咽鼓管上隐窝的形态学改变与中耳炎性病变的关系研究

The relation between the morphological change of supratubal recess and otitis media

目的:观察咽鼓管上隐窝的解剖特征及其在中耳炎性病变时的形态学改变,探讨咽鼓管上隐窝的形态学改变与中耳炎性病变的关系。方法:用颞骨薄层CT摄片方法,对正常耳和不同类型中耳炎患者患耳的咽鼓管上隐窝的形态、大小进行观察、测量。结果:正常耳咽鼓管上隐窝的前后径为(3.83±1.28)mm,垂直径为(3.67±1.14)mm,高度为(3.76±0.36)mm,齿突长度为(2.84±0.38)mm,左右侧比较差异无统计学意义(P>0.05);咽鼓管上隐窝的形态与乳突气化类型无关(P>0.05)。胆脂瘤型中耳炎患耳的咽鼓管上隐窝形态与正常耳比较差异有统计学意义(P<0.05),患耳咽鼓管上隐窝的形态(前后径、垂直径与高度以及齿突长度)均与乳突气化类型无关(均P>0.05);本组有8耳的咽鼓管上隐窝结构有确切的、不同程度的骨质破坏,占40%(8/20)。慢性化脓性中耳炎(单纯型)患耳咽鼓管上隐窝的形态与正常耳比较差异无统计学意义(P>0.05)。结论:胆脂瘤型中耳炎患耳的咽鼓管上隐窝的形态明显小于正常耳,咽鼓管功能不良时,则可能影响中耳通气引流系统,进而于鼓膜局部逐渐形成内陷囊袋,最终形成胆脂瘤型中耳炎。慢性化脓性中耳炎(单纯型)患耳咽鼓管上隐窝的形态与正常耳比较差异无统计学意义。临床上应充分考虑咽鼓管上隐窝在中耳胆脂瘤发病和手术治疗中的重要临床意义。

Objective：To observe the anatomic characteristics of supratubal recess and the morphological change of it in the sick ear.To investigate the relation between the morphological changes of supratubal recess and otitis media.Method：Using high resolution CT to observe and measure the supratubal recess of the normal ears and the ailing ones.Result：For the normal adults,the anteroposterior diameter of the supratubal recess is（3.83±1.28）mm,the vertical diameter（3.67±1.14）mm,the height（3.76±0.36）mm;and the length of the cog is（2.84±0.38）mm.The size of the supratubal recess showed no significant difference between left and right（P0.05）.There was no relationship between the size of the supratubal recess and pneumatization of mastoid cells（P0.05）.There was significant differences in size of the supratubal recess between normal ears and the ears with cholesteatoma（P0.05）,but there was no relationship between the size of the supratubal recess and pneumatization of mastoid cells（P0.05）in the ears with cholesteatoma.There was no significant differences in size of the supratubal recess between normal ears and the ears with chronic otitis media（P0.05）.In the ears with cholesteatoma,40% had osseous destruction in supratubal recess.Conclusion：For the normal adults,the size of the supratubal recess showed no significant difference between left and right,and there was no relationship between the size of the supratubal recess and pneumatization of mastoid cells.Anterior tympanic isthmus,posterior tympanic isthmus and supratubal recess which is the supplement of the formers constitute the air way between attic and mesotympanum.The supratubal recess of the cholesteatoma is smaller than the normal,when the eustachian tube dysfunction occurs,the air way in the middle ear would herein be affected,and cholesteatoma forms eventually.There was no significant differences in size of the supratubal recess between normal ears and ears with chronic otitis media,as in the clinic.The effect of the supratubal recess should be taken into account when we consider the pathogeny and treat ment of the middle ear cholesteatoma.