临床误诊误治
臨床誤診誤治
림상오진오치
CLINICAL MISDIAGNOSIS & MISTHERAPY
2014年
11期
59-62
,共4页
鼻咽肿瘤%脑脊液耳漏%误诊%伴渗出液中耳炎
鼻嚥腫瘤%腦脊液耳漏%誤診%伴滲齣液中耳炎
비인종류%뇌척액이루%오진%반삼출액중이염
Nasopharyngeal neoplasms%Cerebrospinal fluid rhinorrhea%Diagnostic errors%Otitis media with effusion
目的：探讨首诊误诊为分泌性中耳炎疾病的误诊原因及防范措施。方法对我院2006年2月—2013年4月收治的首诊误诊为分泌性中耳炎73例的临床资料进行回顾性分析。结果73例出现听力下降伴耳闷胀感40例,听力下降伴耳后淋巴结增大20例,听力下降伴鼻塞5例,耳闷胀感伴头痛4例,耳闷胀感伴鼻出血及单纯耳闷胀感各2例。62例在外院首诊误诊为分泌性中耳炎,11例于我院首诊误诊为分泌性中耳炎。误诊时间1~8个月,平均3个月。结合病史、临床表现、医技检查及病理检查结果最终确诊鼻咽癌53例,脑脊液耳漏及腺样体肥大各5例,鼻咽纤维血管瘤4例,咽旁间隙囊肿3例,外淋巴漏2例,颈内动脉瘤1例。结论临床上对以中耳积液为首发或合并症状患者,应详细询问病史、认真体格检查,仔细观察鼓膜形态、色泽及积液情况,并综合电测听及声导抗检查结果对病情进行分析,必要时可行鼻咽镜、CT及MRI等检查,以提高首诊准确率。
目的：探討首診誤診為分泌性中耳炎疾病的誤診原因及防範措施。方法對我院2006年2月—2013年4月收治的首診誤診為分泌性中耳炎73例的臨床資料進行迴顧性分析。結果73例齣現聽力下降伴耳悶脹感40例,聽力下降伴耳後淋巴結增大20例,聽力下降伴鼻塞5例,耳悶脹感伴頭痛4例,耳悶脹感伴鼻齣血及單純耳悶脹感各2例。62例在外院首診誤診為分泌性中耳炎,11例于我院首診誤診為分泌性中耳炎。誤診時間1~8箇月,平均3箇月。結閤病史、臨床錶現、醫技檢查及病理檢查結果最終確診鼻嚥癌53例,腦脊液耳漏及腺樣體肥大各5例,鼻嚥纖維血管瘤4例,嚥徬間隙囊腫3例,外淋巴漏2例,頸內動脈瘤1例。結論臨床上對以中耳積液為首髮或閤併癥狀患者,應詳細詢問病史、認真體格檢查,仔細觀察鼓膜形態、色澤及積液情況,併綜閤電測聽及聲導抗檢查結果對病情進行分析,必要時可行鼻嚥鏡、CT及MRI等檢查,以提高首診準確率。
목적：탐토수진오진위분비성중이염질병적오진원인급방범조시。방법대아원2006년2월—2013년4월수치적수진오진위분비성중이염73례적림상자료진행회고성분석。결과73례출현은력하강반이민창감40례,은력하강반이후림파결증대20례,은력하강반비새5례,이민창감반두통4례,이민창감반비출혈급단순이민창감각2례。62례재외원수진오진위분비성중이염,11례우아원수진오진위분비성중이염。오진시간1~8개월,평균3개월。결합병사、림상표현、의기검사급병리검사결과최종학진비인암53례,뇌척액이루급선양체비대각5례,비인섬유혈관류4례,인방간극낭종3례,외림파루2례,경내동맥류1례。결론림상상대이중이적액위수발혹합병증상환자,응상세순문병사、인진체격검사,자세관찰고막형태、색택급적액정황,병종합전측은급성도항검사결과대병정진행분석,필요시가행비인경、CT급MRI등검사,이제고수진준학솔。
Objective To discuss the causes of the diseases misdiagnosed as secretory otitis media at first vist, and propose preventive measures. Methods Clinical data of 73 cases misdiagnosed as secretory otitis media at first vist from Feb-ruary 2006 to April 2013 in our department was retrospectively analyzed. Results The main performances included ear full-ness with hearing loss (40 cases), hearing loss with enlarged retroauricular lymph nodes (20 cases), hearing loss and nasal obstruction (5 cases), ear fullness with headache (4 cases), aural fullness with nasal hemorrhage (2 cases) and ear fullness (2 cases). A total of 62 cases were misdiagnosed as secretory otitis media at first vist in other hospital, and 11 cases were in our hospital. The misdiagnosis duration was from 1 to 8 months ( averaged 3 months) . According to the history, clinical fea-tures, pathology and laboratory examinations, the final diagnosises were made:53 cases of nasopharyngeal carcinoma, 5 cases of cerebrospinal fluid leakage, 5 cases of adenoid hypertrophy, 4 cases of nasopharyngeal angiofibroma, 3 cases of parapharyn-geal cysts, 2 cases of perilymphatic fistula, and one case of internal carotid artery aneurysm. Conclusion The patients with middle ear effusion as first or combined symptom should be asked detail history and take physical examinations. Careful obser-vation of tympanic membrane morphology, color and effusion should be taken. We should combine audiometry and tympanom-etry results to analyze the disease. Sometimes nasopharyngoscope, CT and MRI are necessary for improving the accuracy rate of first diagnosis.
