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

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。     

The ultrastructure of cholesterol granuloma of the middle ear: an electron microscope study.

The ultrastructure of giant cells in cholesterol granuloma is described, with particular reference to their role in the absorption of cholesterol needles. Cholesterol is a highly resistant substance in its crystalline form and it is confirmed that the giant cells are endowed with endoplasmic structures and organelles and are partly crowded with lysosomes, as evidence of the active role of the giant cells in the absorption and removal of cholesterol formed in the granuloma from blood, mucus or necrotic material.     

Invasive middle ear cholesterol granuloma involving the basal turn of the cochlea with profound sensorineural hearing loss.

STUDY DESIGN: A retrospective surgical case review. SETTING: A tertiary-care, university teaching hospital. PATIENTS: The authors describe a unique case operated on for a middle ear cholesterol granuloma, which had invaded the cochlea and vestibule causing profound sensorineural deafness. INTERVENTIONS: Extended radical mastoidectomy and labyrinthectomy with musculofascial seal. RESULTS: Successful postoperative outcome with no recurrence seen after 2 years of follow up. CONCLUSION: To the authors' knowledge, this is the first reported case of a primary middle ear cholesterol granuloma with direct invasion into the cochlea. Such invasion of the otic capsule by cholesterol granulomas is rare and presents a diagnostic challenge to the attending otologist and radiologist. Salient points of the case history, pathogenesis, imaging studies, histopathology, and management are presented with a review of the current literature.     

Cholesterol granuloma of the middle ear: cause of idiopathic hemotympanum

We report a case of a 49-year-old man with a cholesterol granuloma of the middle ear in an only hearing ear. As it mimicked a vascular middle ear tumor, a contrast cranial computed tomography and a gadolinium-enhanced-magnetic resonance imaging with vascular reconstructions were performed, confirming that both carotid artery and jugular vein were near the lesion but not involved. This patient could be managed with a conservative hearing preserving approach. Differential diagnosis of vascular middle ear anomalies is reviewed, specially in relation to cholesterol granulomas as a cause of idiopathic hemotympanum.     

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.     

Plasma cell granuloma of the middle ear and mastoid. Case report.

We present the case of a 37-year-old man with plasma cell granuloma affecting the middle ear and mastoid. At magnetic resonance imaging scan, the lesion appeared as a homogeneously enhancing mass of soft tissue replacing the majority of the mastoid bone and causing vascular compression. After surgical resection, microscopic examination showed predominantly plasmacytes, and histochemical studies confirmed a polyclonal origin consistent with nonneoplastic plasma cell granuloma. We believe this is the first case report of plasma cell granuloma affecting the middle ear and mastoid.     

A blue middle ear mass: Cholesterol granuloma mimicking a glomus tumor and endolymphatic sac tumor

Cholesterol granuloma (CG) is the most common benign lesion of the petrous apex, however, it can grow significantly large and become destructive causing a diagnostic dilemma. This case presents a 25-year-old female with 2-year history of left-sided progressive and profound hearing loss, a transient left-sided facial paralysis and cranial nerve 10 palsy who presented with a blue middle ear mass. Her diagnosis did not become apparent until direct visualization intraoperatively. The objective of this case study is to highlight the destructive capabilities of CG and the importance to keep it in the differential diagnosis of a large, erosive, expansile skull base lesion in order to avoid overly aggressive resection or other unnecessary treatment.