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中国南方的耳真菌病的诊断与治疗。

Diagnosis and treatment of otomycosis in southern China.

机构信息

Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

出版信息

Mycoses. 2019 Nov;62(11):1064-1068. doi: 10.1111/myc.12979. Epub 2019 Sep 2.

Abstract

To analyse and discuss the clinical features and pathogenic characteristics, diagnosis and treatment of patients with otomycosis in southern China. Two hundred fifty-six patients from southern China diagnosed with otomycosis were randomly separated into two groups: the drug filling group and drug smearing group. Patients in the drug filling group were first examined and then had the pathogenic secretions in their external auditory canals cleared by otoendoscopy. Then, the local antifungal cream triamcinolone acetonide clotrimazole was injected into the external auditory canal. The same treatment was undertaken 1 week later and repeated once or twice more. Patients in the drug smearing group were also treated by otoendoscopy. Then, they were told to smear their external auditory canals once per day with the antifungal cream. All cases were followed for more than 6 months after the 3- to 4-week treatment. The main symptoms and otoendoscopic examination were used to evaluate the prognosis. Aspergillus was the commonest fungus. The cure rate was 93% in the drug filling group and 81% in the drug smearing group. Otomycosis is very common in southern China, but it lacks characteristic features in its early stages. Once diagnosed, the local lesions in the external auditory canal should be cleared thoroughly using otoendoscopy, and then, the local antifungal cream is injected into external auditory canal. The cure rate can be significantly improved with the foregoing treatment.

摘要

分析并讨论中国南方地区患者的耳真菌病的临床特征和发病特点、诊断和治疗。将 256 例在中国南方地区确诊为耳真菌病的患者随机分为两组:药物填充组和药物涂抹组。药物填充组患者首先进行检查,然后使用耳内镜清除其外耳道的病原分泌物。接着,将局部抗真菌乳膏曲安奈德-克霉唑注入外耳道。1 周后进行相同的治疗,并重复进行 1 到 2 次。药物涂抹组患者也接受耳内镜治疗。然后,他们被要求每天在外耳道涂抹抗真菌乳膏。所有病例在 3-4 周治疗后均随访 6 个月以上。主要症状和耳内镜检查用于评估预后。曲霉菌是最常见的真菌。药物填充组的治愈率为 93%,药物涂抹组的治愈率为 81%。耳真菌病在中国南方地区非常常见,但在早期缺乏特征性表现。一旦确诊,应使用耳内镜彻底清除外耳道的局部病变,然后将局部抗真菌乳膏注入外耳道。采用上述治疗方法可以显著提高治愈率。

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