先天性中耳胆脂瘤临床诊治及误诊分析

Analysis of the clinical diagnosis and therapy and misdiagnosis for congenital middle ear cholesteatoma

目的探讨先天性中耳胆脂瘤的诊断、治疗方法以及误诊原因,减少漏诊、误诊。方法对我院收治的9例先天性中耳胆脂瘤患者临床资料进行回顾性分析。结果9例均行手术治疗,病理确诊,其中6例行听力重建,随访3个月-2年半,气骨导差为20 dB左右,术后1年者复查颞骨CT均未发现胆脂瘤残留及复发。所有患者均有误诊病史,误诊率100%。结论先天性中耳胆脂瘤临床少见,起病隐匿,易漏诊、误诊,诊断可根据Levenson诊断标准和影像学检查,早期手术治疗可获得较好听力重建效果。提高对本病的认识,影像学检查和仔细的局部检查可提高诊疗水平,避免误诊、误治,避免严重并发症发生。

OBJECTIVE To investigate the methods of diagnosing and treating congenital middle ear cholesteatoma and causes of misdiagnosis.METHODS This was a retrospective review of 9 cases of congenital middle ear cholesteatoma in this hospital.R ESULTS 9 patients all received operative treatment and def inite diagnosis was made by histopathologic investigation.The ossicular reconstruction was performed to 6 patients.All of the cases were followed-up for 3 months-2.5 years.A-B gap was 20 d B.After 1 year,no residual or recurrence of cholesteatoma was found in CT scan.All patients had been misdiagnosed.Misdiagnosis rate was 100%.CONCLUSION Congenital middle ear cholesteatoma is a clinically rare and diagnosis is usually delayed in clinical practice due to the silent nature of the disease in its early stage.Preoperative diagnosis may be based on Levenson diagnostic criteria and CT imaging.Early surgical treatment can obtain a good effect of hear ing reconst r uction.To avoid misdiag nosis and incorrect treatment,radiological evaluation and careful local examination are really important,which may also avoid serious complications.