Deguine C
Rev Laryngol Otol Rhinol (Bord). 1990;111(5):463-8.
Cholesteatoma of the middle ear is bilateral in 10% of cases. Depending upon the ethnical characteristics or socio-economic levels, the frequency of cholesteatoma for a normal population varies from 1 in a 1,000 to 1 in 10,000. So, it becomes evident that the controlateral ear of cholesteatoma has to be considered at risk. The chances of seeing a cholesteatoma develop and particularly of observing the evolutionary stages are multiplied by 100 or 1,000! This report concerns the results of systematic examination of controlateral ear of 200 consecutive cholesteatomas, using binocular microscope and routine otoscopic photography. Eardrum was normal for 1/3 cases only. Modifications of the aspect of the tympanum related with active or sequellar lesions chronic otitis have been observed in all other cases. This finding leads us to the conclusion that cholesteatoma of the middle ear is related in the great majority of cases with the chronicle ear disease. Tubal insufficiency is of prime importance if we consider the high incidence of retractions pockets. Papillary invagination at the level of Shrapnell membrane is induced by chronical inflam-mation. Epithelial migration from the edges of a perforation is rare and only accidental. Clinical evaluation of the condition of the controlateral ear may also give indications about the background, the eustachian tube function and help for the choice of surgical technique radical or conservative.
中耳胆脂瘤在10%的病例中为双侧性。根据种族特征或社会经济水平，正常人群中胆脂瘤的发病率从千分之一到万分之一不等。因此，很明显，胆脂瘤患者的对侧耳也有患病风险。观察到胆脂瘤发展，尤其是观察其演变阶段的几率会增加100倍或1000倍！本报告涉及对连续200例胆脂瘤患者的对侧耳进行系统检查的结果，使用双目显微镜和常规耳镜摄影。仅三分之一的病例鼓膜正常。在所有其他病例中，均观察到与慢性中耳炎活动期或后遗症相关的鼓膜外观改变。这一发现使我们得出结论，在大多数情况下，中耳胆脂瘤与慢性耳部疾病有关。如果考虑到内陷袋的高发病率，咽鼓管功能不全至关重要。慢性炎症会导致松弛部鼓膜处的乳头状内陷。穿孔边缘的上皮迁移很少见，且只是偶然现象。对侧耳状况的临床评估也可以提供有关背景、咽鼓管功能的线索，并有助于选择根治性或保守性手术技术。
