中耳胆固醇肉芽肿的诊断与手术治疗

目的探讨中耳胆固醇肉芽肿的诊断与手术治疗方法。方法分析14例（15耳）经手术并病理证实的中耳胆固醇肉芽肿患者的病例资料。其中，行完壁式乳突根治加鼓室探查加中耳置管术6耳；完壁式乳突根治加听骨链重建6耳；改良乳突根治加鼓室成形3耳。结果1耳改良乳突根治加鼓室成形术后仍间断溢液；1耳中耳置管术后2周通气管脱落，中耳积液复发，需通气管重新置入半年病情缓解后取出。所有病例术后随访0．5～3年，14耳术后语频听力提高15dBHL以上，1耳术后听力无改变。结论中耳胆固醇肉芽肿应及早手术治疗。根据病变的程度、部位及范围，采取不同的手术方法。原则是彻底清除病变，建立咽鼓管、鼓室、鼓窦、乳突的通气系统。

The diagnosis and surgical treatment for cholesterol granuloma in middle ear

Objective To explore the feasible program of diagnosis and surgical procedures for the treatment of cholesterol granuloma in middle ear cleft based on a clinical trial.Methods Included in this retrospective study were 14 cases（15 ears） with middle ear cholesterol granuloma confirmed by surgery and histopathology, with their clinical data. diagnostic and therapeutic course analyzed carefully to sum up the experience with the diagnosis and treatment of this kind of lesion. Results Out of these cases.6 ears received the surgery of intact canal wall mastoidectomy, supplemented with exploratory tympanotomy and grommet insertion,6 ears undergone the operation of intact canal wall mastoidectomy, supplemented with ossicular chain reconstruction,and the other three ears operated on by modified radical mastoidectomy plus tympanoplasty.Among them,1 ear was seen still with intermittent discharge after modified radical mastoidectomy combined with tympanoplasty, and 1 ear was seen with the middle ear secretion reoccurred two weeks later following the grommet insertion,but cured by grommet re-inserting and with it removed six months latex All these patients were followed up for 0.5 to 3 years after the surgery, with 14 ears showing their hearing level in the range of speech frequencies elevated more than 15 dB HL and 1 ear with no change in hearing threshold as evaluated by the end of following up period. Conelusions Oholesterol granuloma in middle ear cleft should be treated surgically at an earlier stage based on the treating principles of cleaning up the diseased tissues as completely as possible and creating a ventilation system for the middle ear cleft The selection of surgical procedures depends upon the location,extend and severity of the lesion.