慢性化脓性中耳炎及中耳胆脂瘤术前颞骨 CT 及耳内镜评估的意义

目的探讨颞骨CT及耳内镜对慢性化脓性中耳炎静止期及中耳胆脂瘤术前评估的重要性。方法回顾性分析慢性化脓性中耳炎静止期及中耳胆脂瘤患者42耳病历资料，从CT、耳内镜及术中发现进行分析。结果①根据CT结合术中所见，慢性化脓性中耳炎静止期CT分型分为单纯型、硬化灶型、肉芽型、硬化灶肉芽型。胆脂瘤型CT主要表现为听骨链消失或锤砧关节消失，乳突大部分呈硬化型，少部分为板障型，上鼓室鼓窦扩大，上鼓室、中鼓室甚至后鼓室乳突腔为软组织影占据，部分病例外半规管骨质破坏、面神经管水平段骨质破坏，部分病例外耳道后壁骨质破坏；单纯型CT示中耳鼓室乳突呈不完全气化型；硬化灶型CT示中耳鼓室乳突呈硬化型，病变局限于中鼓室，锤骨柄及镫骨周围有“类似骨质影”包裹；肉芽型、硬化灶肉芽型CT相似，示病变累及鼓室及乳突，听骨链基本完整，面神经管水平段骨质完整，但硬化灶型与肉芽型区别之处在于前者鼓室内听骨链周围有“类骨质”样散在高密度影。②耳内镜所见慢性化脓性中耳炎静止期鼓膜紧张部穿孔，鼓膜可有钙化斑；中耳胆脂瘤型则有上鼓室内陷或穿孔、后上象限穿孔、大穿孔、外耳道顶壁或后上壁下塌。结论慢性化脓性中耳炎静止期及中耳胆脂瘤的术前CT及耳内镜评估，对病变性质、范围、程度及指导手术起重要作用。

Significance of preoperative temporal bone CT and endoscopy on the treatment of chronic suppurative otitis media.

Objective To explore the significance of CT scan and endoscopy on the treatment of chronic suppurative otitis media. Methods Clinical data of 35 patients （42 ear） suffering from chronic suppurative otitis media or middle ear cholesteatoma between January 2008 and Januaryr 2011 were reviewed. Results of temporal bone CT scan and oto- scopy were analyzed. Results @CT results of chronic suppurative otitis media could be divided into simple, sclerotic, granular and mixed type. Feature of middle ear cholesteatoma was the disappearance of ossicular chain or incudomalleo- lar joint and attic mesotympanum was occupied by soft tissue. Lateral semicircular canal bone, horizontal segment of the facial nerve canal and external auditory canal bone were destroyed in some cases. In simple type, incomplete mas- toid gasification was noted. In sclerotic type, sclerotic mastoid and similar bone shadow around the handle of malleus and stapes were prominent. CT results of granular type and mixed type were similar, in which the lesions involved the tympanic and mastoid, but not ossicular chain and facial nerve canal. （~） Characteristic of otoscopy for chronic suppura- tive otitis media was the perforation of membrane tensa and eardrum calcification. For middle ear cholesteatoma, perfo- ration of shrapnell＇ s membrane, posterior superior quadrant and fall down of the top wall of external auditory meatus, et al, could be identified. Condusion CT scan and otoscopy are important methods to assess the nature of the lesions, range, degree, and surgical options for chronic suppurative otitis media and middle ear cholesteatoma.