Lee Jun Ho, Hong Seok Min, Kim Chang Woo, Park Yeo Hoon, Baek So-Hye
Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Hallym University, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Hallym University, Seoul, Republic of Korea.
Auris Nasus Larynx. 2015 Apr;42(2):107-12. doi: 10.1016/j.anl.2014.08.006. Epub 2014 Sep 8.
This clinical study was performed to analyze the characteristics of attic cholesteatoma occurring behind a tiny retraction of the pars flaccida, which was classified as Tos type I or II and had an intact pars tensa of the tympanic membrane.
The clinical records of patients who underwent tympanomastoidectomy for attic cholesteatoma at a tertiary care referral center (Kangdong Sacred Heart Hospital of Seoul, Korea) between March 2004 and December 2012 were retrospectively reviewed. Eleven patients (five men and six women) who underwent tympanomastoidectomy between March 2004 and December 2012 for attic cholesteatoma occurring behind a tiny attic retraction were included. The mean age of patients was 41.1 years (range 20-58 years) and the mean duration of follow-up was 29.5 months (range 13-52 months).
Every patient had a unilateral cholesteatoma, and the opposite side was normal except in one patient. Hearing loss was the most common symptom, followed by earfullness and otalgia. Five patients had type I attic retraction, and six patients had type II attic retraction. No patient had definite scutum erosion. Interestingly, during regular postoperative checkup, one patient was found incidentally for the opposite ear. Six patients had a cholesteatoma sac that was separated from the pars flaccida, whereas in five patients it was in contact with the pars flaccida but was easily separated. Six patients had a limited cholesteatoma within the epitympanum, and five patients had extension beyond the epitympanum. The average air-bone gap was 24.3±10.1dB before the operation and 14.2±6.6dB after the operation. Every patient had an intact tympanic membrane without retraction pocket postoperatively. There was no recurrence of cholesteatoma during follow-up.
The rate of attic cholesteatomas occurring behind a tiny retraction of the pars flaccida was 7.7% (11 of 142 patients with attic cholesteatoma). Attic retractions must be followed closely using endoscopy, microscopy, and temporal bone Computed tomography, even though the patient has a tiny retraction of the pars flaccida or a normal hearing level.
本临床研究旨在分析松弛部微小内陷（分类为托斯I型或II型）且鼓膜紧张部完整的上鼓室胆脂瘤的特征。
回顾性分析2004年3月至2012年12月在三级转诊中心（韩国首尔江东圣心医院）因上鼓室胆脂瘤接受鼓室乳突切除术患者的临床记录。纳入2004年3月至2012年12月间因松弛部微小内陷导致的上鼓室胆脂瘤而接受鼓室乳突切除术的11例患者（5例男性，6例女性）。患者平均年龄41.1岁（范围20 - 58岁），平均随访时间29.5个月（范围13 - 52个月）。
所有患者均为单侧胆脂瘤，除1例患者外，对侧均正常。听力损失是最常见症状，其次是耳闷和耳痛。5例患者为I型上鼓室内陷，6例患者为II型上鼓室内陷。无患者有明确的盾板侵蚀。有趣的是，在定期术后检查时，偶然发现1例患者对侧耳也有病变。6例患者的胆脂瘤囊与松弛部分离，而5例患者的胆脂瘤囊与松弛部接触但易于分离。6例患者上鼓室内胆脂瘤局限，5例患者胆脂瘤超出上鼓室范围。术前平均气骨导间距为24.3±10.1dB，术后为14.2±6.6dB。所有患者术后鼓膜完整，无内陷袋。随访期间无胆脂瘤复发。
松弛部微小内陷导致的上鼓室胆脂瘤发生率为7.7%（142例上鼓室胆脂瘤患者中的11例）。即使患者有松弛部微小内陷或听力水平正常，也必须使用内镜、显微镜和颞骨计算机断层扫描密切随访上鼓室内陷情况。
