摘要
目的:提高对慢性中耳炎真菌感染的重视并进行合理治疗。方法:回顾性分析2003年1月-2007年12月确诊为慢性中耳炎真菌感染的患者共36例(39耳),分析致病真菌的菌种、治疗方法和疗效。结果:36例(39耳)取中耳分泌物真菌培养,丝状真菌25例(27耳),酵母样真菌11例(12耳)。本组中手术加局部治疗(拒绝口服抗真菌药物)1耳,手术加口服伊曲康唑冲击治疗35耳(双耳慢性中耳乳突炎真菌感染未手术侧),口服伊曲康唑冲击治疗3耳。随访3～36个月,1耳拒绝口服伊曲康唑,术后3周患耳搏动性流脓发作,反复发作3次;手术加口服伊曲康唑35耳中,2耳分别于术后4个月和6个月复发,给予局部过氧化氢冲洗后涂抹达克宁软膏3周后再次干耳;未手术的3耳口服伊曲康唑后干耳,无复发,且有1耳鼓膜穿孔自行愈合。结论:对持续耳漏抗细菌治疗无缓解者,应考虑真菌感染可能,尽早取分泌物涂片镜检或真菌培养;确诊为慢性中耳炎真菌感染者应以局部治疗为主,辅以全身治疗,上述治疗不能缓解或伴有骨质破坏者可联合手术彻底清除病变组织、缩窄乳突腔及鼓室成形以提高听力。
Objective：To diagnose the mycotic otitis media correctly and to explore the most adequate treatment for the disease. Method： Thirty-six inpatients （39 ears） with mycotic otitis media in Nanjing Drum Tower Hospital from Jan. 2003 to Dec. 2007 were analyzed retrospectively. Morphous of the fungi, the methods and efficacies of the treatment were analyzed respectively. Result：According to the fungal cultures, 27 ears were induced by mold fungus and 12 ears were induced by budding fungus. Among these 36 patients （39 ears）, myringoplasty accompanied local antifungal cream were applied in on e ear, mastoidectomy with canal wall down and/or tympanoplasty accompanied with oral antifungal medication were administrated in 35 ears, only oral antifungal drugs were used in 3 ears （the contral ear of the bilateral mycotic otitis media, which was not treated by surgery）. All of the patients were followed up for 3 to 36 months, otorrhea occurred in the patients who refused to oral antifungal medication for 3 weeks after the myringoplasty, then dry again by local antifungal cream, but otorrhea recurred 3 times within 2 years. Thirty-five patients （38 ears） acquired dry ear after surgery and/or oral antifungal drugs, but 2 of the 38 ears recurred separately at the fourth and sixth month after their surgeries, then dry again by irrigation with hydrogen peroxide and by administrating local antifungal cream for 3 weeks. Conclusion： Otologists should ele vate suspicion of mycotic otitis media when they meet patients with continuous otorrhea and patients who did not respond to the antibacterial treatment. The diagnosis based on microbiological findings, such as direct microscopy or fungal cultures should be done as soon as possible. If the otomycosis is decided, we suggest that topical treat ment should be selected firstly, although most patients in present study were treated by surgery accompanied with oral antifungal medications. If there is obvious bone erosion, surgery is necessary to excise the pathological tissues, minificate the mastoid cavity and close the middle cavity in order to improve the hearing and prevent the infection from the outer ear.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2009年第1期11-13,共3页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
中耳炎
慢性
真菌性
诊断
治疗
otitis media, chronic, mycotic
diagnosis
treatment
