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題名 | 急性中耳炎併發腦膜炎--病例報告=Acute Otitis Media Complicated by Meningitis--Case Report |
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作者 | 王俊傑; 李啟鐘; 戴中杰; | 書刊名 | 中華民國耳鼻喉科醫學雜誌 |
卷期 | 35:1 民89.01-02 |
頁次 | 頁47-50 |
分類號 | 416.821 |
關鍵詞 | 急性中耳炎; 腦膜炎; Acute otitis media; Meningitis; |
語文 | 中文(Chinese) |
中文摘要 | 在抗生素發明前,中耳炎是顱內感染之主要來源;抗生素發明後,耳源性顱內感染則較為少見。常見的耳源性顱內感染,多是小兒急性化膿性中耳炎或成人慢性中耳炎合併膽脂瘤所引起,而由成人急性中耳炎引起的實屬少見。本科於1998年5月間經歷1名病患,因右耳疼痛及聽力減退已有3日至院就診。鼓膜穿刺抽出膿樣積液,診斷為急性化膿性中耳炎。經藥物治療數日後,病人卻出現高燒、嘔吐、頭部僵硬、意識昏迷等疑似腦膜炎之症狀。其中耳積液、血液及腦脊髓液之培養結果均為肺炎鏈球菌,且病人並無其他之感染源,也無慢性中耳炎之病史,故診斷為急性中耳炎併發之腦膜炎。住院後給予抗生素及支持療法,病人除出現左眼眼球運動受限之後遺症外,預後良好。 |
英文摘要 | Otitis media was one of the major causes of intracranial infection before the advent of antibiotics. Otogenic intracranial complications are frequently associated with acute suppurative otitis media in children or chronic otitis media with cholesteatoma in adults. Acute otitis media in the adult rarely leads to meningitis. A 38-year-old woman with no past otological history developed a high fever and neck stiffness with bacteremia three days after tympanocentesis for acute suppurative otitis media. Streptococcus pneumonia was isolated from the culures of the middle ear effusion, blood, and cerebrospinal fluid. The patient was then given intravenous wide-spectrum antibiotics and supportive treat-ment(aqua-penicillin 3 million units IV q6h, ceftriaxone 1g IV q12h, and dexamethasone 5 mg IV q6h for 10 days). The patient improved and was discharged two weeks later with mild limitation of left eye movement. We have learned from this unusual case that intracranial complications can still occur in acute otitis media, even after tympanocentesis. |
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