Epidemiology of middle ear and mastoid cholesteatomas. Study of 1146 cases

Middle ear cholesteatoma is an important and relatively common disorder which may have serious consequences.AimThe purpose was to conduct a retrospective study of the statistics of 1,146 middle ear surgical procedures for middle ear cholesteatoma in adults and children of low income living in distant areas from our city.MethodsFrom 1962 to 1988 there were 1,146 surgeries for unilateral or bilateral cholesteatomas in children and adults, which were reviewed for the following criteria: total number of surgeries, sex, onset of the first symptoms, duration of the disease, the site of perforation, the cholesteatoma site, changes in the ossicular chain, the contralateral ear, bilateral cholesteatomas, the site of residual cholesteatoma, and complications.ResultsResults are shown graphically on a pie chart.ConclusionThe etiology of cholesteatomas remains unknown. Epidemiological and statistical data, surgical reports, and conclusions of experimental studies are welcome, as they may provide support for clarifying the pathogenesis of cholesteatoma. Our results were compared with internationally published papers. We found no published papers on the epidemiology of cholesteatoma in the Brazilian literature.     

Congenital cholesteatoma of the middle ear and mastoid. Apropos of 5 cases]

Five cases of congenital cholesteatoma of the middle ear and mastoid as defined by Derlacki's criteria were encountered over a 14 month period. They make up 5% of all cases of cholesteatoma managed over the same period of time. Three were young children and all presented with unilateral hearing loss. One had associated multiple congenital abnormalities of the external and middle ear. Only in one patient was the diagnosis made on initial otoscopic examination and the remainder diagnosed on CTscan, myringotomy and tympanotomy. All were operated on; three by the intact canal wall technique, one by the canal down technique with mastoid cavity obliteration and one by atticotomy with lateral attic wall reconstruction. One patient required a second stage operation for excision of an extension of disease deep to the superior semicircular canal via the middle cranial fossa approach in order to preserve cochlear function. These five cases illustrate the diagnostic pitfalls of this condition in which silent danger lurks behind an intact tympanic membrane.     

10例中耳和乳突术后迟发性面神经麻痹的临床观察

目的 :探讨中耳和乳突术后迟发性面瘫的病因、治疗及转归。方法 :对 10例中耳、乳突术后迟发性面瘫进行诊断、治疗和预后观察 ,患者均采用激素、营养神经和扩血管药物及理疗等综合治疗。结果 :迟发性面瘫多发生于术后第 4天左右。面神经功能Ⅱ～Ⅲ级 ,绝大部分病例在 3周左右完全恢复 ,且无任何后遗症。结论 :慢性中耳炎中耳乳突术后迟发性面瘫的发生可能为局部面神经或鼓索神经微创伤引起局限性反应性水肿所致 ;也可能与并发单纯疱疹病毒感染有关。     

10例中耳和乳突术后迟发性面神经麻痹的临床观察

目的探讨中耳和乳突术后迟发性面瘫的病因、治疗及转归.方法对10例中耳、乳突术后迟发性面瘫进行诊断、治疗和预后观察,患者均采用激素、营养神经和扩血管药物及理疗等综合治疗.结果迟发性面瘫多发生于术后第4天左右.面神经功能Ⅱ～Ⅲ级,绝大部分病例在3周左右完全恢复,且无任何后遗症.结论慢性中耳炎中耳乳突术后迟发性面瘫的发生可能为局部面神经或鼓索神经微创伤引起局限性反应性水肿所致;也可能与并发单纯疱疹病毒感染有关.     

Cholesteatoma of the middle ear and mastoid. A comparison of CT scan and operative findings

High-resolution CT scanning accurately depicts the status of the structures of the temporal bone, allowing delineation of pathology prior to surgical exploration of ears with cholesteatoma. It provides information concerning location and extent of disease as well as possible anatomic variations and complications that may be encountered. The main advantages of CT scanning over polytomography are superior soft-tissue contrast resolution and improved spatial detail at a reduced radiation dose for the patient.     

Adenomatous tumors of the middle ear and mastoid

Three cases of middle ear and mastoid neoplasms are reported as “adenomatous tumors” since in their search of the literature the authors did not find any previously described lesions with a similar histologic appearance and benign biologic behavior. Microscopically, all three tumors are similarly composed of solid cords and nests of closely-packed small cells having an epithelial appearance. Two distinct cell types are present: cuboidal cells, arranged in a rudimentary gland-like pattern, and angular cells forming irregular nests with no distinct pattern. All three tumors developed in patients in their 20′s, over a period of months with minimal symptoms; yet in all of the lesions the tympanic membrane was intact at the time of initial examination. None of the neoplasms was diagnosed preoperatively, and, once removed, all three tumors were pathologic enigmas and therapeutic problems in view of the initial and subsequent consultant pathologic opinions; nevertheless, total local excision with preservation of the tympanic membrane would appear to be safe treatment in these cases. The term “adenomatous tumor” is applied to these three neoplasms because: 1. a true glandular epithelial origin warranting the term adenoma or adenocarcinoma cannot be proven; and 2. the biologic behavior and prognosis is not necessarily reflected by the histologic appearance. A more specific term reflecting the origin and behavior of these tumors does not appear possible without the study of further cases.     

中耳乳突手术并发面神经麻痹23例临床分析

目的：探讨中耳乳突手术引起面瘫的原因、预防和治疗方法。方法：对１９７６～１９９１年的１０３２例行中耳乳 手术并发面神经麻痹的２３例进行回顾性分析,结果：２３例均匀不完全性周围性面瘫,作面神经减压术１例,治愈６例,好转４例,无效３例,保守治疗１０例,治愈５例,好转３例,无效２例。结论：即发型面瘫在排除麻醉药所致外,就意味着神经损伤,应立即探查神经并减压,迟发型面瘫首选保守治疗,预后较好,１个月后仍无效者,再手术。     

Adenomatous tumors of the middle ear and mastoid

Adenomatous tumors of the middle ear and mastoid have been called adenoma or adenocarcinoma. The clinical and pathologic distinction between the two has been difficult. The resultant pathologic ambiguity makes it difficult to decide whether conservative or radical management is appropriate. The Otologic Medical Group's (OMG) experience with glandular tumors of the middle ear and mastoid over the past 27 years was reviewed. Thirteen cases were found and analyzed with respect to signs and symptoms at presentation. Extensive histopathologic review with light and electron microscopy was performed on tumor specimens. Two distinctive histopathologic and clinical patterns were identified. The mixed type of tumor was always confined to the middle ear and mastoid, was commonly misdiagnosed as chronic otitis media, and rarely demonstrated otic capsule or facial nerve involvement. The papillary pattern always had extension to the petrous apex and frequently involved the middle and/or posterior cranial fossa. Papillary tumors were more frequent in females and usually involved the facial nerve. On the basis of the findings in this review as well as information from the literature, we have come to the following conclusions: 1. The correct general pathologic heading be Adenomatous Tumors of the Middle ear and Mastoid with each tumor then being subclassified into Mixed or Papillary tumor and adenocarcinoma when warranted by histology. 2. There is a high rate of local recurrence. 3. Long-term follow-up (at least 10 years) for all adenomatous tumors is necessary. 4. Primary surgical treatment is required.     

Embryonal rhabdosarcoma of the middle ear and mastoid

Two cases of embryonal rhabdomyosarcoma, arising from the middle ear, are described. It is a rare mesenchymal tumour of childhood, with a very poor prognosis. The literature is briefly reviewed and the difficulties encountered in diagnosis are outlined.     

Radiotherapy in the treatment of middle ear and mastoid carcinoma.

The treatment of temporal bone carcinoma is a widely discussed topic with marked variation in published results. Most conclude that a combination of radical surgery and radiotherapy is the optimum treatment. The present study reviews the results of radiotherapy used as the main primary treatment for this condition. Five-year survival in 56 patients was 32% for radical and palliative therapy, with an excellent response in 'early' cases. It is concluded that improvement in survival could be attained by defining those groups which would benefit from a combination of treatment methods.     

外耳道胆脂瘤侵犯中耳乳突11例临床分析

目的总结外耳道胆脂瘤侵犯中耳的临床表现、诊断及治疗方法.方法回顾分析1987至2001年收入院治疗的11例侵犯中耳乳突的外耳道胆脂瘤的临床资料.结果侵入中耳乳突的部位多为鼓膜松弛部,其余依次为外耳道后壁、紧张部.乳突片表现为乳突密度升高,4例有较明显的骨性外耳道扩大.4例进行了颞骨CT检查,示外耳道有软组织影及外耳道骨质破坏现象.手术清理胆脂瘤上皮、肉芽及坏死骨质,修补外耳道后壁及鼓膜.术后均未见复发.结论病变侵入中耳乳突的部位多为鼓膜松弛部.颞骨CT检查和仔细询问病史在诊断外耳道胆脂瘤侵犯中耳乳突中十分重要.合理选择术式对最大限度的保存听力、预防复发同样关键.     

Aeration of the middle ear and mastoid in tympanoplasty

In order to achieve a good hearing result following tympanoplasty it is necessary to maintain an aerated middle ear space. Poor Eustachian tube function is most commonly blamed in cases of failure to obtain an adequately aerated middle ear following tympanoplasty. Although this may be the true etiology in some cases, middle ear adhesions, loss of support of the posterior canal wall and inadvertent blockage of the Eustachian tube orifice by graft material may be contributing factors. Aeration of the mastoidectomy cavity is also important to prevent collapse of the posterior canal wall, retraction pockets and to insure an adequate air reserve. Surgical techniques for prevention of these complications and a means of bypassing the totally blocked Eustachian tube are discussed.