分泌性中耳炎为首发症状的颞下窝良性肿瘤12例报告

Benign Tumors in Infratemporal Fossa with Otitis Media with Effusion as the First Symptom:A Report of 12 Cases

目的 分析以分泌性中耳炎(otitis media with effusion,OME)为首发症状的颞下窝(infratemporal fossa,ITF)良性肿瘤患者的症状及体征特点,探索内镜下经鼻和经口切除手术的治疗效果。方法 回顾性选取2011年1月至2022年1月在空军军医大学西京医院耳鼻咽喉头颈外科以OME症状就诊,ITF实体肿瘤并接受内镜下经鼻和经口切除手术的患者12例。根据是否存在鼻咽部肿物隆起(nasopharyngeal mass,PM),分为OME伴PM组(OMEwPM)4例,OME不伴PM组(OMEnPM)8例。同时选取确诊为ITF良性实体肿瘤而无OME症状的PM组(nOMEwPM)14例。比较伴OME的ITF良性肿瘤患者与无OME的ITF良性肿瘤患者肿瘤体积、肿瘤在ITF区域定位特点,明确ITF肿瘤引起OME的相关因素,总结内镜下经鼻和经口手术治疗的效果。结果 ITF肿瘤体积与OME的无明确相关关系,差异无统计学意义(P>0.05),ITF肿瘤的体积与PM有相关关系,差异有统计学意义(P<0.05)。ITF肿瘤的病理类型与OME的发生无相关关系,但肿瘤在ITF的原发部位与OME的发生有相关关系,ITF的B1区、C区肿瘤更易引起OME。结论 OME可能是ITF肿瘤早期或唯一临床症状,鼻咽部检查可能无异常表现,而影像学检查有助于降低漏诊率。根据肿瘤在ITF的定位特点选择经鼻或经口手术治疗长期疗效稳定,有临床推广运用价值。

Objective To report characteristic symptoms and physical signs of benign tumors of the infratemporal fossa(ITF) with otitis media with effusion(OME) as the initial symptom,as well as outcomes of endoscopic transnasal and transoral tumor resection.Methods Cases of benign tumors of the ITF,grouped based on presence of OME(with OME n=12;without OME n=14),were retrospectively analyzed,including tumor volume and location in the ITF,and factors leading to OME.Outcomes of endoscopic transnasal and transoral surgery were summarized.Results There was no clear correlation between the tumor volume and occurrence of OME(P=0.1292),but tumor volume was correlated to occurrence of nasopharyngeal mass(P=0.0083).Pathological type of tumor was not correlated with occurrence of OME,but the primary site of tumor in the ITF was,with tumors in the B1 and C regions more likely to cause OME.Conclusion OME can be the early or only clinical symptom of ITF tumors while nasopharyngeal examination may be unremarkable.Imaging examination can help reduce missed diagnosis.Transnasal or transoral surgery can be selected based location of the tumor in the ITF.It produces consistent long-term outcomes and is worthy of clinical adoption.