中耳创伤的评估和治疗
- Authors
- Adele Karen Evans, MD, FAAP
Adele Karen Evans, MD, FAAP
- Associate Professor, Pediatric Otolaryngology - Head and Neck Surgery
- Wake Forest University School of Medicine
- Steven D Handler, MD, MBE
Steven D Handler, MD, MBE
- Professor, Otolaryngology: Head and Neck Surgery
- University of Pennsylvania School of Medicine
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
- Translators
- 江满杰, 副主任医师，副教授
江满杰, 副主任医师，副教授
- 南京军区南京总医院耳鼻咽喉头颈外科
引言
头部钝伤或贯通伤、直接耳创伤或气压伤(由于诸如爆炸伤、航空旅行或带水肺潜水的事件)可导致中耳创伤。小儿和成人损伤需要的治疗步骤相同。治疗单纯性鼓膜小穿孔的患者可针对污染伤口使用抗生素滴耳剂、防水(防止中耳进水)及评估以确保穿孔愈合。显著听力损失(≥40dB)、眩晕、眼球震颤、共济失调、或面神经损伤的患者，需立即由耳鼻喉科医生(ear, nose and throat surgeon, ENT surgeon)评估，必要时还需其他专科医生评估(如神经外科医生评估颅脑损伤)。
中耳钝伤或贯通伤的治疗总结在此。耳气压伤和颞骨骨折的评估和治疗将单独讨论。 (参见“耳气压伤”和“儿童颅骨骨折的临床表现、诊断和治疗”和“成人颅骨骨折”)
流行病学
多达1/3的严重颅脑损伤及超过一半的颞骨颅底骨折患者会发生中耳损伤、邻近内耳结构损伤或两者合并损伤[1-3]。这些损伤包括鼓室积血(图片 1)、听力损失、脑脊液(cerebrospinal fluid, CSF)瘘、耳囊损伤和外伤性外淋巴瘘[1-5]。
如果颞骨骨折合并有面神经麻痹、脑脊液耳漏或兼有两种情况，那么耳囊损伤的可能性为4-5倍[4]。
中耳创伤也可继发于外耳道直接钝伤[如掌掴耳朵(“拳击耳”)、滑水或滑雪时摔倒压在耳朵上、机动车碰撞或运动损伤(如摔跤)]，或者是贯通伤(如棉签、火柴梗、枪伤或者是锻接或焊接火花)[3,4,6-9]。
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2016-08-11.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Ort S, Beus K, Isaacson J. Pediatric temporal bone fractures in a rural population. Otolaryngol Head Neck Surg 2004; 131:433.
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