Myospherulosis in the operated temporal bone

Summary Myospherulosis is an unusual foreign-body reaction occurring in tissues exposed to petrolatum-based products. Histopathologically this disorder is characterized by the presence of large and small tissue spaces containing amorphous debris and peculiar sac-like structures enclosing numerous brown spherical bodies. A rare case of myospherulosis of the middle ear and mastoid is presented and the literature is reviewed.     

Middle ear carcinoma originating from a primary acquired cholesteatoma: a case report.

OBJECTIVES: To describe middle ear carcinoma originating from the matrix of primary acquired cholesteatoma in a 43-year-old man and to discuss the relationship between middle ear carcinoma and cholesteatoma. STUDY DESIGN: Case report. SETTING: Department of Otolaryngology, Head and Neck Surgery of Niigata University Medical and Dental Hospital, which is a tertiary care center, Niigata, Japan. PATIENT: A 43-year-old man demonstrated symptoms resembling those of cholesteatoma: facial palsy, gradually progressive hearing loss, and chronic draining of the right ear. Other objective findings also supported a finding of cholesteatoma, but a computed tomographic scan and magnetic resonance imaging scan showed a well-enhanced mass and extensive bony erosion in the middle ear. At surgery, a granulous tumor in the mastoid cavity was diagnosed as squamous cell carcinoma, and closely coexisting cholesteatoma was found. Surgical specimen demonstrated carcinoma and cholesteatoma in the same field. INTERVENTION: Radiation and chemotherapy were performed followed-up by mastoidectomy. CONCLUSION: Because middle ear carcinoma has a poor prognosis, it is important to detect lesions early. It is necessary to consider that middle ear carcinoma arises from not only chronic otitis media or surgical invasion but also from primary acquired cholesteatoma.     

10例先天性中耳胆脂瘤临床分析

目的：探讨先天性中耳胆脂瘤的临床特征及手术方法。方法：回顾性分析10例先天性中耳胆脂瘤患者的临床资料。5例经耳内途径行鼓室探查并一期鼓室成形术,3例行闭合式乳突根治术及鼓室成形术,2例行开放式乳突根治术及鼓室成形术。结果：术中见5例胆脂瘤局限于中后鼓室,3例位于中鼓室及上鼓室,2例病变范围广泛,侵及乳突。术后6个月平均纯音听阈为30dBHL,气骨导差在20dB以内,复查颞骨CT均未发现胆脂瘤残留和复发。结论：先天性中耳胆脂瘤病变隐匿,常于鼓室前方或后方,易破坏听骨链,导致传导性聋;影像学检查可为诊断及术式选择提供依据;早期手术治疗可获得较好的听力重建效果。     

中耳慢性炎症伴周围性面神经麻痹的病因分析

目的探讨中耳慢性炎症伴周围性面神经麻痹的发病原因。方法回顾性分析41例中耳慢性炎症伴周围性面神经麻痹病例的临床资料。所有病例术中仔细探查面神经骨管情况及病变累及部位。全部病例的病变组织进行病理学检查。结果4例（10％）面神经骨管完整，在面神经骨管破坏的病例中，病变累及鼓室段面神经33例（89％）。术后病理结果显示：24例（59％）为胆脂瘤，14例（34％）为肉芽，3例（7％）为结核。结论中耳慢性炎症导致周围性面神经麻痹多与胆脂瘤病变有关，面神经鼓室段是最常受累部位。其主要因素是感染沿神经组织的蔓延而不是受压萎缩。面神经骨管破裂并不是感染扩散的必要条件。     

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。     

保留乳突的改良完壁式鼓室成形术的临床疗效观察

目的 探讨局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤行上鼓室径路保留乳突的改良完壁式鼓室成形术的长期临床疗效.方法 诊断慢性化脓性中耳炎、中耳胆脂瘤47例(47耳)患者,结合患者专科检查,依据手术方式不同分A、B两组,A组行上鼓室径路保留乳突的改良完壁式鼓室成形术,B组行完壁式乳突切开+鼓室成形术.术后随访5～7...     

Transmastoidal resection of an endaural encephalocele--a case report

BACKGROUND: There are transmastoid, transtemporal and combined approaches for surgical management of endaural encephaloceles. The advantages of a transmastoid approach are the exploration and option of surgical treatment of the middle ear cavity without craniotomy. Nevertheless there are recent studies preferring the transtemporal or combined approach because of the better survey. PATIENT: We present a 27-year old male patient, who developed hearing loss and otorrhea of the right side. He underwent middle ear surgery associated with cholesteatoma three times before. On examination there was a smooth pulsatile mass taking origin in the roof and almost filling the external auditory canal. High-resolution CT and MRI scans of the petrous bone demonstrated a spherical soft tissue mass communicating with the middle cranial fossa. The encephalocele was exposed and resected through a transmastiodal approach. Behind the cele a relapsing cholesteatoma was found and resected in the same session. The laterobasilar defect was sealed with ear cartilage and a perichondrium flap. CONCLUSION: There are three different surgical approaches to manage laterobasilar encephaloceles. Due to the history of a previous cholesteatoma we performed a transmastoidal approach. A transtemporal approach alone would have failed to notice the relapsing cholesteatoma and would have led to a greater trauma.     

Clinico-morphologic aspects of chronic mesotympanitis

The present authors examined 84 patients with chronic mesotympanitis, 72 of which showed pathological lesions of the middle ear mucosa and bone. This was confirmed by X-ray contrasting examination before surgery and histological examination of tissue samples. Histological analysis showed that the level of destructive changes in middle ear cavities depended on the disease duration. Fibrous tissues of varying degree of maturity, cholesteatoma, tympanosclerotic patches, encapsulated fragments of caries bone frequently cause blockade of the aditus which complicates the chronic process in middle ear cavities and should be regarded as an absolute indication for surgical treatment of chronic mesotympanitis.     

Primary cholesteatoma of petrous bone presenting as cervical fistula

A unique case of primary cholesteatoma of the petrous bone is described. The patient presented with a cutaneous fistula of the anterior cervical triangle and was initially diagnosed and treated as sebaceous cyst or imflammatory lympha node for 3 months. Later examination showed white mass in the right external auditory canal and a severe conductive hearing loss. Radiological findings revealed a massive soft tissue consistent with cholesteatoma in the right petrous bone. The lesion was successfully managed with an endoscopy-assisted technique leaving the neurovascular structures in situ without operative complications. A review of the literature shows that only a few cases of cervical abscess associated with mastoid cholesteatoma have been reported. We also discussed the diagnosis, clinical features and surgical strategy for petrous bone cholesteatoma.     

Brain abscess secondary to the middle ear cholesteatoma: a report of two cases

We experienced two cases of brain abscess secondary to middle ear cholesteatoma. One, a 61-year-old woman, presented with left otalgia, appetite loss and nausea. The computed tomography obtained on admission revealed a middle ear cholesteatoma. The magnetic resonance image showed the presence of a brain abscess in the cerebellum. The brain abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. Part of the cholesteatoma invaded the posterior cranial fossa was could not be removed from the otological surgical field. The patient has been under observation as an outpatient for 6 months already and no abnormal signs have been detected.

The other patient, a 55-year-old man, was admitted to our hospital for a detailed examination because he had right otalgia and progressive headache. The examination of spinal fluid obtained by lumbar puncture showed marked elevation of the white blood cells count. Computed tomography revealed a middle ear cholesteatoma. The magnetic resonance image obtained on admission showed an area of low-intensity encapsulated by an area of high-intensity in the right temporal lobe. The abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. The patient has been under observation for 1 year already and has presented no signs of recurrence.     

人乳头状瘤病毒及其相关基因在中耳胆脂瘤中的表达

目的 探讨人乳头状瘤病毒（ｈｕｍａｎ ｐａｐｉｌｌｏｍａｖｉｒｕｓ,ＨＰＶ）感染在中耳胆脂瘤发生发展中的作用。方法 运用共同引物聚合酶链反应（ｐｏｌｙｍｅｒａｓｅ ｃｈａｉｎ ｒｅａｃｔｉｏｎ,ＰＣＲ）和核酸分子斑点杂交法对４４例（４４耳）中耳胆脂瘤标本组织中的ＨＰＶ ＤＮＡ进行检测,并结合其中３５例（３５耳）的病理学检查结果进行对比分析。结果 １２耳（３４．３％）中耳胆脂瘤组织中观察到了ＨＰＶ感     

Pathology of the eustachian tube in otitis media: an electron microscopic study

The ultrastructure of the mucosa of the eustachian tube was studied in four temporal bones showing tympanosclerosis, cholesteatoma, otitic meningitis and a grafted tympanic membrane (tympanoplasty). The mucosa of tube was abnormal in the four cases confirming the relationship between the state of the eustachian tube and the inflammatory process in the middle ear. The observed abnormalities included: ciliary loss, abnormal ciliary morphology and motility, oedema of the microvilli, hyperplasia of the goblet cells and the seromucinous acini, desquamation of the non-ciliated cells and appearance of mast cells in the lamina propria of the tube. Ciliary changes were the most frequent abnormalities and the morphological changes, in general, were fewest in the case of healed tympanoplasty. The pathophysiology of the morphological changes was discussed and correlated with the disease in the middle ear.     

中耳间变性大T细胞淋巴瘤1例并文献复习

目的 探讨中耳间变性大T细胞淋巴瘤的临床特点及诊疗方法,以便对其进行早期诊断.方法 回顾性分析1例中耳间变性大T细胞淋巴瘤患者的临床资料并复习相关文献进行总结.结果 淋巴瘤多发生于骨骼、骨髓、皮下组织和脾脏,发生于中耳者罕见.中耳淋巴瘤起病时均无浅表淋巴结肿大,通常表现为耳痛、听力下降及耳内溢液(浆液性、脓性或血性),...     

Inflammatory cells in chronic middle ear disease. Value of lymphocyte subset determination in ear surgery

Lymphoid cell subsets were studied in biopsy specimens of uninfected and infected ear canal epidermis, tympanic membrane, cholesteatoma epithelium, and middle ear and antrum granulation tissue. All specimens showing uninfected squamous epithelium, including those of cholesteatoma membrane, contained only a few lymphoid cells. Biopsies of infected squamous epithelium showed enhanced Ts/c activity in the subepithelial layer. Granulation tissue showed normal Th/i activity. B-cells and NK cells appeared in small numbers. Lymphoid cell subset analysis is indicated in ears reconstructed with allograft material to detect signs of rejection. It is of little value in cases of chronic inflammatory middle ear disease which have not previously been operated upon.     

儿童胆脂瘤型中耳炎的临床特征

目的：探讨儿童胆脂瘤型中耳炎的临床特征。方法：对35例（40耳）15岁以下儿童胆脂瘤型中耳炎患者的胆脂瘤在病变范围、听骨损坏程度方面进行分级，并与同期住院的20例（21耳）成年患者进行比较。结果：儿童胆脂瘤型中耳炎的病变范围较成人广，听小骨损坏程度较成人重，两者有统计学差异。儿童组病变范围与听骨损坏之间有统计学的相关性，手术前后听力无明显变化。结论：与成人胆脂瘤型中耳炎相比，患儿病变范围广泛，听骨和骨质破坏严重，更具侵袭性，大多数儿童因病变广泛，需要外耳道后壁开放的根治性手术；听力的保存取决于病变范围、术前听力水平和术式选择。     

Computed tomographic evaluation of middle ear aeration following intact canal wall tympanoplasty

The condition of the mastoidectomy cavity following intact canal wall tympanoplasty (ICWT) is always of great interest to the otosurgeon. We evaluated the status of postoperative aeration in a stable ear following ICWT for various types of chronic otitis media using high-resolution computed tomography (CT). The mastoidectomy cavity in all the cases of simple suppurative otitis is totally aerated and that in over 60% of the cases of adhesive otitis, attic type cholesteatoma and adhesive type cholesteatoma is obliterated by a soft tissue density mass. The size of aerated spaces in the postoperative middle ear cavity not only depends on the type of chronic otitis media but also tends to correlate with the degree of mastoid pneumatization in the opposite ear. CT is useful for the postoperative assessment of middle ear aeration.     

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.     

表皮生长因子受体和Ki67及p16在成人中耳胆脂瘤中的表达

目的:研究表皮生长因子受体(EGFR)、Ki67、p16在成人中耳继发性胆脂瘤上皮中的表达情况,分析它们之间的相互关系,探讨其表达对胆脂瘤上皮侵袭能力的影响。方法:应用免疫组织化学SP染色方法检测EGFR、Ki67和p16在30例成人中耳胆脂瘤上皮、21例成人胆脂瘤患者外耳道正常皮肤、17例正常人外耳道中的表达情况,应用计算机图像分析系统对其阳性表达进行定量分析。结果:EGFR、Ki67、p16在成人中耳继发性胆脂瘤上皮中阳性表达率分别为70.0%,60.0%,46.7%,与外耳道正常皮肤相比表达均差异有统计学意义。成人中耳胆脂瘤中EGFR、Ki67与p16之间表达均无相关性(均P>0.05)。胆脂瘤侵袭能力与EGFR、Ki67表达有显著相关性(均P<0.01)。EGFR、Ki67表达灰度值越低,表达密度越高,胆脂瘤侵袭能力越强。p16在成人中耳胆脂瘤中的表达与侵袭能力之间无相关性(P>0.05)。EGFR、Ki67、p16在成人中耳胆脂瘤中阳性细胞主要分布于上皮全层,以基底层和棘层为著,呈高度表达;而在对照组中阳性细胞仅在基底层表达,呈弱表达。结论:EGFR、Ki67、p16在成人中耳胆脂瘤中呈高表达,EGFR、Ki67的表达与成人中耳胆脂瘤的侵袭能力有高度相关性,提示成人中耳胆脂瘤具有高度增殖能力,其中细胞因子EGFR、Ki67、p16起到重要的作用。