The Clinical Diagnosis And Treatment Of Otitis Media Combined With Subperiosteal Abscess

Objective: To investigate the clinical features,diagnosis,treatment,and prognosis of otitis media complicated with post-auricular subperiosteal abscess.Methods: We retrospectively analyzed the clinical data of patients admitted to the First Affiliated Hospital of Fujian Medical University from January 2005 to December 2017 for the treatment of otitis media combined with post-auricular subperiosteal abscess.Clinical information was collected,including gender,age,and clinical symptoms,course of disease,audiology,imaging,test indicators,pathology,explore the appropriate treatment options,follow-up of the prognosis,and analysis of special cases and other complications of treatment points.Results: Of the 43 patients,26 were male(60.47%)and 17 were female(39.53%).The oldest was 61 years old with a minimum of 76 days,with an average of 14.34 years.There are 24 cases on the left side and 19 cases on the right side.There were 22 acute and 22 chronic cases of middle ear mastoiditis.There were 24 cases(55.81%)of pus in ear,20 cases(46.51%)of ear pain,32 cases(74.42%)of hearing loss,9 cases(20.93%)of tinnitus,and 12 cases(27.91%)of fever.There were 42 cases(97.67%)with post-ear swelling,39 cases(90.70%)with post-ear pain,and 27 cases(62.79%)with post-ear flu.The post-ear abscess broke out of the skin and formed fistulas in 12 cases(27.91%).Positive bacteria culture in 18 cases.Conservative treatment in 8 cases,35 cases of surgical treatment.After operation,18 cases had simple granulation and 17 cases had cholesteatoma.In the surgical patients,there were 4 cases of concealed middle ear mastoiditis,1 case of congenital cholesteatoma,4 cases of the root of the zygomatic arch abscess,4 cases of sigmoid sinus thrombophlebitis,and 4 cases of labyrinth fistula.Intraoperative abscess was located in only 17 cases in the sieve area,13 cases in the non-screen area mastoid cortex,and 5 cases in the mastoid cortex of the mastoid area and other sites.There were 28 cases of primary suture and 7 cases of secondary suture.34 cases of post-auricular incision.In the conservative treatment group and the surgical treatment group,the number of days in the two groups was significantly different(P=0.036<0.05).Eight patients in the conservative group received dry ear,no otitis media and abscess recurrence,no other complications;12 patients in the surgical group lost follow-up,23 patients had no otitis media and abscess recurrence,dry ears in 16 cases,wet ears in 7 cases,2 cases after dizziness,there was a decrease in hearing in 2 patients.There was no significant difference between the two groups of wet and dry ears(Fisher's exact test,P=0.146>0.05).There was no significant difference in dizziness and hearing loss between the two groups after treatment(Fisher).Accurate probability test,P=1.000>0.05)Conclusions: post-auricular subperiosteal abscess accompanied by otitis media are predominant in infants and adolescents.The clinical symptoms and signs may not be typical.It is necessary to improve the appropriate imaging to exclude occult diseases and define the extent of lesions,to exclude other intracranial and extracranial complications,and to culture and drug sensitivity to choose the right antibiotic.Short course of disease,no intracranial complications,can be treated with antibiotics,or combined abscess needle,tympanic puncture and other conservative programs.For conservative treatment,cholesteatoma or other intracranial and extracranial complications,mastoid surgery should be performed in time.