Langerhans细胞与胆脂瘤型中耳炎

应用ＡＴＰ酶组织化学、免疫组织化学和超微结构等研究，观察胆脂瘤表皮铺片及冰冻切片中Ｌａｎｇｅｒｈａｎ细胞（ＬＣ），以及Ｔ４，Ｔ８，Ｂ细胞和ＨＬＡ－ＤＲ阳性细胞的形态，分布，并通过形态学计量和图象分析得出，胆脂瘤表皮中ＬＣ密度与外耳道皮肤表皮中ＬＣ密度差异无显著性。胆脂瘤基质中Ｔ４平均面数密度和Ｔ４／Ｔ８比值高于正常人外周Ｔ４／Ｔ８之比，通过细胞与细胞间相互作用，ＬＣ可能在中耳胆脂瘤发生中起到一定作     

郎格罕氏细胞与胆脂瘤型中耳炎

郎格罕氏细胞是广泛分布于人体内，并存在于多种病变组织中的一种具有免疫活性多种功能的细胞，研究胆脂瘤基质中的郎格罕氏细胞存在、分布、数量、形态以及相关细胞－Ｔ淋巴细胞的关系，将有助于提示胆脂瘤型中耳炎的发生及发展，从而认识胆脂瘤基质中的郎格罕氏细胞的作用，从免疫学角度探索耳胆脂瘤的形成。     

小儿胆脂瘤型中耳炎7例

慢性化脓性中耳炎目前在我国仍是一种常见的多发病 ,在儿童期发病率较高 ,其中胆脂瘤型亦非少见 ,但因其发病较为隐匿 ,且临床变化较复杂 ,故常易引起误诊。现将近年来收治的 7例 (8耳 )报告如下。1　临床资料1 1　一般资料小儿胆脂病瘤型中耳炎 7例 ,男 6例 ,女 1例 ,其中单耳6例 ,双耳 1例 ,共计 8耳 ;年龄 6岁半～ 12岁 ,平均 9.7岁 ;病程 1月～ 7年 ,平均 2 .5年 ;病状及听力检查 :患耳流脓血 5例 (6耳 ) ,其中 4例 (5耳 )伴耳后红肿疼痛发作史 ,1例伴耳后瘘管形成 ,1例 (1耳 )并患侧面瘫 ;2例反复发生患耳后红肿 ,无耳流脓血 ;除 2例 (…     

胆脂瘤型中耳炎的CT表现特点

目的探讨和总结胆脂瘤中耳炎的CT表现特点。方法对80例耳手术证实为胆脂瘤型中耳炎的CT影像特点进行分类和归纳。结果胆脂瘤的CT影像主要表现为：盾板破坏；有软组织充填的扩大的上鼓室；软组织包裹的听小骨移位：有软组织充填的边缘清楚的扩大骨腔隙，充填的软组织可呈均匀型、网格型和周边间隙型；中耳结构骨组织的破坏及硬化型乳突等表现。结论盾板破坏，有软组织充填的边缘清晰的扩大骨腔隙，中耳腔结构骨组织的破坏．是胆脂瘤CT表现的基本特征。     

粘连型胆脂瘤中耳炎的临床特点

OBJECTIVE: To study the clinical characteristics of adhesive type cholesteatoma. METHODS: Fifty-two cases (52 ears) of adhesive type cholesteatomas were reviewed. Of the 52 cases there were 30 males and 22 females; 24 left ears and 28 right ears. The age of the patients ranged from 8 to 70 years. All of the patients were treated by tympanoplasty, and the open and close methods were performed in 37 ears and 10 ears, respectively. Other methods were employed in the remaining 5 cases. Nine ears underwent tympanoplasty type "O" without ossicular re-construction for an increase in the threshold of the bone conduction. Types I, III and IV tympanoplasties were performed in 1, 16 and 26 ears, respectively. RESULTS: The structures of the upper parts of the stapes had disappeared in 25 ears, which was significantly higher in this series than that in the attic type cholesteatoma. The over-all recovery rate of hearing was 69.8%, while 75.9% and 55.6% in the open and closed tympanoplasties, respectively. Postoperative complications of perforations and re-adhesions of the tense part of the tympanic membrane were observed in 3 and 4 ears, respectively. CONCLUSIONS: Adhesive type cholesteatoma is not uncommon. The cause of this disease may be the functional defects in the pharynotympanic tube. A thorough and effective treatment for the secretory otitis media is crucial for the prevention of adhesive type cholesteatomas. The open method tympanoplasty was considered as the first choice for adhesive type cholesteatoma while the closed method must be great careful.     

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。     

胆脂瘤型中耳炎细菌培养与药敏分析

胆脂瘤型中耳炎是耳鼻咽喉科常见疾病,不仅影响听力,还可引起严重的颅内外并发症而危及生命。术后干耳是目前临床较难解决的问题,虽然其与术中清理病变是否彻底有直接关系,但其主要致病菌复杂多变,且近年来由于抗生素的广泛应用,病原茵敏感性发生了变化。为了解胆脂瘤型中耳炎的病原菌分布及耐药情况。     

胆脂瘤型中耳炎发生机制

胆脂瘤型中耳炎是一种常见的慢性中耳炎,其发病机制尚不清楚。本文就胆脂瘤上皮的特性、胆脂瘤骨质破坏机制及胆脂瘤上皮细胞增殖与凋亡的基因调控等方面的研究进展加以综述。     

胆脂瘤型中耳炎发生机制

胆脂瘤型中耳炎是一种常见的慢性中耳炎,其发病机制尚不清楚。本文就胆脂瘤上皮的特性、胆脂瘤骨质破坏机制及胆脂瘤上皮细胞增殖与凋亡的基因调控等方面的研究进展加以综述。     

开放式鼓室成形术治疗胆脂瘤型中耳炎疗效观察

目的探讨开放式鼓室成形术治疗胆脂瘤型中耳炎的临床效果和影响预后的因素.方法对胆脂瘤型中耳炎116例行开放式鼓室成形术,并对手术方法进行分析.结果经1-5年随访,颞肌筋膜完全成活109例,6例再穿孔,1例复发流脓,患者均有短且大的外耳道,术腔上皮化、干耳.术后9个月听力提高10dB56例、15-20dB34例,25-30dB6例,20例无变化.结论施行开放式鼓室成形术,只要彻底清除乳突、中耳病变,恢复中耳通气功能,可以消除炎症,防止胆脂瘤复发和提高听力.     

中耳胆脂瘤并发迷路瘘管的临床特征

目的 探讨中耳胆脂瘤并发迷路瘘管的诊断和处理方法.方法 回顾分析2012年9月至2018年9月在我院住院行中耳胆脂瘤手术患者658例,其中并发迷路瘘管52例(7.9％),收集其术前临床表现、纯音听阈结果、影像学表现,术中探查所见及处理方式,术后恢复情况等结果进行统计学分析.结果 52例迷路瘘管患者术前有眩晕症状32例(...     

Intracranial Extension of Acquired Aural Cholesteatoma

Objective Cholesteatoma of the petrous bone extending into the intracranial region is an unusual occurrence. Most cases have been attributed to secondary extension of a primary epidermal blastomatous malformation of the temporal bone into the middle or posterior fossae. Within the past two and a half decades, intracranial extension of acquired aural cholesteatoma has been recognized as a likely alternative to this mechanism. Recent literature has rejoined this observation by considering both primary and secondary cholesteatoma of the petrous bone as a single group, petrosal cholesteatoma. The present study is presented to analyze the clinical presentation, imaging findings, and surgical treatment of six patients with acquired aural cholesteatoma extending into the intracranial region. Findings in this study are compared with the extant literature on congenital and acquired cholesteatoma of the petrous bone. This study proposes that petrosal cholesteatoma is a valid anatomical construct; however, the pathogenesis of petrosal cholesteatoma is still important in understanding the clinical presentation and management of cholesteatoma that extends beyond the usual confines of the middle ear and mastoid. Study Design Retrospective case review conducted at a tertiary referral center. Methods From 1985 to 1999, 477 patients were surgically treated for acquired aural cholesteatoma. Patients with intracranial extension of cholesteatoma were studied. Clinical presentation, imaging studies, operative findings, surgical treatment, and postoperative results were evaluated. Results Six cases in a series of 477 patients with acquired aural cholesteatoma had intracranial extension of disease. In this series, the most frequent pathway for intracranial extension was supralabyrinthine through the supratubal recess into the middle cranial fossa. A less frequent pathway was via the retrofacial air cells into the posterior cranial fossa. Surgical access for removal of intracranial cholesteatoma was accomplished through several approaches including translabyrinthine, transcochlear, retrolabyrinthine, and middle cranial fossa. In two patients who had reoperation for possible residual disease, one was free of residual disease and one was found to have residual cholesteatoma in the region of the horizontal facial nerve. Conclusion Acquired aural cholesteatoma can extend into either the middle or posterior cranial fossae. In this study, cholesteatoma extended into the middle fossa through the supratubal recess along the labyrinthine facial nerve and into or above the internal auditory canal. A less frequent path is through the retrofacial air cells into the posterior fossa. Intracranial acquired cholesteatoma is generally small and presents with complaints related to underlying otitis media rather than the neurological deficits that are often associated with primary petrous bone cholesteatoma. While computed tomography and magnetic resonance imaging are both required to differentiate congenital petrous cholesteatoma from other lesions of the petrous bone, computed tomography of the temporal bone is usually sufficient to diagnosis and define intracranial extension of acquired aural cholesteatoma. These lesions can be completely excised rather than exteriorized.     

Langerhans cells in human middle ear cholesteatomas

Summary Langerhans cells have been found in cholesteatomas for many years. It is believed that they are immunocompetent cells and have the same role in cell-mediated immunologic mechanisms in cholesteatoma as well as in skin. This study used the transmission electron microscope to observe the cellular characteristics of Langerhans cells and the apposition phenomenon of Langerhans cells with lymphocyte-like cells in human middle ear cholesteatomatous tissue. These findings are evidence for cell-mediated immune responses in middle ear cholesteatomas. In vitro Langerhans cells conditioned medium prepared from Lewis rat skin was used to show its effects on protein synthesis and the differentiation of basal cells. Since the cellular behaviour of basal cells is important in the development and pathogenesis of cholesteatoma, the present study shows that Langerhans cells may have some role in the clinical formation of a cholesteatoma. Since cells extracted from rat skin may have a different response from that of cells from human middle ear cholesteatoma, further investigations are necessary to compare the biological effects of both tissues. Correspondence to: W.-Y. Chao     

中耳炎的颅内外并发症

目的：探讨化脓性中耳炎引起颅内外并发症的临床特征。方法：回顾性分析1993年3月一2002年8月我院收治的有颅内外并发症的急慢性化脓性中耳炎患者60例的临床资料。结果：60例患者中，单项并发症49例(81．6％)，2项以上并发症11例(18．3％)，总计74例次，其中乙状窦病变13例，硬膜外脓肿2例，脑膜炎4例，脑脓肿3例，迷路炎20例，耳周围脓肿18例，颈部脓肿2例，面瘫12例。结论：颅内外并发症的发病率较以前有所降低，严重的并发症少见；影像学检查可提供重要的诊断依据，手术探查是最可靠的诊断和治疗方法。     

胆脂瘤性中耳炎的手术方式选择

目的;探讨提高手术治疗胆脂瘤性中耳炎疗效的方法,方法：对采用经上鼓室,经鼓窦筛区和完整外耳道－乳突联合进路手术清除病变。并同时一期完成鼓室成形手术为８６０例胆脂瘤性中耳炎病人的临床资料进行分析。结果：三种术式的复发率分别为１０％,１１％和６％,５年内听力提高分别为５６％,４４％和６９％,５￣１５年内分别为４５％,３４％和６２％,鼓膜形态不同程度异常（内陷,粘连和穿孔）分别为４３％,４７％和１２％。     

Metronidazole uptake in the cholesteatomatous membrane in chronic otitis media

Summary Previous investigations have demonstrated a good uptake of metronidazole in the middle ear mucosa. We have now presented a trial study in which there was also a significant uptake of metronidazole in the cholesteatomatous membranes of patients with chronic otitis media.     

保留骨桥的乳突鼓室成形术(IBM)远期疗效与相关技术再探讨

目的探讨中耳乳突显微外科手术中闭合技术与开放技术相结合的保留骨桥的乳突鼓室成形术0ntact—bridgemastoitympanoplastyIBM）手术技术及相关问题。方法总结2000年1月-2005年12月我院107例（耳）IBM手术病例中资料完整的79例，在切开乳突保留低位骨桥的基础上，采用面隐窝开放、分期手术及清除病灶后面隐窝等残留腔隙的封闭填充与耳道成形等改进技术，观察远期情况。结果随访1—5年（79／107例，随访率73．8％），11例出现不同问题，干耳率86．08％（68／79例），语言频率气导术后平均值较术前提高18．2±5．6dBHL。发现问题包括上鼓室鼓窦处肉芽组织残留、鼓膜穿孔、乳突填充骨粉漏出、外耳道狭窄以及分期手术的I期术后后鼓室、骨桥下孤立胆脂瘤珠、骨桥下底板周围纤维粘连组织、面神经嵴过高等。结论以乳突鼓室成形术的闭合技术和开放技术为出发点，在保留低位骨桥后对相关技术加以改进，综合运用面隐窝处理、缺损组织的填充与修复、分期手术、耳道生理形态的恢复与成形等现代耳显微外科技术，IBM手术效果良好。     

保留听骨链胆脂瘤手术后通气对听力改善的对比观察

目的观察胆脂瘤手术保留正常耳道和听骨链并辅以围手术期中耳通气机通气的听力效果。方法回顾分析2002年10月到2010年4月间由资深术者所进行的41例采用"多种技术"完壁式并保留完整听骨链的胆脂瘤手术。充气组:术后采用充气治疗者,共12例,其中男3例,女9例;年龄28～75岁,中位年龄42岁;术前气骨导差(GAP)为(32.42±14.68)dBHL。对照组:以往手术采用同样技术但没有充气者,共29例,其中男15例,女14例;年龄15～65岁,中位年龄42岁;术前GAP为(26.79±11.84)dBHL。二组术前GAP的对照统计分析U检验值为1.1850.05。治疗前二组GAP差别没有显著性意义,表明二组具有可比性。充气组中耳充气每天1～2次,连续2周。所有充气治疗组和对照组病例术后都随访12个月以上。结果充气组术后GAP为(8.58±11.3)dBHL,与术前(32.42±14.68)dBHL相比较,经U检验,U值为4.46>P0.01=2.58,P<0.01,差异有极显著性意义。同样,对照组术后GAP为(13.21±9.64)dBHL,与术前(26.79±11.84)dBHL相比较,经U检验,U值为4.74>P0.01=2.58,P<0.01,差异也有极显著性差异。充气组和对照组的两组术后听力对比U检验,U值为-1.170.05,两组术后GAP差别没有显著性意义。但是,充气组12例术后GAP全部缩小到<20dB以内,6例(50%)在<10dB以内;而对照组则有4例(14%)没有缩小到<20dB以内。结论对术中保留听骨链患者给予围手术期充气治疗,术后能获得更好的听力效果。