m^(6)A modification of lncRNA in middle ear cholesteatoma

Objective:Middle ear cholesteatoma is a non-tumorous condition that typically leads to hearing loss,bone destruction,and other severe complications.Despite surgery being the primary treatment,the recurrence rate remains high.Therefore,exploring the molecular mechanisms underlying cholesteatoma is crucial for discovering new therapeutic approaches.This study aims to explore the involvement of N6-methyladenosine(m^(6)A)methylation in long non-coding RNAs(lncRNAs)in the biological functions and related pathways of middle ear cholesteatoma.Methods:The m^(6)A modification patterns of lncRNA in middle ear cholesteatoma tissues(n=5)and normal post-auricular skin tissues(n=5)were analyzed using an lncRNA m^(6)A transcriptome microarray.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analyses were conducted to identify potential biological functions and signaling pathways involved in the pathogenesis of middle ear cholesteatoma.Methylated RNA immunoprecipitation(MeRIP)-PCR was used to validate the m^(6)A modifications in cholesteatoma and normal skin tissues.Results:Compared with normal skin tissues,1525 lncRNAs were differentially methylated in middle ear cholesteatoma tissues,with 1048 showing hypermethylation and 477 showing hypomethylation[fold change(FC)≥3 or<1/3,P<0.05].GO enrichment analysis indicated that hypermethylated lncRNAs were involved in protein phosphatase inhibitor activity,neuron-neuron synapse,and regulation ofα-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid(AMPA)receptor activity.Hypomethylated lncRNAs were associated with mRNA methyltransferase activity,secretory granule membrane,and mRNA methylation.KEGG analysis revealed that hypermethylated lncRNAs were mainly associated with 5 pathways:the Hedgehog signaling pathway,viral protein interaction with cytokines and cytokine receptors,mitogen-activated protein kinase(MAPK)signaling pathway,cytokine-cytokine receptor interaction,and adrenergic signaling in cardiomyocytes.Hypomethylated lncRNAs were mainly involved in 4 pathways:Renal cell carcinoma,tumor necrosis factor signaling pathway,transcriptional misregulation in cancer,and cytokine-cytokine receptor interaction.Additionally,MeRIP-PCR confirmed the changes in m^(6)A methylation levels in NR_033339,NR_122111,NR_130744,and NR_026800,consistent with microarray analysis.Real-time PCR also confirmed the significant upregulation of MAPK1 and NF-κB,key genes in the MAPK signaling pathway.Conclusion:This study reveals the m^(6)A modification patterns of lncRNAs in middle ear cholesteatoma,suggests a direction for further research into the role of lncRNA m^(6)A modification in the etiology of cholesteatoma.The findings provide potential therapeutic targets for the treatment of middle ear cholesteatoma.

Pediatric Middle Ear Congenital Cholesteatoma: A Case Report

Congenital cholesteatoma（CC）is a rarely seen benign tumor of the temporal bone. There are five general sites of extradural occurrence: the middle ear, external auditory meatus, mastoid, squamous portion and the petrous apex of the temporal bone. CC grows slowly and presents no symptoms at the early stage. Delayed and mis-diagnosis are common with this condition. Case report A 10-year-old boy presented with a 3-month history of hearing loss on right side. There was no history of otorrhea, facial palsy, previous otological procedures or trauma. Otoscopy revealed a bulging posterosuperior quadrant in the otherwise intact right tympanic membrane （Fig.1）. Pure tone audiometry showed an average threshold of 51 dB for 500, 1000, 2000 and 4000Hz, with a 40 dB air-bone gap, suggesting a moderate conductive hearing loss（Fig.4）. CT scan of the temporal bone showed an isolated soft tissue density lesion in the middle ear（Fig.2）.

A Novel Surgery Classification for Endoscopic Approaches to Middle Ear Cholesteatoma

This study aimed to develop a novel surgery classification for an endoscopic approach to middle ear cholesteatoma.We retrospectively analyzed the surgical approaches and outcomes of patients with middle ear cholesteatoma.Middle ear cholesteatoma surgeries were divided into four types and two special types as follows:type I,attic retraction pocket,which only requires tympanostomy tube placement or retraction pocket resection and cartilage reconstruction;typeⅡ,cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid cholesteatoma lesions,including type Ⅱa,requiring only use of a curette,and type Ⅱ b,requiring use of an electric drill or chisel;type Ⅲ,cholesteatoma not limited to the attic,in which endoscopy cannot confirm complete removal of mastoid cholesteatoma lesions,requiring the combined use of endoscope and microscope to perform endoscopic tympanoplasty and"Canal Wall Up"mastoidectomy;type Ⅳ,extensive involvement of mastoid cavity cholesteatoma lesions and/or cases with a potential risk of complications,removal of which can only be performed under a microscope for"Canal Wall Down"mastoidectomy.In addition,there were two special types:"difficult external auditory canal"and congenital cholesteatoma in children.In our system,type I and type U middle ear cholesteatoma surgery was completely performed under an endoscope alone.However,estimating the extent of the lesions,determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to middle ear cholesteatoma.The classification of endoscopic middle ear cholesteatoma surgery may benefit the selection of surgical indications.

Congenital cholesteatoma of the middle ear-a report of 10 cases

Objectives To study clinical, imaging features and treatment outcomes of congenital cholesteatoma of middle ear (CCME). Methods This is a retrospective review of 10 CCME cases selected from 952 cholesteatoma cases treated between January 1995 and December 2005 at the Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital. The main outcome measures were the site of origin, clinical features, surgical findings, imaging characteristics and hearing results. Results The mean age of the 10 patients was 16 years(ranged from 10 to 24 years), with 6 being older than 18 years. There were 7 males and 3 females. The average delay to diagnosis was longer than 2 years. The mean preoperative PTA was 55 dB HL, with a mean ABG of 45 dB. Typical cholesteatomas were seen behind the tympanic membrane in the superoposterior quadrant on otoscopy only in 2 patients. High resolution CT was completed in all patients. Most of the patients(8/10) were diagnosed with otosclerosis or ossicular abnormality before operation. All patients underwent a one-stage tympanoplasty following transmeatal explorative tympanotomy and complete cholesteatoma removal, except one, who underwent a CWU mastoidectomy due to extensive cholesteatoma involvement. The choleasteatoma lesion was confined to the superoposterior mesotympanum in all patients. The mean postoperative PTA was 20 dB HL. All patients were followed-up for at least 1.5 years postoperatively. Revision procedures were performed in 2 patients for hearing deterioration. No residual or recurrence of cholesteatoma was found. Conclusion CCME is a rare disease that often gets delayed diagnosis. Residual lesions and the prognosis mainly depend on the extent of the lesion.

Potential otogenic complications caused by cholesteatoma of the contralateral ear in patients with otogenic abscess secondary to middle ear cholesteatoma of one ear:A case report

BACKGROUND Otogenic brain abscess caused by middle ear cholesteatoma is a potentially serious and life-threatening complication in the ear,nose,and throat clinic.The mortality rate associated with otogenic brain abscesses is 8%–26.3%.Recently,in China,the incidence of brain abscess secondary to middle ear cholesteatoma has started to increase due to antibiotic resistance.CASE SUMMARY A 55-year-old male presented hearing loss in the right ear and headache for 1 mo in 2018.Computed tomography(CT) showed an area of low density in the right middle ear and mastoid and auditory ossicle defects and a small amount of soft tissue density in the left middle ear.The parietal wall of the right tympanic cavity and the posterior wall of the mastoid sinus were thin and less continuous.Cranial magnetic resonance imaging revealed an area of low intensity encapsulated by an area of high intensity in the right temporal lobe.We diagnosed him with a brain abscess secondary to middle ear cholesteatoma.He received surgery to drain the abscess followed by a modified radical mastoidectomy.The patient visited our department 3 years later because of intermittent otorrhea in the left ear.CT revealed that the area of the soft tissue density in the left middle ear and mastoid was significantly increased.The posterior wall of the mastoid sinus was destroyed,leaving the left middle ear connecting with the brain.The patient underwent a modified radical mastoidectomy in the left ear CONCLUSION Regular follow-up and timely treatment of contralateral ear disease are vital for the prevention of otogenic complications in patients with otogenic abscesses secondary to middle ear cholesteatoma in the unilateral ear.

Endoscopic ear surgery in middle ear cholesteatoma

Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a minimally invasive alternative for microscopic approach.We aim to evaluate the feasibility,structural,functional and quality of life outcomes of endoscopic technique in middle ear cholesteatoma.Method:This prospective study was conducted at a tertiary care hospital from January 2017 to January 2018 including 32 adult patients who were treated by TEES for middle ear cholesteatoma.Feasibility of endoscopic technique was assessed by the conversion rates,visualization of middle ear structures and complications.Structural outcomes were evaluated in terms of graft uptake at the third month follow-up and presence of residual or recurrent disease.Functional outcomes were evaluated in terms of postoperative air-bone gap closure at third month follow-up.Patient outcomes in terms of post-operative pain,cosmetic score,day of return to daily activities and patient comfort scores were evaluated.The quality of life outcomes were evaluated using chronic ear survey(CES)and short form questionnaire12 version 2(SF-12V2)which are disease specific and general quality of life assessment tools respectively.Result:Out of 32 patients,endoscopic intact canal wall mastoidectomy was done for 28 and endoscopic canal wall down mastoidectomy in 4 patients.One(3.1%)patient had to be converted to microscopic technique.Median follow-up period was 32.8 months(9e46 months).There were no post-operative complications in any of our patients.The mean middle ear structural visibility index score was 8.4±1.4 with the use of zero-degree endoscope.Graft uptake rate at third month follow-up was 100%.Two(6.3%)patients had recurrent disease at 6 months follow-up and were treated by revision endoscopic surgery.The air conduction(51.3±20.2 dB vs.34.5±20.4 dB,p<0.001),and air-bone gap(33.5±11.1 dB vs.16.9±11.8 dB,p<0.001)has been significantly improved.The mean pain score at 0 hours,6 hours and 24 hours after surgery were 2.5/10,1.6/10 and 0.75/10 respectively.At the discharge,the mean patient comfort score was 9.3±0.6 out of 10.Mean cosmetic score was 9.3±0.5 at the third month follow-up.There was significant post-operative improvement in the sub-scale and total scores of CES and SF-12V2.Conclusion:Endoscopic approach to middle ear cholesteatoma is feasible and confers excellent structural,functional as well as patient related quality of life outcomes.

Middle ear foreign body causing cholesteatoma and external auditory canal granuloma: a case report

Objective Patients with unilateral ear discharge and hearing loss often have external or middle ear diseases. We present a 55-year-old man who suffered from persistent ear discharge and hearing loss in the left ear. Local findings showed that his left ear canal was filled with a large amount of granulation tissue, with purulent, foul-smelling discharge. Computed tomography indicated left middle ear cholesteatoma and mass shadow in the left external auditory canal. Modified radical mastoidectomy was performed. A piece of white plastic stick was found in the middle ear during the operation. Foreign body-induced cholesteatoma and external auditory canal granuloma in adults are very rare. We present this rare case so that these conditions can be better recognized and understood.

Modification of closed tympanoplasty in middle ear cholesteatoma

Background Classic mastoidectomy and modified mastoidectomy are traditional surgical procedures for middle ear cholesteatoma with goals of eradicating diseases, creating dry ears and preventing severe complications. However, the drawback of these procedures is the lack of hearing improvement. Therefore, our study aimed to investigate the effects and safety of a modification of closed tympanoplasty for middle ear cholesteatoma. Methods Eighty-three patients were recruited in this study based on the following two criteria： each patient had middle ear cholesteatoma in one ear; the affected ears had a functional eustachian tube and had neither intracranial nor extracranial complications. All the patients received a modification of closed tympanoplasty which included ossicular reconstruction with total ossicular replacement prosthesis （TORP） or partial ossicular replacement prosthesis （PORP） and membrane repair with conchal cartilage-perichondral complex. Results All the 83 cases had dry ears with membranes healed within 4-6 postoperative weeks. After 6 postoperative months, there were 3 cases with re-perforation at the tympanic membrane center and after 1.5 postoperative years, there were 5 cases with cholesteatoma recurrence （6.02%）. Function tests after one postoperative year exhibited an improvement of pure tone audiometry （PTA） in 27 cases that was more than 30 dB, in 33 cases between 20-29 dB, 14 cases with improvement between 10-19 dB, and in 9 cases there was no improvement. Conclusions The modified closed tympanoplasty procedure for middle ear cholesteatoma in the present study has all the advantages of both close-cavity and open-cavity procedures. It has low recurrence rate and good hearing improvement.

Clinical characteristics of patients with labyrinthine fistulae caused by middle ear cholesteatoma

Background Labyrinthine fistula （LF） is a very common clinical complication mainly caused by middle ear cholesteatoma. Whether the presence of different degree LF caused by middle ear cholesteatoma aggravates neurosensory hearing loss （NSHL） and what is the degree of the hearing loss caused by LF were still under controversial. This study aimed to investigate whether the LF degree is correlative with the age distribution, disease duration and hearing loss degree for cholesteatomatous patients. Methods The files of 143 patients with middle ear cholesteatoma were selected and reviewed in a retrospective study. Seventy-eight patients with LF were divided into three types according to the degree of destruction of labyrinth. Sixty-five patients without LF were randomly chosen for control. Then, we compared the clinical characteristics of patients with or without labyrinthine fistulae caused by middle ear cholesteatoma. Results According to the study, cholesteatomatous patients with LF were older and suffered longer disease duration than those without LF. Hearing loss is severe with high frequencies both in patients with and without LF. Moreover, inner ear impairment is correlative with the degree of destruction in labyrinth, and more severe destruction in labyrinth follow the more severe symptoms correlative with inner ear impairment. Conclusion Surgical intervention should be performed as early as possible for these cholesteatomatous patients.

Endoscopic Management of Pediatric Cholesteatoma

Pediatric cholesteatoma occurs in one of two forms:congenital cholesteatoma,developing from embryonic epidermal cell rests or acquired cholesteatoma,associated with a focal defect in the tympanic membrane.This disease has been traditionally managed with the operating microscope,often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities.Recently,advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive,transcanal endoscopic approach.This review discusses the current literature relating to the etiopathogenesis,assessment and endoscopic management of pediatric cholesteatoma.Early outcomes of endoscopic treatment,emerging trends and technologies are also reviewed.

A Retrospective Study on Cholesteatoma Otitis Media Coexisting with Cholesterol Granuloma

To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma,63 cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed.All cases were surgically and pathologically verified.15 cases of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients.All 15 cases had a long-term history of otitis media,such as otorrhea(sanguine purulent otorrhea and bloody otorrhea in 8 cases)and perforation of the eardrum(perforation of pars flaccida in 8 cases).Temporal bone CT scans showed cholesteatoma in 11 cases.All patients were treated surgically,and cholesteatoma and cholesterol granuloma were found coexisting alternately,the latter lying mainly in the tympanic antrum,attic and mastoid air cells.Chocolate-colored mucus was accumulated in well-developed mastoid air cells,and glistening dotty cholesterol crystals were also found.In most cases,enlarged aditus,destruction of lateral attic wall,erosion of ossicular chain,exposure of horizontal segment of facial nerve and tegmen of attic were observed.Occlusion of Eustachian tube was noted in 6 cases,and occlusion of tympanic isthmus was revealed in all cases.A post-operative dry ear was achieved in all patients,and hearing improvement was achieved in all 12 cases following tympanoplasty.Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological etiology:occlusion of ventilation and disturbance of drainage.The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea.CT and magnetic resonance imaging are useful for the diagnosis before operation.The surgical approach depends on the location,extension and severity of the lesion,The purpose of surgery is to remove the lesion and create an adequate drainage.

Endoscopic transcanal modified canal-wall-down mastoidectomy for cholesteatoma

Attic cholesteatoma with antral extension in tight sclerotic mastoid cavities is a common presentation that creates difficult decision-making intraoperatively.Drilling through a sclerotic and small mastoid cavity,keeping the canal wall intactis often difficult and increases the risk of serious injury.Consequently,a canal-wall-down mastoidectomy is often performed.The endoscopic transcanal modified canal-wall-down mastoidectomy approach al lows the benefits of an open cavity for cholesteatoma resection and the benefits of a closed cavity for better long-term care and a more normal ear canal and middle ear reconstruction.

PTHrP促进RANKL诱导巨噬细胞分化为破骨细胞参与中耳胆脂瘤骨破坏

目的:骨质进行性吸收破坏是中耳胆脂瘤最重要的临床特征之一,可导致一系列颅内外并发症,而目前中耳胆脂瘤骨破坏的机制尚未明确。本研究旨在探究甲状旁腺激素相关蛋白(parathyroid hormone-related protein,PTHrP)参与中耳胆脂瘤骨破坏的机制。方法:收集后天性中耳胆脂瘤患者的25例胆脂瘤标本和13例外耳道正常皮肤组织标本。采用免疫组织化学染色方法检测PTHrP、核因子κB受体活化因子配体(receptor activator for nuclear factor-kappa B ligand,RANKL)和骨保护素(osteoprotegerin,OPG)在中耳胆脂瘤和外耳道正常皮肤组织中的表达,抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase,TRAP)染色法检测中耳胆脂瘤和外耳道正常皮肤组织中是否存在TRAP阳性多核巨噬细胞。选取小鼠单核巨噬细胞RAW264.7细胞进行干预,分为RANKL干预组和PTHrP+RANKL共同干预组,采用TRAP染色法检测2组破骨细胞的生成情况,实时聚合酶链反应(real-time polymerase chain reaction,real-time PCR)检测干预后2组破骨细胞相关基因TRAP、组织蛋白酶K(cathepsin K,CTSK)和活化T细胞核因子1(nuclear factor of activated T cell cytoplasmic 1,NFATc1)的mRNA表达水平,骨吸收陷窝实验检测2组破骨细胞的骨吸收功能。结果:免疫组织化学染色结果显示,PTHrP和RANKL在中耳胆脂瘤组织中的表达均显著增高,OPG表达降低(均P<0.05),且PTHrP的表达与RANKL、RANKL/OPG比值均呈显著正相关,与OPG表达呈显著负相关(分别r=0.385、r=0.417、r=-0.316,均P<0.05)。同时,PTHrP、RANKL的表达水平与中耳胆脂瘤的骨破坏程度均呈显著正相关(分别r=0.413、r=0.505,均P<0.05)。TRAP染色结果显示中耳胆脂瘤上皮周围基质中有大量TRAP阳性细胞,并存在细胞核数量为3个或3个以上的TRAP阳性破骨细胞。RANKL或PTHrP+RANKL联合干预5 d后,与RANKL干预组相比,PTHrP+RANKL联合干预组的破骨细胞数量显著增加(P<0.05),且破骨细胞相关基因TRAP、CTSK和NFATc1的mRNA表达水平均升高(均P<0.05)。骨吸收陷窝扫描电镜结果显示RANKL干预组、PTHrP+RANKL联合干预组的骨片表面均形成骨吸收陷窝;与RANKL干预组相比,PTHrP+RANKL联合干预组的骨片表面骨吸收陷窝数量显著增加(P<0.05),面积也更大。结论:PTHrP可能通过促进RANKL诱导胆脂瘤组织周围基质中的巨噬细胞分化为破骨细胞,参与中耳胆脂瘤骨破坏。

儿童中耳胆脂瘤合并颅内并发症的临床特征及诊疗分析

目的探讨儿童中耳胆脂瘤合并颅内并发症的临床特点和诊治要点。方法回顾性选取2020年6月—2023年2月河南省儿童医院和首都医科大学附属北京儿童医院收治的3例儿童中耳胆脂瘤合并颅内并发症的病例资料,总结耳流脓、发热、头痛、呕吐、意识障碍等临床表现,以及治疗方式、多学科会诊、术中情况、治疗结局等特点。结果3例患者中,男1例,女2例,均有耳流脓病史,伴有发热、头痛,其中1例出现喷射性呕吐、意识障碍等颅内压增高的表现。3例患者入院时均完善头颅CT及MRI、颞骨CT,2例合并硬脑膜外脓肿,1例合并小脑脓肿。入院后均经验性应用广谱抗菌药物治疗。3例患者均进行多学科会诊,制定围手术期方案,首先解决患儿高热、头痛、喷射性呕吐、意识障碍等急症,在颅内症状控制后与神经外科医师联合在全身麻醉下行根治性手术,并根据细菌培养及药敏试验改用敏感抗菌药物治疗,3例患者均治愈出院,术后随访无复发。结论对儿童中耳胆脂瘤患者,当出现高热、头痛时,一定要警惕颅内并发症的出现,及时行头颅CT及MRI,并与多学科协作进行围手术期管理,在患者病情稳定后给予根治性乳突开放术,清除病变,通畅引流,以达到安全治愈的目的。

中耳胆脂瘤病因及发病机理的研究进展

中耳胆脂瘤是位于中耳内由角化的鳞状上皮细胞、上皮下的结缔组织以及角化碎片构成的囊性结构,由于具有过度增生及骨质吸收破坏等病理生理特性,临床上常可有听力下降、面瘫等颅内、外并发症,严重的甚至危及生命。其病因及发病机制仍未完全清楚。通过查阅复习医学文献,综合临床诊治体会,从多学科、多领域探讨中耳胆脂瘤的病因病机,提升对中耳胆脂瘤的认识,以期在临床上减少或避免并发症的发生,提高患者的生活质量。

耳内镜下中耳乳突胆脂瘤手术55例

目的探讨经外耳道耳内镜下中耳乳突部胆脂瘤切除术的效果。方法外耳道内C形切口,分离外耳道皮瓣,暴露鼓环,若松弛部穿孔,掀开鼓环;若紧张部大穿孔,保留前下方鼓环,暴露鼓室,清除鼓室内肉芽组织。持续灌流模式下磨除上鼓室外侧壁骨质,清除上鼓室胆脂瘤、听小骨周围病变,磨除乳突表面骨质,清除乳突腔胆脂瘤。内置明胶海绵支撑,视听小骨破坏程度置入不同类型人工听骨,乳突腔及上鼓室表面放置耳屏软骨,外覆软骨膜或生物膜。耳屏软骨膜内置法或耳屏软骨-软骨膜夹层法修补鼓膜,铺平外耳道皮瓣,术腔填塞。结果术前气导听阈中位数52.0(33.8~67.5)dB HL,显著高于术后6个月25.0(15.0~50.0)dB HL(Z=-6.454,P=0.000);术前气骨导距中位数35.0(21.2~52.5)dB HL,显著高于术后6个月15.0(3.8~27.5)dB HL(Z=-6.453,P=0.000)。55例术后2周,1、3、6个月复诊,以后每隔3个月进行一次复诊,随访24个月,55例鼓膜愈合良好,2例术后1年复发,均无面瘫、感音神经性耳聋等并发症。结论结合持续与非持续灌流模式,耳内镜下经外耳道入路行中耳乳突部胆脂瘤手术,鼓膜愈合良好,并发症少,术后患者听力改善明显,是一种微创、安全有效的手术方式。

两种生活质量量表在慢性化脓性中耳炎中的差异比较

目的使用慢性中耳炎疗效调查量表(chronic otitis media outcome test,COMOT-15)和苏黎世慢性中耳炎量表(Zurich chronic middle ear inventory,ZCMEI-21)评估慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)及中耳胆脂瘤患者健康相关生活质量(health-related quality of life,HRQoL)的总体情况,比较两份问卷相关性及差异。方法回顾性选取2020年5月—2022年5月在兰州大学第二医院耳鼻咽喉头颈外科行手术治疗的101例CSOM和中耳胆脂瘤患者为研究对象,采用COMOT-15及ZCMEI-21,结合患者性别及气导平均听阈(air conduction-pure tone average,AC-PTA)比较患者的HRQoL,采用Cronbach'sα评价内部一致性并作为信度指标,使用Pearson相关性分析量表之间的相关性及与患耳AC-PTA间的相关性,使用Mann-Whitney U检验探究性别与量表间的相关性。结果101例患者两种量表得分均呈正态分布,除COMOT-15耳部症状维度(Cronbach'sα=0.602)和ZCMEI-21耳部症状维度(Cronbach'sα=0.473)外,两份问卷总维度和子维度均表现出满意的内部一致性。CO-MOT-15和ZCMEI-21的总维度与子维度之间存在中等到强的相关性;术侧患耳AC-PTA与两份量表总维度、耳部症状、听力、社会心理维度之间存在较好的相关性;耳部症状维度与两份量表总维度、听力、社会心理维度之间存在较好的相关性;COMOT-15和ZCMEI-21在性别方面存在不同程度的差异。结论两种量表具有较高的内部一致性、强相关性,但侧重点不同。COMOT-15侧重听力,涉及不同场景下的听力情况,适合以听力为重点的研究。ZCMEI-21提供了慢性中耳炎耳部症状的综合评估,如眩晕、耳流脓等症,在社会心理、就医问题上,更能反映患者心理健康及对医疗需求的真实情况,同时应严格规范量表的时间窗以确保数据的真实有效性。

中耳胆脂瘤乳突改良根治术中面神经裸露的相关危险因素分析及关联性研究

目的探讨中耳胆脂瘤乳突改良根治术中面神经裸露情况,并分析相关危险因素,为临床医师提供手术参考。方法回顾性分析2016年1月至2023年9月因“中耳胆脂瘤”于广东省梅州市人民医院行乳突改良根治术的296例(301耳)患者的临床资料。采用单因素分析和多因素logistic回归分析探讨性别、年龄、病程、手术耳、外半规管瘘、硬脑膜暴露、乙状窦暴露、外耳道后壁破坏、乳突气化类型、镫骨破坏以及盾板破坏与面神经裸露的关联性。结果301耳中耳胆脂瘤乳突改良根治术中有118耳发现有面神经裸露,发生率为39.2%,最常见发生部位是鼓室段83.1%(98/118)。单因素分析显示:面神经裸露(+)组和面神经裸露(-)组的外半规管瘘、硬脑膜暴露、镫骨破坏、乙状窦暴露、外耳道后壁破坏、盾板破坏比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示:外半规管瘘(β=0.993,OR=2.700,95%CI=1.380~5.279)、镫骨破坏(β=1.794,OR=6.014,95%CI=3.453~10.477)、外耳道后壁破坏(β=1.124,OR=3.078,95%CI=1.587~5.971)为面神经裸露的危险因素(P<0.05)。同时随着共存危险因素个数增加,出现面神经裸露的风险随之增高,特别是当外半规管瘘+镫骨破坏+外耳道后壁破坏三个危险因素累积共存时,面神经裸露的风险提高了16.3倍(β=2.791,OR=16.290,95%CI=3.704~71.643)。结论中耳胆脂瘤面神经裸露率为39.2%,好发于鼓室段。外半规管瘘、镫骨破坏、外耳道后壁破坏为面神经裸露的危险因素,当上述多个危险因素累积时,面神经裸露风险进一步增加。

非编码RNA在中耳胆脂瘤发病机制中的研究进展

中耳胆脂瘤是耳鼻咽喉科常见病,是致聋的主要疾病之一,具有过度增殖性、迁移侵袭性、复发性等临床特征。目前,还没有有效的药物治疗方法,手术切除仍然是唯一可行的治疗策略。非编码RNA(non-coding RNA,ncRNA)是一种本身不翻译为蛋白质但可在转录及转录后水平调控基因表达的内源性RNA,参与了发育、器官形成、细胞增殖与凋亡等多种生理过程。近年来,越来越多的研究显示,ncRNA与中耳胆脂瘤的发生发展密切相关,涉及多种生物学过程。我们针对ncRNA在中耳胆脂瘤角质形成细胞的增殖、迁移和凋亡、局部炎症反应及骨质破坏等过程中的作用及相关机制进行综述,为中耳胆脂瘤非手术治疗提供新的思路和靶点。

上鼓室胆脂瘤手术治疗

上鼓室胆脂瘤多数由鼓膜松弛部Prusska间隙形成囊袋产生。如何既彻底清除病灶,又能保护听力,是治疗该病的关键。现对2004年3月～2010年6月我科的26例上鼓室胆脂瘤患者行上鼓室、后上鼓室外侧壁重建,一期鼓室成形术,报道如下。