苏州大学附属儿童医院
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【】目的:探讨婴幼儿结核性中耳炎的临床表现、诊断策略、临床治疗分析。方法:回顾我院2021年04月-2025年01月收治的3例结核性中耳炎的患儿临床资料。其中,男2例、女1例,年龄为(5.67±2.05)月,经过抗生素治疗后疗效欠佳,完善相关血常规、耳脓培养、乳突CT及MRI检查,择期予以改良乳突根治术、外耳道肉芽清理手术治疗,并根据细菌学检查结果调整抗生素使用,症状稳定后出院定期随访。结果:3例患儿术前表现出反复耳道流脓、外耳道肉芽增生表现,其中,2例患儿术前有肺部结核感染表现。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糖球菌(MRSA)阳性,并根据药敏试验选择利奈唑胺抗感染治疗。术前的乳突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。术中病理见慢性肉芽肿性炎症,伴干酪样坏死。其中2例术后转至传染专科医院继续救治,1例术后出院口服利奈唑胺接受随访观察。结论:婴幼儿结核性中耳炎发生较隐匿,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,调整抗结核药物使用,术后定期复查关注乳突病变恢复情况。
Objective To investigate the clinical manifestations, diagnostic strategies and clinical treatment of infantile tuberculous otitis media.Methods The clinical data of 3 children with tuberculous otitis media admitted to our hospital from April 2021 to January 2025 were retrospectively reviewed. Among them, there were 2 boys and 1 girl, with an average age of (5.67 ± 2.05) months. After antibiotic treatment, the therapeutic effect was unsatisfactory. Relevant blood routine, ear discharge culture, mastoid CT and MRI examinations were completed. Modified mastoidectomy and external auditory canal granulation tissue removal surgery were performed at an appropriate time. Antibiotics were adjusted according to the results of bacteriological examination. The children were discharged after their symptoms were stable and followed up regularly. Results Before surgery, all 3 children showed recurrent ear discharge and granulation tissue hyperplasia in the external auditory canal. Among them, 2 children had pulmonary tuberculosis infection before surgery. The ear discharge culture results of 2 children before surgery indicated positive methicillin-resistant Staphylococcus aureus (MRSA), and linezolid was selected for anti-infection treatment based on the drug sensitivity test. Mastoid CT before surgery showed mastoiditis with partial bone destruction in the middle ear; MRI before surgery showed mass-like signals in the mastoid and external auditory canal, with long T1 and long T2, and fat-suppressed T2 signals. Intraoperative pathology showed chronic granulomatous inflammation with caseous necrosis. Two children were transferred to a specialized infectious disease hospital for further treatment after surgery, and 1 child was discharged after surgery and received follow-up observation by taking linezolid orally.Conclusion Tuberculous otitis media in infants and young children occurs relatively insidiously, often complicated with multi-drug resistant bacterial infections, and has poor response to traditional antibiotic treatment. Mastoid CT and MRI should be completed in a timely manner, and mastoidectomy should be performed to remove the lesion. The diagnosis should be confirmed based on bacteriological and pathological examinations after surgery, and anti-tuberculosis drugs should be adjusted. Regular follow-up should be conducted after surgery to monitor the recovery of mastoid lesions.
