中耳胆固醇肉芽肿的诊断及治疗

目的:探讨中耳胆固醇肉芽肿的发病原因、诊断和接受中耳乳突手术治疗后的效果。方法:回顾性分析我院1999年8月～2004年4月接受中耳乳突手术治疗和经病理证实的18例(19耳)中耳胆固醇肉芽肿患者的临床资料,其中,接受完壁式乳突根治加鼓室探查加中耳置管术7耳,完壁式乳突根治加鼓室探查加听骨链成形加中耳置管术2耳,完壁式乳突根治加鼓室探查术3耳,完壁式乳突根治加鼓膜成形术2耳,开放式乳突根治加鼓室成形术4耳,单纯乳突切除术1耳。结果:置管者术后1～3个月拔除中耳通气管,鼓膜愈合良好;未置中耳通气管者,1～2个月鼓膜颜色正常。术后听力均有不同程度提高,纯音测听达到应用水平(语频气导平均听阈30dB以内)15耳(79%)。所有患者随访0.5～2年,除1耳因咽鼓管不通,长期留置中耳通气管外,其余患者无复发。结论:中耳胆固醇肉芽肿的病因为中耳炎症引起含气腔通气受阻,引流障碍及含气腔出血。确诊有赖于病理诊断。中耳乳突手术彻底去除病变,建立乳突鼓室咽鼓管良好的通气系统,是手术成功的关键。

The diagnosis and therapy for cholesterol granuloma of middle ear

Objective:To explore the diagnosis for cholesterol granuloma of middle ear, and discuss the effect of middle ear surgery for this disease.Method:The files of 18 patients (19 ears) with cholesterol granuloma of middle ear were reviewed in a retrospective study.All patients received middle ear and mastoid surgery,and all involved tissues were verified as cholesterol granuloma by pathologic examination.Result:The patients undergoing ventilation tube insertion were extubated 1-3 months after surgery and the eardrums healed well. The eardrums of the patients without ventilation tube insertion became normal 1-2 months after surgery. The hearing threshold after surgery of all patients improved. Beside one patients with eustachian tube obstructed had ventilation tube inserted with long term,no patient had symptoms recurred.Conclusion:The cholesterol granuloma of middle ear results from the bleeding, occlusion of ventilation and disturbance of drainage of the air cavity because of the middle ear inflammation. The diagnosis depends on the pathological examination. The middle ear and mastoid surgery, removing the diseased tissues completely, creating a ventilation system of mastoid-tympani-Eustachian are the key point of the middle ear surgery.