Title: [Clinical analysis of complications of suppurative otitis media in children].
Abstract: Objective:To summarize and analyze the clinical manifestations and surgical treatment for complications of suppurative otitis media in children. Method:The characteristic of 35 children under 14 years old with suppurative otitis media who had no response to conservative treatment were analyzed retrospectively. Of the patients, 23 cases(65.7%) with subperiosteal abscess, 7 cases (20.0%) with peripheral facial paralysis, 2 cases(5.7%) with brain abscess, 1 case(2.9%) with Bezold abscess, 1 case(2.9%) with labyrinthitis, 1 case (2.9%) with sigmoid sinus thrombophlebitis. Thirty cases(85.7%) were less than 5 years old. The operation methods included mastoidotomy(17 cases), mastoidotomy combined with grommet insertion(12 cases), canal wall up mastoidectomy(4 cases), canal wall down mastoidectomy(2 cases). Result:CT examination showed that 6 cases of middle ear infection complicated with extensive bone destruction in mastoid process, middle cranial fossa base and auditory ossicles. The severity of hearing loss was positively correlate to the presence of auricular meatus purulence(P<0.05), but not to the onset time of hearing loss, disease duration and the bacteria species(P>0.05). After a 6 months postoperative follow-up, all the wounds were well recovered. 26 patients received audiology tests at 3 months after operation, 18 cases with normal hearing or mild conductive hearing loss preoperatively had normal hearing after operation, 2 cases with moderate conductive hearing loss had a 10-15 dB HL increase in air-bone gap after operation,hearing reconstructions surgery was not performed in 1 case of severe mixed hearing loss and 1 case of moderate conductive hearing loss due to serious damage in the middle ear structure, therefore no significant improvement in hearing in these two cases,four cases with extremely severe hearing loss before the operation had no hearing improvement, while nine cases did not provide the hearing results. Conclusion:The symptoms of otitis media in children were not obvious while the complications could be severe, especially in younger children. Repeatedly auricular meatus purulence may indicate hearing impairment. Microbiological examination should be conducted at the early stage, and prompt treatment should be performed based on hearing and temporal bone CT scan to prevent irreversible complications and sensorineural hearing impairment.目的:总结并分析儿童化脓性中耳炎并发症的临床表现及手术治疗方法。 方法:回顾性分析14岁以下经保守治疗无效的35例化脓性中耳炎患儿的资料,35例均伴有颅内外并发症,其中单纯骨膜下脓肿23例(65.7%),周围性面瘫7例(20.0%),脑脓肿2例(5.7%),Bezold脓肿1例(2.9%),迷路炎1例(2.9%),乙状窦血栓性静脉炎1例(2.9%)。≤5岁者30例(85.7%)。手术方式包括乳突切开术(17例)、乳突切开术联合鼓膜置管术(12例)、完璧式乳突切开及鼓室成形术(4例)、开放式乳突切开及鼓室成形术(2例)。 结果:CT检查提示6例患儿中耳感染合并乳突、中颅窝底和听小骨广泛骨质破坏。听力学改变的严重程度与耳道流脓具有相关性(P<0.05),与术前是否存在听力下降的临床主诉、病程长短、细菌培养结果等相关性均无统计学意义(P>0.05)。术后0.5、1、6个月随访,所有患儿伤口恢复良好。26例有术后3个月的听力学报告,其中18例术前听力正常及轻度传导性听力下降患儿术后复查听力正常,2例中度传导性听力下降患儿术后听力气骨导差提高10~15 dB HL,1例重度混合性听力下降及1例中度传导性听力下降患儿中耳结构破坏严重,术中无条件重建,手术侧听力无明显改善,4例术前极重度听力下降患儿术后听力无改善;9例未提供听力结果。 结论:儿童中耳感染往往症状隐匿,并发症严重,尤其是低龄儿童,反复耳道流脓提示听力损伤的可能性更大。临床应尽早完善微生物检查及培养,根据听力及颞骨CT检查及时治疗,防止严重不可逆的颅内外并发症及感音神经性听力损失的发生。.
Publication Year: 2020
Publication Date: 2020-07-01
Language: en
Type: article
Indexed In: ['pubmed']
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