儿童急性中耳炎并发耳后骨膜下脓肿的临床分析

Clinical analysis of acute otitis media with postauricular subperiosteal abscess in children

目的 分析儿童急性中耳炎并发耳后骨膜下脓肿的临床特点和治疗方案。方法 回顾性分析2010年9月—2020年8月住院治疗的9例急性中耳炎并发耳后骨膜下脓肿患儿的临床资料,分析可能的致病原因、致病菌和治疗措施。结果 9例患儿发病前均有上呼吸道感染史,出现耳部症状至入院治疗病程2~3周。2例鼓膜完整患儿采用乳突切开并鼓膜切开置管术,另7例鼓膜穿孔溢脓患儿采用脓肿切开引流及每日换药。脓液细菌培养示肺炎链球菌5例,咽峡链球菌2例,2例未见细菌生长。术后住院7~10 d,耳后肿胀消退,外耳道流脓停止。随访12~18个月,9例患儿均未见复发,疗效均满意。结论 儿童急性中耳炎并发耳后骨膜下脓肿,治疗方法以脓肿切开引流或乳突切开术为主,辅以静滴抗生素,绝大部分预后良好。

Objective To analyze the clinical characteristics and treatment of acute otitis media with postauricular subperiosteal abscess in children.Methods The clinical data of nine children with the diagnosis of “acute otitis media, postauricular subperiosteal abscess” hospitalized from September 2010 to August 2020 were retrospectively analyzed, inluding the possible etiology, pathogenic bacteria and treatments.Results All nine children had a history of upper respiratory tract infection before the onset, and the course of middle ear symptoms to admission was 2-3 weeks. Two case with intact tympanic membrane was treated with mastoidectomy, myringotomy and ventilation tube insertion. Seven cases with tympanic membrane perforation and pyorrhea were treated with incision and drainage of abscess, and the daily dressing change. The results of bacterial culture of the pus showed that five cases of Streptococcus pneumoniae, two cases of Streptococcus anginosus, and two cases without bacterial growth. After hospitalization for 7-10 days, the swelling subsided and the purulence stopped. The patients were followed up for 12-18 months. The therapeutic effect was satisfactory without recurrence in all 9 cases.Conclusions Acute otitis media with subperiosteal abscess in children is mainly treated by abscess incision or mastoidotomy, supplemented with intravenous antibiotics. Most children with the disease have a good prognosis.