山东大学耳鼻喉眼学报 ›› 2025, Vol. 39 ›› Issue (6): 17-22.doi: 10.6040/j.issn.1673-3770.0.2024.444

• 重点专题——侧颅底外科交叉融合 • 上一篇    

坏死性外耳道炎临床诊治18例

李赞1-7,卢奇2-7,申卫东2-7,侯昭晖2,4-7,吴南2-7   

  1. 1.呼伦贝尔市人民医院 耳鼻咽喉科, 内蒙古 呼伦贝尔 021008;
    2.中国人民解放军总医院第六医学中心 耳鼻咽喉头颈外科医学部, 北京 100037;
    3.中国人民解放军总医院第一医学中心 耳神经侧颅底外科, 北京 100853;
    4.听觉与平衡觉全国重点实验室, 北京 100037;
    5.国家耳鼻咽喉疾病临床医学研究中心, 北京 100037;
    6.聋病教育部重点实验室, 北京 100853;
    7.聋病防治北京市重点实验室, 北京 100853
  • 发布日期:2025-11-19
  • 通讯作者: 吴南. E-mail:maxpanda1979@126.com
  • 基金资助:
    国家重点研发计划(2022YFC2402700)

Clinical diagnosis and treatment features of 18 cases of necrotizing otitis externa

LI Zan1-7, LU Qi2-7, SHEN Weidong2-7, HOU Zhaohui2,4-7, WU Nan2-7   

  1. 1. Department of Otorhinolaryngology, Hulunbuir People's Hospital, Hulunbuir 021008, Inner Mongolia, China 2. Senior Department of Otorhinolaryngology & Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital, Beijing 100037, China3. Department of Oto-Neurology & Skull Base, College of Otolaryngology-Head & Neck Surgery, the First Medical Center of Chinese PLA Genera Hospital, Beijing 100853, China4. State Key Laboratory of Hearing and Balance Science, Beijing 100037, China5. National Clinical Research Center for Otolaryngologic Diseases, Beijing 100037, China6. Key Laboratory of Hearing Science, Ministry of Education, Beijing 100853, China7. Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Beijing 100853, China
  • Published:2025-11-19

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摘要： 目的 探讨坏死性外耳道炎的临床特点和治疗方法。 方法 回顾性分析18例(20耳)坏死性外耳道炎患者的临床资料,分析总结患者的临床表现及体征、影像学检查、实验室检查、诊治特点及预后。 结果 18例患者中男10例、女8例,单侧发病16例,双侧发病2例。典型临床表现为耳痛、耳溢液和听力下降等,其中4例患者伴发不同程度的周围性面瘫。影像学检查提示15例发生耳道骨质破坏,4例严重者伴有颅底的广泛受累。根据临床表现和影像学特点对本组病例进行临床分期,其中Kraus Ⅰ期14例、Ⅱ期2例、Ⅲ期2例。予以保守治疗12例,结合外科手术干预6例,出院后继续抗感染治疗2个月,并随访1年以上。10个月后复发1例,6个月后对侧耳再发1例,出院5个月后在外院去世1例,其余患者均顺利康复。 结论 坏死性外耳道炎应首先积极处理合并症,治疗以合理应用抗感染药物为主,对于保守治疗效果欠佳、病情较重或出现严重并发症者,应及时行外科干预,多可获得较好预后,但颅底或颅内受累者预后不良。

关键词: 坏死性外耳道炎, 颅底骨髓炎, 恶性外耳道炎, 临床诊治, 预后

Abstract: Objective To explore the diagnosis and treatment features of necrotizing otitis externa. Methods We retrospectively analyzed the clinical data of 18 patients(20 ears)with necrotizing otitis externa including clinical features, diagnosis, treatment and prognosis. Results Among the 18 patients, 10 were male and 8 were female, with unilateral onset in 16 cases and bilateral onset in 2 cases. Typical clinical features were ear pain, otorrhea and hearing loss. Four cases developed facial paralysis of varying degrees. Imaging examinations indicated bone destruction of the external auditory canal in 15 cases, and extensive involvement of the skull base was observed in 4 severe cases. The clinical staging was based on clinical manifestations and imaging features. This group of cases included 14 cased of Kraus stage Ⅰ, 2 cases of Kraus stage Ⅱ and 2 cases of Kraus stage Ⅲ. 12 patients were treated by medication and 6 patients underwent surgical management. The anti-infective therapy was continued for 2 months after the patients discharge from the hospital and followed up for more than 1 year. One case recurred after 10 months, another one recurred in the contralateral ear after 6 months and a patient passed away 5 months later, while the rest of patients recovered successfully. Conclusion Necrotizing otitis externa should be actively treated with comorbidities. The main treatment is anti-infection. For those who have been treated with unsatisfactory results, serious conditions or severe complications, timely surgical intervention is recommended. A good prognosis can mostly be achieved, while those with skull base or intracranial involvement have a poor prognosis.

Key words: Necrotizing otitis externa, Skull base osteomyelitis, Malignant otitis externa, Clinical Diagnosis and Treatment, Prognosis

中图分类号: 

  • R764.1
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