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1、單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,上海市第六人民醫(yī)院,Shanghai Sixth Peoples Hospital,上海市第六人民醫(yī)院,Shanghai Sixth Peoples Hospital,單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,上海市第六人民醫(yī)院,Shanghai Sixth Peoples Hospital,單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,Cholesteatoma,Shankai Yin,Prof,Dept of Oto

2、laryngology,the sixth hospital affiliated to Shanghai jiaotong university,Otolaryngology institute at Shanghai jiaotong university,CholesteatomaShankai Yin Pro,Epidemiology,Exact prevalence is unknown,Incidence estimated between 3 and 12.6 per 100,000,EpidemiologyExact prevalence i,Classification,Co

3、ngenital,Acquired,Primary acquired(retraction pocket),Secondary acquired,ClassificationCongenital,Pathogenesis,Congenital,Arise from embryonal rests of epithelial cells,Location(petrous pyramid,mastoid and middle ear cleft),Levenson criteria,White mass medial to normal TM,Normal pars flaccida and te

4、nsa,No history of otorrhea or perforations,No prior otologic procedures,Prior bouts of otitis media not grounds for exclusion,PathogenesisCongenital,Theories,“Acquired”inclusion theory,-Tos,Epidermal rest theory,-Teed Michael,Theories “Acquired”inclusi,Congenital cholesteatoma,Congenital cholesteato

5、ma,Primary acquired,Eustachian tube dysfunction,Poor aeration of the epitympanic space,Retraction of the pars flaccida,Normal migratory pattern altered,Accumulation of keratin,enlargement of sac,Primary acquired,Primary acquired cholesteatoma,Primary acquired cholesteatoma,Secondary acquired,Implant

6、ation surgery,foreign body,blast injury,Metaplasia transformation of cuboidal epithelium to squamous epithelium from chronic infection,Invasion/Migration medial migration along permanent perforation of TM,Papillary ingrowth intact pars flaccida,inflammation in Prussacks space,break in the basal memb

7、rane,cords of epithelium migrate inward,Secondary acquired,上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma,Clinical manifestations,Common,Painless otorrhea,Refractory/recurrent ear infections,Conductive hearing loss,Uncommon,Vertigo/Sensorineural,Facial nerve paralysis,CNS infections,Brain herniation/CSF leak,Pneum

8、ocephalus,Clinical manifestationsCommon,history,Physical Examination,Otomicroscopy,Posterosuperior retraction pocket with squam,Granulation from diseased bone,Aural polyps,Pneumatic otoscopy positive fistula response suggests erosion into labyrinth,Cultures should be obtained in infected ears,Diagno

9、sis,historyDiagnosis,Audiology,usually conductive loss,may vary greatly;confirm with tuning forks,Imaging,CT temporal bone definitely obtain for revision cases,complications of chronic suppurative otitis media,sensorineural hearing loss,vestibular symptoms,other complications of cholesteatoma,Audiol

10、ogy,Imaging,Purpose,Diagnosis,Determining extent,Risk assessment,Modalities,Plain film,Computed tomography scans,Magnetic Resonance imaging,ImagingPurpose,Goals of CT Imaging,Middle ear ventilation,Ossicular destruction,Epitympanum access,Mastoid cortex,Tegmen integrity,Labyrinth involvement,Facial

11、nerve involvement,Surgical changes,Goals of CT ImagingMiddle ear,上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma,上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma,上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma,CT disadvantages,Granulation tissue vs.cholesteatoma,Specific soft tissue problems,Dural involvement,Abscess,Brain herniation,Labyrinth inv

12、olvement,Sigmoid sinus thrombosis,MRI needed,CT disadvantagesGranulation ti,MR Imaging,Hypointense on T1,Isointense to brain,Intermediate on T2,Nonenhancing,Granulation tissue does enhance,Recurrence detection,Lesions 2mm,90%sensitive,100%specificity,MR ImagingHypointense on T1,T2,Delayed contrast T

13、1,T2Delayed contrast T1,Differential Diagnosis,Chronic serous otitis media,Jugulotympanic paragangliomas,Cholesterol granulomas,Neurofibromas,Hemangiomas,Arachnoid cyst,Jugular bulb anomalies,Tympanosclerosis,encephalocele,Differential DiagnosisChronic,Treatment,Create a“dry and safe”ear,TreatmentCr

14、eate a“dry and saf,Non-surgical,Treat the Infection Floxin Otic Drops,Decrease the inflammation Topical steroids,Debridement of the external canal,Non-surgicalTreat the Infecti,Surgical,Atticotomy,Radical Mastoidectomy,Bondy Modified Radical(Canal wall down)mastoidectomy,Tympanoplasty and canal wall

15、 up mastoidectomy,SurgicalAtticotomy,Prognosis,Residual or recurrent cholesteatoma over 5 years 15 to 40%,Reported to be up to 67%in the pediatric population,Close follow-up,Regular examinations,needed-6 months,PrognosisResidual or recurrent,Complications,Dural tear-CSF leak,Fistula of the horizonta

16、l semicircular canal(vertigo)Up to 10%,Facial nerve injury,Injury to the sigmoid sinus/jugular bulb,Otitic Hydrocephalus,Hearing loss,30%have conductive loss pre-operatively,Postoperatively,an additional 30%have worsening or onset of hearing loss due to extent of disease,Infection Meningitis,Abscess,lateral sinus thrombosis Up to 1%,ComplicationsDural tear-CSF,Predisposing factors,Virulent organisms,Cholesteatoma and bone erosion,Presence of a congenital dehiscence(e.g.dehiscent facial canal)or