婴幼儿结核性中耳炎临床治疗分析

Clinical treatment analysis of infantile tuberculous otitis media

摘要:

目的 探讨婴幼儿结核性中耳炎(TOM)的临床表现、诊断策略、临床治疗分析。方法 回顾苏州大学附属儿童医院2021年4月—2025年1月收治的3例TOM患儿的临床资料，3例患儿术前表现出反复耳道流脓、外耳道肉芽增生，均有不同程度的肺部结核感染表现。2例患儿术前耳脓培养结果提示合并耐甲氧西林金黄色葡萄球菌阳性，并根据药敏试验选择利奈唑胺抗感染治疗。术前乳突CT检查提示中耳乳突炎伴有部分乳突骨质破坏；术前MRI提示乳突及外耳道团块状信号影，呈长T1长T2、T2压脂信号影。择期予以改良乳突根治及外耳道肉芽清理手术，并根据细菌学检查结果调整抗生素使用。结果 3例患儿术中见乳突腔及鼓室腔肉芽组织增生，黏膜水肿，伴有脓液，检查听小骨链完整。术后病理见慢性肉芽肿性炎症，伴干酪样坏死。术后3例患儿继续接受系统抗结核药物治疗，其中1例因纤支镜检查麻醉意外不幸死亡。其余2例患儿抗结核药物治疗病情稳定，术后无反复低热，外耳道干燥无脓液，目前仍在随访观察中。结论 婴幼儿TOM发生较隐匿，合并多重耐药菌感染，对传统抗生素治疗效果欠佳，应完善乳突CT及MRI，及时予以乳突切开清理病灶，术后结合细菌学检查及病理学检查明确诊断，需结合系统抗结核药物治疗，术后定期复查关注乳突病变恢复情况。

Abstract:

Objective To investigate the clinical manifestations, diagnostic strategies and clinical treatment of infantile tuberculous otitis media(TOM). Methods It was retrospectively analyzed for the clinical data of 3 children with TOM admitted to the Children’s Hospital Affiliated to Soochow University from April 2021 to January 2025. All 3 children had repeated manifestations of otorrhea and granulation tissue hyperplasia in the external auditory canal before the operation, who had manifestations of pulmonary tuberculosis infection to varying degrees. The preoperative ear discharge culture results of the two children indicated positive for methicillin-resistant Staphylococcus aureus. Linezolid was selected for anti-infection treatment of the two children based on the drug sensitivity test. The preoperative mastoid CT examination showed mastoiditis with partial destruction of the mastoid bone. The preoperative MRI indicated mass-like signal shadows in the mastoid and external auditory canal, which showed long T1 and long T2, and fat-suppressed T2 signal shadows. Modified radical mastoidectomy and external auditory canal granulation tissue removal surgery were performed at an appropriate time, and the use of antibiotics was adjusted according to the results of bacteriological examination. Results During the operation, granulomatous tissue hyperplasia in the mastoid and tympanic cavities, mucosal edema, accompanied by pus was observed in 3 cases, who had the intact ossicular chain upon examination. Postoperative pathology revealed chronic granulomatous inflammation accompanied by caseous necrosis. After operation, 3 patients continued to receive systemic antituberculosis drug treatment. Among them, 1 case unfortunately died due to bronchoscopy anesthesia. The other 2 children were stable after treatment with anti-tuberculosis drugs, no recurrent low fever, dry external ear canal without pus. They are still under follow-up observation at present. Conclusions TOM in infants and young children occurs relatively insidiously, who is often complicated by multi-drug resistant bacterial infections with poor response to traditional antibiotic treatment. It is necessary to complete mastoid CT and MRI, and promptly perform mastoidectomy to clear the lesion. After the operation, a clear diagnosis should be made based on bacteriological and pathological examinations. Systemic anti-tuberculosis drugs should be combined with treatment. Regular postoperative follow-up should be conducted to monitor the recovery of mastoid lesions.