Basset J M, Fleury P, Kuffer R, Bré M, Despreaux G, Fabre A, Fleury D
Ann Otolaryngol Chir Cervicofac. 1985;102(4):217-27.
The authors report 27 new cases of osteomatous chronic otitis, with (15) or without (12) cholesteatomas, with perforated (13) or intact (14) drum, the latter sometimes having a very atypical appearance (2), frankly purulent or simply inflammatory. This results in a wide range of clinical appearances. There are two macroscopic forms: the diffuse attico-antral form and localized forms (drum - C.S.C.L.). The authors emphasize: the primordial interest of tomography (or CT scan), the keystone of their discovery, as well as the dangers of their surgical treatment. In addition to review of these known concepts, two forms have been identified: 1) Osteomatous attico-chain monoblock, where the ossicles of the ear are adherent in their entirety, either to the external attical wall or, much more rarely, to the medial attical wall. They describe 13 cases, the pattern of which is very different, according to whether the diagnosis is one of cholesteatomatous chronic otitis or not. In the absence of cholesteatoma (8 cases), the clinical picture is suggestive of otospongiosis or of chronic otitis with intact drum. The surgical procedure is related to these findings: 1 completion of myringoplasty, 7 piston-malleus. In cases of cholesteatomatous chronic otitis (5 cases), the picture is completely different, the cholesteatoma developing at leisure, behind the impenetrable osteomatous shield. Once again, the surgical procedure is modified: 4 vast evacuation cavities and one mastoatticotomy for giant cholesteatoma with intact drum. 2) Diffuse and "progressive" osteomatous stenosis of the walls of the E.A.M. The authors describe 6 cases occurring either during cholesteatomatous chronic otitis, or within a few weeks, simulating chronic otitis with intact drum.
作者报告了27例骨瘤性慢性中耳炎病例，其中伴有胆脂瘤的有15例，不伴有胆脂瘤的有12例；鼓膜穿孔的有13例，鼓膜完整的有14例，后者有时外观非常不典型（2例），有明显脓性或单纯炎症表现。这导致了广泛的临床症状。有两种宏观形态：弥漫性上鼓室 - 鼓窦型和局限性形态（鼓膜 - 慢性化脓性中耳炎局限型）。作者强调：体层摄影术（或CT扫描）的首要价值，这是他们发现的关键，以及手术治疗的风险。除了回顾这些已知概念外，还确定了两种类型：1）骨瘤性上鼓室 - 听骨链整块型，耳部听小骨全部附着于上鼓室外侧壁，或更罕见地附着于上鼓室内侧壁。他们描述了13例，根据是否为胆脂瘤性慢性中耳炎，其模式差异很大。在无胆脂瘤的情况下（8例），临床表现提示耳硬化症或鼓膜完整的慢性中耳炎。手术方式与这些发现相关：1例鼓膜成形术完成，7例活塞 - 锤骨植入。在胆脂瘤性慢性中耳炎的情况下（5例），情况完全不同，胆脂瘤在不可穿透的骨瘤屏障后从容发展。手术方式再次改变：4例广泛清除腔隙，1例为鼓膜完整的巨大胆脂瘤行乳突上鼓室切开术。2）外耳道壁弥漫性“进行性”骨瘤性狭窄。作者描述了6例，发生于胆脂瘤性慢性中耳炎期间，或在几周内，类似鼓膜完整的慢性中耳炎。
