儿童隐匿性乳突炎合并乙状窦周围炎的临床特征分析

张星; 陈敏; 张杰; 杨扬; 刘志勇

doi:10.13201/j.issn.1001-1781.2019.12.010

儿童隐匿性乳突炎合并乙状窦周围炎的临床特征分析

- 1. 山西省儿童医院妇幼保健院耳鼻喉科(太原, 030013);
- 2. 国家儿童医学中心首都医科大学附属北京儿童医院耳鼻咽喉头颈外科

详细信息

通讯作者: 陈敏,E-mail:13581886206@163.com

中图分类号: R764.2

收稿日期: 2019-02-01

Clinical features of occult mastoiditis complicated with periphlcbitis of sigmoid sinus in children

- 1 Department of Otolaryngology, Children's Hospital of Shanxi Women Health Center of Shanxi, Taiyuan, 030013, China;
- 2 Department of Otolaryngology Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University

More Information

Corresponding author: CHEN Min, E-mail: 13581886206@163.com

Received Date: 01 February 2019

摘要

摘要: 目的:探讨儿童隐匿性乳突炎合并乙状窦周围炎的临床特点及诊治原则。方法:回顾性分析4例隐匿性乳突炎合并乙状窦周围炎患儿的临床资料。结果:4例患儿均有短暂急性中耳炎病史,因间断头痛/耳后疼痛、乳突区肿胀就诊。查体:鼓膜大体正常,纯音听阈测试听力正常,声导抗B型;颞骨CT可见乳突软组织影,乙状窦壁骨质破坏,核磁增强提示乳突后方囊状病变,囊壁强化,乙状窦受压。在足量、透血脑屏障抗生素抗炎前提下尽早行乳突切开探查术。术后病理均为炎性肉芽,随访12~18个月无复发。结论:短暂急性中耳炎病史、头痛/耳后疼痛伴乳突区肿胀时应考虑隐匿性乳突炎颅内并发症可能,需及时行颞骨影像学及听力检查以明确诊断。治疗原则是在抗感染治疗基础上尽早手术开放乳突,改善引流。
- 儿童 /
- 隐匿性乳突炎 /
- 乙状窦周围炎
Abstract: Objective: To investigate the clinical characteristics and principle of treatment of occult mastoiditis accompanied with periphlcbitis of sigmoid sinus in pediatrics. Result: Four cases, with a short-time acute otitis media history, complained of headache/retroauricular pain, with papillary swelling, diagnosed as occult mastoiditis accompanied with periphlcbitis of sigmoid sinus according to the results of the temporal bone CT and MR. All of them had normal tympanic membrane, normal pure tone threshold, but type B tympanogram. CT scan of temporal bone showed soft tissue shadow of mastoid process, bone destruction of sigmoid sinus wall, and nuclear magnetic enhancement suggested cystic lesion behind mastoid process. With the usage of sufficient amount and anti-inflammatory antibiotics of permeable brain barrier, mastoidectomy were performed as early as possible. All the postoperative pathology showed inflammatory granulation, and no recurrence happened during the follow-up periods of 12-18 months.Conclusion: Intracranial complications in occult mastoiditis should be taken into account, with contemporary acute otitis media history, headache/retroauricular pain, and papillary swelling. Temporal bone image examination and hearing test should be done timely. Once the diagnosis was confirmed, on the basis of anti-infection treatment, the operation should be done as early as possible to to open the mastoid and improve the ventilation drainage of middle ear.
- child /
- mastoiditis /
- periphlcbitis of sigmoid sinus

HTML全文

参考文献(19)

[1]	TOVI F,LANTSBERG S,HERTZANU Y.Bone scanning in masked mastoiditis[J].J Otolaryngol,1992,21:454-457.
[2]	DALY K A,HOFFMAN H J,KVAERNER K J,et aI.Epidemiology,natual history,and risk factors:panel report from the ninth international research conference on otitis media[J].Int J Pediatr otorhinolaryngol,2010,74:231-240.
[3]	PAPARELLA M M,SHEA D,MEYERHOFF W L,et al.Silent otitis media[J].Laryngoscope,1980,90:1089-1098.
[4]	PAPARELLA M M,KIMBERLEY B P,ALLEVAM.The concept of silent otitis media.Its importance and implications[J].Otolaryngol Clin North Am,1991,24:763-774.
[5]	张全安,PAPARELLA M M.中耳炎隐蔽性发病的病理因素探讨[J].临床耳鼻咽喉科杂志,1998,12(7):302-305.
[6]	HOLT G R,GATES G A.Masked mastoiditis[J].Laryngoscope,1983,93:1034-1037.
[7]	SCHACHERN P,PAPARALLA M M,SANO S,et al.A histopathological study of the relationship between otitis media and mastoditis[J].Laryngoscope,1991,101:1050-1055.
[8]	FELITO A,PAPARALLA M M,RANOLDO A,et al.The entity known as chronic silent(subclinical)otitis media:a common lesion and a forgotten diagnosis[J].Acta Otolaryngol,2003,123:749-751.
[9]	SAMUEL J,FERNANDES C M.Otogenic complications with an intact tympanic membrane[J].Laryngoscope,1985,95:1387-1390.
[10]	PENIDO NDE O,BORIN A,IHA L C,et al.Intracranial complications of otitis media:15years of experience in 33patients[J].Otolaryngol Head Neck Surg,2005,132:37-42.
[11]	黄选兆,汪吉宝.实用耳鼻咽喉科学[M].北京:人民卫生出版社,1998:917-920.
[12]	刘立新,于子龙,戴海江,等.隐性乳突炎并乙状窦血栓静脉炎及耳后骨膜下脓肿1例[J].国际耳鼻咽喉头颈外科杂志,2006,3(3):211-212.
[13]	陈志宏,倪道凤.隐匿性乳突炎(附4例报告)[J].中国耳鼻咽喉颅底外科杂志,2003,9(3):139-141.
[14]	李瑞香,吴南,侯昭晖.耳源性乙状窦血栓性静脉炎的诊断和治疗(附6例病例分析)[J].中华耳科学杂志,2017,15(4):447-453.
[15]	张秋贵,孙彦,朱富高.耳源性脑脓肿105例临床分析[J].中华耳科学杂志,2003,1(2):36-38.
[16]	PAPARELLA M M,FROYMOVICH O.Surgical advances in treating otitis media[J].Ann Otol Rhinol Laryngol Suppl,1994,13:49-53.
[17]	ULANOVSKI D,YACOBOVICH J,KORNREICHL,et al.Pediatric otogenic sigmoid sinus thrombosis:12-year experience[J].Int J Pediatr Otorhinolaryngol,2014,78:930-933.
[18]	GARCIA R D,BAKER A S,CUNNINGHAM M J,et al.Lateral sinus thrombosis associated with otitis media and mastoiditis in children[J].Pediatr Infect Dis J,1995,14:617-623.
[19]	SITTON M S,CHUN R.Pediatric otogenic lateral sinus thrombosis:role of anticoagulation and surgery[J].IntJPediatrOtorhinolaryngol,2012,76:428-432.