Iino Y, Imamura Y, Hiraishi M, Yabe T, Suzuki J
Department of Otolaryngology, Teikyo University School of Medicine, Tokyo, Japan.
Laryngoscope. 1998 Jul;108(7):1071-6. doi: 10.1097/00005537-199807000-00022.
To clarify mastoid pneumatization in children with congenital cholesteatoma and compare their clinical characteristics.
The mastoid pneumatization of 34 children with congenital middle ear cholesteatoma, of 34 age-matched children with unilateral acquired cholesteatoma, and of 17 age-matched control children without middle ear diseases was studied.
The sizes of the mastoid cells were measured from 1.5-mm sliced semiaxial sections of a temporal bone computed tomography scan. The sum of the two areas from the two images, one showing the lateral semicircular canal and the other, 3 mm below this, was defined as the area of the pneumatized mastoid cells.
The mastoid cells in ears of children with congenital cholesteatoma were poorly pneumatized compared with those of control children without middle ear diseases, but were better pneumatized compared with those of children with acquired cholesteatoma. In children with congenital cholesteatoma, the degree of pneumatization in the cholesteatoma side was significantly poorer than that in the opposite side. A well-pneumatized mastoid was seen in ears with no episode of otitis media, in ears with the open-type cholesteatoma, and in ears with ossicular anomalies.
The presence of cholesteatoma matrix accelerates the inflammatory response when middle ear infections occur, and this probably leads to the suppression of mastoid pneumatization. The authors also propose the hypothesis that cholesteatoma in most congenital cases is the open type, and that middle ear inflammation may contribute to the formation of cystic and closed-type cholesteatoma.
阐明先天性胆脂瘤患儿的乳突气化情况，并比较其临床特征。
对34例先天性中耳胆脂瘤患儿、34例年龄匹配的单侧后天性胆脂瘤患儿以及17例年龄匹配的无中耳疾病对照儿童的乳突气化情况进行了研究。
从颞骨计算机断层扫描的1.5毫米半轴切片中测量乳突气房的大小。将两张图像的两个区域之和定义为气化乳突气房的面积，其中一张图像显示外半规管，另一张图像位于其下方3毫米处。
与无中耳疾病的对照儿童相比，先天性胆脂瘤患儿耳内的乳突气房气化较差，但与后天性胆脂瘤患儿相比气化较好。在先天性胆脂瘤患儿中，胆脂瘤侧的气化程度明显低于对侧。在无中耳炎发作的耳、开放型胆脂瘤耳和听骨链异常的耳中可见气化良好的乳突。
胆脂瘤基质的存在会在中耳感染发生时加速炎症反应，这可能导致乳突气化受到抑制。作者还提出了一个假设，即大多数先天性病例中的胆脂瘤为开放型，中耳炎症可能有助于囊性和封闭型胆脂瘤的形成。
