简介：Congenitalcholesteatoma(CC)isararelyseenbenigntumorofthetemporalbone.Therearefivegeneralsitesofextraduraloccurrence:themiddleear,externalauditorymeatus,mastoid,squamousportionandthepetrousapexofthetemporalbone.CCgrowsslowlyandpresentsnosymptomsattheearlystage.Delayedandmis-diagnosisarecommonwiththiscondition~1.CasereportA10-year-oldboypresentedwitha3-monthhistoryofhearinglossonrightside.Therewasnohistoryofotorrhea,facialpalsy,previousotologicalproceduresortrauma.Otoscopyrevealedabulgingposterosuperiorquadrantintheotherwiseintactrighttympanicmembrane(Fig.1).Puretoneaudiometryshowedanaveragethresholdof51dBfor500,1000,2000and4000Hz,witha40dBair-bonegap,suggestingamoderateconductivehearingloss(Fig.4).CTscanofthetemporalboneshowedanisolatedsofttissuedensitylesioninthemiddleear(Fig.2).

简介：ObjectivesTostudyclinical,imagingfeaturesandtreatmentoutcomesofcongenitalcholesteatomaofmiddleear(CCME).MethodsThisisaretrospectivereviewof10CCMEcasesselectedfrom952cholesteatomacasestreatedbetweenJanuary1995andDecember2005attheDepartmentofOtolaryngology-HeadandNeckSurgery,ChinesePLAGeneralHospital.Themainoutcomemeasureswerethesiteoforigin,clinicalfeatures,surgicalfindings,imagingcharacteristicsandhearingresults.ResultsThemeanageofthe10patientswas16years(rangedfrom10to24years),with6beingolderthan18years.Therewere7malesand3females.Theaveragedelaytodiagnosiswaslongerthan2years.ThemeanpreoperativePTAwas55dBHL,withameanABGof45dB.Typicalcholesteatomaswereseenbehindthetympanicmembraneinthesuperoposteriorquadrantonotoscopyonlyin2patients.HighresolutionCTwascompletedinallpatients.Mostofthepatients(8/10)werediagnosedwithotosclerosisorossicularabnormalitybeforeoperation.Allpatientsunderwentaone-stagetympanoplastyfollowingtransmeatalexplorativetympanotomyandcompletecholesteatomaremoval,exceptone,whounderwentaCWUmastoidectomyduetoextensivecholesteatomainvolvement.Thecholeasteatomalesionwasconfinedtothesuperoposteriormesotympanuminallpatients.ThemeanpostoperativePTAwas20dBHL.Allpatientswerefollowed-upforatleast1.5yearspostoperatively.Revisionprocedureswereperformedin2patientsforhearingdeterioration.Noresidualorrecurrenceofcholesteatomawasfound.ConclusionCCMEisararediseasethatoftengetsdelayeddiagnosis.Residuallesionsandtheprognosismainlydependontheextentofthelesion.

简介：Aims:Thegoalofthepresentstudyistosummarizeourexperienceonsurgicalmanagementofretractionpockets(RP)asapreventivetoolagainstcholesteatomas.Methods:Twenty-fiveearshavebeenfollowedupforameanperiodof6.16±4.35years(from1to17years).Thesamplepresentedameanageof47.56±19.11years(from16to73years).Allpatientsunderwentcartilagegraftsurgery.Furthermore10(40%)underwenttympanoplasty(TPL)typeI,14(56%)TPLtypeIIand1(4%)TPLtypeV.Results:Elevenears(44%)showedcholesteatoma:allthesecaseswerestageIIIaccordingtoCharachonstaging,andstageIVorVaccordingtoGersdorffclassification.Twelvepatients(48%)showederosionoftheossicularchain.Ofthese,fivewereassociatedwithcholesteatomaandsevenonlywithretraction.Therecurrencerateofcholesteatomawas12%.NoneofthepatientswithastageIIorIIIRP(accordingtoGersdorffclassification)developedcholesteatoma.TherecurrenceofRPwas0%.Inregardstoliteraturereview,sevenreferenceswereselected.Thesestudiesshowedasuccessraterangingfrom79.1%to88%,whilerecurrencesofRPvariedfrom6.4%to13%.Onlyonestudyspecifiedarecurrencerateofcholesteatomaof28%.Conclusions:SurgicaltreatmentofstagesIIandIIIRPisaneffectivetooltopreventcholesteatomaformation.ThepresenceofkeratinaccumulationandcholesteatomaattheRP(stagesIVandV,accordingtoGersdorff)aretherealpredictorsofpoorprognosis.

简介：Objective:ToevaluateHighResolutionComputerTomography(HRCT)inthediagnosisofexternalearcanalcholesteatoma.Methods:Inthisretrospectivestudy,HRCTsof27patientswithexternalearcanalcholesteatomawerereviewed.Thechangesintheexternalearcanal,tympanicmembrane(TM),scutum,tympanumandmastoidweremeasuredandcategorized.Results:Fourteenpatientsshowednoormilddestructionintheexternalearcanal(stageIgroup).Eightpatientshadobviousenlargementintheexternalearcanal(stageIIgroup)butshowedlimiteddestructionsofthemastoidboneandnodamageofthetympanums.Fivepatientshadseriousdestructionofthemastoidboneanddamageofthetympanum(stageIIIgroup).AllpatientsinthestageIIIgroupshowedacompressionofmanubriumsandTMs,with3havingdamagesonossicularchain.BonedestructionoftheverticalsectionoffacialnervecanalwasdiscoveredinonecaseinthestageIIIgroup.Conclusion:HRCTcanprovidedetailinformationabouttheextentofexternalearcanalcholesteatoma.Suchinformationcanbeusedtoidentifyspecialsituationswithseriouscomplicationsandtodifferentiateexternalearcanalcholesteatomafrommiddleearcholesteatoma.

简介：Objective:Thepresentstudyaimedtoevaluatethepossibilityofusingcoherentanti-StokesRamanspectroscopy（CARS）microscopytodeterminethespecificmolecularmorphologyofcholesteatomabydetectingthenaturalvibrationalcontrastofthechemicalbondswithoutanystaining.Materialsandmethods:SpecimensfromthemastoidandtympanicmembranewithandwithoutcholesteatomawereanalyzedusingCARSmicroscopy,two-photonexcitedfluorescence（TPEF）microscopy,andthesecondharmonicgeneration（SHG）microscopy.Results:Incholesteatomatissuesfromthemastoid,astrongresonantsignalat2845cm-1wasobservedbyCARS,whichindicatedthedetectionoftheCH2hydro-carbonlipidbondsthatdonotgeneratevisiblesignalsat2940cm-1suggestiveofCH3bondsinaminoacids.Astrongresonantsignalat2940cm-1appearedinanareaofthesamespecimen,whichalsogeneratedabundantsignalsbyTPEFandSHGmicroscopyat817nm,whichwassuggestiveofcollagen.Inthetympanicmembranespecimenwithcholesteatoma,astrongresonantsignalwithcorrugatedmorphologywasdetected,whichindicatedthepresenceoflipids.AstrongsignalwasdetectedinthetympanicmembranewithchronicotitismediausingTPEF/SHGat817nm,whichindicatedcollagenenrichment.TheCARSandTPEF/SHGimageswereinaccordancewiththehistologyresults.Conclusion:TheseresultssuggesttheneedtodevelopanovelCARSmicroendoscopethatcanbeusedincombinationwithTPEF/SHGtodistinguishcholesteatomafrominflammatorytissues.

简介：ObjectivePatientswithunilateraleardischargeandhearinglossoftenhaveexternalormiddleeardiseases.Wepresenta55-year-oldmanwhosufferedfrompersistenteardischargeandhearinglossintheleftear.Localfindingsshowedthathisleftearcanalwasfilledwithalargeamountofgranulationtissue,withpurulent,foul-smellingdischarge.Computedtomographyindicatedleftmiddleearcholesteatomaandmassshadowintheleftexternalauditorycanal.Modifiedradicalmastoidectomywasperformed.Apieceofwhiteplasticstickwasfoundinthemiddleearduringtheoperation.Foreignbody-inducedcholesteatomaandexternalauditorycanalgranulomainadultsareveryrare.Wepresentthisrarecasesothattheseconditionscanbebetterrecognizedandunderstood.