胆脂瘤型中耳炎合并胆固醇肉芽肿的诊断和外科治疗

目的 探讨胆脂瘤型中耳炎合并胆固醇肉芽肿的病因、临床表现、诊治方法及二者的关系.方法 回顾性分析12 例(12耳) 经手术和病理诊断为胆脂瘤型中耳炎合并胆固醇肉芽肿患者的临床表现、颞骨CT 扫描、手术及随访资料.结果 12 例均有反复耳流脓,其中果酱样分泌物4 耳,脓血性分泌物3 耳,血性分泌物1 耳,脓性分泌物4 耳.听力损失为轻到重度传导性或混合性耳聋,乳突CT 扫描均有骨质破坏吸收,分别采用乳突根治术或改良乳突根治+ 听力重建术治疗,术后随访1-2 年无复发.结论 果酱样或脓血性耳溢液是胆脂瘤型中耳炎合并胆固醇肉芽肿的主要临床特征之一,治疗以手术为主,根据病变情况行听力重建.

Diagnosis and surgical treatment on cholesteatoma otitis media coexisted with cholesterol granuloma

Objective To study the pathogenesis,clinical manifestations,diagnosis and treatment of cholesteatoma otitis media accompanying cholesterol granuloma and their relations.Methods Clinical data about 12 patients(12 ears) with cholesteatoma otitis media accompanying cholesterol granuloma diagnosed by surgery and pathology were retrospectively analyzed,including their clinical manifestations,CT scan of temporal bone,operation and follow-up.Results Of the 12 patients with recurrent otorpyorrhea,4 had jam-like secretion,3 had sanguine secretion,1 had bloody secretion,and 4 had purulent secretion.Hearing disability was manifested as mild-severe conductive hearing loss or mixed deafness.Mastoid CT scanning showed destruction of bone and bone resorption,which underwent mastoidectomy or modified radical mastoidectomy plus hearing reconstruction.The patients were followed up for 1-2 years,during which no recurrence was observed.Conclusion Jam-like or bloody otopyorrhea is one of the key characteristics of cholesteatoma otitis media accompanying cholesterol granuloma and surgery is the chief choice of its treatment.Hearing is reconstructed depending on the condition of patients.