中耳胆固醇肉芽肿

目的探讨中耳胆固醇肉芽肿的诊断及治疗方法。方法对2004年以来经手术及病理诊断确诊的13例中耳胆固醇肉芽肿患者的临床资料进行回顾性分析。结果13例患者中,胆脂瘤型中耳炎并胆固醇肉芽肿8例,分泌性中耳炎并胆固醇肉芽肿4例,中耳胆固醇肉芽肿（蓝鼓膜）1例,均有不同程度的传导性或混合性听力下降,全部病例均经手术治疗而痊愈,术中见三种不同的中耳炎疾病均交错存在胆固醇肉芽肿病变,肉芽肿大多位于中耳乳突腔、鼓室入口、上鼓室、鼓室窦等处。结论中耳胆固醇肉芽肿常与各种中耳慢性疾病并存,病变可广泛存在于中耳各部,治疗以手术彻底清除病灶为主。     

中耳胆固醇肉芽肿的探讨

本文就３５例经病理证实为中耳乳突胆固醇肉芽肿的病例资料，对本病的发生，诊断，侵犯部位及治疗和术后复发之原因等问题进行探讨。认为中耳胆固醇肉芽肿的主要病因是咽鼓管通道受阻，好发部位主要是鼓窦入口和鼓窦、上鼓室、乳突气房及鼓室窦。     

中耳胆固醇肉芽肿并发胆脂瘤的处理及治疗效果分析

中耳胆固醇肉芽肿常存在于各种慢性中耳疾病中,如胆脂瘤型中耳炎、慢性分泌性中耳炎和特发性蓝鼓膜等。本文对我院2004年3月—2007年10月的住院病例经手术和病理诊断证实中耳胆固醇肉芽肿并发胆脂瘤的14例病人进行临床分析,以探讨本病的发病原因及诊断,并对手术疗效进行分析。     

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     

中耳胆固醇肉芽肿的临床特点与治疗

中耳胆固醇肉芽肿或称胆固醇肉芽肿性中耳乳突炎 ,是发生于鼓室、鼓窦或乳突的一种含有胆固醇结晶和多核巨细胞的肉芽肿。 1992 2 0 0 0年我院共收治 11例 12耳中耳胆固醇肉芽肿患者 ,全部经手术和病理证实。本文对其病因、诊断、临床特点和治疗等进行分析。1　 资料与方法1.1　 临床资料11例 ( 12耳 )患者 ,男 2例 ,女 9例 ;年龄 10 5 0岁 ,平均 2 6.4岁。病程 15ｄ2 0年 ,平均 2年 10个月 ,<1年者 7例。 4例于 10 2 0年前有化脓性中耳炎病史 ,均干耳 10年以上 ;5例 ( 5耳 )无明显诱因 ;2例有分泌性中耳炎病史 ,其中 1例鼓膜置管后感染 ,炎…     

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。     

中耳胆固醇肉芽肿手术治疗策略探讨

目的:探讨中耳胆固醇肉芽肿手术治疗的策略。方法:对19例中耳胆固醇肉芽肿患者的临床资料进行回顾性分析。其中4例行单纯鼓膜置管术,8例行完壁式乳突切除+后鼓室切开+鼓膜置管术,7例行开放式乳突切除+鼓膜置管术。结果:术后随访0.5～3.3年。4例行单纯鼓膜置管术的患儿中,2例术后复发;8例行完壁式乳突切除+后鼓室切开+鼓膜置管术的患者中,3例术后复发;7例行开放式乳突切除+鼓膜置管术的患者无一例复发。在目前情况良好的14例患者中,有12例患者听力较术前明显改善。结论:对初发、病变范围局限的青少年患者,术前应完善检查以排除咽鼓管机械性阻塞因素,可选择单纯鼓膜置管术,术后定期观察;对症状反复发作、单纯置管或完壁式乳突切除+后鼓室切开+鼓膜置管术无效、病程较长或病变范围广泛的患者,应选择做保留鼓室完整性的开放式乳突切除+鼓膜置管术。     

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。     

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。     

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。     

Mucin gene expression and mouse middle ear epithelium

Objectives

To investigate the expression of recently identified human mucin genes in an in vitro model of cultured mouse middle ear epithelial cells (MMEEC).

Methods

MMEEC were established, RNA was extracted and primers were designed for RT-PCR to assess for expression of mucin genes Muc1, Muc2, Muc3, Muc4, Muc5AC, Muc5B, Muc6, Muc7, Muc8, Muc9, Muc10, Muc11/12, Muc13, Muc15, Muc16, Muc17, Muc18, Muc19 and Muc20 expression.

Results

Mucin genes Muc1, Muc2, Muc3, Muc4, Muc5AC, Muc5B, Muc9, Muc10, Muc13, Muc15, Muc16, Muc18, Muc19 and Muc20 were identified and expressed in MMEEC. The genes Muc6, Muc7, Muc8, Muc11/12 and Muc17 were not identified.

Conclusion

Many of the mucin genes that have been recently identified in human MEE and chinchilla MEE are also expressed in MMEEC. There are differences in expression, however, which may have implications in utilizing various animal models for study of middle ear physiology and pathogenesis; specifically as it relates to mucin gene expression.     

Extending the chinchilla middle ear epithelial model for mucin gene investigation

Objectives

To investigate the expression of recently identified human mucin genes in an in vivo model of the chinchilla middle ear epithelium (CMEE).

Methods

CMEE was harvested, RNA was extracted and primers were designed for RT-PCR to assess for expression of mucin genes Muc6, Muc17 and Muc18. Further sequencing of these genes was also accomplished.

Results

Mucin genes Muc6, Muc17 and Muc18 was assessed and found to be identical to the expression in human and mouse MEE.

Conclusion

This study further characterizes mucin gene expression in the CMEE and provides additional sequence data for chinchilla middle ear genes. The concordance of this gene expression data to that of both the human and mouse models further demonstrates the utility of this animal model in OM investigations.     

Direct measurement of middle ear pressure through the eustachian tube

Summary We report a method for measuring middle ear pressure through the eustachian tube. We used a 1-mm-diameter micro-tip catheter pressure transducer (Mikro-tip) and inserted this into the tympanic cavity through the eustachian tube. In preliminary studies, we measured four normal ears, two ears with tubal dysfunction, one ear with a dry perforation and 13 ears with otitis media with effusion (OME). Among those ears with OME, three showed negative middle ear pressure, three slight positive pressure and one normal pressure. These findings suggest that our transtubal method is reliable and useful for measuring middle ear pressure.     

Lymphangioma of the middle ear and mastoid simulating chronic otitis media with effusion

Lymphangiomas are benign congenital malformations of the lymphatic system. Middle ear lymphangioma is extremely rare entity. A 14-year-old male patient with otitis media with effusion, which was previously diagnosed to be middle ear and mastoid lymphangioma, was treated. There were no cerebrospinal fluid fistula, solitary mass, and meningitis findings. All properties of chronic otitis media with effusion were present in that case. This case is unique with these clinical properties. Middle ear and/or mastoid lymphangioma should be remembered in the differential diagnosis of chronic middle ear effusions.     

High frequency distortion product otoacoustic emissions in children with and without middle ear dysfunction

OBJECTIVE: Distortion product otoacoustic emissions (DPOAEs) (9-16kHz) are a useful measure of the function of the cochlea, which may be damaged by ototoxic drugs during anticancer chemotherapy. As children undergoing chemotherapy may also have middle ear problems, it is necessary to know if middle ear problems would have a confounding effect on the ability of DPOAEs to assess cochlear function in the extend high frequency region (9-16kHz). The present study aimed to investigate the effect of middle ear dysfunction on DPOAEs in the extended high frequency region in young children. METHODS: The sample was comprised of 100 ears of 50 school-aged children (21 boys and 29 girls) with a mean age of 6.3 years (S.D.=0.5; range 5.3-7.3). Otoscopy, pure tone hearing screening, tympanometry, acoustic reflexes and DPOAEs for both the conventional and extended high frequencies were administered to each child under typical school screening conditions. Participants were classified into one of three groups based on immittance (tympanometry and acoustic reflex) results. They included a "pass immittance" group, a "fail immittance" group and an "undetermined" group (with a pass in either tympanometry or acoustic reflexes, but not both). DPOAE amplitudes and signal-to-noise ratios (SNRs) were measured and compared across the three groups of participants. RESULTS: The fail immittance group showed significantly smaller DPOAE amplitudes and SNRs when compared to the other two groups at frequencies ranging from 1 to 9.5kHz and at 13kHz, but not at 10, 11, 12 and 14kHz. There was no significant difference in DPOAE results between the pass immittance and undetermined groups. CONCLUSIONS: Despite the adverse effects of middle ear dysfunction, its effect on DPOAEs in the extended high frequency region was not as severe as that in the lower frequency region. Hence, assessment of cochlear function in children with a middle ear lesion in the extended high frequencies using DPOAEs should be made with caution.     

Sequential analysis of serum proteins in middle ear effusions

Summary Two otomicroscopically well-defined types of otitis media (OM) — one culture-negative serous (SOM) and the other purulent (POM) — were induced in rats by mechanically obstructing the eustachian tube or by splitting the soft palate. Samples of middle ear effusions (MEE) produced and sera were characterized electrophoretically and immunochemically at 1, 2, 3, 4 and 6 weeks after inducing middle ear fluid. The levels of albumin, transferrin, IgG, IgG1, IgG2, IgM, IgA, and secretory IgA (S-IgA) were determined. All proteins increased 3- to 10-fold in the MEE of the SOM group, whereas the concentrations in the POM group were low. Concentrations of some of the MEE proteins were seen to increase during the course of SOM, while concentrations in the POM group appeared to diminish. The protein content of the MEE in SOM and POM changed dynamically during the observation period. These alterations differed between the two types of OM, reflecting the differing mechanisms that produce the MEE content. These findings indicate that sequential characterization of effusion material in animal OM models may elicit information which might allow staging of this complex disease clinically. Offprint requests to: U. Johansson, Department of Otorhinolaryngology, Sundsvalls sjukhus, S-85186 Sundsvall, Sweden