Gupta M, Singh S, Singh H, Chauhan B
B-ENT. 2014;10(1):35-40.
To evaluate the usefulness of antibiotic+steroid irrigation of the middle ear in patients with otitis media with small perforation and pulsatile discharge.
A prospective, randomised, evaluator-blinded study was carried at a single tertiary care centre over eight years, looking at 100 patients with chronic suppurative otitis media involving small tympanic membrane perforations and pulsatile mucopurulent discharge. The patients were randomised and divided into two groups. In group A, the examination under microscope, with suction cleaning of the external canal, was followed by irrigation of the middle ear with antibiotic+steroid solution for up to one week, while group B was prescribed self-administration of the same drops with systemic antibiotics. The patients were followed up daily for 10 days to monitor otorrhoea relief and on a weekly basis subsequently to monitor the healing of the tympanic membrane.
Forty-nine patients in group A had a dry ear after 3-7 days of daily suction and the irrigation of middle ear with the antibiotic+steroid solution and 44 had a healed tympanic membrane after an average three months of follow-up. Five patients with dry ear but persistent perforation underwent tympanoplasty, while only one patient with a persistent ear discharge underwent mastoid exploration. In group B, eight patients on oral antibiotics and self-administration of the same drops had dry ear while 34 had dry ear after receiving intravenous antibiotics. Thirty perforations healed spontaneously and 12 required tympanoplasty. In 8 patients, the tympano-mastoid was explored and these patients had dry, hearing ears only after surgery.
Patients with chronic suppurative otitis media involving small perforations and pulsatile discharge can be managed conservatively with simple suction cleaning + middle ear irrigation with antibiotics + steroid drops.
评估抗生素联合类固醇中耳灌洗术对鼓膜小穿孔伴搏动性耳漏的中耳炎患者的疗效。
在一家三级医疗中心进行了一项为期八年的前瞻性、随机、评估者盲法研究，观察100例慢性化脓性中耳炎患者，这些患者鼓膜有小穿孔且伴有搏动性黏液脓性耳漏。患者被随机分为两组。A组在显微镜下检查，对外耳道进行吸引清洁后，用抗生素加类固醇溶液中耳灌洗长达一周，而B组则采用自行滴用相同滴剂并联合全身使用抗生素。患者每天随访10天以监测耳漏缓解情况，随后每周随访以监测鼓膜愈合情况。
A组49例患者在每日吸引及抗生素加类固醇溶液中耳灌洗3 - 7天后耳干，平均随访三个月后44例鼓膜愈合。5例耳干但穿孔持续存在的患者接受了鼓室成形术，而只有1例持续性耳漏患者接受了乳突探查术。B组中，8例口服抗生素并自行滴用相同滴剂的患者耳干，34例在接受静脉抗生素治疗后耳干。30处穿孔自行愈合，12处需要鼓室成形术。8例患者接受了鼓室 - 乳突探查术，这些患者仅在术后耳干且听力恢复。
对于鼓膜小穿孔伴搏动性耳漏的慢性化脓性中耳炎患者，可通过简单的吸引清洁加抗生素加类固醇滴剂中耳灌洗进行保守治疗。
