结核性中耳炎误诊原因分析（附2例报告）

发布时间：2018-07-23 18:47

【摘要】： 目的：探讨结核性中耳炎的误诊原因,加深对结核性中耳炎的认识和警惕性,减少该病漏、误诊,达到早期治疗,减少并发症发生、提高治愈率。方法：回顾分析2例误诊的结核性中耳炎患者的临床表现、辅助检查、影像表现及处理方法、随访情况、误诊原因,并进行文献复习, 结果：2例病人术前均误诊为“慢性化脓性中耳炎(肉芽肿型)”,术后经病理才正确诊断。经“乳突根治术”联合抗结核治疗1年后,临床症状基本消失,术腔上皮化,病情痊愈。结论：“结核性中耳炎”病例较少见,临床医生经验少,近来临床表现不典型,影像学检查常无特异表现,检测手段受限,容易误诊、漏诊,对“慢性中耳炎”患者有以下情况者需提高警惕：1、病程短、无明显发病诱因；2、抗生素治疗效果不佳,容易复发；3、肉芽呈苍白色；4、早期出现严重听力下降甚至感音神经聋者；5、颞骨CT提示骨质破坏严重,特别是出现死骨者；6)有结核病史或既往史、结核接触史者,特别是婴幼儿未接种卡介苗而出现结核中毒症状者：7)面瘫发生早者；应及时行耳道分泌物结核杆菌培养、PCR、PPD、胸片、结核抗体、鼓室肉芽活检等检测进一步检查排除确诊,以免漏诊。确诊后,治疗包括全身和局部抗结核治疗药物的应用、手术治疗和支持治疗。对于急性开放性肺结核合并结核性中耳炎时,早期有效的抗结核治疗可以防止严重的听力损失及并发症的发生。对那些引流通畅、无并发症的结核性中耳炎患者应积极抗结核治疗。对于合并有中耳胆脂瘤,或引流不畅、抗结核治疗无效,或合并有颅内外并发症者,则应及时手术治疗,同时联合抗结核治疗。
[Abstract]:Objective: to explore the causes of misdiagnosis of tuberculous otitis media, deepen the awareness and vigilance of tuberculous otitis media, reduce the leakage, misdiagnosis, achieve early treatment, reduce complications and improve the cure rate. Methods: two cases of tuberculous otitis media who were misdiagnosed were analyzed retrospectively. The results showed that the two patients were misdiagnosed as "chronic suppurative otitis media (granulomatous type)" before operation. After 1 year of radical mastoidectomy combined with anti-tuberculosis treatment, the clinical symptoms were basically disappeared, the operative cavity epithelized and the condition cured. Conclusion: the cases of tuberculous otitis media are rare, the clinicians have less experience, the recent clinical manifestations are not typical, the imaging examination often has no special manifestation, the examination method is limited, and it is easy to misdiagnose and miss diagnosis. The patients with "chronic otitis media" need to be on guard against the following conditions: the disease course is short, there is no obvious inducement, antibiotic treatment is not good, easy to relapse, granulation is pale; (4) severe hearing loss or even sensorineural deafness occurred in early stage. Temporal bone CT showed that bone destruction was serious, especially in those with dead bone. In particular, children who had tuberculosis poisoning symptoms without BCG vaccination) had early onset of facial palsy; they should be examined in time for PCRRPPDs, chest films, tuberculosis antibodies, granulation biopsies in tympanic chambers and other tests to remove the diagnosis of diagnosis. Avoid missed diagnosis. After diagnosis, treatment includes systemic and local antituberculous drug use, surgical treatment and support therapy. For acute open pulmonary tuberculosis complicated with tuberculous otitis media, early effective antituberculous treatment can prevent severe hearing loss and complications. Patients with tuberculous otitis media with unobstructed drainage and no complications should be actively treated with anti-tuberculosis therapy. For those complicated with middle ear cholesteatoma, poor drainage, ineffective antituberculous treatment, or complicated with extracranial complications, surgical treatment should be performed in time and combined with antituberculous therapy.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764.21

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