中耳先天性胆脂瘤的高分辨率CT表现

目的 结合手术所见,探讨中耳先天性胆脂瘤的影像学特征.方法 回顾性分析16例(16耳)中耳先天性胆脂瘤患者的高分辨率CT(high-resolution CT,HRCT)表现和术中所见.病例分为3组:第1组胆脂瘤局限于鼓室;第2组胆脂瘤由鼓室向后发展,突向鼓窦或乳突,周边结构无明显受侵;第3组胆脂瘤范围广,周边结构广泛...     

完壁加盾板修复等多种技术治疗中耳胆脂瘤效果分析

目的 分析观察完壁法加盾板修复等多种技术治疗中耳胆脂瘤的效果.方法 2001年9月至2006年1月手术的113例中耳胆脂瘤患者,男60例,女53例;双耳11例,共124耳.其中11耳经2次手术,1耳经3次,共137耳次手术.手术采取耳内切口,保留外耳道后壁,综合采用气钻铣切割耳道整块取骨、自体骨制臼柱枪柱听骨、鼓索弹压听骨、透明质酸酯膜防粘连、轮廓化清除病灶、耳道壁(盾板)重建、上鼓室乳突再气化、早期咽鼓管吹张等多种技术.平均随访(36.58±20.47)个月.术后随访的气骨导差＜20 dB,或术后气骨导差虽＞20 dB,但气导＜40 dB者为手术成功.术后气骨导差＜10 dB,或气骨导差虽＞10 dB但手术前后气骨导差的差值＞30 dB为显效;其余为有效.结果 术后118耳(95.2%)没有胆脂瘤复发,112耳(90.3%)具有正常耳道,鼓膜愈合.胆脂瘤复发6耳、听力下降5耳、鼓膜再穿孔1耳共计12耳再手术并随访＞12个月.112耳只经一次手术者术前气骨导差为(33.61±12.35)dB,术后气骨导差为(13.58±9.27)dB,差异有统计学意义(t=18.35,P＜0.01).12耳再手术者首次术前的气骨导差(38.83±12.43)dB,最后随访的气骨导差(10.38±8.99)dB,与首次术前相比,差异有极显著统计学意义(t=5.38,P＜0.001).手术有效47耳(37.9%),手术显效59耳(47.6%).手术成功共106耳(85.5%).骨导变化:术前平均骨导阈为(17.3±13)dB,与随访平均骨导阈(15.15±11.79)dB比较,差异统计学意义(t=4.77,P＜0.01).其中骨导阈上升21耳(16.93%),不变42耳(33.87%),下降61耳(49.19%).10例19岁以下患者术后气骨导差为(8.80±5.27)dB,听力全部达到成功.结论 完壁法加盾板修复等多种技术治疗中耳胆脂瘤,术后大多数不仅可以获得安全、干耳和正常的耳道,绝大多数听力可改善甚至恢复正常.复发率低,且复发后用同样的治疗方法仍能获得很好效果.对少年儿童能保持生理的耳道和听力,尤其有益.多种技术采用对骨导亦是安全的.     

影像学检查在慢性胆脂瘤型中耳乳突炎患者中的诊断价值

目的 分析CT+核磁共振DWI对慢性胆脂瘤型中耳乳突炎患者的诊断价值。方法 选取2019年2月—2022年7月楚雄州人民医院88例慢性中耳乳突炎患者,术前均接受CT、核磁共振DWI检查。比较CT、核磁共振DWI对慢性中耳乳突炎胆脂瘤的检出情况。分析慢性胆脂瘤型中耳乳突炎患者的CT及核磁共振DWI表现。以手术病理检查结果为金标准,比较CT、核磁共振DWI对慢性中耳乳突炎患者胆脂瘤病变的灵敏度、特异度及准确度。分析CT、核磁共振DWI与手术病理检查结果间的一致性。结果 CT检查灵敏度为51.7%、特异度为83.1%、准确度为72.7%,CT与手术病理检查结果间的一致性检验Kappa=0.360,差异具有统计学意义(P=0.001),但一致性低。核磁共振DWI检查灵敏度62.1%、特异度89.8%、准确度为80.7%,核磁共振DWI与手术病理检查结果间的一致性检验Kappa=0.543,差异具有统计学意义(P<0.001),一致性中等。结论 核磁共振DWI对慢性胆脂瘤型中耳乳突炎的诊断价值高于CT,但CT提供了更好的空间定位,二者是互补技术,二者的结合应用有助于对胆脂瘤和听骨链状态的术前评估,对术式及入路的选择有一定的指导价值。     

中耳胆脂瘤研究进展

中耳胆脂瘤是耳鼻咽喉科较为常见的一种慢性中耳疾病,长期外耳道流脓、鼓膜穿孔、听力下降为其主要特点,它对周围组织具有侵袭性,易引起中耳传音结构的破坏和骨质吸收,进而引起面瘫、迷路炎、耳后骨膜下脓肿及各种颅内外并发症。中耳胆脂瘤的病因及发病机制复杂,治疗方法的疗效争议较多。本文主要将近年来关于中耳胆脂瘤的病因、发病机制及治疗进展进行综述。     

HRCT常规重建与后处理对CSOM及中耳胆脂瘤诊断价值

目的探讨高分辨率CT扫描常规轴位、冠状位重建图像及图像后处理技术对慢性化脓性中耳炎及中耳胆脂瘤的诊断价值。方法对经手术病理证实并行64排螺旋CT容积扫描慢性化脓性中耳炎及中耳胆脂瘤共105例(107耳)进行回顾性分析。在常规轴位及冠状位重建图像基础上,综合运用图像后处理技术,根据主要CT表现:1、鼓室、鼓窦腔软组织密度影;2、听骨链骨质破坏情况;3、鼓室、鼓窦壁骨质破坏情况;进行术前分型,并将手术阳性结果与CT表现进行比较分析。结果慢性化脓性中耳炎59耳,其中单纯型8耳,肉芽型36耳,硬化灶肉芽型15耳;中耳胆脂瘤48耳,术前CT分型准确率为89%。对主要CT征象,常规轴位+冠状位显示率为88%,结合图像后处理技术,显示率为95%。对于所有可CT显示的术中阳性发现,均可以用多平面重组进行显示;容积再现及多平面容积再现对锤骨、砧骨破坏能较好显示,对镫骨破坏显示受到一定限制;曲面重组对面神经骨管破坏显示较满意,对听骨链骨质破坏也有一定的价值。结论 HRCT能对CSOM及中耳胆脂瘤进行较准确的术前分类、分型,常规轴位、冠状位重建图像能较全面、准确地对解剖和病变进行显示,各种图像后处理技术特别是MPR能提高CSOM及中耳胆脂瘤细微病变显示率和诊断准确率,具有很高的临床应用价值。     

胆脂瘤型中耳炎的CT表现特点

目的探讨和总结胆脂瘤中耳炎的CT表现特点。方法对80例耳手术证实为胆脂瘤型中耳炎的CT影像特点进行分类和归纳。结果胆脂瘤的CT影像主要表现为：盾板破坏；有软组织充填的扩大的上鼓室；软组织包裹的听小骨移位：有软组织充填的边缘清楚的扩大骨腔隙，充填的软组织可呈均匀型、网格型和周边间隙型；中耳结构骨组织的破坏及硬化型乳突等表现。结论盾板破坏，有软组织充填的边缘清晰的扩大骨腔隙，中耳腔结构骨组织的破坏．是胆脂瘤CT表现的基本特征。     

先天性中耳胆脂瘤

目的探讨先天性中耳胆脂瘤的位置、范围、临床症状、影像学特征及手术治疗。方法本文回顾性分析了解放军总医院耳鼻咽喉-头颈外科自1995年1月～2005年10月诊治的952例胆脂瘤患者的治疗结果,对其中10例先天性中耳胆脂瘤的起源、临床特征及手术前后的听力进行了评估。结果10例先天性中耳胆脂瘤患者的平均年龄为16岁(10～24岁),其中7例为男性,3例为女性,出现症状到临床确诊的平均时间为2年。术前平均纯音听阈为55dB,平均气-骨导差为45dB,有2例患者的鼓膜像上可以看到典型的先天性中耳胆脂瘤表现。所有病例均进行了高分辨率颞骨CT扫描。8例术前分别被诊断为耳硬化症或听骨链畸形。所有病例都在外耳道径路鼓室探查清除胆脂瘤后进行了一期鼓室成型术,除了1例因为病变广泛选择了完壁式乳突根治和鼓室成型术。本组所有病例的胆脂瘤均位于中-后鼓室,主要是在砧镫关节处。术后的平均气-骨导差小于20dB。所有病例术后至少随访1年半,2例病人因为术后听力下降进行了二期手术。本组病例中经手术探查或CT复查,没有发现胆脂瘤残留或复发。结论原发性中耳胆脂瘤临床罕见,常被延误诊断,其预后和残留、复发比例主要决定于病变范围。     

中耳胆脂瘤一例

患者 男，19岁。因左耳流脓反复发作10年，眩晕、恶心反复发作2年入院。发病以来，伴左耳耳鸣及听力下降，无头痛呕吐，无口角歪斜及闭眼障碍。查体：一般情况好，心肺腹无阳性体征。左外耳道后上壁下塌破溃。左耳纯音测听（听力级）骨导平均听阈20dB，气导平均听阈60dB。颞骨CT：左侧颞骨示溶骨性骨质破坏，正常鼓室、鼓窦及乳突结构消失，听小骨显示不清，     

小儿中耳胆脂瘤

本文就小儿中耳胆脂瘤的分类、发病率、病因与发病机理以及诊断、治疗和预后进行了综述。同时阐述了小儿与成人中耳胆脂瘤的异同以及小儿中耳胆脂瘤的临床特点。     

儿童中耳先天性胆脂瘤

中耳先天性胆脂瘤最常见于儿童,发病与胚胎时期鼓室内表皮样结构的残留或鼓环抑制功能障碍等因素有关。临床上以渐进性传音性聋及完整鼓膜后白色团块为特征,无鼓膜穿孔及耳手术史。根据病变情况,选择适当手术,可望彻底清除病变,保存患耳听力。     

慢性化脓性胆脂瘤型中耳炎的高分辨CT诊断

目的探讨高分辨CT(HRCT)对慢性化脓性中耳炎(胆脂瘤型)的诊断价值.方法对238例经手术及病理证实的中耳胆脂瘤的CT征象与手术所见进行对照研究.结果(1)CT诊断胆脂瘤的敏感性最高在上鼓室(81.25%),最低在乳突(50%).(2)CT显示胆脂瘤的病理改变为①鼓室乳突腔内胆脂瘤影;②胆脂瘤周低密度环;③鼓室乳突腔边缘骨质硬化;④鼓室乳突腔扩大;⑤听骨链破坏.结论CT检查对于中耳胆脂瘤的诊断及指导手术有很大帮助.     

胆脂瘤中耳炎术后复发或残留胆脂瘤的原因与处理

目的:探讨胆脂瘤中耳炎术后复发或残留胆脂瘤的原因和处理方法.方法:对102例(105耳)中耳胆脂瘤术后复发或残留患者分别进行处理.20耳经耳内镜下清理残留或复发的胆脂瘤,切除肉芽;85耳行乳突再根治术.结果:全部患者随访1年以上,101耳于处理后2～8周获得干耳,4耳仍间断流脓;全部患者耳内镜复查均未见胆脂瘤复发.其中23耳同期行鼓室成形术,术后气导听力均提高15 dBHL以上.结论:首次手术不彻底或术后引流不畅是胆脂瘤复发或残留的主要原因.对于面神经嵴够低,乳突、鼓窦、鼓室骨质开放足够、引流好者经耳内镜下清理、换药可痊愈;对于面神经嵴过高,引流不畅者需行乳突再根治,符合条件者可同期行鼓室成形术.     

Micronucleus frequency in acquired middle ear cholesteatoma

Objective—To determine the micronucleus (MN) frequency of acquired cholesteatoma tissue using an MN assay.

Material and Methods—Eighteen patients were diagnosed as having chronic otitis media with acquired cholesteatoma and were divided into primary and secondary acquired cholesteatoma groups. Cholesteatoma tissue and normal tissue specimens from the external ear canal skin were taken from the patients during surgical operations. MN frequencies of cholesteatoma and control samples were determined according to standard criteria.

Results—The MN frequencies of the cholesteatoma and control tissues were 0.54%±0.31% and 0.24%±0.11%, respectively (p<0.01). MN frequencies for the primary and secondary acquired cholesteatoma groups were 0.63%±0.36% and 0.46%±0.26%, respectively (p>0.05). MN frequencies in cholesteatoma patients without and with complications were 0.42%±0.19% and 0.85%±0.37%, respectively (p<0.05).

Conclusion—MN frequencies were found to be increased in cholesteatoma tissues when compared with external ear canal skin. The MN frequency in five cases with complications was higher than in cases without complications. These results indicate that there could be associations between MN frequency and acquired cholesteatoma and between MN frequency and complications.     

罕见中耳巨大胆脂瘤1例

中耳胆脂瘤是一种常见的慢性中耳疾病,特征是中耳腔、乳突腔及岩尖存在高度增殖的角化鳞状上皮和邻近骨质的破坏吸收,上皮细胞脱落、上皮碎屑堆积而形成胆脂瘤[1].现将我科收治的1例罕见巨大胆脂瘤病历资料报告如下.     

Propylene glycol-induced cholesteatoma in chinchilla middle ears

Propylene glycol is a solvent commonly used in topical otic preparations. This study examines the occurrence of inflammatory changes and cholesteatoma in chinchilla middle ears after the application of propylene glycol in varying concentrations. A total of 32 ears were studied, divided into four treatment groups. Three groups received propylene glycol in concentrations of 10%, 50%, and 90%. One group received normal saline. Six weeks after the application of propylene glycol to the middle ear through the bulla, examination revealed cholesteatoma, tympanic membrane perforations, and middle ear adhesions in most of the ears subjected to 50% and 90% propylene glycol. Only one ear treated with 10% propylene glycol showed a cholesteatoma, while the group treated with normal saline showed only mild inflammation. Histologic preparations confirmed cholesteatoma and revealed replacement of the normal columnar epithelium by keratinizing stratified squamous epithelium, inflammatory infiltration, and granulation tissue eroding underlying bone. We conclude that exposure to propylene glycol in high concentrations will consistently produce cholesteatoma in chinchilla middle ears. Although the effects of propylene glycol in the human middle ear are yet to be investigated, we recommend the avoidance of otic preparations containing high concentrations of propylene glycol in patients with tympanic membrane perforations.     

Localization of fibronectin in human middle ear cholesteatoma

Summary Fibronectin was localized in human cholesteatoma tissues by immunohistochemical methods. The avidin-biotin-peroxidase complex staining method was used with specific fibronectin antibody. Fibronectin appeared to be localized in the matrix of the cholesteatoma studied, particularly on the surface of the cell membranes and the nuclei of the basal cells and in connective tissue. Fibronectin was not seen in the granular layer or in the keratin area. Fibronectin was found on the surface of granulation tissue, mononuclear cells, fibroblasts and endothelial cells of blood vessels. These findings were confirmed by the immunofluorescent staining method. Our previous study showed that fibronectin induced a migration of keratinocytes, macrophages and fibroblasts demonstrated by the Boyden's chamber chemotaxis assay. Macrophages and fibroblasts were shown to produce collagenase, a bone resorption factor, in cholesteatomatous tissue. The present study showed the presence of fibronectin in the matrix of cholesteatoma and granulation tissue, suggesting that fibronectin might play an important role in the clinical development and invasive behavior of cholesteatoma.     

中耳先天性胆脂瘤1例

<正>中耳先天性胆脂瘤是少见疾病,常因病变隐匿而导致临床上延误诊断和治疗,随着影像学技术的提高和显微镜检查的普及,发现报道的先天性胆脂瘤病例逐渐增多。先天性胆脂瘤早期可无任何表现,逐渐出现传导性聋、耳痛,听力进行性下降,严重者可出现面瘫和神经性聋,甚至出现颅内并发症[1],由于无流脓、鼓膜穿孔等耳部症状,单侧的听力下降容易被忽略,诊断不易做出。现将解放军405医院耳鼻喉科2014年3月收治的先天性胆脂