科门诊病例216例,所有病例的主要症状为耳痒反复发作,病程5-72d。所有病例均实施病史询问体格检查及患耳外耳道分泌物真菌镜检或真菌培养。216例病例被随机分为二组,一组为三药合用组115例(129耳),另一组为二药合用组101例(112耳),三药合用组药物是硝酸咪康唑乳膏+糠酸莫米松乳膏+氧氟沙星眼膏,二药合用组药物为硝酸咪康唑乳膏+糠酸莫米松乳膏,所有病例实施治疗20-48d。结果所有病例鼓膜完整。216例病例患耳分泌物真菌镜检或真菌培养结果阳性。其中35例真菌镜检结果阴性病例真菌培养结果阳性。经治疗三药合用组治愈97人,有效13人,总有效率为95.65%(110/115)。二药合用组治愈69人,有效16人,总有效率为84.16%(85/101)。两组总有效率存在显著性差异,三药合用组总有效率高于二药合用组(P<0.01)。结论真菌培养可以有效防止因真菌镜检假阴性而导致的漏诊,对于外耳道分泌物真菌镜检阴性又疑似OEM的患者应实施外耳道分泌物真菌培养。抗真菌药+激素+抗细菌药联合应用对OEM的治疗,其疗效优于抗真菌药+激素。密切接触真菌感染源可能是OEM复发的重要原因之一。

Objectives To report author’s experiences in diagnosis and treatments of Otitis Externa Mycotica(OEM).Methods Two hundred and sixteen patients,who had recurrent itching in ear as the main complaint,presented to the Department of Otolaryngology Head and Neck,PLA Army General Hospital,between August 2013 and Septem-ber 2017,with a disease course from 5 to 72 days.All the patients received a questionnaire interview and were subjected to microscopic fungal examination or culture of concha secretions.Patients were randomly selected to receive a three-drug combination(miconazole nitrate cream,furoic acid loperamide hydrochloride cream and Ofloxacin eye oint-ment)(n=115,129ears)or a two-drug combination(miconazole nitrate cream and furoic acid loperamide hydrochloride cream)(n=101,112ears)treatment for 20-48 days.Results The eardrum was intact in all patients.Concha secretions were positive of fungi from microscopic examination or culture in all 216 patients.Mmicroscopic examination was nega-tive in 35 patients.Itchiness and external auditory canal skin lesions were completely resolved in 97 and improved in 13 patients,respectively,following treatments in the three drug treatment group,with a combined rate of effectiveness at 95.65%(110/115).In the two drug treatment group,itchiness and skin lesion completely resolved in 69 patients and im-proved in 16 patients,yielding a combined rate of effectiveness of 84.16%(85/101).There was significant difference be-tween the two groups(P<0.01).Conclusion Fungal culture can effectively prevent missed OEM diagnosis in patients with false negative concha secretions microscopic examination and should be considered in suspected cases when micro-scopic fungal examination is negative.For OEM treatment,a combination of antifungal drugs with steroids and antibiotics is superior over a combination of antifungal drugs with steroids alone.Close contact with the source of fungal infec-tion may be one of the important reasons for recurrence.