慢性肉芽性鼓膜炎(附29例诊疗总结及文献复习)

Chronic granular myringitis (A report of 29 cases and literature review)

目的 探讨慢性肉芽性鼓膜炎的病因及治疗方法。方法 总结经治的29例慢性肉芽性鼓膜炎,分析其病因、主要临床表现、误诊情况及治疗方法,并复习相关文献。结果 外耳道进水及外伤各占69％、13％,细菌及真菌感染各占60％、35％;用耳科杯状咬钳直接清除肉芽组织,或用固体硝酸银烧灼肉芽,能有效地消除肉芽;用自制的冰黄散纱条填于外耳道深部,2周后29例均治愈,其中1例1.5个月内复发。结论 外耳道进水及外耳道皮肤受损为本病的主要诱因;假单胞菌、金黄色葡萄球菌及真菌是主要致病微生物;误诊是由于局部清洁不彻底,对本病认识不足;显微镜下清除肉芽或用固体硝酸银烧灼肉芽安全可靠,冰黄散纱条局部填压能缩短治疗时间。

Objective To determine the etiology and treatment of chronic granular myringitis. Methods A total of 29 cases of myringitis granulosa were examined and the etiology, clinical features, previous misdiagnoses and the treatment were analyzed. Results Water entering the external auditory canal and injury to the epithelia amounted to 69% and 13% of the respective cases. Bacteria and fungus accounted for 60% and 35% of the respective cases. Cauterization granulation with solid silver nitrate was effective. Twenty-nine patients were cured by stuffing the external auditory canal with special gauze strip soaked in special liquid medicine. One patient recurred in a short time. Conclusion Water entering the external auditory canal and injury to the epithelia were the major predisposing factors. The reasons for misdiagnosis were lack of recognition of the condition and not completely cleaning up the external auditory canal. Bacteria and fungus were common causative organisms. It was safe to cauterize granulation with solid silver nitrate. Stuffing the external auditory canal with a special gauze strip soaked in special liquid may shorten the treatment.