浅论慢性中耳乳突炎伴鼓室骨壁损害的HRCT特征及临床价值探讨【摘要】目的探讨慢性中耳乳突炎损害鼓室壁的HRCT特征及其临床价值。方法对28例32耳慢性中耳乳突炎的影像资料进行回顾性分析。结果(1)鼓室盖异常8耳占25%,其中骨质疏松2耳，骨壁菲薄1耳，骨壁缺损5耳；(2)颈动脉管异常6耳占%,其中骨质疏松2耳，骨质硬化3耳，骨壁缺损1耳；(3)颈静脉孔壁异常5耳占%,其中骨质疏松2耳，骨壁菲薄1耳，骨壁缺损2耳；(4)乙状窦骨壁异常13耳占%,其中乙状窦骨壁缺损3耳，乳突窦骨壁破坏10耳，听小骨缺损、移位5耳；(5)骨迷路异常7耳占%,其中鼓岬缺损1耳，前庭窗模糊1耳，蜗窗缺损2耳，面神经管缺损2耳，外半规管缺损1耳；(6)鼓膜异常21耳占%,其中鼓膜缺损7耳，鼓膜增厚7耳，鼓膜内陷5耳，外耳道骨质破坏2耳。结论运用HRCT扫描横断位和冠状位相结合，除能显示慢性中耳乳突炎病变征象外，还能确定其鼓室各壁的骨质损害部位、程度及与周围结构的关系，对手术处理具有重要意义。【关键词】中耳乳突炎；鼓室壁；高分辨力CTAbstractObjectiveToinquireintotheHRCTfeaturesandclinicalvalueofchronicotomastoiditisassociatedwithimpairmentofthetympanicimagedataon28cases(32ears)ofchronicotomastoiditiswasretrospectivelyHRCTfeaturesof28cases(32ears)ofchronicotomastoiditisassociatedwithimpairmentofthetympanicwallwereasthefollows.(1)Theroofofthetympanumwasabnormalin8ears(25%),ofwhichosteoporosisoccurredin2,thebonewallwasthinin1andbonewalldefectsoccurredin5;(2)Thecarotidcanalwasabnormalin6ears(%)，ofwhichosteoporosisoccurredin2andbonewalldefectsin1;(3)Thejugularforamenwasabnormalin5ears(%)，ofwhichosteoporosisoccurredin2,thebonewallwasthinin1andbonewalldefectsoccurredin2;(4)Thesigmoidsinuswallwasabnormalin13ears(%),ofwhichsigmoidgroovedefectsoccurredin3,antrumtympanicumenlargementin10anddislocationoftheauditoryossiclesin5;(5)Theosseouslabyrinthinewallwasabnormalin7ears(%),ofwhichtympanumdefectsoccurredin1,thevestibularwindowwasfuzzyin1,fenestracochleaedefectsoccurredin2,facialcanaldefectsin2andlateralsemicircularcanaldefectsin1;(6)Thetympanicmembranewasabnormalin21ears(%),ofwhichtympanicmembranedefectsoccurredin7,tympanicmembranethickeningin7,otopiesisin5andexternalauditorycanalwallerosioninaxialandcoronalviewofHRCTisofclinicalvalueinthedeterminationofthelocality,oxtentionandsecondarychangesofchronicotomastoiditisassociatedwithimpairmentofthetympanicwallforoperativetreatment.KEYWORDSotomastoiditistympanicwallhighresolutioncomputerizedtomography慢性化脓性中耳乳突炎的影像学检查,可为临床诊断和手术治疗提供重要影像学信息［1-3］。其中,值得关注的一个问题是中耳乳突炎病变,如炎性肉芽、胆脂瘤等,侵及鼓室、鼓窦、乳突及周边骨壁,使正常解剖屏障损害,感染藉此向毗邻组