| The middle ear cholesteatoma is a acquired chronic disease. It can destroy progressively middle ear and its surrounding construction (such as facial nerve, construction of basis cranii, et al), so that the hearing decreases and serious even fatal complications occur. However, the middle ear cholesteatoma is one of the commonest diseases in otorhinolaryngology. The main hypotheses in formation mechanism of the cholesteatoma include: the theory of the bag-form inside sinks, epithelium transition theory, squamous epithelium metaplasia theory and the base cells proliferation theory. The otitis media cholesteatomatica (OMC) has the following special clinical characteristics: 1. Pus flows from ear for a long period of time, the quantity of pus is more or less and the pus has specific odors. 2. Hearing check shows that they all have serious conductive deaf. However the hearing decrease at this time is not very serious just because middle ear cholesteatoma can form a false link at the interrupting otosteon. In the late stage, pathological changes spread to the cochlea, which can lead to the mixture deaf. There is marginal perforation in the posterior superior flacci part or tension part in eardrum. From perforation place we can see grey color scale-scrap-like or bean-dregs-like materials in the drum which have no the fixed form and have strange bad smells. Perforation of the flacci part of drum was easily undiagnosed if covered up by the skin of scab. From X ray of mastoid or CT scan of temple bone, there are usually bone destructive areas with the dense and regular margin in the epitympanic recess, tympanic sinus and (or) papillary sinus. Nowadays the severity and the incidence rate of complications of OMC reduce year by year, however operation is still the only effective treatment. We analysis retrospectively the clinical date of their hearing improvement, dry ear time and postoperative relapse and so on. The results reveal the following: postoperative symptoms all obvious improved. The hearing before and after the operation is calculated based on pure-tone average air conduction threshold and air bone gap. Among 63 patients with radical mastoidectomy, 59 patients maintain the same hearing level as before, and the hearing of 4 patients decreases compared with before. Among 31 patients with open I-stage tympanoplasty, the hearing of 19 patients improved more than 15dB, and 3 patients reach application level, and 2 patients of them have PFA-ABG less than 15dB, the effective rate is 77.4 percent. In the 12 patients treated with combined approach tympanoplasty (CAT), 6 patients made hearing improvement more than 15dB, 2 patients reach the application hearing level, 2 have PFA-ABG less than 15dB, and the effective rate is 83.3 percent. After tympanomastoidectomy they all have hearing improvement at difference levels, but there is no evidence that there is conspicuous differention between open I-stage tympanoplasty and CAT on the improvement of the patient hearing. In 43 patients with tympanoplasty, 12 patients had large cholesteatoma (large cholesteatoma is referred that can lead to the destruction of the middle ear), 6 of them have no hearing improvement, 31 cases had small cholesteatoma (small cholesteatoma is defined that the focal only involves tympanic cavity and (or) tympanic sinus), and 2 patients of them made no hearing improvement. Thus different degree of cholesteatoma gets different postoperative hearing improvement. The dry ear gained time is 4~9 weeks after operation, and the mean time is 6 weeks. There is no difference between difference approaches of operation. Two of them complain of intermittent supportive discharge for half a year, which is cured on the second operation, 4 patients of them get transient vertigo and vomiting during 1 or 2 days after operation, nevertheless the symptoms disappeared within 3 days. None of the patients has prospoplegia or other intracranial and extracranial complications, 6 patients relapse in more than 5 years after operation and all are cured throug... |
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