上鼓室内陷袋的临床特征分析

目的：探讨上鼓室内陷袋的临床特征。方法：分析92例（118耳）上鼓室内陷袋患者的临床资料、临床表现（常以耳闷胀感、听力下降及耳鸣为主诉）、耳内镜检查及分级、听力学、影像学检查及并发病变。结果：118耳中，TosⅠ～Ⅳ级分别为15耳（12．7％），48耳（40．7％），23耳（19．5％）及32耳（27．1％）。耳内镜下可见并发的分泌性中耳炎41耳（34．7％）、中耳膨胀不全16耳（13．6％）、粘连性中耳炎8耳（6．8％）及内陷袋胆脂瘤。纯音测听以传导性聋为主，少数还有以传导性聋为主的混合性聋。因并发中耳疾病及疾病性质的不同，而对听力的影响也不同，且差异也有统计学意义（P〈0．01）。Ⅰ～Ⅲ级各病变组与Ⅳ级病变对听力的影响有统计学意义（P〈0．01），Ⅰ～Ⅲ级之间的听阈无统计学意义（P〉0．01），声阻抗以平坦型及负压为主。其中97耳CT及X线摄片结果显示，乳突气化不良程度与对照组有差异（P〈0．01）。结论：上鼓室内陷袋反映中耳负压状态，其发病机制与咽鼓管功能、炎症、乳突气化程度相关；因其存在发展为内陷袋胆脂瘤的潜在危险，故临床上应加强早、中期病变的随访及干预。

Clinical manifestation of attic retraction pocket

OBJECTIVE: To analyze the clinical manifestation of attic retraction pocket. METHOD: Ninety-two patients with 118 involved ears were studied. The clinical data including clinical manifestation, endoscopic findings and gradings,hearing tests, imaging findings and accompanying lesions. RESULT: According to Tos's grades, 15 ears (14/118,12.7%) belonged to stage I, 48 (42/118, 40.7%) belonged to stage II, 23 (23/104,19.5%) belonged to stage III and 32 (32/118, 27.1%) belonged to stage IV. Patients always complained of ear blockage,hearing loss and tinnitus. Accompanying lesions including otitis media with effusion, middle ear atelectasis, adhesive otitis media and retraction pocket cholesteatoma could be found by endoscopy. The results of pure audiometry were related to the grades of lesions. Most patients had conductive hearing loss and a few patients had mixed hearing loss. The tympanometry in most cases was type B or C. Imaging examination (CT or X-ray) of 97 ears showed poor pneumatization of mastoids and there was a significant difference between involved group and control group (P < 0.01). CONCLUSION: The attic retraction pocket reflected the negative pressure of middle ear and its pathogenesis was related with the function of Eustachian tube, inflammation and pneumatization of mastoid. Since it had a risk to develop into retraction pocket cholesteatoma, following-up and interferon to early or middle stage lesion should be paid more attention.