慢性中耳乳突炎的X线平片与CT诊断

目的 探讨慢性中耳乳突炎的X线平片与CT征象及诊断价值.方法 对手术证实30例慢性中耳乳突炎患者术前进行X线平片与CT扫描并与手术病理结果对照分析.结果 胆脂瘤9例,表现为中耳腔、上鼓室以及鼓窦内团块状软组织密度影,鼓室、鼓窦壁骨质硬化和破坏,听小骨破坏、移位、消失.肉芽肿型12例,表现鼓室、鼓窦内片状、条状软组织密度影,听小骨破坏不明显.单纯型9例,表现为乳突气房模糊.结论 传统X线检查次于CT,CT是慢性中耳乳突炎较为可靠的诊断手段.     

A method for studying cholesteatomas in vivo,with special attention to epithelial-mesenchymal interaction*

A model for studying human cholesteatomas in vivo in the immunodeficient ‘nude’ mouse is described. Transplanted cholesteatoma membranes from 13 patients showed in 10 marked and fast growth in 14–21 days, whereas 3 showed necrosis. Findings ofcystic lesions lined by a thin stratified keratinizing epithelium were frequent and in contrast with transplanted jaw keratocyst the connective tissue reaction was weak. This experimental system may be useful for further studies of factors of importance for the regulation of differentiation and growth of middle ear mucosal epithelium.     

Surgical treatment of pediatric cholesteatomas

OBJECTIVE:: Management of pediatric cholesteatomas remains controversial. We reviewed our 16-year experience in the surgical treatment of cholesteatomas in children and describe a treatment paradigm. STUDY DESIGN:: The authors conducted a retrospective review. METHODS:: A total of 106 mastoidectomies (86 for an acquired cholesteatoma and 20 for a congenital cholesteatoma) were performed in children 16 years old and younger from 1988 to 2003. Follow up ranged from 2 years to 12 years with a mean follow-up period of 6 years. Hearing outcomes, cholesteatoma recidivism, and dry mastoid cavity were the main outcomes measured. RESULTS:: Seven (7%) patients had revision surgery for cholesteatoma recidivism. Rates of cholesteatoma recurrence for canal all up (CWU) and canal wall down (CWD) mastoidectomy groups were similar (8% vs. 6%). The percentage of patient with good serviceable hearing (pure-tone average cholesteatomas should be individualized with CWD mastoidectomy chosen for patients with recurrent or more extensive disease. We conclude that the CWU procedure is an adequate surgical option for treating most acquired and congenital cholesteatomas, preventing disease recurrence, and maintaining good hearing outcomes.