中耳畸形合并胆脂瘤的临床特点分析

Analysis of clinical characteristic of the middle ear malformation with cholesteatoma

目的探讨中耳畸形合并胆脂瘤的临床特点。方法回顾性分析自2011年9月至2016年11月收治的中耳畸形合并胆脂瘤23例（23耳）的临床资料．了解其发病特点、畸形好发部位。结果本组患者100％有听力下降，90．0％有耳流脓、耳鸣，86．96％鼓膜松弛部穿孔。95．7％乳突气化不良，73．9％鼓窦未发育或发育不良。100％听骨链有破坏，56．5％听骨链畸形，52．2％面神经裸露，30．4％上鼓室有增生骨块。结论中耳畸形合并胆脂瘤患者症状及体检与中耳胆脂瘤相似。颞骨高分辨率CT（HRCT）能很好地显示畸形部位及破坏范围，乳突多气化不良，畸形好发部位依次为鼓窦发育不良、听骨链畸形、面神经裸露、上鼓室增生骨块。手术应由经验丰富的耳科医生在显微镜下完成．

Objective To discuss the clinical characteristic of middle ear malformation with cholesteatoma. Methods From September, 2011 to November, 2016, 23 cases of middle ear malformation with cholesteatoma were collected. Their symptoms, ENT examination, temporal bone high resolution computed tomography （HRCT） and intraoperative findings were analyzed. Results All 23 patients had hearing loss. 90.0% patients had ear discharge and tinnitus. 86.96% patients had perforation in pars flaccida of tympanic membrane. 95.7% patients had poor mastoid gasification. 73.9% patients had undeveloped or dysplastic tympanic antrum. 100% patients had destruction of the ossicular chain. 56.5% patients had malformation of the ossicular chain. 52.2% patients had exposed facial nerve. 30.4% pa- tients had hyperplasia of the attic bone. Conclusion The symptoms and physical examinations of middle ear malformarion with cholesteatoma are the same as middle ear cholesteatoma. Poor mastoid gasification can usually be detected on temporal bone HRCT. The most common malformation is dysplastic tympanic antrum, followed by malformation of the ossicular chain, exposed facial nerve and hyperplasia of the attic bone. Temporal bone HRCT can indicate the malformation and destruction quite well.