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试述慢性化脓性中耳炎及其临床分型。

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2021-12-25 11:51
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慢性化脓性中耳炎是可累及中耳粘一骨膜,甚至骨质的慢性化脓性炎症疾病。特点为鼓膜穿孔,反复流脓,听力损害,可引起危及生命的颅内外并发症。临床分为三型:
(1)单纯型:病变主要在鼓室粘膜,分泌物为粘脓性或粘液性,无臭,鼓膜穿孔多为紧张部中央性穿孔,致轻度传导性耳聋。
(2)骨疡型:病变破坏较广泛,侵蚀骨壁及鼓环,破坏听骨,形成慢性骨疡灶,可发生肉芽增生石分泌物呈脓性,有臭味,经久不愈。鼓膜多发生边缘性穿孔或紧张部大穿孔,鼓室内常有肉芽及息肉,耳聋较重。可引起严重并发症。
(3)胆脂瘤型:外耳、中耳脱落上皮逐渐堆积,形成胆脂瘤,并经鼓隐窝,鼓窦侵及乳突气房,在继续增长中压迫骨质,破坏骨壁,鼓膜松弛部或紧张部后上边缘性穿孔,脓臭,并带有胆脂瘤样物。乳突X光片或CT可显示鼓隐窝、鼓窦和乳突有边缘整齐的圆形透光区。感染可侵入颅内产生严重并发症。


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