[Diagnosis and treatment of intracranial and extracranial complications of acute suppurative otitis media in children].

内容摘要

Objective:To summarize the different diagnostic and treatment approaches and prognostic characteristics of intracranial and extracranial complications of acute suppurative otitis media in children, and to provide a reference for clinical diagnosis. Methods:Data from 36 children with acute otitis media complicated by intracranial and extracranial complications, admitted to our department from January 2015 to November 2023, were reviewed. One patient with purulent meningitis died of acute cerebral hernia in the PICU; the others received surgery based on their condition, along with antibiotics and glucocorticoids as indicated. All were followed for ≥6 months. Age, medical history, treatment regimen, and outcomes were analyzed. Results:Among the 36 children, 18 with postauricular subperiosteal abscess and 2 with temporal abscess were all cured. Tympanostomy tubes were removed at 3-6 months without perforation sequelae. Four cases of perisigmoid sinus abscess all recovered. Three cases of sigmoid sinus thrombophlebitis were cured; among them, 1 showed partial recanalization of the sigmoid sinus during follow-up, while the other 2 did not achieve recanalization. Among the 3 cases of peripheral facial palsy, 2 recovered completely, and 1 recovered to grade II facial nerve function during follow-up. Of the 2 cases of sensorineural hearing loss, 1 underwent cochlear implantation and 1 received conservative treatment. One case of subdural abscess recovered, and 1 case of subdural abscess complicated with cerebellar abscess also recovered. Conclusion:Complications of acute otitis media in children are diverse and present with various manifestations. During diagnosis and treatment, emphasis should be placed on imaging examinations to detect lesions in a timely manner. Adequate and full-course antibiotic therapy should be administered; when necessary, restricted antibiotics such as linezolid may be selected based on drug susceptibility testing. Depending on the patient's general condition, timely mastoidectomy should be performed when complications arise, with a strategy of atticotomy, posterior tympanotomy, and tympanostomy tube placement to reestablish mastoid and tympanic cavity drainage. Among the surgical approaches, posterior tympanotomy helps preserve the ossicular chain while maintaining drainage. In addition, collaborative diagnosis and treatment involving neurology and neurosurgery should be emphasized. 目的：总结儿童急性化脓性中耳炎的颅内外并发症不同诊疗方式及预后特点，给临床诊断提供参考。 方法：总结2015年1月至2023年11月住院的儿童急性中耳炎伴有颅内外并发症的36例患儿相关病例资料，除1例化脓性脑膜炎患儿入PICU监护室急发脑疝后死亡，其余患儿根据其病情选择手术方式。同时根据患儿情况选择抗生素及糖皮质激素补液治疗，随访半年以上，分析其年龄、病史、治疗方案及预后结果。 结果：36例患儿，18例耳后骨膜下脓肿及2例颞部脓肿均治愈，3～6个月取鼓膜置管无穿孔后遗症；乙状窦周围脓肿4例，均痊愈；3例乙状窦血栓静脉炎治愈，其中1例随访提示乙状窦部分再通，余2例未复通。3例周围性面瘫中2例痊愈，1例面神经功能随访过程中恢复至2级。2例感音性聋患儿中1例行人工耳蜗植入术，另1例保守治疗。1例硬膜下脓肿痊愈；1例硬膜下脓肿合并小脑脓肿痊愈。 结论：儿童急性中耳炎并发症多且表现多样，诊治过程中应重视影像学检查以及时发现病变情况。病程中应进行足量、足疗程抗生素治疗，必要时可以根据药敏结果选择利奈唑胺等限制级抗生素。根据患儿一般情况，有并发症时及时乳突切开，采用上鼓室开放的策略，通过后鼓室开放和鼓膜置管，重建乳突鼓室引流。在开放式术式中后鼓室开放能在保护听骨链的同时维持引流。除此之外，还需重视神经内科及外科的联合诊治。.