Adjuvant hyperbaric oxygen in malignant external otitis.
Adjuvant hyperbaric oxygen in malignant external otitis.
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恶性外耳炎的辅助高压氧治疗。
DOI：
10.1001/archotol.1992.01880010093022
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Allen Dinesman
中科院分区：
文献类型：
--
作者：
J. Davis;G. Gates;Charles J. Lerner;Merritt G. Davis;J. Mader;Allen Dinesman
外耳道坏死性侵袭性假单胞菌感染（恶性外耳道炎）是一种罕见但重要的疾病在老年人。这种疾病的高发病率，甚至死亡率，已经降低了早期和密集使用的组合抗假单胞菌抗生素。然而，在严重免疫功能低下的患者或感染累及颅底、多个颅神经或脑膜的患者中，常规治疗已经延长、强化且相对无效。我们对16例恶性外耳道炎患者进行了高压氧辅助治疗。在6例患者中，感染处于晚期，在先前治疗后感染复发，并且抗假单胞菌抗生素重复治疗失败。所有16例患者在抗生素治疗方案中加入30天的高压氧治疗后均迅速反应，所有患者在1至4年的随访期间均无感染或神经功能缺损。未观察到这种治疗方式的并发症。高压氧治疗逆转组织缺氧，这增强了嗜氧微生物的吞噬杀伤，并刺激新微血管生成。此外，高压氧增强氨基糖苷类抗生素的作用。对于晚期或复发性恶性外耳道炎，应考虑辅助高压氧治疗。
Necrotizing invasive pseudomonal infection of the external auditory canal (malignant external otitis) is an uncommon but important disorder in the elderly. The high morbidity, and even mortality, of this disorder has been reduced by the early and intensive use of combination antipseudomonal antibiotics. However, in severely immunocompromised patients or in infection involving the base of the skull, multiple cranial nerves, or the meninges, conventional therapy has been prolonged, intensive, and relatively ineffective. We treated 16 patients with malignant external otitis with adjuvant hyperbaric oxygen therapy. In six patients, infection was in advanced stages, infections were recurrences after previous treatment, and repeated treatment with antipseudomonal antibiotics had failed. All 16 cases responded promptly when a 30-day course of hyperbaric oxygen was added to the antibiotic regimen, and all patients remained free of infection or neurologic deficit during 1 to 4 years of follow-up. No complications of this treatment modality were noted. Hyperbaric oxygen therapy reverses tissue hypoxia, which enhances phagocytic killing of aerobic microorganisms, and stimulates neomicroangiogenesis. In addition, hyperbaric oxygen augments the action of aminoglycoside antibiotics. Adjuvant hyperbaric oxygen therapy should be considered in advanced or recurrent cases of malignant external otitis.