鼓膜置管长期无症状向中耳内侧迁移：一例病例报告及文献综述

文献信息

中文摘要

背景与临床意义： 鼓膜置管（TT）通常在6-18个月内被排出至外耳道，而向内侧迁移进入中耳是一种罕见并发症。内侧迁移的置管与耳痛、耳漏、传导性听力损失、肉芽肿及外淋巴瘘相关，但也可能保持临床无症状；对于无症状的内侧迁移置管是否应取出，目前尚无共识。
病例介绍： 一名24岁男性接受常规耳鼻咽喉科检查，无耳科主诉。他4岁时因分泌性中耳炎接受双侧鼓膜置管，已完全缓解，此后未再接受耳科手术。耳镜检查显示鼓膜完整，透过鼓膜可见鼓室后下象限内有一圆形蓝色结构；耳内镜确认该异物与中耳黏膜接触。鼓室压图显示A型曲线，纯音测听显示听阈正常且对称。高分辨率计算机断层扫描显示中耳腔含气、乳突气房发育良好、听骨链完整，无慢性中耳炎的影像学特征。采取保守治疗，计划每6-12个月进行临床和听力学复查；最近一次复查为诊断后3个月，患者仍无症状。
结论： 内侧迁移的鼓膜置管可在中耳内滞留二十年而无炎症、结构损伤或听力损失。对于经选择的鼓膜完整、听力正常且影像学无异常的患者，在告知患者何种症状需复诊的前提下，结构化观察是替代取出的合理选择。

英文摘要

Background and Clinical Significance: Tympanostomy tubes (TTs) are normally extruded into the external auditory canal within 6-18 months, whereas medial migration into the middle ear is a rare complication. Medialized tubes have been associated with otalgia, otorrhea, conductive hearing loss, granuloma and perilymphatic fistula, yet may remain clinically silent; no consensus exists on whether asymptomatic medialized tubes should be removed. Case Presentation: A 24-year-old man attended a routine otorhinolaryngological examination without otological complaints. He had undergone bilateral TT insertion at four years of age for otitis media with effusion, with complete resolution and no further otological procedures. Otoscopy demonstrated an intact tympanic membrane through which a round, blue structure was visible within the posteroinferior quadrant of the tympanic cavity; otoendoscopy confirmed a foreign body in contact with the middle ear mucosa. Tympanometry showed a type A curve and pure-tone audiometry showed normal, symmetrical thresholds. High-resolution computed tomography showed an aerated middle ear cleft, well pneumatized mastoid cavities, an intact ossicular chain and no radiological features of chronic otitis media. Conservative management was adopted, with clinical and audiological review planned at 6-12-month intervals; at the most recent review, three months after diagnosis, the patient remained asymptomatic. Conclusions: A medially migrated TT may be retained within the middle ear for two decades without inflammation, structural damage or hearing loss. In selected patients with an intact tympanic membrane, normal audiometry and unremarkable imaging, structured observation is a defensible alternative to removal, provided the patient is counseled about the symptoms that should prompt review.