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Received:May 20, 2019 Published Online:January 20, 2020
Received:May 20, 2019 Published Online:January 20, 2020
中文摘要: 目的 总结南方地区真菌性外耳道炎患者的临床表现、病原学特点和治疗转归,探讨耳内镜清理+曲安奈德克霉唑乳膏局部注入法治疗真菌性外耳道炎的临床疗效。
方法 选取2014年1月至2015年12月就诊的来自南方地区、资料完整的256例真菌性外耳道炎患者,随机分为两组,注药组(152例)采用耳内镜下先清理外耳道内真菌病变,再外耳道内注入曲安奈德克霉唑乳膏,每周复诊同上治疗1次,共3~4次;涂药组(104例)采用耳内镜下清除真菌病变,嘱患者自行外耳道内涂曲安奈德克霉唑乳膏,每天1次,每周复诊治疗1次,共3~4次。随访6个月,以症状和耳内镜检查结果评价效果。非随机法连续选择部分患者取外耳道分泌物行真菌病原学培养。
结果 两组共256例真菌性外耳道炎患者,主要症状是耳痒(89.8%)、耳内阻塞感(80.9%)、流脓(69.1%)、听力下降(51.2%)、耳痛(42.2%)、耳内臭味(18.0%)等。96例外耳道分泌物行真菌病原学检测,89例阳性,7例阴性,培养阳性率92.7%;89例中曲霉菌属75例,念珠菌属8例,6例未能鉴别出真菌种属。随访6个月以上,注药组152 例,治愈141例,复发11例;涂药组104 例,治愈86例,复发18例;注药组治愈率(92.8%)高于涂药组(82.7%),差异有统计学意义(χ2=6.235,P=0.013)。
结论 真菌性外耳道炎南方地区常见,早期多无特殊症状,以耳痒、耳内流液和耳内阻塞感较常见,耳内镜的临床应用能提高其早期诊断率。曲霉菌属感染最常见,连续多次耳内镜下彻底清除局部病变、同期抗真菌药物局部注药能显著提高治愈率。
Abstract:Objective To summarize the clinical manifestations,etiological characteristics and treatment outcome of patients with fungal external otitis in Southern China to explore the clinical effect of endoscopic debridement plus triamcinolone acetonide cream local injection in the treatment of fungal external otitis.
Methods A total of 256 patients with fungal external otitis from the Southern China region between January 2014 and December 2015 were randomly separated into the injection group(n=152) and drug smearing group(n=104).In injection group,triamcinolone acetonide cream was injected into the external auditory canal after the fungal lesions were cleared under the otoendoscopy,once a week,for 3-4 times.In smearing group,the fungal lesions were cleared under the otoendoscopy,and patients were instructed to apply triamcinolone triazide cream to the external auditory canal, once a day,and revisited once a week for a total of 3-4 times.After 6 months follow-up,the therapeutic effects were evaluated by main symptoms and otoendoscopic results.The secretion of external auditory canal was continuously collected from some patients randomly by non-random method for fungal pathogen culture.
Results The main symptoms of 256 patients were ear itching (89.8%),ear blocked(80.9%),pus discharge (69.1%),hearing loss (51.2%),ear pain (42.2%),ear odor (18.0%),and so on.Pathogenic detection of fungi in secretion of ear canal in 96 cases showed that 7 cases were negative,and 89 cases(92.7%) were positive with 75 cases of Aspergillus,8 cases of Candida and 6 cases of positive culture results without identified species.Over 6 months follow-up,141 cases were cured,and 11 cases recurred in injection group;86 cases were cured,and 18 cases were recurred in smearing group.The cure rate in injection group was significant higher than that in smearing group (92.8%% vs 82.7%,χ2=6.235,P=0.013).
Conclusions Fungal external otitis is very common in Southern China.In the early stage,there are no special symptoms.Ear itching,ear blocked and pus discharge are the main symptoms.The clinical application of otoendoscopy can significantly improve the early diagnosis rate.Aspergillus species is the most common pathogenic fungus.Clearing the local lesions in the external auditory canal under otoendoscopy and injection the canal with local antifungal cream could improve the therapeutic effect obviously.
keywords: Fungal external otitis Otoendoscope External auditory canal Local filling Antifungal agents Aspergilus
文章编号: 中图分类号: 文献标志码:B
基金项目:广东省自然科学基金项目(2015A030313180);广东省科技创新战略专项资金科技援疆项目(2018YJ037)
Author Name | Affiliation |
LI Yong-qi,HE Li-feng | Department of Otolarynogology,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510630,China |
Author Name | Affiliation |
LI Yong-qi,HE Li-feng | Department of Otolarynogology,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510630,China |
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