中耳胆固醇肉芽肿8例报告

目的 :探讨中耳胆固醇肉芽肿 (CG)的病因、发病机制、诊断及治疗。方法 :回顾性分析 8例 (9耳 )CG患者的临床资料。 8例 (9耳 )均为轻～中度传导性聋 ,鼓膜呈“蓝鼓膜”征 ,鼓室压曲线图为B型 (除 1例鼓膜紧张部穿孔外 ) ,其中 7例 (8耳 )行鼓室探查术 ,开放上鼓室、鼓窦及乳突气房 ,彻底清除肉芽组织 ,有 5例行中耳置管术 ,2例行中耳乳突改良根治术 ;另 1例仅行鼓膜穿刺抽液。结果 :1例失访。 7例 (8耳 )术后随访 0 .5～ 6年 ,6例 (7耳 )无复发 ;1例 (1耳 )复发 ,再次行手术治疗 ,术后 1年无复发。结论 :对不明原因的血性耳溢液及蓝鼓膜 ,应结合CT提高术前诊断率。对CG应采取手术治疗 ,清除病变 ,建立鼓室及乳突的通气、引流。     

The histopathology of mastoidectomy cavities,with particular reference to persistent disease leading to chronic otorrhoea

Open cavity mastoidectomy remains the principal surgical treatment of middle ear cholesteatoma in the United Kingdom. A significant proportion of mastoid cavities are prone to intermittent or continuous discharge. In this study the histopathological features of material removed from 159 mastoid cavities at revision surgery were reviewed. Findings included squamous epithelium with acute and chronic inflammation, foreign body granuloma and aural polyps. Of particular note was the very infrequent finding of discharging cavities lined with respiratory epithelium, suggesting that retained mucosa in mastoid air cells is not a common cause of persistent otorrhoea.     

The histopathology of mastoidectomy cavities, with particular reference to persistent disease leading to chronic otorrhoea.

Open cavity mastoidectomy remains the principal surgical treatment of middle ear cholesteatoma in the United Kingdom. A significant proportion of mastoid cavities are prone to intermittent or continuous discharge. In this study the histopathological features of material removed from 159 mastoid cavities at revision surgery were reviewed. Findings included squamous epithelium with acute and chronic inflammation, foreign body granuloma and aural polyps. Of particular note was the very infrequent finding of discharging cavities lined with respiratory epithelium, suggesting that retained mucosa in mastoid air cells is not a common cause of persistent otorrhoea.     

中耳胆固醇肉芽肿的诊断及治疗

目的:探讨中耳胆固醇肉芽肿的发病原因、诊断和接受中耳乳突手术治疗后的效果。方法:回顾性分析我院1999年8月～2004年4月接受中耳乳突手术治疗和经病理证实的18例(19耳)中耳胆固醇肉芽肿患者的临床资料,其中,接受完壁式乳突根治加鼓室探查加中耳置管术7耳,完壁式乳突根治加鼓室探查加听骨链成形加中耳置管术2耳,完壁式乳突根治加鼓室探查术3耳,完壁式乳突根治加鼓膜成形术2耳,开放式乳突根治加鼓室成形术4耳,单纯乳突切除术1耳。结果:置管者术后1～3个月拔除中耳通气管,鼓膜愈合良好;未置中耳通气管者,1～2个月鼓膜颜色正常。术后听力均有不同程度提高,纯音测听达到应用水平(语频气导平均听阈30dB以内)15耳(79%)。所有患者随访0.5～2年,除1耳因咽鼓管不通,长期留置中耳通气管外,其余患者无复发。结论:中耳胆固醇肉芽肿的病因为中耳炎症引起含气腔通气受阻,引流障碍及含气腔出血。确诊有赖于病理诊断。中耳乳突手术彻底去除病变,建立乳突鼓室咽鼓管良好的通气系统,是手术成功的关键。     

中耳胆固醇肉芽肿的诊断和手术治疗

目的探讨中耳胆固醇肉芽肿(CG)的发病机制、临床特点及治疗效果。方法回顾性分析43例CG患者的临床资料，其中42病例经手术及病理证实。主要临床表现包括听力下降43/43例，耳闷感29/43例，咖啡样耳漏12/43例，耳鸣26/43例。蓝鼓膜为典型体征36/43例。颞骨高分辨CT（HRCT）主要表现为中耳乳突软组织阴影，可伴有听骨链破坏（17/43），手术中发现（13/43）与术前符合率76.47%（13/17）。结果手术方法选择完璧式乳突切除+鼓室探查+鼓室置管术31例，完璧式乳突切除+鼓室探查+听骨链重建术11例，单纯鼓室置管术1例。术后随访0.5～3.0年,无复发。术后1～2个月鼓膜颜色恢复正常，听力均有不同程度提高，骨气导间距平均减少（25.0±3.5）dB。结论CG的主要临床表现为听力下降、耳闷感、耳鸣、咖啡样耳漏和蓝鼓膜。HRCT对中耳胆固醇肉芽肿诊断及手术有重要参考价值。诊断明确应采取手术治疗,清除病变,建立鼓室及乳突的通气、引流，并重建听力     

Reconstruction of the posterior auditory canal with hydroxyapatite-coated titanium.

There are a variety of techniques for treating chronically discharging radical mastoid cavities. The purpose of this article is to report the preliminary results of an original technique for reconstruction of the posterior auditory canal using a titanium net combined with porous hydroxyapatite coating. Titanium is fixed with two screws to the mastoid tip and zygomatic root to prevent the risk of implant dislocation. Eight patients with chronically discharging radical mastoid cavities that failed medical management underwent reconstruction of the mastoid cavity using this technique. After surgery, all cases had rapid healing and good aeration of the middle ear and mastoid. One tympanic membrane reperforated, and no extrusion of the prostheses were detected clinically or on computed tomography scanning. The minimum postoperative follow-up period has been 12 months (range 12-48 months). To date, there has been no evidence of cholesteatoma recurrence. The preliminary results remain encouraging. Larger series and longer follow-up, however, are advisable to prove real validity.     

耳后多种自体中胚层软组织及皮质骨粉填充乳突修复耳道后壁在开放式手术中的临床应用

目的 探讨在开放式鼓室成形术治疗慢性化脓性中耳炎和胆脂瘤型中耳炎中,采用耳后多种自体中胚层软组织和乳突皮质骨粉填充乳突术腔、修复耳道后壁以恢复耳道生理状态的临床应用。方法 慢性化脓性中耳炎和胆脂瘤型中耳炎患者21例,借助于原有开放式鼓室成形术的手术基础,设计采用耳后多种自体中胚层软组织及乳突皮质骨粉,填充乳突术腔、修复外耳道后壁,以恢复耳道生理状态。结果 术后随访6个月以上,除1例愈合后虽获干耳但仍遗留鼓膜小穿孔外,其余病例鼓膜均愈合,新外耳道较原耳道略宽敞,无明显分泌物积聚,无胆脂瘤复发,耳道干燥,后壁光滑,后内上角未形成钝角鼓膜,干耳率100%,鼓膜愈合率95.2%。结论 在开放式鼓室成形术手术基础上,采用耳后多种中胚层组织和自体骨粉填充乳突术腔修复外耳道后壁,取材方便、修复方式简便,术后修复组织无液化坏死,愈合良好。远期随访观察,术后耳道后壁形态稳定,上皮化良好,皮肤色泽正常,耳道管腔略大且更趋近于术前正常生理状态,对恢复耳道生理结构和功能具有积极意义。     

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。     

Conservative tympanomastoidectomy

The objectives of tympanomastoid surgery are elimination of irreversible middle ear and mastoid disease, usually cholesteatoma, and maintenance or restoration of serviceable unaided hearing. There are a surprising number of techniques described in the literature but in essence they break down into two schools of thought, those who favor an intact posterior canal wall technique in most cases and those who feel that the possibly improved hearing results obtained with an intact posterior canal wall technique do not warrant the additional risks involved. Sheehy recently has reported an incidence of 35 percent persistence or regrowth of cholesteatoma found in mastoid re-explorations following the intact posterior canal wall technique for management of epitympanic and mastoid cholesteatoma. We believe there are excellent reasons for removing the posterior canal wall routinely in dealing with mastoid cholesteatoma. This technique is far superior in obtaining permanent control of the disease process, usually results in a small trouble-free mastoid cavity, and does not seriously interfere with reconstruction of a serviceable sound conducting mechanism in the majority of cases. In analyzing the results of 100 consecutive mastoid operations for the period from 1970 through 1972, it was possible to maintain or reconstruct the sound conducting mechanism in 94 percent. In those cases which had preoperative bone conduction of 35 db ISO or better for the speech frequencies, the type and percentage hearing results obtained are presented. Endaural modified radical mastoidectomy combined with tympanoplastic repair at the time of definitive surgery permits maximum visualization of the middle ear space. Because most mastoids which harbor cholesteatoma are sclerotic, small trouble-free mastoid cavities result from this type of surgery and the open mastoid technique offers the best prospects to the patient for obtaining a dry safe ear without danger of persistent or recurrent cholesteatoma in the mastoid segment. It does not seriously preclude tympanoplastic reconstruction of a functioning sound conduction mechanism. When feasible, tympanoplastic repair should be done at the same time definitive mastoid surgery is done. This can usually be accomplished in one brief hospitalization and a minimum of postoperative visits to the physician's office.     

中耳胆固醇肉芽肿并发胆脂瘤的回顾性分析

目的 探讨中耳胆固醇肉芽肿并发胆脂瘤的病因、发病机制及二者间的相互关系,并就该病的诊断及治疗方法进行讨论。方法 采用回顾性研究,总结分析我院1988年3月－2000年5月经手术和病理诊断证实的63例中耳胆固醇肉芽肿患者中并发胆脂瘤15例患者的临床资料。结果 15例患者均有较长时间的病史,除不同的程度的听力下降外,皆有耳溢然,其中脓血性及血性耳溢液8例;均有鼓膜穿孔,其中松弛部穿孔10例。11例颞骨CT扫描者均报告为胆脂瘤型中耳炎。15例皆行手术治疗,术中发现胆固醇肉芽肿与胆脂瘤交错存在,胆固醇肉芽肿多好发于鼓窦、上鼓室及乳突腔,6例乳突气化良好者气房内有咖啡色粘液蓄积,并有闪烁发亮的点状胆固醇结晶。12例出现鼓窦扩大、上鼓室外侧壁破坏、听骨链侵蚀、鼓室天盖及面神经水平段暴露等骨质破坏。6例咽鼓管鼓口、15例鼓峡阻塞。所有病例术后均干耳,12例行鼓室成形术者11例术后听力有不同程度的提高。结论 中耳胆固醇肉芽肿与胆脂瘤的病理生理改变有共同之处,即均有通气受阻、引流障碍,二者可能为同一致病因素引起的两个不同且相互作用的病理过程。对慢性中耳炎患者出现不 明原因的血性耳溢液者应想到本病可能,应结合CT、磁共振成像（magnetic resonance imaging,MRI)提高术前诊断率。治疗应根据病变部位、范围和程度不同采取不同的术式,其原则是彻底清除病变、通畅引流。     

慢性化脓性中耳炎及中耳胆脂瘤术前颞骨CT及耳内镜评估的意义

目的 探讨颞骨CT及耳内镜对慢性化脓性中耳炎静止期及中耳胆脂瘤术前评估的重要性。方法 回顾性分析慢性化脓性中耳炎静止期及中耳胆脂瘤患者42耳病历资料,从CT、耳内镜及术中发现进行分析。结果 ①根据CT结合术中所见,慢性化脓性中耳炎静止期CT分型分为单纯型、硬化灶型、肉芽型、硬化灶肉芽型。胆脂瘤型CT主要表现为听骨链消失或锤砧关节消失,乳突大部分呈硬化型,少部分为板障型,上鼓室鼓窦扩大,上鼓室、中鼓室甚至后鼓室乳突腔为软组织影占据,部分病例外半规管骨质破坏、面神经管水平段骨质破坏,部分病例外耳道后壁骨质破坏;单纯型CT示中耳鼓室乳突呈不完全气化型;硬化灶型CT示中耳鼓室乳突呈硬化型,病变局限于中鼓室,锤骨柄及镫骨周围有“类似骨质影”包裹;肉芽型、硬化灶肉芽型CT相似,示病变累及鼓室及乳突,听骨链基本完整,面神经管水平段骨质完整,但硬化灶型与肉芽型区别之处在于前者鼓室内听骨链周围有“类骨质”样散在高密度影。②耳内镜所见慢性化脓性中耳炎静止期鼓膜紧张部穿孔,鼓膜可有钙化斑;中耳胆脂瘤型则有上鼓室内陷或穿孔、后上象限穿孔、大穿孔、外耳道顶壁或后上壁下塌。结论 慢性化脓性中耳炎静止期及中耳胆脂瘤的术前CT及耳内镜评估,对病变性质、范围、程度及指导手术起重要作用。     

中耳胆固醇肉芽肿病例分析及诊治

目的　探讨中耳胆固醇肉芽肿诊治原则及手术治疗方案的选择和疗效。方法　回顾分析我院2006年3月～2014年8月经手术和病理证实18例中耳胆固醇肉芽肿患者的临床资料。所有患者根据病变程度选择不同术式。结果　所有患者均随访半年以上。2例因咽鼓管功能障碍,需长期留置鼓膜置管;1例鼻咽癌复发转移至中耳乳突内,转肿瘤科进一步治疗;其余患者术后均干耳,无复发,纯音听阈也有不同程度改善。结论　中耳胆固醇肉芽肿病因主要有含气腔通气受阻、引流障碍、含气腔出血及骨髓裸露。中耳乳突手术彻底去除病变, 建立乳突-鼓室-咽鼓管良好的通气系统是手术成功的关键。     

中耳炎性病变患者的人工耳蜗植入

目的探讨伴中耳炎性病变的患者进行人工耳蜗植入的适应证、手术方法和术后并发症的发生情况。方法对1995年5月至2006年2月完成的866例人工耳蜗植入术的临床资料进行回顾性分析。术前或术中发现伴中耳乳突炎性病变患者共41例，其中男17例，女24例，年龄1岁3个月-38岁，平均10岁2个月；左耳人工耳蜗植入18例，右耳植入23例，均为单侧植入。其中慢性分泌性中耳炎13例，隐蔽性中耳炎18例，中耳炎后遗症鼓膜穿孔1例，双侧胆脂瘤中耳炎2例，中耳乳突肉芽肿7例。中耳炎性病变伴内耳、中耳畸形7例。对于双侧胆脂瘤中耳炎乳突根治术后患者，设计采用了带蒂翻转帽状腱膜法保护植入电极和面神经。结果41例患者经 Ⅰ期或分期手术，术后随访时间5个月至6年11个月，平均未发现耳部炎性并发症，装置工作良好。结论慢性非化脓性中耳炎、中耳乳突肉芽肿、中耳炎后遗症伴鼓膜穿孔者可采用Ⅰ期或分期方法行人工耳蜗植入。胆脂瘤中耳炎在彻底去除病变基础上可分期行人工耳蜗植入术。对于乳突根治术后没有足够组织覆盖保护植入电极的病例，可采用带蒂翻转帽状腱膜方法。存在活动性中耳乳突炎症者为手术禁忌证。中耳炎性病变患者人工耳蜗术后应长期随访。     

中耳胆固醇肉芽肿并发胆脂瘤的回顾性分析

目的探讨中耳胆固醇肉芽肿并发胆脂瘤的病因、发病机制及二者间的相互关系,并就该病的诊断及治疗方法进行讨论.方法采用回顾性研究,总结分析我院1988年3月～2000月5月经手术和病理诊断证实的63例中耳胆固醇肉芽肿患者中并发胆脂瘤15例患者的临床资料.结果15例患者均有较长时间的病史,除不同程度的听力下降外,皆有耳溢液,其中脓血性及血性耳溢液8例;均有鼓膜穿孔,其中松驰部穿孔10例.11例颞骨CT扫描者均报告为胆脂瘤型中耳炎.15例皆行手术治疗,术中发现胆固醇肉芽肿与胆脂瘤交错存在,胆固醇肉芽肿多好发于鼓窦、上鼓室及乳突腔,6例乳突气化良好者气房内有咖啡色粘液蓄积,并有闪烁发亮的点状胆固醇结晶.12例出现鼓窦扩大、上鼓室外侧壁破坏、听骨链侵蚀、鼓室天盖及面神经水平段暴露等骨质破坏.6例咽鼓管鼓口、15例鼓峡阻塞.所有病例术后均干耳,12例行鼓室成形术者11例术后听力有不同程度的提高.结论中耳胆固醇肉芽肿与胆脂瘤的病理生理改变有共同之处,即均有通气受阻、引流障碍,二者可能为同一致病因素引起的两个不同且相互作用的病理过程.对慢性中耳炎患者出现不明原因的血性耳溢液者应想到本病可能,应结合CT、磁共振成像(magneticresonanceimaging,MRI)提高术前诊断率.治疗应根据病变部位、范围和程度不同采取不同的术式,其原则是彻底清除病变、通畅引流.     

Correlation between temporal bone pneumatization, location of lateral sinus and length of the mastoid process.

The relationship between temporal bone pneumatization and the location of the lateral sinus and length of the mastoid process was investigated in 60 fresh frozen adult temporal bones, by plain X-rays, computed tomography and surgical dissection including otomicroscopic findings. Temporal bone pneumatization was classified as small, moderate and large. After drilling, the shortest distances between the middle fossa dura and mastoid tip representing the mastoid length and between the sigmoid sinus and posterior border of external auditory canal were measured and compared to the degree of pneumatization. The distances in the specimens with pathological eardrum and adhesions in the middle ear were compared to the ones without gross pathology. The length of mastoid process was significantly shorter in specimens with small pneumatization than those with large (Mann Whitney P less than 0.001). The specimens with a pathological eardrum and middle ear adhesions had a significantly shorter mastoid length than those without gross pathology. There was no significant difference between degree of pneumatization and the shortest distance between sigmoid sinus and external auditory canal (Mann Whitney P greater than 0.05). It is demonstrated that the 'under-developed' mastoid process can be a consequence of hampered pneumatization.     

Large cholesterol granuloma cysts in the mastoid. Clinical and histopathologic findings

Large cholesterol cysts were found in revision surgery in six patients with previous ear surgery one to 28 years ago. The cysts mimicked brain herniation in open cavities, filled the mastoid and ear canal in closed cavities, or caused postauricular swelling. Bone around the cysts was soft and granulomatous. Secretory cells were scarce in the epithelial lining of the lumen, but subepithelial glands were frequent. Cholesterol granulomas and hemosiderin-laden macrophages were present inside the wall. The cyst lining and the glands under it showed cytokeratin staining typical for simple and glandular epithelia. Antiprekeratin antibodies showed no decoration of the lining but reacted positively with the meatal skin. These findings prove that respiratory-type epithelium separated from an aerated middle ear does not undergo changes into keratin-forming epithelium.     

高分辨CT在中耳乳突术后病变诊断中的应用

目的 探讨在慢性化脓性中耳炎中耳乳突术后,高分辨CT在中耳乳突病变及中耳乳突结构诊断中的应用。方法:回顾性分析了65例因慢性中耳炎中耳乳突术后复发性病变行再次手术患者的高分辨CT结果,将CT结果与手术所见进行对比分析。结果 高分辨CT可诊断中耳乳突腔内复发病变的们置和范围;并能确定面神经、半规管骨管的完整性,其诊断准确性与手术所见有较好的诊断符合率;也能较好的判断锤骨、砧骨的完整性。结论高分辩CT可准确的诊断中耳乳突手术后复发、残留病变的位置和范围,并能明确面神经、半规管等重要结构的完整性以及可能的解剖变异,而这些信息不可能单从临床检查中发现,因此对于中耳乳突手术后需要再手术的患者应常规进行高分辨CT检查。     

Assessment of total middle ear reconstruction by patient survey correlated with clinical findings

OBJECTIVE: Our objective was to assess, by patient survey and clinical examination, the results of correctional total middle ear reconstruction of problematic mastoid cavities following radical or modified radical mastoidectomy. SETTING: This study was performed in an academic tertiary referral center. PATIENTS: The study consisted of a retrospective survey, using the modified hearing satisfaction scale, of 50 patients, who had undergone total middle ear reconstruction of their problematic mastoid cavities. The survey results were correlated with their postoperative clinical findings. RESULTS: Postoperatively, 98% of these patients expressed satisfaction in terms of improvement of their preexisting otorrhea (median of 4.32 satisfied), 65% were satisfied with their hearing and 85% were satisfied with the overall of this operation. The survey results had a good correlation with the audiometric findings and the clinical findings, i.e. the surgery resulted in a dry ear in all 50 patients and 51% of these patients showed hearing improvement of more than 5 dBHL. CONCLUSIONS: This study indicates that most patients were satisfied with the outcomes of this operation. The patients' point of view and the postoperative clinical data both indicate that total middle ear reconstruction is an excellent procedure for correcting problematic mastoid cavities following a radical or modified radical mastoidectomy. The hearing satisfaction scale is a useful instrument for assessing patient satisfaction following this surgical procedure.     

Cholesterol granuloma presenting as an isolated middle ear tumor

Patients with cholesterol granuloma of the middle ear cleft will usually present with a secretory otitis media, and exhibit evidence of diffuse disease within the mastoid upon roentgenographic evaluation. The following patient with an isolated middle ear cholesterol granuloma presented with signs and symptoms more closely resembling a glomus tumor.     

中耳胆固醇肉芽肿

目的 探讨中耳胆固醇肉芽肿的病因、发病机制以及治疗方法。方法 回顾性总结分析我院1988年3月～2003年3月经手术和病理证实的70例(耳)中耳胆固醇肉芽肿病人的临床资料。70例(耳)中，术前诊断为胆脂瘤型中耳炎37例，骨疡型中耳炎13例，此二者之中考虑胆固醇肉芽肿者13例；中耳乳突术后感染5例，分泌性中耳炎7例，特发性血鼓室8例，其中考虑可能为胆固醇肉芽肿者2例。所有病人均有不同程度听力下降、耳闭塞感或伴耳鸣，亦可有耳溢液、头痛、头昏及其他症状。70例(耳)均接受手术治疗，依照术前检查，根据病变程度不同而选择不同术式。结果 65例(耳)干耳，随访1年以上无复发。3例(耳)行改良乳突根治加鼓室成形术，术后半年流脓，后改行乳突根治术，术后均干耳；2例(耳)行鼓室探查加鼓窦开放术，术后半年及1年又流脓伴听力下降，后改行改良乳突根治加鼓室成形术，术后干耳。结论 中耳胆固醇肉芽肿的病因主要有：含气腔通气受阻、引流障碍及含气腔出血。中耳胆固醇肉芽肿与特发性血鼓室、分泌性中耳炎及胆脂瘤关系密切。术式的选择应根据病变范围和程度来决定，其原则是彻底清除病变，保持通畅引流。