中耳胆脂瘤伴面神经受累的临床特点及其情绪变化

Clinical characteristics and the emotional changes in middle ear cholesteatoma with facial nerve involvement

目的探讨中耳胆脂瘤伴面神经受累的临床特点及其情绪变化。方法选取2013年1月至2015年5月于我院耳鼻喉科住院接受治疗的80例中耳胆脂瘤患者为观察组,另选取同时期耳鼻喉科80例非中耳胆脂瘤患者为对照组。统计分析患者面神经骨管缺损部位情况;比较患者缺损部位、恢复时间、面神经功能及焦虑抑郁情绪。结果观察组中神经骨管缺损25例:膝状神经节+水平段1例、水平段17例、垂直段3例、水平段+垂直段4例。术前、术后发生面瘫的患者均有3例,术后发生面瘫均为面神经骨管胆脂瘤破坏,出现不同程度的损伤,面神经暴露且与胆脂瘤及肉芽粘连,术前面瘫比术后面瘫发生时间、恢复时间长,缺损部位无明显差异。观察组面神经功能明显低于对照组,术后6个月观察组患者病情明显改善(P<0.05)。观察组入院前、出院前焦虑情况明显高于对照组(P<0.05),出院前观察组抑郁情况明显高于对照组(P<0.05),出院后6个月2组患者术后焦虑、抑郁情况均明显改善(P<0.05)。结论中耳胆脂瘤伴面神经受累部位多为水平段,术后有发生面瘫风险,术前面瘫比术后面瘫发生时间、恢复时间长,患者焦虑情况、抑郁情况较严重,术后6个月中耳胆脂瘤伴面神经受累患者病情明显改善等临床特点,干预后均有明显改善。

Objective To investigate the clinical characteristics and the emotional changes of middle ear cholesteatoma with facial nerve involvement.Methods The observation group included 80 cases with middle ear cholesteatoma who were admitted into the Department of otorhinolaryngology,in our hospital from January 2013 to May 2015.The control group included 80 cases without middle ear cholesteatoma in the same period.We statistically analyzed the defect sites of facial nerve canal,and compared the defect sites,recovery time,facial nerve function and the emotion of anxiety and depression.Results In the observation group,25 cases were nerve canal defect,including 1case of the geniculate ganglion ＋ horizontal section,17 cases of horizontal section,3cases of vertical section and 4cases of horizontal section ＋ vertical section.There were 3cases of facial paralysis before the surgery and another 3cases after the surgery.All the postoperative facial paralysis cases were resulted from bony destruction of facial nerve canal,which showed a different degree of damage,the exposure of facial nerve and the adhesion of cholesteatoma and granulation.The occurrence time and recovery time of facial paralysis before the surgery was longer than those after the surgery;however there was no significant difference for the defect sites.The facial nerve function in the observation group was significantly worse than that of the control group,and the status of patients in the observation group was significantly improved 6months after the surgery（P〈0.05）.The anxiety in the observation group was significantly higher than that of the control group either before admission or before discharge from the hospital（P〈0.05）.The depression in the observation group was significantly more obvious than that in control group before admission and discharge from the hospital（P〈0.05）.The anxiety and depression were significantly improved in both observation group and control group 6 months after discharge from hospital（P〈0.05）.Conclusion The most common defect site in middle ear cholesteatoma with facial nerve involvement was horizontal section,and there was risk for facial paralysis after the surgery.The occurrence time and recovery time of facial paralysis before the surgery was longer than those after the surgery.There were more serious anxiety and depression in patients.The symptoms were significantly improved in middle ear cholesteatomawith facial nerve involvement 6months after the surgery and all the significant improvements were after intervention.