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目的探讨咽鼓管上隐窝及其与上鼓室空气通道的状态在胆脂瘤中耳炎发病过程中的意义。方法观察胆脂瘤中耳炎52例(52耳,观察组)及乳突气化良好无慢性中耳炎病史的外伤性面神经麻痹患者16例(16耳,对照组)术中咽鼓管上隐窝及其与上鼓室通道开放状态。结果对照组16耳均呈清晰的咽鼓管上隐窝结构,呈膜性闭锁4耳(25.0%)。观察组52耳(100%)咽鼓管上隐窝与上鼓室前方呈完全闭锁,无相通病例。与对照组差异有统计学意义(x~2=46.421,P=0.000)。其中骨性闭锁34耳(65.4%),膜性闭锁18耳(34.6%);上鼓室空间狭小。全组均为硬化或气化不良型乳突。结论咽鼓管上隐窝与上鼓室的气流通道闭塞更容易造成上鼓室和乳突负压状态,可能是形成胆脂瘤的原因之一;咽鼓管上隐窝与上鼓室通道的解剖学变异可能是胆脂瘤中耳炎的易患因素。提示胆脂瘤中耳炎行完壁式鼓室成形术时开放该通道可能有助于防止术后复发。
Objective To investigate the significance of the condition of the upper eustachian tube and the tympanum air channel in the pathogenesis of otitis media with cholesteatoma. Methods Twenty-six cases (16 ears, control group) of eustachian tube were treated with cholesteatoma otitis media (52 ears, observation group) and mastoid gasification without history of chronic otitis media With the tympanic channel open state. Results The control group of 16 ears showed a clear eustachian tube crypt structure, membranous atresia 4 ears (25.0%). Observation group of 52 ears (100%) on the eustachian tube and the upper front of the tympanic cavity was completely blocked, no similar cases. There was significant difference with the control group (x ~ 2 = 46.421, P = 0.000). There were 34 ears (65.4%) with bony atresia and 18 ears (34.6%) with membranous atresia. The upper tympanic space was small. The whole group were hardened or poorly vaporized mastoid. Conclusion Occlusion of the upper eustachian tube and the upper tympanum is more likely to cause negative pressure on the upper tympanic mastoid and papilla, which may be one of the reasons for the formation of cholesteatoma. Anatomy of the supratemporal and upper tympanic canal passages Variability may be a predisposing factor to otitis media in cholesteatoma. Prompt cholesteatoma otitis media open wall tympanoplasty open the channel may help prevent postoperative recurrence.