Tsuji Kojiro, Sone Mieko, Kakibuchi Masao, Sakagami Masafumi
Department of Otolaryngology, Hyogo College of Medicine, 1-1 Mukogawa, Hyogo 663-8501, Nishinomiya, Japan.
Auris Nasus Larynx. 2002 Apr;29(2):111-4. doi: 10.1016/s0385-8146(01)00146-8.
To examine the clinical findings of acquired bilateral cholesteatoma with special reference to incidence of habitual sniffing and sniff-related negative middle ear pressure.
Eighty-eight fresh cases of unilateral cholesteatoma and 33 fresh cases of bilateral cholesteatoma, which were operated on at Department of Otolaryngology, Hyogo College of Medicine, were examined in this study. Responses to a detailed questionnaire were obtained from the patients concerning about the habit of habitual sniffing to relieve aural symptoms such as aural fullness, autophonia or hyperacusis. The same questionnaire was obtained from unilateral cholesteatoma patients to compare the incidence of habitual sniffing with that of patients with bilateral cholesteatoma. We measured the negative middle ear pressure at the time of sniffing by using TTAG (tubo-tympano aerodynamic graphy, Nagashima Co. Ltd, Tokyo). We also compared the positive percentage of the sniff test in bilateral cholesteatoma with in unilateral cholesteatoma and normal controls. Sniff test was performed in 30 patients with bilateral cholesteatoma, 20 patients with unilateral cholesteatoma and 20 normal controls.
In 33 patients with bilateral cholesteatoma (66 ears), 57 ears had the pars flaccida type (86.4%) and 9 ears had the pars tensa type (13.6%). Cholesteatoma of pars flaccida type were predominant in bilateral cholesteatoma. The rate of habitual sniffing of bilateral cholesteatoma (23/33, 69.7%) was significantly higher than that of unilateral cholesteatoma (21/88, 23.9%). The incidence of positive sniff test in bilateral cholesteatoma (19/30, 63.3%) was significantly higher than in unilateral one (6/20, 30%) and normal control (3/20, 15%).
Habitual sniffing was closely related to the pathogenesis of bilateral cholesteatoma, especially in cases with bilateral pars flaccida type.
研究获得性双侧胆脂瘤的临床特征，特别关注习惯性吸鼻动作的发生率以及与吸鼻相关的中耳负压情况。
本研究对在兵库医科大学耳鼻喉科接受手术的88例单侧胆脂瘤新发病例和33例双侧胆脂瘤新发病例进行了检查。向患者发放详细问卷，询问其是否有通过习惯性吸鼻来缓解耳闷、自听增强或听觉过敏等耳部症状的习惯。对单侧胆脂瘤患者也采用相同问卷，以比较双侧胆脂瘤患者与单侧胆脂瘤患者习惯性吸鼻的发生率。我们使用TTAG（鼓室压力图，东京长岛株式会社）测量吸鼻时的中耳负压。我们还比较了双侧胆脂瘤、单侧胆脂瘤患者及正常对照者吸鼻试验的阳性率。对30例双侧胆脂瘤患者、20例单侧胆脂瘤患者和20名正常对照者进行了吸鼻试验。
在33例双侧胆脂瘤患者（66耳）中，57耳为松弛部型（86.4%），9耳为紧张部型（13.6%）。双侧胆脂瘤中以松弛部型胆脂瘤为主。双侧胆脂瘤患者习惯性吸鼻的比例（23/33，69.7%）显著高于单侧胆脂瘤患者（21/88，23.9%）。双侧胆脂瘤患者吸鼻试验阳性率（19/30，63.3%）显著高于单侧胆脂瘤患者（6/20，30%）及正常对照者（3/20，15%）。
习惯性吸鼻与双侧胆脂瘤的发病机制密切相关，尤其是双侧松弛部型胆脂瘤病例。
