【病因病理】1鼓室体瘤(tympanic1body1tumor)是局限于鼓室内的起源于鼓室的舌咽神经鼓室支(Jacobson’s1nerve)及迷走神经耳支(Arnold’s1nerve)的化学感受器瘤，l早期主要在鼓室内生长。
【临床表现及诊断】
1.波动性耳鸣。
2.耳闷感，l有轻度传导性耳聋。
3.透过鼓膜可见鼓岬表面红色肿块。
4.影像学检查11中耳冠位和水平位CT显示鼓岬处有边缘光滑的软组织占位改变，l乳突无破坏(图5-19-1)。
图5-19-111冠位CT示鼓室内孤立的鼓室体瘤
【治疗】手术摘除。
1.耳道入路 局限于鼓室内的肿瘤可做鼓耳道皮瓣，l经鼓环下进入鼓室。
2.开放面神经鼓索三角的后鼓室入路 如果耳道小，l鼓室不能充分暴露，l可在保留外耳道后壁的情况下，l经开放面神经-鼓索三角进入后鼓室。必要时可切除鼓索神经，l充分开放后鼓室。
3.开放式乳突切除入路 肿瘤大时则行去除外耳道后壁的乳突切开术。显示肿瘤后，l可在控制性降压的情况下切除肿瘤，l彻底止血。
参考文献
1.Bath1AP，lRowe1JR，lInnes1AJ.Malignant1otitis1externa1with1optic1neuritis.J1of1Laryngology1＆1Otology.1998.112：i274—277
2.Bauer1CA，lCoker1NJ.Update1on1facial1nerve1disorders.Otolaryngol1Clin1North1Am，l1996，l29(3)：i445
3.Bernstein1JM，lShanahan1TC1Schaffer1FM.Further1observations1on1the1role1of1the1MHC1genes1and1certain1hearing1disorders.Acta1Otolaryngol(Stockh)1996，l116(5)：i666-671
4.Charles1W1C，lJohn1M1F，lLee1A1H.Otolaryngology1Head1and1Neck1Surgery.2nd1ed.Mosby-Year1book，lInc.，l1993
5.Charles1W1C，lJohn1M1F，lLee1A1H，let1al.Otolaryngology1Head1＆1Neck1Surgery.3rd1ed.Vol14.Missouri：iMosby-Year1book，lInc.，l1998.2561-2867，l3197-3221
6.Dai1CF，lKanoh1N，lWang1ZM1et1al.Study1on1facial1motoneuronal1death1after1proximal1or1distal1facial1nerve1transection.Am1J1Otol.2000，l21：i115
7.Engstrom1M，lAbdsaleh1S，lAhlstrom1H，let1al.Serial1Gadolinium1enhanced1magnetic1resonance1imaging1and1assessment1of1facial1nerve1function1in1Bell’s1palsy.Otolaryngol1Head1Neck1Surg，l1997，l117：i559
8.Frisina1DR；Frisina1RD.Speech1recognition1in1noise1and1presbycusis：irelations1to1possible1neural1mechanisms.Hear1Res，l1997，l106(1-2)：i95-104
9.Gantz1BJ，lRubinstein1JT，lGidley1P，let1al.Surgical1management1of1Bell’s1palsy.Laryngoscope，l1999，l109：i1177
10.Gehanno1P.Ciprofloxacin1in1the1treatment1of1malignant1external1otitis.Chemotherapy，l1994，l1：i35-40
11.Gordon1G，lGiddings1NA.Invasive1otitis1externa1due1to1Aspergillus1species：icase1report1and1review.Clin1Infect1Dis，l1994，l19：i866-870
12.Hariri1MA.Sensorineural1hearing1loss1in1bullous1myringitis.A1prospective1study1of1eighteen1patients.Clinical Otolaryngology1＆1Allied1Sciences.1990；15：i351-353
13.Hern1JD，lAlmeyda1J，lThomas1DM，let1al.Malignant1otitis1exerna1in1HIV1and1AIDS.(review)1996；110：i770-775
14.John1B.Booth.Otology1in1SCott-Brown’s1Otoloryngology，lFifth1Edition，lButter1worths
15.Kerr1A1G，lGroves1J.Scott1Brown’s1Otolaryngology.Vol16.5th1ed.London：iButterworths，l1987
16.Kong1WJ，lEgg1G，lHussl1B，let1al.A1study1of1neurotransmitters1in1human1inner1ear.Preservation1of1human1temporal1bone1and1value1of1organ1donation1for1inner1ear1research.Acta1Otolaryngol，l1994，l114(3)：i245-53
17.Kong1WJ，lEgg1G，lHussl1B，let1al.Localization1of1chat-like1immunoreactivity1in1the1vestibular1endorgans1of1the1rat.Hear1Res，l1994，l75(1-2)：i191-200
18.Kong1WJ，lHussl1B，lThumfart1WF，let1al.Ultrastructural1localization1of1GABA-like1immunoreactivity1in1the1human1utricular1macula.Hear1Res，l1998，l119(1-2)：i96-103，l104-12
19.Kong1WJ，lHussl1B，lThumfart1WF，let1al.Ultrastructural1localization1of1GABA-like1immunoreactivity1in1the1vestibular1periphery1of1the1rat.Acta1Otolaryngol，l1998，l118(1)：i90-5
20.Kong1WJ，lRen1T，lNuttall1AL11Electrophysiological1and1morphological1evaluation1of1the1acute1ototoxicity1of1sodium1nitroprusside.Hear1Res，l1996，l99(1-2)：i22-30
21.L.Carter1Computed1tomography1of1the1head1and1neck.Vol15.Churchill1Livingstone.New1York，l1985
22.Larsson1C，lBernstrom-Lundberg1C，lEdstrom1S，let1al.Tumor1necrosis1factor-a1response1and1herpesvirus1infection1in1Bell’s1palsy.Laryngoscope，l1998，l108：i1171
23.Naiberg1J，lBerger1G，lHawke1M.The1pathologic1features1of1keratosis1obturans1and1cholesteatoma1of1the1external1auditory1canal.Arch1of1Otolaryngology，l1984，l110：i690-693
24.Nuttall1AL，lLawrence1M.Intracellular1potential1changes1of1Corti’s1organ1with1anoxia.Arch1Otolaryngol.1979.105(10)：i574-8
25.Piepergerdes1MC，lKramer1BM，lBehnke1EE.Keratosis1obturans1and1external1auditory1canal1cholesteatoma.Laryngoscope，l1980，l90：i383-391
26.schrott-Fischer1A，lEgg1G，lKong1WJ，let1al.Immunocytochemical1detection1of1choline1acetyltransferase1in1the1human1organ1of1Corti.Hear1Res，l1994，l78(2)：i149-57
27.Seidman1MD；Khan1MJ；Dolan1DF；Quirk1WS.Age-related1differences1in1cochlear1microcirculation1and1auditory1brain1stem1response.Arch1Otolaryngol1Head1Neck1Surg，l1996，l122(11)：i1221-1226
28.Shire1JR，lDonegan1JO.Cholesteatoma1of1the1external1auditory1canal1and1keratosis1obturans.Am1J1of1Otology.1986，l7：i361-364
29.Slattery1WH13rd，lBrackmann1DE.Skull1base1osteomyelitis.Malignant1external1otitis.Otolaryngol1Clin1North1Am11996，l29：i795-806
30.Walter1B，lHans1HN，lCarl1RP.Ear1Nose1and1Throat1Disease(second1revised1edition).Georg1Thieme1Verlay1Thieme1Medical1Publishers.Inc.Stuttgart.New1York，lNew1York，l1994
31.卜国弦，l樊忠主编，l耳鼻喉神经外科学.吉林科学技术出版社，l1992
32.董民声主编.实用耳科学.华夏人民出版社，l1994
33.韩萍，l熊茵.CT扫描分册.武汉：i湖北科技出版社，l2000
34.何望春.五官及颈部影像诊断学.天津：i天津科学出版社，l1998
35.何永照，l姜泗长主编.耳科学.上海：i上海科学技术出版社，l1983
36.黄选兆，l汪吉宝主编.实用耳鼻咽喉科学.北京：i人民卫生出版社，l1998
37.黄选兆主编.耳鼻咽喉科学.第4版.北京：i人民卫生出版社，l1995
38.黄选兆主编.耳鼻咽喉科学.第3版.北京：i人民卫生出版社，l1990
39.马廉亭主编.微侵袭神经外科学.北京：i人民卫生出版社，l1999
40.汪吉宝，l刘世英，l王丽雅.中耳乳突CT扫描的临床应用.临床耳鼻咽喉科杂志，l1987，l1：i133
41.汪吉宝，l刘世英.分泌性中耳炎误诊漏诊分析.中华耳鼻咽喉科杂志，l1994，l29：i201
42.汪吉宝.自身免疫性内耳病的研究现状.中华耳鼻咽喉科杂志，l1995，l30：i60
43.王杰，l戴春富，l黄新生，l等.缺血性面瘫动物模型的建立.临床耳鼻咽喉科杂志，l1999，l13(10)：i464
44.王荣光主编.临床耳科学.石家庄：i河北科学技术出版社，l1990
45.王正敏主编.耳鼻喉科学.上海：i上海科学技术出版社，l1988
46.王正敏主编.耳鼻咽喉科学.第2版.上海：i上海科学技术出版社，l1991
47.王正敏主编.临床耳鼻咽喉科学.上海：i上海医科大学出版社，l1996
48.王正敏主编.颅底外科学.上海：i上海科学技术出版社，l1995