中耳癌的诊断与治疗

目的通过对11例中耳癌病人的诊断、治疗及预后进行分析总结,以提高中耳癌的早期诊断率及生存率.方法收集、分析1983～1994年我科收治的11例中耳癌病人,其中9例中耳癌的患者行颞骨次全切除+术后放疗,2例中耳肉瘤的患者1例化疗,1例放疗.结果11例中耳癌随访5年,3例无复发,1例术后5年脑转移再次手术,术后良好.7例死于肿瘤局部复发、扩散.结论积极治疗中耳炎可能降低中耳癌发病率,中耳癌早期发现及时治疗可提高生存率.对较晚的中耳癌,病变已侵犯周围组织,应考试以放射治疗为主.     

中耳癌的研究进展

中耳癌是发生在中耳和乳突区的少见恶性肿瘤,病理上以鳞癌最常见,恶性程度高.早期临床症状多不典型,常与慢性中耳炎的表现相似,不易早期发现,诊断主要依靠影像学检查及病理检查.近年来国际上对中耳癌的治疗策略不一,以外科手术为主的综合治疗是本病主要的治疗措施,且预后较差.     

中耳癌的研究进展

中耳癌是发生在中耳和乳突区的少见恶性肿瘤,病理上以鳞癌最常见,恶性程度高.早期临床症状多不典型,常与慢性中耳炎的表现相似,不易早期发现,诊断主要依靠影像学检查及病理检查.近年来国际上对中耳癌的治疗策略不一,以外科手术为主的综合治疗是本病主要的治疗措施,且预后较差.     

外耳道及中耳癌的单纯放疗20例分析

外耳道及中耳癌少见,在耳鼻喉科门诊约4000～20000患者仅有本病1例。该病发病隐蔽,多有慢性化脓性中耳炎病史,易被忽视,确诊时往往已达晚期,故疗效欠佳。本文对我科1977年5月～1984年5月间20例单纯放射治疗的病人进行分析,重点讨论晚期外耳道及中耳癌单纯放疗的方法,疗效及预后。     

细胞间黏附分子1与早期放射性中耳炎的实验研究

目的 探讨细胞间黏附分子1(ICAM-1)在放射性中耳炎中的作用。方法 采用^60Co γ射线3Gy／次，5次／周，以15、30、45Gy不同总剂量照射豚鼠右耳，造成放射性中耳炎的动物模型，以SP免疫组织化学法行中耳黏膜中细胞黏附分子检测，同时观察放射剂量和白细胞浸润的关系。结果 正常豚鼠中耳黏膜ICAM-1未见表达，射线照射后ICAM-1可表达在中耳黏膜上皮和血管内皮细胞，并且随着放射剂量的增加而增强；ICAM-1的表达与白细胞的浸润呈正相关。结论 细胞间黏附分子参与放射线导致的中耳黏膜炎症反应，这可能对解释放射性中耳炎的机制有一定作用。     

治疗13例外耳道癌和中耳癌的临床经验

外耳道癌及中耳癌较为罕见。我院自1990年2月~2000年8月共收治13例,现报道如下:1资料与方法1.1一般资料本组13例,其中男性8例,女性5例;年龄5~77岁,平均52岁。发生在外耳道4例,中耳1例,外耳道及中耳均有肿瘤8例。伴随症状:耳道流脓10例,听力减退8例,耳区疼痛7例,耳道出血6例,面瘫6例,头痛3例,张口困难3例,颈部淋巴结肿大1例。其中有慢性中耳炎病史者7例。本组13例均经组织病理学证实。其中鳞状细胞癌5例,腺样囊性癌3例,腺癌及鳞状上皮乳头状瘤恶变各2例,恶性神经鞘瘤1例。1.2治疗方法单纯放疗4例;耳道肿物切除术 乳突扩大根治术 术后放疗5例;…     

放射性中耳损伤的实验研究

本文就放射线对中耳形态功能的损伤及近年来放射线生物损伤机理的实验研究进行了综述并提出了放疗后渗出性中耳炎的可能的预防方法。     

鼻咽癌放射治疗对中耳功能的影响及分泌性中耳炎的预防

目的 探讨放射治疗绎鼻咽癌患者中 功能的影响，寻找有效的防治措施。方法 观察１６３例鼻咽癌患者放疗前后分泌性中耳炎的发生及中耳压的改变。结果 鼻咽癌患者施疗后中耳炎的发生率为４１．６％（１０２／２４５只耳），其中放疗后６个月之内分泌性中耳炎发生率达４７．１％（４８／１０２只耳），放疗所致分泌性中耳炎与电离辐射对中耳的直接损伤和放疗前中耳负压的升高有密切的关系。结论 发生分泌性中耳炎是放射治疗对鼻咽     

鼻咽癌以渗出性中耳炎为首发症状三例

众所周知,鼻咽癌可以引起咽鼓管咽口阻塞.使中耳腔呈负压,产生积液,导致听力下降、耳闷、头胀等症状。但我们遇3例反复发作渗出性中耳炎后患鼻咽癌,提示渗出性中耳炎和鼻咽癌两者之间有某种联系,很可能是潜在的鼻咽癌患者。所以及时检查鼻咽部,并跟踪随访,必要时取活检,通过对渗出性中耳炎的诊治,早期检查出鼻咽癌患者,可提高鼻咽癌的早期诊断率。     

鼻咽癌放射治疗后分泌性中耳炎的临床观察

目的 探讨鼻咽癌患者放射治疗后分泌性中耳炎的发生，寻找有效的防治措施。方法 观察104例（208只耳）鼻咽癌患者放疗前后分泌性中耳炎的发生。结果 鼻咽癌患者放疗后分泌性中耳炎的发生率为44.1%(64/145只耳），放冶后6个月，分泌性中耳炎的发生率达高峰，为50.1%(33/64只耳）。放疗所致分泌性中耳炎与电离辐射对中耳的直接损伤和放疗前中耳负压升高有密切关系。结论 改进放射治疗设野技术，使用有效药物，采取鼓膜置管和鼓膜切开等方法对防治分泌性中耳炎的发生有一定用处，但其耳瘘发生率很高。     

Carcinoma of the middle ear and external auditory canal

Thirty-one patients with malignant tumors of the middle ear and external auditory canal (EAC) were observed at the University of Virginia Hospital from 1956 through 1980. Of 27 patients with carcinoma, 21 had squamous cell carcinoma, 4 had basal cell carcinoma and 2 had adenoid cystic carcinoma. One Ewing's sarcoma and 3 rhabdomyosarcomas occurred in an age group of one to 10 years. The 27 patients with carcinoma are reviewed with regard to clinical presentation, treatment modality, results and complications. The majority (67%) of patients had a history of chronic ear drainage, 22% had a previous mastoidectomy or polypectomy and 7% had an associated cholesteatoma. The treatment modalities employed depended on the extent of disease and the patient's general condition. Eighty percent of patients with carcinoma limited to EAC were alive and well at 5 years, compared to 43% of patients with involvement of the middle ear. Fifty-six percent of patients without invasion of the petrous bone were alive at 5 years compared to only 20% of patients with petrous bone involvement. The data strongly suggest that survival depends on the extent of disease. The corrected disease free 5 year survival rates were 14% for patients who had surgery alone and 50% for those who had surgery and radiotherapy. Of the three patients with advanced disease who received radiotherapy alone, none survived five years. Surgery or radiotherapy alone is not sufficient for most of the cases of carcinoma of the middle ear, since these patients often present with advanced disease. We recommend combined therapy, especially postoperative radiotherapy, except for early lesions that do not involve the mastoid or petrous bone. Other series suggest radiotherapy would be adequate and more effective than surgery for early lesions. Surgery will provide the diagnosis, determine the extent of disease, offer adequate drainage of infected material and relieve most pain before radiation therapy.     

Analysis of anatomical factors controlling the morbidity of radiation-induced otitis media with effusion.

PURPOSE: To analyze the anatomical factors controlling the morbidity of radiation-induced otitis media with effusion (OME) and determine how to best preserve middle ear function when treating nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Forty patients with nasopharyngeal carcinoma undergoing 3-D radiotherapy (RT) planning and curative RT were analyzed retrospectively. The difference in dosage over the middle ear cavity and the isthmus of the Eustachian tube (ET) was evaluated. Pure tone audiometry and impedance audiometry tests were performed before and after RT. RESULTS: Mean dosages over the isthmus of the ET for acoustic impedance and pure tone audiometry were recorded. Differences in dosage among the three classifications of unchanged, improved, and worsened ears were statistically significant. CONCLUSION: There was a correlation between the morbidity of radiation-induced OME and the radiation dosage over the middle ear cavities. Decreased OME morbidity was observed when the dosage over the isthmus of the ET was below 52 Gy and the dosage over middle ear cavity was below 46 Gy.     

鼻咽癌患者的中耳压力检测及其临床意义的探讨

目的：观察尚未接受放疗的鼻咽癌（ＮＰＣ）患者的耳部并发症情况,测量其中耳压力并探讨其临床意义。方法：调查１６０例ＮＰＣ患者放疗前一周内耳部并发症情况,并测量其中耳压力（ＭＥＰｓ）,另选择８０例鼻咽慢性炎症患者作对照组测量ＭＥＰｓ。结果：尚未放疗的ＮＰＣ患者有３７．５％（６０／１６０）并发分泌性中耳炎,ＮＰＣ组较对照组有一较高的中耳负压,不同ＴＮＭ分期及不同肿瘤部位的ＮＰＣ患者均普遍存在中耳高负压。     

鼻咽癌3-D计划放射治疗后放射性中耳炎的临床分析

背景与目的:中耳咽鼓管损害高峰发生在放疗后半年,并且在很多病例可持续终身,至今为止临床上尚无有效的治疗方法,寻求放射治疗中中耳鼓室及咽鼓管更好的保护仍是放射治疗医师面临的责任,在精确放疗技术应用逐渐普遍的今天,肿瘤周围正常组织和器官的保护受到越来越多的重视,但到目前为止,有关中耳放射损伤的研究报道极少。我们采用回顾性分析的方法,通过比较鼓室腔及骨性段咽鼓管剂量分布与放疗后分泌性中耳炎的发生率,评价在鼻咽癌3-D计划放射治疗中中耳功能保护的可能性,同时了解放疗后时间、化疗、T分期等因素对结果的影响。方法:40例80耳有完整听力学检查材料的鼻咽癌3-D计划放射治疗的患者进入此项研究。所有病例放疗前后均经耳部检查,电测听及声阻抗测听,放疗后随访时间为6~24个月。电测听以500,1 000,2 000,4 000 Hz听阈平均值计算气骨导差,声阻抗根据鼓室图分为A、B、C 3型,A型为正常鼓室图,B型为中耳鼓室积液,C型为咽鼓管功能不良。结果:79耳符合声阻抗分析条件。放疗后62%耳与放疗前保持不变,13%耳得到改善,25%耳恶化。鼓室腔及骨性段咽鼓管剂量分布在恶化耳与其他各组耳之间比较差异有显著性。80耳电测听分析结果,放疗后无变化耳58%,改善耳12%,恶化耳30%。分析剂量因素对声阻抗结果的影响,恶化组的鼓室腔及骨性段咽鼓管平均受照剂量为(5379.81±706.01)cGy,不变组的平均受照剂量为(4735.72±812.30)cGy,改善组的平均剂量为(4652.86±809.78)cGy;分析剂量因素对电测听结果的影响,恶化组的中耳及骨性咽鼓管平均受量为(5229.38±778.11)cGy,不变组的平均受量为(4719.64±744.82)cGy,改善组的平均剂量为(4702.38±922.21)cGy。统计分析发现3组的剂量差异有显著性。T分期变化及1年内或1年后时间分组对听力测试结果的影响差异有显著性,而化疗对听力测试结果的影响不明显。结论:在鼻咽癌3-D放射治疗中,如将鼓室腔及骨性段咽鼓管剂量控制在4700 cGy以下,则可明显减少延迟性放射性中耳炎的发生率。对中耳鼓室腔及骨性段的保护随着肿瘤体积的增大可能性减少。放射性中耳功能损伤发病高峰在1年内,在放疗前具有正常听觉功能者,放疗1年后有更多的机会从放射损伤中恢复。     

Adenoid cystic carcinoma of the middle ear

A rare case of primary adenoid cystic carcinoma of the middle ear is reported. The nomenclature is discussed. The importance of histological examination of any granulation tissue or polypidal masses from the ear is stressed. The need to report even isolated cases is mentioned.     

Innovative Use of Tympanometry and Scintigraphy in Preoperative Assessment of the Patients with Chronic Otitis Media

Normal middle ear volume indicates the well ventilated middle ear and subsequently the normal function of the Eustachian tube. We carried out preoperative assessment of the middle ear volume by tympanometry and scintigraphic evaluation of Eustachian tube patency in patients with unilateral otitis media. We correlated the middle ear volume and Eustachian tube patency in these patients. Prospective. A total of 58 patients with unilateral otitis media were studied. All patients underwent Eustachian tube scintigraphy. We categorized the patients as Group A with patent Eustachian tube and Group B with blocked Eustachian tube (ET). We assessed the equivalent middle ear volume (VeqME) in all patients and correlated it with ET patency. We also correlated the degree of hearing loss and intraoperative middle ear pathology in two groups. There is strong linear correlation between the ET patency and VeqME of the patients. Degree of hearing loss and the middle ear pathology is also found to be severe in patients with blocked ET and low VeqME. Preoperative assessment of patients with chronic otitis media should include the objective evaluation of middle ear volume and ET patency, as it is the reliable predictor of middle ear pathology.     

Otitis Media with Effusion in Relation to Socio Economic Status: A Community Based Study

Otitis media with effusion (OME) is the presence of non purulent effusion within the middle ear cleft. The symptoms of this disease are not alarming as in suppurative otitis media. The disease is common in young children. The main symptom of this disease is decreased hearing, which may sometime go unnoticed more so if the parents are not attentive. We conducted a community based study among 1,020 school children of the age group 5–10 years from schools of sub-urban areas of Dakshina Kannada district, Karnataka, to explore the relationship of OME in relation to socioeconomic status. Diagnosis of OME was done by clinical examination and tympanometry. Prevalence of OME was 4.5%. Out of 46 cases, 4% belong to upper class, 26% to upper middle class, 26% to lower middle class, 43% to upper lower class.