10例先天性中耳胆脂瘤临床分析

目的：探讨先天性中耳胆脂瘤的临床特征及手术方法。方法：回顾性分析10例先天性中耳胆脂瘤患者的临床资料。5例经耳内途径行鼓室探查并一期鼓室成形术，3例行闭合式乳突根治术及鼓室成形术，2例行开放式乳突根治术及鼓室成形术。结果：术中见5例胆脂瘤局限于中后鼓室，3例位于中鼓室及上鼓室，2例病变范围广泛，侵及乳突。术后6个月平均纯音听阈为30dBHL，气骨导差在20dB以内，复查颞骨CT均未发现胆脂瘤残留和复发。结论：先天性中耳胆脂瘤病变隐匿，常于鼓室前方或后方，易破坏听骨链，导致传导性聋；影像学检查可为诊断及术式选择提供依据；早期手术治疗可获得较好的听力重建效果。

Clinical analysis of ten cases of congenital middle ear cholesteatoma

Objective：To investigate the clinical features and operation treatment of the congenital middle ear cholesteatoma. Method.. A retrospective review of clinical and surgical records of 10 patients with congenital middle ear cholesteatoma were performed. All patients were treated by surgeries,5 of 10 cases deal with one-stage tympa- noplasty after drum exploration by external auditory meatus, 3 cases dealed with closed mastoidotympanectomy and tympanomastoidectomy, 2 cases dealed with open mastoidotympanectomy and tympanomastoidectomy. Result：The cholesteatomas were located at or around the posterior tympanum or mesotympanum in 5 patients, confined to the tympanic cavity and attic in 3 patients, advanced cholesteatoma that extended from the tympanic cavity into the mastoid antrum was seen in 2 patients. The mean postoperative PTA was 30 dB HL, the mean ABG was within 20 dB, after six months. No residual or recurrence of cholesteatoma was found. Conclusion：The congenital chol- esteatoma often originates from the posterior or anterior of the middle ear, with hiding lesion, thus result in severe conductive hearing loss . Imaging examination plays an important role in diagnosing and treating of congenital chol- esteatoma. Early stage surgical treatment can obtain a good hearing reconstruction effect.