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。     

Cholesterol granuloma presenting as a mass obstructing the external ear canal

Background

Cholesterol granuloma (CG) may involve the middle ear, the mastoid bone and the petrous apex. However, CG presenting as a mass obstructing the external ear canal (EEC) is relatively rare and it can be a diagnostic challenge.

Case Presentation

We report a case of a CG occupying the mastoid antrum and presenting as a mass into the EEC. Temporal bone computerized tomography showed a soft tissue mass which eroded the posterior-superior bony wall of the EEC. On magnetic resonance imaging, the mass revealed a high signal on both T1 and T2-weighted images. The CG was removed by a mastoidectomy procedure and the histopathologic report confirmed the diagnosis of CG. A type III tympanoplasty was performed.

Conclusions

The postoperative course was uneventful.     

Cholesterol cyst manifesting as a middle ear vascular tumor

A localized, cystic, "blue ear drum" (idiopathic hymotympanum) mimicking a middle ear vascular tumor occurred in a 12-year-old boy. This lesion must be included in the differential diagnosis of suspected vascular mass of the middle ear. A history of eustachian tube dysfunction should be sought. Physical examination is usually not diagnostic, and a full radiologic evaluation is essential in order to rule out a high jugular bulb, an ectopic carotid artery, or a glomus tumor.     

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.     

The internal carotid artery presenting as middle ear tumor

An additional case of an anomalous course of the internal carotid artery presenting as a middle ear tumor is described. Recognition of the existence of this entity resulted in the correct diagnosis by arteriography. A plea is made for arteriographic study of all “vascular” middle ear tumors prior to surgical exploration and biopsy.     

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.     

Acoustic neurinomas presenting as middle ear tumors

Since the advent of the widespread use of the operating microscope and the excellent graduate and post-graduate training in otology, more and more otosurgeons are exploring disease of the middle and inner ear; consequently, more and more unusual and varied anomalies and tumors are being described. This paper describes the unusual presentation of acoustic neurinomas in the middle ear. Most acoustic nerve tumors arise within the meatus of the internal auditory canal, producing the syndrome of the cerebellopontine angle. In the first case presented, the tumor did not arise in the usual location, and this points out the fact that acoustic nerve tumors may arise anywhere along the course of the VIIIth nerve. It is felt that the tumor must have arisen in one of the smaller branches of the inferior vestibular nerve, lateral to the vestibule, as it did not extend medially beyond the medial wall of the vestibule. Instead, it presented in the cochlear windows as a middle ear tumor. In the second case, the tumor apparently arose in the usual location, in the meatus of the internal auditory canal. Its lateral extension was unusual, in that the tumor filled the entire labyrinth and presented as a middle ear tumor in the cochlear windows of the middle ear, and its extension medially, produced the classical findings of the cerebellopontine angle tumor.     

Cholesterol granuloma of the maxillary sinus presenting as sinonasal polyp

Cholesterol granuloma is usually found in chronic middle ear diseases. However, it rarely occurs in the sinonasal regions and only a few case reports can be found in the literature. The etiology of sinonasal cholesterol granuloma is not yet known, and the clinical manifestations are nonspecific. Most patients presented with nasal discharge. Our patient is the only reported case presenting with nasal obstruction and facial pain. Here we present a patient with cholesterol granuloma of the maxillary sinus with a nasal polyp, whose clinical, imaging, and histological characteristics were unique. The tumor was excised via the transnasal endoscopic sinus approach without recurrence after 3 years of follow-up.     

Meningiomas presenting in the middle ear

Meningiomas can present in the middle ear either as primary tumors or as an extension of an intracranial tumor. Symptoms and signs of such rare tumors are easily confused with more common conditions of the ear. Two cases of meningiomas involving the middle ear are presented, the operative details of the second case are summarized because of the unusual extent of the tumor. A brief review of primary intratympanic meningiomas reported in the literature is also presented. An account of the pathology, diagnois, and treatment of meningiomas in the middle ear is given in the hope that this diagnosis may be considered when middle ear tumors present.     

Epithelioid hemangioendothelioma of middle ear masquerading as glomus tumor

Hemangioendothelioma is still one of the less-known tumors of vascular origin. The authors report the case of a 38-year-old man who presented with unilateral, nonpulsatile timnitus, aural fullness, and a sense of imbalance. Imaging showed a contrast enhancing soft tissue mass lesion involving the external auditory canal and middle ear, mimicking as glomus tumor. Histopathological examination of surgical specimen showed it to be hemagioendothelioma.     

Cholesterol granuloma of the maxillary sinus resembling an invasive,destructive tumor

The case of a maxillary sinus cholesterol granuloma posing as a malignant tumor is presented. The patient was referred to the authors clinic with symptoms typical of maxillary sinusitis, but physical examination suggested the presence of neoplasm. Radiology also resulted in confusing, tumor-like pictures. Histological examination of a preoperative tissue sample identified the process as a cholesterol granuloma, which was removed by a classic Caldwell-Luc operation. The patient has been symptom free since the operation. The pathogenesis of cholesterol granuloma is described, and the problems of establishing a diagnosis without preoperative histology are discussed.     

Precursor B-cell lymphoblastic lymphoma presenting as an isolated external ear swelling in a two-year-old child

The incidence of lymphoma in children is increasing in the United States and is the third most common childhood cancer. The head and neck is second only to the abdomen as the most common site of extranodal presentations of non-Hodgkin's lymphoma (NHL). We present and discuss the diagnosis and management of the first report of a child with an auricular mass as the sole manifestation of B-cell non-Hodgkin's lymphoma. In summary, the otolaryngologist and pediatrician should be cognizant of potential for NHL in atypical lesions of the head and neck in children.