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目的探讨和再认识隐蔽性乳突炎的病因、诊断和治疗方法,预防耳源性颅内外并发症的发生。方法回顾性总结1998年1月至2005年2月,经颞骨薄层CT扫描结合手术中所见乳突病变,证实为隐蔽性乳突炎的11例患者的诊治经过,结合文献分析隐蔽性乳突炎的临床特点。结果11例11耳隐蔽性乳突炎,病程2个月至16年。在出现颅内外并发症之前临床症状不典型,包括听力下降8例次,耳钝痛5例次,轻度头痛3例次;颅内外并发症包括面神经麻痹4例次,眩晕1例次,耳后骨膜下脓肿1例次,颅内感染症状2例次。CT显示板障型乳突5例,气化型乳突6例。10例采用手术治疗。手术方法包括上鼓室开放术(1例),乳突凿开术(1例),开放式乳突根治术(7例)以及完壁式乳突根治术(1例)。术中发现乳突腔和鼓窦内肉芽形成,5例乳突腔肉芽包裹脓肿形成,明显骨髓炎和骨质破坏。经手术治疗的10例患者均治愈,未手术的1例死亡。结论隐蔽性乳突炎临床症状不典型,颞骨薄层CT检查是主要的诊断方法,早期诊断和及时手术治疗对减少并发症是必要的。
Objective To explore and understand the causes, diagnosis and treatment of cryptogenic mastoiditis to prevent the occurrence of extra-cranial intracranial complications. Methods From January 1998 to February 2005, the diagnosis and treatment of 11 cases of concealed mastoiditis were retrospectively reviewed by thin layer CT scan of the temporal bone combined with the mastoid lesions seen in the operation. Combined with literature analysis, The clinical features of inflammation. Results 11 cases of 11 ears concealed mastoiditis, duration of 2 months to 16 years. Clinical symptoms before onset of intracranial complications were not typical, including 8 cases of hearing loss, 5 cases of auricular acuity and 3 cases of mild headache. The extracranial complications included 4 cases of facial paralysis, 1 case of dizziness, 1 case of ear dizziness Subperiosteal abscess in 1 case, symptoms of intracranial infection in 2 cases. CT showed platety mastoid in 5 cases, gasification mastoid in 6 cases. 10 cases were treated by surgery. Surgical procedures included upper tympanotomy (1 case), mastoidotomy (1 case), open mastoidectomy (7 cases), and complete wall mastoidectomy (1 case). During operation, granulomas were found in the mastoid cavity and the sinuses, and 5 cases of mastoid granuloma formed abscesses with obvious osteomyelitis and bone destruction. All 10 patients who underwent surgery were cured and 1 patient died without surgery. Conclusion The clinical symptoms of cryptogenic mastoiditis are not typical. The thin-slice CT examination of the temporal bone is the main diagnostic method. Early diagnosis and timely surgical treatment are necessary to reduce the complications.