Clinical analysis of congenital microtia complicated with retroauricular subperiosteal abscess in 7 cases
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摘要: 目的 分析先天性小耳畸形并发耳后脓肿的病因及临床特点，探讨其发病机制及预后。方法 对178例先天性小耳畸形患者中7例以“耳后脓肿”就诊患者进行回顾性研究，均行乳突切开，病变清理，分泌物送细菌培养试验，根据中耳病变情况，同期行开放式乳突切开+鼓室成形术3例，完壁式乳突切开+鼓室成形术3例，乳突根治术1例，术后观察伤口愈合情况，并于3个月后进行随访。结果 患者以青年为主，术前平均气骨导差为(57.14±9.51) dB，术后平均气骨导差(40.00±11.54) dB，较术前有(17.14±11.12) dB提高。术后耳后脓肿得到有效控制，半年随访至今脓肿无复发。结论 乳突炎的早期诊断对先天性小耳畸形合并骨膜下脓肿具有重要意义，应尽早诊断及干预，一旦发展为脓肿，应尽早行鼓室成形术，清理病变，通畅引流，为耳郭畸形修复提供有利条件。Abstract: Objective To dissect the etiology and clinical features of congenital microtia with retroauricular subperiosteal abscess, and to explore its pathogenesis and prognosis.Methods Among 178 patients with congenital microtia, 7 cases concomitant with " retroauricular subperiosteal abscess" were collected in this retrospective study. All of the 7 patients underwent mastoidotomy, the lesions were cleared, and secretions were sent to the bacterial culture test. According to the middle ear lesions, we performedopen mastoidectomy + tympanoplasty in 3 cases, wall mastoidectomy + tympanoplasty in 3 cases of andradical mastoidectomy in 1 case.The wound healing was observed subsequently, and the patients were followed up 3 months later.Results The patients were mainly young. The average of air-bone gap before operation was (57.14±9.51) dB. The average ofair-bone gap after operation was (40.00±11.54) dB, which was lower than that before (17.14±11.12) dB. The operation can effectively control the flow of pus and improve hearing. Postoperative ear abscess was effectively controlled, and there is no recurrence, after half a year of follow-up.Conclusion Early diagnosis of mastoiditis is of great significance for congenital microtia complicated with retroauricular subperiosteal abscess. It should be diagnosed and intervened as soon as possible. Once it develops into abscess, tympanoplasty should be performed as soon as possible, for cleaning lesions and draining obstruction, subsequently as to provide favorable conditions for the repair of auricular malformation.
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Key words:
- congenital microtia /
- abscess /
- cholesteatoma
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图 2 纯音测听检查结果 2a：右耳；2b：左耳； 图 3 患者计算机断层扫描(CT)影像 黄色方框示气化型乳突，乳突气房充斥软组织影，考虑乳突炎症发作；红色方框示听骨链形态不规则，提示听骨链畸形。
表 1 7例患者的临床资料
例序 性别 年龄/岁 症状 小耳畸形分级(Marx) CT表现 手术方式 外耳道胆脂瘤 分泌物培养 术后半年是否复发 1 男 28 右耳痛1个月 3 气化型乳突，外耳道闭锁，鼓室腔小，锤砧骨畸形，镫骨形态可 开放式乳突切开+鼓室成形术 是 铜绿假单胞菌 否 2 男 6 右耳后流脓2年 1 气化型乳突，外耳道闭锁，锤砧骨融合，镫骨菲薄，砧镫纤维连接 完璧式乳突切开+鼓室成形术 是 无细菌生长 否 3 女 17 右耳痛7 d 1 气化型乳突，外耳道狭窄，外耳道软骨部及骨部缩窄，鼓膜松弛部穿孔伴肉芽形成，紧张部内陷，镫骨底板结构消失，面神经水平段骨质缺损 完璧式乳突切开+鼓室成形术 是 无细菌生长 否 4 男 30 右耳反复红肿3年 1 气化型乳突，外耳道狭窄，外耳道骨性闭锁，深部可见胆脂瘤，鼓膜缺失，锤砧骨融合，面神经乳突段裸露，咽鼓管口骨性狭窄 乳突根治术 是 金黄色葡萄球菌 否 5 女 15 右耳后流脓15 d 1 硬化型乳突，外耳道内胆脂瘤，锤骨柄及砧骨长突消失，镫骨头受侵蚀 开放式乳突切开+鼓室成形术 是 无细菌生长 否 6 男 5 右耳后流脓11 d 1 气化型乳突，外耳邻近皮下炎症，外耳道骨部狭窄，鼓膜处骨性闭锁，听骨链完整 开放式乳突切开+鼓室成形术 是 金黄色葡萄球菌 否 7 女 20 右耳后反复疼痛20年 1 气化型乳突，外耳道口狭窄，外耳道深部胆脂瘤及肉芽形成，听骨链完整 完璧式乳突切开+鼓室成形术 是 金黄色葡萄球菌 否 
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表 2 7例患者手术前后听力比较
例序 术前气骨导差/dB 术后半年气骨导差/dB 差值/dB 1 70 40 30 2 60 30 30 3 50 50 0 4 60 50 10 5 40 20 20 6 60 40 20 7 60 50 10
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