易漏诊的胆脂瘤型中耳炎

目的 探讨和提高对无明显临床症状的胆脂瘤型中耳炎诊断水平，避免误诊和漏诊。方法 对31例经手术和病理证实的无明显临床症状的胆脂瘤型中耳炎病史资料进行回顾性分析。结果 31例（31耳）中21例（67.7%)无明显耳漏史，22例有鼓膜独特部位（松弛部，紧张部后上方）轻微变化，如内陷、隆起、小肉芽、盯聍样覆盖和针尖样穿孔，有9例看不到穿孔。听力损失以中、轻度传导性聋为主。鼓室功能曲线呈B型变化为特征；X线诊断符合率为41.9%(13/31)，CT检查诊断符合率为80.6%(25/31)；胆脂瘤侵犯部位范围是上鼓室、听骨链、鼓窦、乳突和中鼓室；约35.5%(11例）病例分别有面神经骨管受损、脑膜暴露、迷路瘘管或（和）2种以上损害。结论 易漏诊的胆脂瘤型中耳炎由于无明显临床症状，往往容易漏诊和误诊，而其病变则呈隐蔽性发展，只是发展过程相对缓慢。如不能及时诊断和治疗，危害甚大，须引起临床医师的警惕。

Missed diagnostic cholesteattomaous otitismedia]

OBJECTIVE: To explore the missed diagnostic cholesteattomaous otitismedia lacked of clinical symptoms in order to minimize the mistake in clinical diagnose. METHODS: A retrospective study of 31 cases with the missed diagnostic cholesteattomaous otitismedia, confirmed by surgery and pathology, was conducted. RESULTS: Twenty-one cases (67.7%) had not obvious otorrhea. There were only slight finding such as attic retraction, apophysis, small granulation tissue, ear wax covered or tiny, even non, perforation in the pars flaccida or the superior and posterior pars tensa of the ear-drum. In general, the hearing loss is slight or medium conductive deafness. The type B curve was showed in tympanogram. The diagnosis rate of X-ray was only 41.9%, and 80.7% for the computed tomography. The middle ear structures aggressed by cholesteames was epitympanum, ossicular chain, tympanic antrum, mastoid process and mesotympanum. The complications occurred in 11 cases (35.5%) were the expose of facial nerve or and the meninges, or, and the labyrinth fistula. CONCLUSION: The cases with the cholesteatoma lack obvious clinic symptoms would result in the missed diagnosis because of slow and long term during cholesteatoma development. Sometimes misdiagnosed or missed diagnosis happened to in such cases of cholesteatoma with little clinical manifestation, and it is so dangerous for the patients in such case. Therefore, otolaryngologist must pay more attention to the missed diagnostic cholesteattomaous otitismedia.