慢性中耳乳突炎侵犯鼓室骨壁的HRCT探讨

HRCT of Chronic Otomastoiditis Damaging Tympanic Wall

目的:着重研究慢性中耳乳突炎侵犯鼓室壁的HRCT特征及其临床价值。材料和方法:收集经临床和手术证实的慢性中耳乳突炎28例计32耳,并伴有鼓室壁损害的HRCT资料,回顾性分析影像学表现,评价临床意义。结果:①鼓室盖异常68耳,占25%。其中,骨质疏松2耳,骨壁菲薄1耳,骨壁缺损5耳;②颈动脉管异常6耳,占18.7%。其中,骨质疏松2耳,骨壁缺损1耳;③颈静脉孔壁异常5耳,占15.6%。其中,骨质疏松2耳,骨壁菲薄1耳,骨壁缺损2耳;④乙状窦骨壁异常13耳,占40.6%。其中,乙状窦骨壁缺损3耳,乳突窦骨壁破坏10耳,听小骨糜烂、移位5耳;⑤骨迷路异常7耳,占21.8%。其中,鼓岬缺损1耳,前庭窗模糊1耳,蜗窗缺损2耳,面神经管缺损2耳,外半规管缺损1耳;⑥鼓膜异常21耳,占65.6%。其中,鼓膜缺损7耳,鼓膜增厚7耳,鼓膜内陷5耳,外耳道骨质破坏2耳。结论:运用HRCT扫描横断位和冠状位相结合,除能显示慢性中耳乳突炎病变表现外,还能确定其鼓室各壁的骨质损害部位、程度及与周围结构的关系,对手术处理具有重要意义。

Objective：To study the clinical value and CT features of chronic otimastoiditis tympanic wall by HRCT.Methods：CT features of chronic otomastoeditis damaging tympanic wall in 28 cases（32 ears）were proved by clinical and operation,respectively.In 32 ears,simple type in 3 ears,cholesteatoma type in 17 ears,and granuloma type in 12 ears.Results：HRCT features in 32 ears（28 cases）of chnonic otomastoiditis damaging tympanic wall as following：1.In roof of tympanum abnormal 8 ears（25%）,osteoporosis 2 ears,thin bone wall 1 ear,bone destruction 5 ears.2.In carotid canal abnormal 6 ears（18.7%）,Osteoperosis 2 ears,osterosclerosis 3 ears,and bone plate defect 1 ear.3.In jugular foramen abnormal 5 ears（15.6%）,osteoporosis 2 ears,thin bone wall 1 ear,bony defect 2 ears.4.In sigmoid sinus wall abnormal 13 ears（40.6%）,Sigmoid groove defect 3 ears,antrum tympanicum enlargement 10 ears erosion and dislocation of auditory ossicles 5 ears.5.In Labyrinthine wall abnormal 7 ears（11.9%）,promontory of tympanum defect 1 ear,vestibular window 1 ear,Fenestra cochleae window 2 ears,facial nerve canal defect 2 ears,semicircular canal defect 1ear.6.In tympanic membrane abnormal 21 ears（65.8%）,tympance membrane defect 7 ears,tympance membrane thickening 7 ears,tympane membrane invagination 5 ears,exterial canal wall erosion 2 ears.Conclusion：Axial and coronal view of HRCT had its clinical value in the diagnosis of position,extension,secondary changes in chronic otomastoiditis damaging tympanic wall for operation treatment.