外耳道灌注派瑞松治疗真菌性外耳道炎的疗效分析

Efficacy analysis of perfusion of pevisone in external auditory canal for fungal otitis externa

摘要:

目的 探讨外耳道灌注给药方式对真菌性外耳道炎的临床价值。方法 选取单侧真菌性外耳道炎患者202例，随机分为传统涂布组（n = 89）和外耳道灌注组（n = 113）。所有患者均在耳内镜下清理外耳道真菌团，冲洗外耳道后给予派瑞松乳膏治疗1周，第10天复诊评估疗效，并随访6个月。结果 真菌性外耳道炎发病率呈逐年上升的趋势，主要发病于夏季。202例患者主要临床表现为耳痒（90.6%）、耳堵塞感（85.1%）和耳漏（54.0%）；危险因素主要是掏耳（98.0%），其次是配戴耳机/耳塞（37.6%）。真菌培养阳性率为84.4%（27/32），曲霉菌属占多数（74.1%）。1周疗程完成后，传统涂布组有效71例，无效18例，外耳道灌注组有效103例，无效10例，有效率分别为79.8%和91.2%，两组患者比较，差异有统计学意义（P < 0.05）。随访6个月后，传统涂布组复发22例，外耳道灌注组复发9例，复发率分别为29.3%（22/75）和8.9%（9/101），两组患者比较，差异有统计学意义（P < 0.05）。复发主要原因是工作环境潮湿和年龄较大。在治疗过程中，传统涂布组耳痛发生率高于外耳道灌注组。结论 外耳道灌注派瑞松治疗真菌性外耳道炎，操作简便，效果明显，不易复发，便于临床特别是基层单位推广应用。

Abstract:

Objective To investigate the clinical value of external auditory canal perfusion in treatment of fungal otitis externa.Methods 202 patients with unilateral fungal otitis externa were randomly divided into traditional coating group (n = 89) and external auditory canal perfusion group (n = 113). All these patients were treated with pevisone cream for one week after cleaning the external auditory canal fungal mass under otoscope. The efficacy was evaluated on day 10 and followed up for 6 months.Results The incidence of fungal external otitis was increasing year by year, mainly in summer. The primary symptoms of 202 patients were ear itching (90.6%), aural fullness (85.1%) and otorrhea (54.0%). Ear picking was the main risk factor (98.0%), followed by wearing earbuds (37.6%). The positive rate was 84.4% (27/32) in 32 fungal cultures, and Aspergillus was the majority (74.1%). After one week of treatment, 71 cases received good therapeutic effect and 18 cases did not got in the traditional coating group, 103 cases were for the better and 10 cases were not in the external auditory canal perfusion group, the effective rates were 79.8% and 91.2%, respectively (P < 0.05). After six months of follow-up, there were 22 cases of recurrence in the traditional coating group and 9 cases in the external auditory canal perfusion group. The recurrence rates were 29.3% (22/75) and 8.9% (9/101), respectively (P < 0.05). The main reasons for recurrence are damp working environment and age. During the treatment, the incidence of earache was higher in the traditional coating group than in the external auditory canal perfusion group.Conclusion The external auditory canal perfusion of pevisone in the treatment of fungal otitis externa is simple, effective, and not easy to relapse, which is convenient for clinical application, especially in grass-roots units.