Adult-onset Otitis Media with Effussion
洪培凱(Pei-Kai Hung)；黃威雄(Wei-Hsiung Huang)
成人 ； 積液性中耳炎 ； adult ； otitis media with effusion
|Volume or Term/Year and Month of Publication||
40卷1期（2005 / 01 / 01）
13 - 18
背景：小兒積液性中耳炎多因上呼吸道感染波及中耳所造成，以抗生素加上必要時放置中耳通氣管，可以達到很好的治療效果。成人積液性中耳炎則是一個常見但卻少被研究的問題，藥物治療的效果不甚理想。為探討成人積液性中耳炎的病因與細菌學，設計此研究。 方法：採回顧性研究，自200l年4月至2002年4月，共收集108名慢性積液性中耳炎成人患者之中耳積液作細菌培養，並分析其病因。 結果：在引起成人積液性中耳炎的病因當中，鼻竇炎、不明病因，及頭頸部腫瘤接受放射治療，為前三大族群，其中不明病因患者之盛行率與年齡成正相關。108個檢體中培養出細菌27株，致病菌中以金黃色葡萄球菌最多，頭頸部腫瘤經放射治療造成的積液性中耳炎之致病菌培養率為26.3%，其他病因則為9.0%。 結論：成人積液性中耳炎是一多病因的疾病，本研究再次確認鼻咽癌是其中不可輕忽的因素。本研究與其他兒童慢性積液性中耳炎比較，成人中耳積液的細菌培養率相對較低，菌種也顯著不同。而頭頸部腫瘤經放射治療造成的積液性中耳炎比其他病因造成的積液性中耳炎之中耳積液有更高之細菌培養率。
BACKGROUND: Otitis media with effusion (OME) in children is frequently associated with upper respiratoly tract infections. The bacteriology and treatment modalities of OME in children have been well established. However, little is known about OME in adults. The clinical characteristics of adult OME differ from those of pediatric OME. The purpose of this study was to explore the etiology and bacteriology of adult OME. METHODS: A prospective study was designed to collect middle ear effusion for bacterial culture from 108 adult patients during the period from April 2001 to April 2002. Another analysis was also performed to evaluate the relationship between the bacterial culture rate and the etiology. RESULTS: The three leading causes of adult-onset OME were sinusitis, idiopathic etiology, and irradiation for head and neck cancer. It was also noted that aged persons had a higher prevalence in the idiopathic etiology group. In total, 27 species of bacteria were isolated from 108 middle ear effusions. Among these, Staphylococcus aureus was the most-common pathogen. The pathogenic bacterial culture rate was 26.3% in patients who had undergone irradiation for head and neck cancer and 9.0% with the other etiologies. CONCLUSIONS: Adult-onset OME is a disease with multiple etiologies, among which nasopharyngeal carcinoma (NPC) cannot be ignored. Compared with previous reports, the bacterial culture rate in adult-onset OME was relatively lower than that reported for pediatric cases. The bacteriologies of adult and pediatric OME differ. Patients with head and neck cancers who undergo irradiation have a significantly higher bacterial culture rate than those with other etiologies.