中耳炎区域性病理差异现象的研究及临床意义

Study on the phenomenon of regionally pathological difference of otitis media and its clinical (significance

目的 研究中耳炎病理过程中 ,中耳腔系统各不同区域病变特点、严重程度的差异及其原因和临床意义。方法 以 2 90耳各型伴炎性渗出液的中耳炎颞骨连续切片作为研究材料 ,将中耳腔系统分为咽鼓管区、前半 后下中鼓室区、听骨链区 (包括后上中鼓室、上鼓室区 )、鼓窦 乳突区分区进行组织病理学比较观察研究。结合 2 5 6耳各型慢性中耳炎薄层CT检查和其中 189耳手术中分区观察结果 ,对各分区病变特点和严重程度差异进行分析。结果 中耳炎时咽鼓管区几乎没有炎性病理变化 ;前半 后下中鼓室区病变轻 ,且多为可逆性病变 ;而听骨链区和鼓窦 乳突区病变明显比前两区严重 ,且多为顽固性或不可逆性病变。结论 这种“中耳炎区域性病理差异现象”是中耳腔系统前、后区域解剖结构、组织的特殊性引起中耳炎时内通风系统病理性阻塞 。

Objective To study the feature and difference of severity of pathological changes in different areas of the middle ear cleft with otitis media (OM) and its pathogeneses and clinical significance. Methods The temporal bone slides of 290 ears with OM with inflammatory effusion had been studied histopathologically under microscope. The histopathological change in different areas has been comparatively observed. 256 cases with various forms of chronic otitis media (COM) have been studied with high-resolution CT, and 189 cases with COM were observed during operation, stressing on the difference of pathogical changes in different areas. Results In the process of OM, the mucosa of the eustachian tube almost has no inflammatory pathological changes, and in hemi-anterior and infer-posterior mesotympanum area was much lightly and reversible pathological change. But the pathological changes in the ossicular chain area was much more serious than the other two areas, and was irreversible or intractable such as granulation tissue, cholesteaoma etc. Conclusions Because of the historical and anatomical distinction difference between anterior and posterior area of the middle ear cleft and blockage of internal ventilation/draining system in process of OM, the stagnancy of inflammatory effusion and formation of granulation tissue in posterior area are the main cause leading to the phenomenon of regionally pathological difference in different areas of the middle ear clefts.