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NEJM：爆震伤后双耳鼓膜穿孔-案例报道

2017-05-11 xing.T MedSci原创

爆震伤鼓膜穿孔
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鼓膜穿孔可发生高能爆炸伤后。尖锐的径向或三角形的穿孔和出血边缘可能表明为创伤性鼓膜穿孔的起源。小穿孔往往只需要观察即可，但较大的穿孔可能需要进行修补，以防止水进入中耳，改善愈合。如果爆炸损伤后突发性听力损伤伴随着急性眩晕伴眼球震颤，中耳探查可以排除内耳瘘管。

患者为一名30岁的男性，因爆炸受伤后双耳新发听力损失和耳鸣而到急诊就诊。在一个婚礼当中准备的庆祝烟花，该患者一直站在一个充满沙子的礼炮旁，该礼炮被意外点燃。



耳镜检查发现双侧鼓膜穿多处穿孔（图A显示右耳，图B显示左耳）。听力测试显示轻度传导性听力损失（20分贝听力水平）和中度4000赫兹感音神经性听力损失（40分贝听力水平）。

鼓膜穿孔可发生高能爆炸伤后。尖锐的径向或三角形的穿孔和出血边缘可能表明为创伤性鼓膜穿孔的起源。小穿孔往往只需要观察即可，但较大的穿孔可能需要进行修补，以防止水进入中耳，改善愈合。如果爆炸损伤后突发性听力损伤伴随着急性眩晕伴眼球震颤，中耳探查可以排除内耳瘘管。

该患者对穿孔的鼓膜进行了修补。三个月后，他的听力测验结果正常，并且耳镜检查显示两耳鼓膜愈合。

原始出处：

Jeroen B. van Rijswijk,et al. Binaural Tympanic-Membrane Perforations after Blast Injury.N Engl J Med 2017; http://www.nejm.org/doi/full/10.1056/NEJMicm1612629

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    2018-04-21 fangcong

    #鼓膜穿孔#

    0

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    2017-05-13 1dd8f26bm82(暂无匿称)

    好资源

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1949227, encodeId=dd93194922ed5, content=<a href='/topic/show?id=311c1033e979' target=_blank style='color:#2F92EE;'>#鼓膜穿孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103379, encryptionId=311c1033e979, topicName=鼓膜穿孔)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=fangcong, createdTime=Sat Apr 21 04:56:00 CST 2018, time=2018-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197522, encodeId=629b19e52265, content=好资源, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150714/IMG55A4FADCE0F987688.jpg, createdBy=23af1632396, createdName=1dd8f26bm82(暂无匿称), createdTime=Sat May 13 11:35:15 CST 2017, time=2017-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377954, encodeId=663613e7954a3, content=<a href='/topic/show?id=0d1ce5437ef' target=_blank style='color:#2F92EE;'>#穿孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75437, encryptionId=0d1ce5437ef, topicName=穿孔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Fri May 12 22:56:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197204, encodeId=cb3819e204dd, content=好资源, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150714/IMG55A4FADCE0F987688.jpg, createdBy=23af1632396, createdName=1dd8f26bm82(暂无匿称), createdTime=Fri May 12 20:26:23 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196525, encodeId=7a1f1965256e, content=鼓膜修补术后鼓膜愈合, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Thu May 11 08:09:15 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196516, encodeId=85531965160d, content=好资源, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150714/IMG55A4FADCE0F987688.jpg, createdBy=23af1632396, createdName=1dd8f26bm82(暂无匿称), createdTime=Thu May 11 08:02:18 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
    2017-05-12 仁医06

    #穿孔#

    0

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    2017-05-12 1dd8f26bm82(暂无匿称)

    好资源

    0

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    2017-05-11 cqykthl

    鼓膜修补术后鼓膜愈合

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1949227, encodeId=dd93194922ed5, content=<a href='/topic/show?id=311c1033e979' target=_blank style='color:#2F92EE;'>#鼓膜穿孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103379, encryptionId=311c1033e979, topicName=鼓膜穿孔)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=fangcong, createdTime=Sat Apr 21 04:56:00 CST 2018, time=2018-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197522, encodeId=629b19e52265, content=好资源, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150714/IMG55A4FADCE0F987688.jpg, createdBy=23af1632396, createdName=1dd8f26bm82(暂无匿称), createdTime=Sat May 13 11:35:15 CST 2017, time=2017-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377954, encodeId=663613e7954a3, content=<a href='/topic/show?id=0d1ce5437ef' target=_blank style='color:#2F92EE;'>#穿孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75437, encryptionId=0d1ce5437ef, topicName=穿孔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Fri May 12 22:56:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197204, encodeId=cb3819e204dd, content=好资源, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150714/IMG55A4FADCE0F987688.jpg, createdBy=23af1632396, createdName=1dd8f26bm82(暂无匿称), createdTime=Fri May 12 20:26:23 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196525, encodeId=7a1f1965256e, content=鼓膜修补术后鼓膜愈合, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Thu May 11 08:09:15 CST 2017, time=2017-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196516, encodeId=85531965160d, content=好资源, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150714/IMG55A4FADCE0F987688.jpg, createdBy=23af1632396, createdName=1dd8f26bm82(暂无匿称), createdTime=Thu May 11 08:02:18 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
    2017-05-11 1dd8f26bm82(暂无匿称)

    好资源

    0