結核性中耳炎：臨床表現與診斷

Tuberculous Otitis Media: Clinical Presentation and Diagnosis

徐銘燦(Min-Tsan Shu) ； 巫剛肇(Kang-Chao Wu) ； 林鴻清(Hung-Ching Lin) ； 陳昱君(Yu-Chun Chen) ； 李國森(Kao-Sen Lee)

《台灣耳鼻喉頭頸外科雜誌》 41卷4期 (2006/08) Pp. 115-120

https://doi.org/10.6286/2006.41.4.115

摘要

背景：結核菌感染是引起慢性化膿性中耳炎的少數病因之一。若未能診斷出來而逕予手術，常導致手術失敗。故有必要及早診斷，以防止永久的聽力喪失及顏面神經麻痺。藉由回顧結核性中耳炎的臨床表現及不同的檢查方式，來尋求如何達到早期診斷。
方法：採回溯性病歷研究方式，回顧自1987年至2005年間，由本院耳鼻喉科醫師診斷之16例結核性中耳炎。
結果：共16名病患，其中男性11名、女性5名，平均年齡45歲。病患主訴包括：耳漏12例(75%)、耳痛8例(50%)、聽力障礙4例(25%)及耳鳴1例(6%)。理學檢查發現：耳膜破孔有14例(87%)、其中多發性破孔有5例(31%)、肉芽組織(granulation)有9例(56%)及顏面神經麻痺2例(12%)。5名病人有兩項檢查結果呈現陽性反應，另外11名有一項呈陽性。各項檢查的陽性率如下：細菌培養43%(3/7)、病理檢查69%(9/13)、聚合酵素鏈反應(polymerase chain reaction)85% (6/7)。從第一次門診至確定診斷所需的時間從1到16.4週，平均4.4週。其中如果初步就臆斷是結核感染，平均2.0週；如果不是，平均5.0週。2名病患在外院治療，12名在本院接受12至18個月的抗結核藥物治療，共追蹤13名患者，疾病獲得緩解。
結論：結核性中耳炎常常被當成一般中耳炎治療，因此慢性中耳炎治療超過5週仍未見改善，結核菌感染應納入鑑別診斷。一旦懷疑就應該積極證明，採取多項傳統檢查，若能適時輔以聚合酵素鏈反應檢查，更可以提高診斷率。

關鍵字

結核病 ； 中耳炎 ； 聚合酵素鏈反應

並列摘要

BACKGROUND: This study was undertaken to increase awareness of the variable presentation of tuberculous otitis media (TOM) and to discuss the clues to the diagnosis of this disease, the range of approaches available for diagnosis and what the most effective diagnostic methods are.
MATERIALS AND METHODS: Retrospective chart review together with an analysis of all the cases of tuberculous otitis media diagnosed by the same otolaryngologist between 1987 and 2005.
RESULTS: We reviewed a series of 16 cases (11 male and 5 female) over a 19-year period. The average age was 45 years. The presenting chief complaints were otorrhea (75%, 12/16), otalgia (50%, 8/16), hearing impairment (25%, 4/16) and tinnitus (6%, 1/16). Physical examination revealed drum perforation in 14 cases (87%), multiple perforations in 5 cases (31%), middle ear granulation in 9 cases (56%) and facial palsy in 2 cases (12%). Using a range of different tests, two positive results were obtained for five cases and only one positive result for the other eleven cases. The positive rates foe the various tests were 33% (2/6) for smear, 69% (9/13) for histological examination, 85% (6/7) for polymerase chain reaction (PCR) and 43% (3/7) for culture. If the initial impression was TOM, the average period to full diagnosis was two weeks, otherwise five weeks were needed to give a correct diagnosis.
CONCLUSION: This study shows that TOM can mimic a variety of middle ear diseases and, therefore a high index of suspicion is very important, especially when the patient is refractory to standard treatment after 5 weeks. A battery of tests including acid-fast smears, a tissue biopsy, polymerase chain reaction (PCR), culture and chest x-rays are needed as comprehensive aid to diagnosis when TOM is suspected. The use of the PCR test seems to have significantly improve the diagnostic rate.

並列關鍵字

tuberculosis ； otitis media ； polymerase chain reaction