少年儿童胆脂瘤型中耳炎手术治疗效果观察

The effect of cholesteatomatous otitis media operation on children and teenagers

目的 :探讨青少年胆脂瘤型中耳炎的特点与手术方式。方法 :回顾分析 1 986至 1 999年收治的少年儿童胆脂瘤型中耳炎 43例、49耳的临床资料。结果 :听骨破坏 43耳 (4 3 49,87 76% ) ,其中三听骨均破坏2 2耳 (2 2 49,44 90 % ) ;听骨链破坏中断 ,包括砧骨和 (或 )镫骨 ,砧骨和 (或 )锤骨 2 1耳 (2 1 49,42 86% ) ;三听骨均破坏 2 2耳中 ,1 9耳 (1 9 2 2 ,86 3 6% )胆脂瘤上皮伴肉芽增生 ,仅胆脂瘤上皮为 3耳(3 2 2 ,1 3 64% )。单纯行上鼓室 乳突根治术 1 6耳 ,上鼓室 乳突根治术同期行鼓室成型术(成形Ⅰ型 Ⅲ型 ) 3 3耳。 48耳术后干耳 ,1耳术后 2周上鼓室肉芽生长 ,感音功能下降。除 2耳因年龄小听力检查不合作外 ,术后听力平均提高5 1dB ,其中气导 (AC)为 5 0 0 ,1 0 0 0 ,2 0 0 0Hz的均值 (下同 ) ,在 3 0dB之内有 2 5耳 (2 5 47,5 3 1 9% ) ,AC在 40dB具有实用听力的 5耳 (5 47,1 0 64% ) ,听力改善率为 63 83 %。结论 :青少年胆脂瘤型中耳炎具有发展快、侵蚀性强、破坏范围大和易复发的特点。为青少年胆脂瘤型中耳炎施术 ,应考虑青少年胆脂瘤的特点 ,视患者的病变情况和病灶范围确定术式。目的是彻底清理病灶。对于病变范围小 。

Objective:To observe the result of operation for children and teenagers with cholesteatomatous otitis media.Method:43 cases (49 ears) were operated and reviewed retrospectively.Result:43 ears had ossicular destruction,21 of them were partial ossicular destruction including incus or stapes and both,incus or malleus and both;the other 22 were total ossicular destruction,19 of them were found granulation accompanied cholesteatomatous epithelium,3 were found only cholesteatomatous epithelium.16 ears were performed merely epitympanum or mastoid radical operation,33 ears were performed epitympanum or mastoid radical operation and tympanoplasty Ⅰ type or Ⅲ type at the same time.Dry ear was obtained after operation in all except 1 ear,which was found granulation on tympanic membrane after postoperative two weeks,and had profound sensorienural deafness.Postoperative hearing improved 5.1dB in average except that 2 ears did not cooperate.Air conduction (AC) of 25 ears was within 30dB,5 ears had useful hearing (under 40dBHL).Hearing efficiency rate was 63.83%.Conclusion:Children and teenager's cholesteatomatous otitis media had the characteristics of fast development,erosion expand and easy recurrent.These characteristics should be considered in operation so as to definite and clear the disease thoroughly.