Hasebe S, Takahashi H, Honjo I, Miura M, Tanabe M
Department of Hearing and Speech Science, Faculty of Medicine, Kyoto University, Kyoto, Japan.
ORL J Otorhinolaryngol Relat Spec. 2001 May-Jun;63(3):160-4. doi: 10.1159/000055733.
This study was carried out to establish which type of cholesteatoma is controllable by conservative treatment from the viewpoint of mastoid ventilation. We examined the area of the air cell system and airspace (aeration) in the mastoid cavity by computed tomography and eustachian tube (ET) function by inflation-deflation test in 20 ears (20 patients) with severe attic retraction for over 12 months (retraction pocket group), 16 ears (16 patients) with cholesteatoma which could be controlled only by conservative treatment for over 12 months (nonsurgical group) and 43 ears (43 patients) which required surgery within a year in spite of similar conservative treatment (surgical group). The size of the mastoid air cell system in the retraction pocket group, nonsurgical group and surgical group was 2.9 +/- 1.3, 1.9 +/- 0.7 and 1.5 +/- 0.9 cm(2) on average, respectively, with no significant difference between both cholesteatoma groups (nonsurgical and surgical group). While aeration was observed in the mastoid in 17 of 20 ears (85.%) in the retraction pocket group and in 12 of 16 ears (75.0%) in the nonsurgical group, aeration was present only in 9 of 43 ears (26.5%) in the surgical group, being significantly less in the surgical group than in the nonsurgical group and the retraction pocket group. In all ears in the retraction pocket and nonsurgical groups, and 19 of 30 ears in the surgical group, ET function was poor, there being no significant difference among the three groups. The present clinical observations suggest that progressiveness of cholesteatoma could be related to the ventilatory conditions in the mastoid rather than ET function, and that conservative treatment may be effective when ears with cholesteatoma have aeration in the mastoid.
本研究旨在从乳突通气的角度确定哪种类型的胆脂瘤可通过保守治疗得到控制。我们通过计算机断层扫描检查了20例（20耳）严重上鼓室回缩超过12个月的患者（回缩袋组）、16例（16耳）仅通过保守治疗超过12个月即可得到控制的胆脂瘤患者（非手术组）以及43例（43耳）尽管接受了类似保守治疗但仍需在一年内进行手术的患者（手术组）的乳突气房系统面积和气腔（通气情况），并通过充放气试验检查了咽鼓管（ET）功能。回缩袋组、非手术组和手术组的乳突气房系统大小平均分别为2.9±1.3、1.9±0.7和1.5±0.9 cm²，两组胆脂瘤组（非手术组和手术组）之间无显著差异。回缩袋组20耳中有17耳（85%）乳突有通气，非手术组16耳中有12耳（75.0%）乳突有通气，而手术组43耳中仅有9耳（26.5%）有通气，手术组的通气情况明显少于非手术组和回缩袋组。回缩袋组和非手术组的所有耳以及手术组30耳中的19耳，咽鼓管功能均较差，三组之间无显著差异。目前的临床观察表明，胆脂瘤的进展可能与乳突的通气状况而非咽鼓管功能有关，并且当胆脂瘤耳的乳突有通气时，保守治疗可能有效。
