Luo Linghui, Gong Shusheng, Bai Guangping, Wang Jibao
Department of Otolaryngology, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022.
J Huazhong Univ Sci Technolog Med Sci. 2002;22(2):168-70. doi: 10.1007/BF02857685.
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.
为探讨胆脂瘤型中耳炎伴胆固醇肉芽肿的病因、发病机制以及胆脂瘤与胆固醇肉芽肿之间的关系，对我院1988年3月至2000年5月期间收治的63例中耳胆固醇肉芽肿患者进行回顾性分析。所有病例均经手术及病理证实。63例患者中发现15例胆脂瘤与胆固醇肉芽肿并存。15例患者均有长期中耳炎病史，如耳漏（8例为血性脓性耳漏和血性耳漏）及鼓膜穿孔（8例为松弛部穿孔）。颞骨CT扫描显示11例有胆脂瘤。所有患者均接受手术治疗，发现胆脂瘤与胆固醇肉芽肿交替并存，后者主要位于鼓窦、上鼓室及乳突气房。在发育良好的乳突气房中积聚有巧克力色黏液，还发现有闪亮的点状胆固醇结晶。多数病例可见鼓窦入口扩大、上鼓室外侧壁破坏、听骨链侵蚀、面神经水平段暴露及上鼓室天盖侵蚀。6例发现咽鼓管阻塞，所有病例均显示鼓室峡部阻塞。所有患者术后均干耳，12例行鼓室成形术的患者听力均有改善。中耳胆脂瘤与胆固醇肉芽肿可能有共同的病理生理病因：通气阻塞和引流障碍。当患者出现慢性中耳炎伴血性耳漏时应考虑本病。CT及磁共振成像对术前诊断有帮助。手术方式取决于病变的部位、范围及严重程度。手术目的是切除病变并建立充分引流。
