背景:非结核分枝杆菌(NTM),一种引起颈面部感染的极其罕见的病原体,可能导致永久性听力损伤或颅内并发症。由于在NTM耳乳突炎的初始发作期间缺乏特定的表现,医生可能会误诊为胆脂瘤或其他常见细菌感染。
方法:一名44岁男性,主诉左侧听觉丰满,耳痛,头晕2个月。
方法:最初的诊断假设是胆脂瘤,这是基于耳镜检查时整个外耳道有粘液样分泌物和左侧混合性听力损失的发白肿块。然而,在手术后2个月的随访中通过微生物培养鉴定NTM。
方法:患者接受左侧鼓室探查切开术。因为诊断出NTM耳乳突炎,开始治疗3周,给予阿奇霉素(500毫克/天,口服给药),头孢西丁(3克/天,静脉滴注),和阿米卡星(750毫克/天,静脉滴注)。维持治疗为阿奇霉素(500毫克/天,口服)和多西环素(200毫克/天,口服给药)7个月。
结果:手术后患者的临床状况最初有所改善,但是耳乳突炎逐渐恶化,合并微妙的脑膜炎,术后2个月。外耳道肿胀阻塞,这使得很难通过耳镜检查来监测治疗效果。因此,我们定期进行前庭功能测试,包括静态姿势描记术,颈前庭诱发肌源性电位,和视频头部冲动测试,评估恢复结果。抗生素治疗后,感染症状明显消退,治疗后7个月无感染复发证据。静态姿势造影和颈椎前庭诱发肌源性电位的改善与临床表现相符,但是视频头部冲动测试显示了不显著的相关性。
结论:如果患者有头晕症状,可以使用前庭试验评估NTM耳乳突炎的临床状况。
BACKGROUND: Nontuberculous mycobacteria (NTM), an extremely rare pathogen causing cervicofacial infections, may result in permanent hearing impairment or intracranial complications. Due to the lack of specific manifestations during the initial onset of NTM otomastoiditis, physicians may misdiagnose it as cholesteatoma or other common bacterial infections.
METHODS: A 44-year-old male who complained of left-sided aural fullness, otalgia, and dizziness for 2 months.
METHODS: The initial diagnosis was hypothesized to be cholesteatoma based on a whitish mass with mucoid discharge filling the entire outer ear canal on otoscopy and left-sided mixed hearing loss. However, NTM was identified by microbial culture at the 2-month follow-up after surgery.
METHODS: The patient underwent a left-sided exploratory tympanotomy. Because NTM otomastoiditis was diagnosed, 3 weeks of starting therapies were administered with azithromycin (500 mg/day, oral administration), cefoxitin (3 g/day, intravenous drip), and amikacin (750 mg/day, intravenous drip). The maintenance therapies were azithromycin (500 mg/day, oral administration) and doxycycline (200 mg/day, oral administration) for 7 months.
RESULTS: The patient\'s clinical condition improved initially after surgery, but the otomastoiditis gradually worsened, combined with subtle meningitis, 2 months after surgery. The external auditory canal became swollen and obstructed, making it difficult to monitor the treatment efficacy through otoscopy. Thus, we used regular vestibular function tests, including static posturography, cervical vestibular evoked myogenic potentials, and video Head Impulse Test, to assess recovery outcomes. After antibiotic treatment, the infectious symptoms subsided significantly, and there was no evidence of infection recurrence 7 months after treatment. Improvements in static posturography and cervical vestibular evoked myogenic potentials were compatible with the clinical manifestations, but video Head Impulse Test showed an unremarkable correlation.
CONCLUSIONS: The clinical condition of NTM otomastoiditis may be evaluated using vestibular tests if patients have symptoms of dizziness.