开放式乳突切除同期鼓室成形术

回顾2006年2月-2008年2月在我科行开放式乳突根治同期鼓室成形术的82例中耳胆脂瘤患者,疗效满意,报告如下。     

乳突腔充填术在开放式鼓室成形术中的应用

目的 :探讨乳突腔充填术在开放式鼓室成形术中对恢复生理性外耳道功能的作用。方法 :对行开放式鼓室成形术的 85例 85耳胆脂瘤型中耳炎 ,以乳突皮质骨、同种异体软骨和 U形肌骨膜瓣同期行乳突腔充填。听骨链重建情况 :因骨导域值增高或行阶段性手术未作听骨链重建 10耳 ,鼓室成形术改良 型 40耳 ,改良 型35耳。结果 :总听觉改善率 76 % ,其中改良 型为 80 % ,改良 型为 71.4%。术后干耳率为 97.6 % ,平均干耳时间(19.86± 5 .31) d。术后随访半年以上 ,具有圆滑外耳道以及良好自净作用的占 89.4%。未见胆脂瘤复发病例。结论 :对没有条件行完壁式鼓室成形术的胆脂瘤型中耳炎 ,行乳突充填可以有效地克服开放式鼓室成形术破坏生理外耳道结构的不足 ,保存外耳道皮肤的自净作用 ,提高患者术后的生活质量。     

乳突根治+开放式鼓室成形术治疗胆脂瘤中耳炎的体会

目的 探讨乳突根治+开放式鼓室成形术治疗胆脂瘤中耳炎的疗效.方法 对37例(37耳)胆脂瘤中耳炎患者行乳突根治+开放式鼓室成形术的临床资料进行分析.结果 随访1～3年,37例(37耳)移植筋膜成活,2例(2耳)鼓膜再穿孔,2例(耳)鼓膜疤痕内陷.术后6个月纯音气导平均听阈(0.5～4 kHz)为39.84±6.24dB...     

上鼓室重建及鼓室成形术在开放式乳突根治中的应用

目的 探讨重建上鼓室外侧壁在开放式乳突根治中的意义。方法 选择开放式乳突根治的病人，同时应用同种异体鼻中隔软骨或自体乳突皮质骨，重建上鼓室外侧壁，完成上鼓室成形术20例。结果 20例手术均获得干耳，术后3～6个月平均气导听力提高20dB以上4耳，l0～20dB 13耳。结论 应用同种异体鼻中隔软骨或自体乳突皮质骨，重建上鼓室外侧壁，能改善行开放式乳突根治病人的听力。     

开放式乳突根治术并IIIa型鼓室成形术治疗胆脂瘤中耳炎的疗效

目的 探讨开放式乳突根治术并IIIa型鼓室成形术治疗胆脂瘤中耳炎的疗效.方法 将68例胆脂瘤中耳炎患者分2组,对照组31例采用开放式乳突根治术;观察组37例采用开放式乳突根治术并IIIa型鼓室成形术,评估治疗效果、纯音听阈及并发症.结果 对照组有效率77.42％低于观察组94.60％,有差异(P<0.05).与对照组比...     

完壁式乳突根治-鼓室成形术

胆脂瘤型中耳炎是耳科常见病,同时也是治疗上存在问题较多的疾病之一,完壁式乳突根治-鼓室成形术治疗胆脂瘤型中耳炎,既能彻底清除病灶,同时又能最大限度地保留或改善中耳及外耳道的生理结构和听觉功能,是治疗胆脂瘤型中耳炎的方法,本文介绍了该术式的手术方法、适应症的选择和胆脂瘤复发及处理等问题.     

保留鼓索神经的开放式乳突根治鼓室成形术

目的:报告开放式乳突根治鼓室成形术中寻找鼓索神经的方法和保留鼓索神经的意义。方法:66例慢性化脓性中耳炎或中耳胆脂瘤患者,术中以砧骨短突为标志,磨低外耳道后壁,沿面神经垂直段找到鼓索嵴(鼓索神经出骨管处),沿鼓索嵴找到游离于鼓室内的鼓索神经,仔细清理鼓索神经表面的病变组织,保持其完整性。结果:24例中耳胆脂瘤患者和42例慢性化脓性中耳炎患者鼓索神经表面胆脂瘤上皮及肉芽彻底清理,无一例鼓索神经断裂,患者术后味觉无明显变化。结论:开放式乳突根治鼓室成形术中彻底清理病变的同时保持鼓索神经的完整性,保留了鼓索神经的结构和功能,可以减低移植于镫骨头上的听小骨膺复物脱落的危险,且可对移植筋膜起支架作用。     

开放式鼓室成形术或乳突根治术中切除乳突尖的优点

目的：总结乳突尖部分切除在开放式鼓室成形术或乳突根治术中的作用。方法：44例胆脂瘤型中耳炎患者中，行单纯乳突根治术(10例)和开放式鼓室成形术(34例，含乳突切除术加鼓室成形术Ⅱ型或Ⅲ型)时．同时切除部分乳突尖外侧壁。结果：切除乳突尖后，乳突容积明显减小，术后3个月随访，干耳43例，占97．6％。干耳时间3周～2．5个月。术后1年随访，无一例胆脂瘤复发。结论：乳突尖部分切除在开放式鼓室成形术或乳突根治术中消灭乳突死腔，最大程度达到干耳，减少胆脂瘤复发，具有重要作用。     

完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎

目的:探讨完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎的临床效果和相关的经验教训.方法:对57例胆脂瘤中耳炎患者实施完壁式乳突根治鼓室成形术.结果:随访1～8年,平均3.7年.术后5例感染流脓,其中3例经及时处理得到控制并愈合,2例二次手术处理后愈合;3例术后因胆脂瘤复发行开放式乳突手术获干耳;鼓膜完整但有内陷者29例,其中2级内陷者13例;术后8个月及1年人工听骨脱出各1例.术后言语频率气导听阈降低>10 dB HL为72.2%(39/54),气骨导差<20 dB HL为53.7%(29/54),气骨导差缩小25 dB HL以上占42.6%(23/54).结论:施行完壁式乳突根治鼓室成形术,如果适应证掌握得当,技术条件许可,患者能按时随访.可以有效保留原中耳乳突解剖结构和改善听力,提高患者生活质量,应予优先选择该术式.     

乳突腔充填术在开放式鼓室成形术中的应用

本文应用乳突骨骼化时保留的乳突骨皮质骨粉充填乳突术腔和上鼓室腔,减小乳突及上鼓室开放术腔,以形成接近生理状态下的外耳道,使术腔引流通畅,提高了干耳率,减少了术后复发及术腔肉芽生长。1资料与方法1.1临床资料2002～2006年行开放式鼓室成形术的中耳炎患者28例,男16例,女12     

中耳胆脂瘤和慢性化脓性中耳炎手术临床分析

目的　探讨中耳胆脂瘤和慢性化脓性中耳炎术式选择及临床效果。方法　对110例中耳乳突病变,包括中耳胆脂瘤和慢性化脓性中耳炎,根据范围显微镜下实施完壁式或开放式乳突根治,部分同时鼓室成形术,随访术后干耳状况、并发症、复发情况以及术后听力改善程度等。结果　110例患者中66例中耳胆脂瘤、44例慢性化脓性中耳炎,出现颅内外并发症者7例。手术方式：51例（46.36%）行完壁式乳突根治术,46例（41.81%）同时行鼓室成形术,59例（53.64%）行开放式乳突根治术。完壁式乳突根治术后听 力提高＞25 dB 37例（33.64%）,＞15 dB 14例（12.72%）;开放式乳突根治术后听力提高＞15 dB 5例（4.55%）,听力减退4例（3.64%）,比较手术前后言语频率区平均听阈,差异有统计学意义（P＜0.05）。术后随访1年发现开放式和完壁式两组胆脂瘤复发共4例。结论　中耳胆脂瘤与慢性化脓性中耳炎通过选择恰当手术方式可获得较好的临床疗效。     

Ultrastructure of the middle ear mucosa in patients with chronic otitis media with cholesteatoma

Mucosa of the middle ear was obtained from the promontory wall in each of 20 patients during cholesteatoma surgery. Specimens were processed for both scanning and transmission electron microscopy. Non-ciliated mucosal cells were commonly found, with most being secretory cells with secretory droplets and microvilli. The patterns of distribution of microvilli on the surface of these cells were variable. The interciliary spaces were stagnated with secretion. Bacilli were present in five cases. Falloff of mucosal cells was common and intercellular spaces were widened. Compound cilia were observed sporadically. Polymorphic nuclear inflammatory cells, macrophages and fibroblasts appeared in the submucosal area. These findings indicate that although remaining adjacent mucosa after removal of cholesteatoma looks free of disease under the operating microscope, it is actually in a diseased condition with impaired mucociliary function. The cells and bacteria seen microscopically may account for postoperative inflammation, thus warranting continued postoperative antimicrobial medication.     

Staging-based surgical results in chronic otitis media with cholesteatoma

Discussions of surgical results in chronic otitis media involving cholesteatoma usually include hearing improvement, side effects, and cholesteatoma recurrence, although such talks could easily involve the influence on surgical results of the intraoperative extension of the cholesteatoma-affected area around the tympanomastoid cavity. Based on intraoperative chronic otitis media staging involving cholesteatoma proposed by the Japan Otological Society in 2010, we studied our tympanoplasty results between April 1997 and March 2010. Hearing improvement in all subjects with pars flaccida cholesteatoma was 79.0% (n= 100) and that with pars tensa 73.3% (n = 30)--results not significantly influenced by intraoperative staging grade but significantly dependent on stapes presence (tympanoplasty type I and III) or absence (type IV). Nine cases of recurrence were seen in pars flaccida and four in pars tensa. Intraoperative side effects and postoperative recurrence often occurred in advanced cases. These findings suggest that intraoperative chronic otitis media staging involving cholesteatoma may make it important to be aware of the need for more careful procedures during surgery and in follow-up.     

Cholesteatoma and chronic otitis media following middle ear intubation

As in any surgical procedure, complications can occur following middle ear intubation for secretory otitis media or atelectasis. Serial Kodachrome studies of the middle ear demonstrate the types of lesions that occur and the methods used to correct them. Chronic otitis media in the form of chronic granulomas or perforations are relatively simple problems that are easily corrected. Cholesteatomas can arise from intubation either by formation of atelectatic pockets following extrusion of the tube or from ingrowth of the surface epithelium of the tympanic membrane onto the medial surface of the tympanic membrane. These lesions often require surgical correction. Middle ear intubation should not be done indiscriminately, and prolonged follow-up of patients is mandatory for the early detection of complications.     

中耳胆脂瘤及慢性化脓性中耳炎患者乳突根治术中面神经裸露及危险因素分析

目的 总结中耳胆脂瘤及慢性化脓性中耳炎患者乳突根治术中的面神经裸露情况,并分析面神经裸露的相关危险因素。方法回顾性分析2015年1月—2019年12月行乳突根治术的1 016例患者的临床资料,均为单耳患者,其中中耳胆脂瘤683耳,慢性化脓性中耳炎333耳,总结其面神经裸露情况及分布部位;采用单因素与多因素Logistic线性回归的统计方法分析年龄、性别、病程、硬脑膜暴露、半规管骨质破坏、乙状窦暴露及病理类型等因素与乳突根治术中面神经裸露的关系。结果1 016例患者中有294耳出现面神经裸露,面神经总裸露率为28.94%（294/1 016）;面神经裸露最常见的部位是水平段（264/294,89.80%）。中耳胆脂瘤的面神经裸露率为32.50%（222/683）,慢性化脓性中耳炎的面神经裸露率为21.62%（72/333）,两者差异具有统计学意义(P=0.0 003)。单因素分析结果显示病理类型、脑膜暴露、术前面瘫、半规管骨质破损及乙状窦暴露均为面神经裸露的相关因素,而与病程、年龄及性别无明显相关。进一步多因素Logistic回归分析结果示：中耳胆脂瘤、半规管骨质破坏及术前面瘫为面神经裸露的危险因素,风险分别增高1.575倍（95%CI：1.141~2.176）、4.171倍（95%CI：2.579~6.746）及13.040倍（95%CI：2.793~60.872）。结论中耳胆脂瘤及慢性化脓性中耳炎患者均可出现面神经裸露,最常见的裸露部位为水平段。半规管骨质破坏、术前面瘫及中耳胆脂瘤是乳突根治术面神经裸露的危险因素。     

The submucous layer of the middle ear in chronic otitis media

Summary In continuation of a previous study on the submucous layer of the middle ear in chronic secretory otitis, the authors describe the same structure in chronic suppurative otitis. The changes proved to be identical with those of chronic secretory otitis, only far more pronounced. As a sign of the suppurative nature of the inflammation, there was marked infiltration of the tissue by neutrophilic leukocytes. Eosinophilic leukocytes were not demonstrated. In the stroma there was an increase in the number of collagen fibrils more marked than in secretory otitis. There were also signs of degenerative changes of the collagen fibrils, in the form of fibrinoid transformation, fibrolysis, and possibly also hyaline transformation. In the present study it was not possible to investigate necrosis, if any, of the bone beneath the submucosa. However, it is a fact that chronic suppurative otitis often involves necrosis of the ossicles. This has previously been explained as a consequence of anoxia caused by the suppurative inflammation, but the proliferation of the capillary network with increased blood flow found in the present study militates against this theory. In a subsequent study it will be endeavoured to elucidate whether such necrosis may be caused, under certain circumstances, by an increased number of histiocytes and neutrophilic leukocytes with a content of lysosomes.

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Zusammenfassung In Fortsetzung einer vorangegangenen Studie über die Submucosa des Mittelohres bei chronisch-sekretorischer Otitis beschreiben die Autoren die gleichen Strukturen bei chronisch-eitriger Mittelohrentzündung. Die Veränderungen erwiesen sick identisch mit denen der chronisch-sekretorischen Otitis, nur weit starker ausgeprägt. Als Zeichen der eitrigen Natur der Entzündung fanden sich deutliche Infiltration des Gewebes mit neutrophlen Leukocyten. Eosinophile Leukocyten waren nicht vorhanden. Im Stroma war die Vermehrung der Anzahl der collagenen Fibrillen deutlicher als bei der sekretorischen Otitis. Hier waren auch Zeichen degenerativer Veränderungen der collagenen Fibrillen in Form von fibrinoider Veränderung, Fibrolyse und möglicherweise auch hyaliner Umwandlung. In der vorliegenden Studie war es nicht möglich, Nekrosen zu untersuchen außer einigen des Knochens unter der Submucosa. Jedoch ist es eine Tatsache, daß bei chronischer, eitriger Otitis häufig eine Nekrose der Ossikeln herbeiführt. Dies wurde früher erklärt als Folge von Anoxie infolge der eitrigen Entzündung, doch spricht die Vermehrung des capillaren Netzwerkes mit vermehrtem Blutzufluß, wie es in der vorliegenden Studie gefunden wurde, gegen these Theorie. In einer folgenden Untersuchung soll versucht werden aufzuklären, ob solche Nekrosen unter gewissen Umständen durch eine vermehrte Zahl von Histiocyten and neutrophilen Leukocyten mit einem Gehalt an Lysosomen verursacht sein können.

     

Recovery time for inflamed middle ear mucosa in chronic otitis media

Conclusion: The present study shows that 2–3 weeks after medical treatment the status of middle ear mucosa in draining ears is similar to that of dry ears for at least 3 months.

Objective: To measure the time required for an inflamed middle ear mucosa to return into optimal state after appropriate medical treatment in chronic suppurative otitis media (CSOM). To assess optimal timing for elective surgical treatment of draining ears in uncomplicated CSOM.

Methods: In this prospective study, the Eustachian tube (ET) mucociliary clearance time (MCT) was used as the method to demonstrate the status of middle ear mucosa. In group 1 (28 patients) ET-MCT was measured in ears that were free of drainage for at least 3 months. In Group 2 (21 patients), ET-MCT was measured in draining ears, who responded to 10–14 days medical treatment, at presentation, after 10 days and 1 month.

Results: The ET-MCT was 8.63?±?1.32 min in group 1 and 28.96?±?8.19 min in group 2 at presentation; and the difference was statistically significant (p?p?=?0.235).     

Interrelations between the middle and inner ear in otitis media

This article reviews the importance of the round-window membrane in exposing the labyrinth to or protecting it from the toxic effects of otitis media. Characteristics of the immune system in the human middle ear and middle-ear mechanisms against bacteria are explained. The role of bacteria and bacterial products in inner-ear damage is detailed, and related pathological events are described. The hypothetical role of inflammatory mediators in bacteria-induced inner-ear toxicity is particularly emphasized. Clinical conditions causing these events are detailed, and the most frequently involved microorganisms are mentioned. Finally, round-window membrane macroscopic and microscopic anatomy is discussed, and considerations about the exact role of membrane inflammation--protection versus damage of the inner ear--are expressed.