中耳胆固醇肉芽肿的诊断和手术治疗

Diagnosis and surgery for cholesterol granuloma of the middle ear

目的探讨中耳胆固醇肉芽肿（CG）的发病机制、临床特点及治疗效果。方法回顾性分析43例CG患者的临床资料，其中42病例经手术及病理证实。主要临床表现包括听力下降43／43例，耳闷感29／43例，咖啡样耳漏12／43例，耳呜26／43例。蓝鼓膜为典型体征36／43例。颞骨高分辨CT（HRCT）主要表现为中耳乳突软组织阴影，可伴有听骨链破坏（17/43），手术中发现（13／43）与术前符合率76．47％（13／17）。结果手术方法选择完璧式乳突切除＋鼓室探查＋鼓室置管术31例，完璧式乳突切除＋鼓室探查＋听骨链重建术11例，单纯鼓室置管术1例。术后随访0．5～3．0年，无复发。术后1．2个月鼓膜颜色恢复正常，听力均有不同程度提高，骨气导间距平均减少（25．0±3．5）dB。结论cG的主要临床表现为听力下降、耳闷感、耳呜、咖啡样耳漏和蓝鼓膜。HRCT对中耳胆固醇肉芽肿诊断及手术有重要参考价值。诊断明确应采取手术治疗，清除病变，建立鼓室及乳突的通气、引流，并重建听力。

Objective To investigate the etiology, chnic characteristics, and pathogenesis of cholesterol granuloma（CG） of the middle ear, as well as to discuss the effect of surgeries. Methods Forty-three patients （43 ears） with cholesterol granuloma of the middle ear were enrolled in this retrospective study, and 42 received middle ear mastoid surgery and were confirmed by a pathologic examination post-operatively. The main clinical manffestatious of CG were hearing loss （43/43）, tinnitus （26/43）, sense of fullness （29/43）, and bloody otorrhea （12/43）, with blue drum as a typical physical sign （36/43）. Temporal bone high resolution computed tomography （HRCT） scan showed soft tissue shadows in 43 cases with erosion of the ossicular chain in 17 cases, which was confirmed by surgeries in 13 cases. Results 31 patients underwent a combined modality treatment ofmastoidectomy, tympanotomy, and grommet insertion and other 11 patients were subjected to a combined strategy of mastoidectomy, tympanotomy, and reconstruction of the ossicular chain. The eardrums of patients became normal 1 to 2 months after the surgeries. The hearing threshold was improved （the improvement of AB-gap was 25 ± 3.5 dB） and no symptoms recurred in all patients after a follow-up from half to 3 years. Conclusion The main clinical features of cholesterol granuloma of the middle ear are hearing loss, tinnitus, sense of fullness, and bloody otorrhea, as well as blue drum. HRCT is useful for diagnosis and operation. As for the treatment of CG, mastoid surgery should be performed on, in which the affected tissues in the middle ear should be completely removed; a ventilation system of the mastoid tympani should be established.