中耳胆固醇肉芽肿

Cholesterol granuloma of the middle ear

目的 探讨中耳胆固醇肉芽肿的病因、发病机制以及治疗方法。方法 回顾性总结分析我院1988年 3月～ 2 0 0 3年 3月经手术和病理证实的 70例 (耳 )中耳胆固醇肉芽肿病人的临床资料。 70例 (耳 )中 ,术前诊断为胆脂瘤型中耳炎 37例 ,骨疡型中耳炎 13例 ,此二者之中考虑胆固醇肉芽肿者 13例 ;中耳乳突术后感染5例 ,分泌性中耳炎 7例 ,特发性血鼓室 8例 ,其中考虑可能为胆固醇肉芽肿者 2例。所有病人均有不同程度听力下降、耳闭塞感或伴耳鸣 ,亦可有耳溢液、头痛、头昏及其他症状。 70例 (耳 )均接受手术治疗 ,依照术前检查 ,根据病变程度不同而选择不同术式。结果 6 5例 (耳 )干耳 ,随访 1年以上无复发。 3例 (耳 )行改良乳突根治加鼓室成形术 ,术后半年流脓 ,后改行乳突根治术 ,术后均干耳 ;2例 (耳 )行鼓室探查加鼓窦开放术 ,术后半年及 1年又流脓伴听力下降 ,后改行改良乳突根治加鼓室成形术 ,术后干耳。结论 中耳胆固醇肉芽肿的病因主要有 :含气腔通气受阻、引流障碍及含气腔出血。中耳胆固醇肉芽肿与特发性血鼓室、分泌性中耳炎及胆脂瘤关系密切。术式的选择应根据病变范围和程度来决定 ,其原则是彻底清除病变 ,保持通畅引流。

Objective To investigate the etiology and pathogenesis of cholesterol granuloma of the middle ear and the treatment for the disease. Methods 70 cases cholesterol granuloma of the middle ear treated in our hospital during the period from March 1988 to March 2003 were retrospectively analysed. All cases were verified by surgery and pathology. Of the all cases, 37 were diagnosed as cholesteatoma otitis media, and 13 as granulational otitis media before the operation; only 13 were considered as cholesterol granuloma. Five cases were diagnosed as postoperative infection of middle ear, 7 cases as secretory otitis media, and 8 cases as idiopathic hemotympanum (among them, 2 cases were considered as cholesterol granuloma). All the cases had the ear symptoms, such as heaering loss, otorrhea, tinnitus, vertigo, etc. The patient was received different operative treatment depending upon different pathological change. Results Post-operative dry ear was obtained in 65 cases and postoperative follow-up for at least one year showed no recurrence. Conclusion The main pathogenesis of cholesterol granuloma includes obstruction of ventilation and drainage and blooding in air cells. Cholesterol granuloma has a close tie with cholesteatoma and secretory otitis media as well as idiopathic hemotympanum. The surgical approach depends upon the location, extension, and severity of the lesion. The principle of surgery is to eliminate the pathological focuses and create an adequate drainage.