目的 探讨慢性化脓性中耳炎合并真菌感染的发病原因、诊断方法及不同治疗方案的疗效。方法 回顾性分析65例慢性化脓性中耳炎伴真菌感染患者的临床资料，根据患者的症状、耳镜检查及真菌鉴定结果进行诊断，分别采用药物治疗（局部抗真菌药滴耳或涂耳、口服抗真菌药、局部抗真菌药滴耳或涂耳+口服抗真菌药）和手术治疗，并进行疗效评估。结果 经真菌鉴定后，所有患者均应用抗真菌药物进行诊断性治疗。局部用药中，制霉菌素甘油滴耳、盐酸特比萘芬乳膏涂耳、复方康纳乐霜或曲安萘德乳膏涂耳后的干耳率分别为66.67%、81.82%和90.00%，口服盐酸特比萘芬片和斯皮仁诺片的干耳率为77.78%和76.92％，联合用药的干耳率为90.91%；9例手术治疗患者均获治愈。65例患者的总治愈率为13.85%，干耳率为81.54％，无效率为4.61％。结论 中耳真菌感染与机体免疫力低下或长期应用抗生素并无明显关联，局部因素可能起主要作用；外耳道及乳突腔内环境潮湿在真菌感染中起重要作用；脓液培养或脓液涂片检查在真菌感染诊断中具有决定性作用。慢性化脓性中耳炎伴真菌感染患者应在控制真菌感染后及时进行鼓室成形术等手术治疗。

Objective To explore possible etiology, diagnosis method, and different treatment plans of chronic suppurative otitis media with fungus infection. Methods Sixty-five cases of chronic suppurative otitis media with fungus infection were retrospectively analyzed. According to the symptoms, otoscopic examination, and diagnosis of fungal identification results, the patients received medicine (local anti-fungus drugs, oral anti-fungus drugs, or local and oral anti-fungus drugs) and ear operation following efficacy evaluation. Results After fungi identification, all patients were treated by anti-fungus drugs as diagnostic therapy. For local medicine, dry ear rates of using glycerin otic nystatin, terbinafine hydrochloride cream, and kenacomb cream or triamcinolone cream were 66.67%, 81.82% and 90.00%, respectively. In oral medicine, dry ear rates of using terbinafine hydrochloride and Sporanox were 77.78% and 76.92%. In local and oral medicine, dry ear rate was 90.91%. Nine patients undergone operation were all cured. The total cure rate was 13.85%; dry ear rate, 81.54%; and inefficiency rate, 4.61%. Conclusion There was no definitive relationship between fungal infection of the middle ear and immunocompromise or long-term using antibiotics. Local factors might play important roles, such as moisture in the ear canal and mastoid cavity. Pus culture and smear examination may play definitive roles in diagnosis. For patients with chronic suppurative otitis media, prompt tympanoplasty should be advised after fungal infection controlled.