Cholesteatoma inoumbwa nehukuru hunoumbwa nemasero epidermal, ari kuseri kwe tympanic membrane, iyo inopinda zvishoma nezvishoma zvivako zvepakati nzeve, zvishoma nezvishoma ichikuvadza. Cholesteatoma kazhinji inotevera chirwere chisingaperi chisina kucherechedzwa. Kana isina kurapwa nenguva, inogona kuparadza nzeve yepakati uye kutungamirira kumatsi, utachiona, kana kuoma kwechiso. Inogonawo kupararira kusvika munzeve yemukati uye kukonzera dzungu, kunyange kune zvimiro zveuropi (meningitis, abscess). Kuongororwa kunobva pakuratidzwa kwehuremu huchena mugero rekunze rekuongorora. Kuongorora kwedombo kunopedzisa kuongorora nekujekesa kuwedzera kwehukuru uhu mukati mezvimiro zvenzeve. Cholesteatoma inoda kurapwa nekukurumidza. Izvi zvinobviswa zvachose panguva yekuvhiyiwa, zvichipfuura nekumashure kwenzeve. Kupindira kwechipiri kwekuvhiya kunogona kuratidzirwa kuti kuve nechokwadi chekusavapo kwekudzoka uye kugadzirisa zvakare ossicles kure.

Cholesteatoma yakatanga kurondedzerwa muna 1683 pasi pezita re "kuora nzeve" naJoseph Duverney, baba ve otology, bazi remishonga rinonyanya kuongorora uye kurapwa kwematambudziko. yenzeve yemunhu.

Cholesteatoma inotsanangurwa nekuvapo kwe epidermis, kureva ganda, mukati memakumbo epakati nzeve, mueardrum, kuseri kwe tympanic membrane uye / kana mu mastoid, nzvimbo dzinowanzove dzisina ganda.

Uku kuumbwa kweganda, kunoita senge cyst kana homwe yakazadzwa nezvikero zveganda, inokura zvishoma nezvishoma muhukuru zvichitungamira kuhutachiona hwepakati kwenzeve uye kuparadzwa kwemapfupa akatenderedza zvimiro. Naizvozvo, cholesteatoma inonzi ngozi chisingaperi otitis.

Kune marudzi maviri echolesteatoma:

• akawana cholesteatoma: iyi ndiyo yakajairika fomu. Inoumba kubva muhomwe yekudzorera ye tympanic membrane, iyo zvishoma nezvishoma inopinda mastoid uye nechepakati nzeve, ichiparadza zvivako zvinosangana nazvo;
• congenital cholesteatoma: izvi zvinomiririra 2 kusvika 4% yecholesteatoma kesi. Inobva kune embryological yakasara yeganda riri pakati kwenzeve. Kuzorora uku kuchaita zvishoma nezvishoma marara matsva eganda ayo anozoungana mukati menzeve, kazhinji muchikamu chemberi, uye kutanga aburitsa huturu hushoma hwekutaridzika kuchena, kuseri kwe tympanic membrane iyo yakaramba yakasimba, kazhinji muvana kana vechidiki, pasina. zvimwe zviratidzo. Kana ikasaonekwa, huwandu uhu huchakura zvishoma nezvishoma uye kuita senge yakawanikwa cholesteatoma, zvichikonzera kurasikirwa kwekunzwa uyezve zvimwe zviratidzo zvinoenderana nekukuvara kunogadzirwa munzeve. Kana cholesteatoma ichikonzera kubuda, inenge yatosvika padanho repamusoro.

Cholesteatoma inowanzo tevera zvirwere zvenzeve zvinowanzoitika nekuda kwekusashanda kwe eustachian tube inokonzera tympanic retraction homwe. Muchiitiko ichi, cholesteatoma inofananidzwa nekuguma kwekushanduka kwehomwe isina kugadzikana yekudzorera.

Zvimwe zvikonzero zvisingawanzo zvikonzero zve cholesteatoma zviripo zvakadai se:

• kukuvadzwa kwepaburi renzeve;
• kukuvadzwa nzeve kwakadai sekutsemuka kwedombo;
• kuvhiyiwa nzeve senge tympanoplasty kana otosclerosis.

Pakupedzisira, zvisingawanzoitiki, munyaya ye congenital cholesteatoma, inogona kuvapo kubva pakuberekwa.

Cholesteatoma inokonzera:

• kunzwa kwekuvharika nzeve;
• recurrent unilateral otitis muvakuru kana vana;
• Kudzokororwa unilateral otorrhea, kureva, chisingaperi purulent nzeve kubuda, yero muruvara uye kunhuwa-kunhuwa (kunhuwa kwe "chizi chekare"), kwete kudzikamiswa nekurapa kana kudzivirira kusimba mumvura;
• kurwadza kwenzeve, kunorwadza munzeve;
• otorrhagia, kureva, kubuda ropa munzeve;
• kuzvimba polyps yeeardrum;
• kuderera kunowedzera pakunzwa: ingave ichionekwa pakutanga kana kuti yekuchinja-chinja, kusanzwa kunowanzobata nzeve imwe chete, asi inogona kuva mativi maviri. Uku kusanzwa kunotanga kuzviratidza muchimiro che serous otitis. Inogona kuipa semugumisiro wekunonoka kwepfupa kuparadzwa kweketani ye ossicles inosangana nehomwe yekudzorera iyo inokura kuva cholesteatoma. Pakupedzisira, munguva refu, kukura kwecholesteatoma kunogona kuparadza nzeve yemukati uye naizvozvo kuva nemhosva yekusanzwa kwakakwana kana cophosis;
• kuoma kwechiso: zvisingawanzoitiki, zvinoenderana nekutambura kwetsinga yechiso inosangana necholesteatoma;
• kunzwa kwedzungu uye kusagadzikana kwekuenzanisa: zvisingawanzoitiki, zvinobatanidzwa nekuvhurwa kwemukati nzeve necholesteatoma;
• zvisingawanzoitiki zvirwere zvakakomba zvakadai semastoiditis, meningitis, kana kuputika kweuropi, kutevera kukura kwecholesteatoma munharaunda yeuropi yenguva pedyo nenzeve.

Kuongororwa kwecholesteatoma kunobva pane:

• otoscopy, kureva kuongororwa kwekiriniki, kunoitwa uchishandisa maikorosikopu nenyanzvi yeENT, iyo inoita kuti zvikwanise kuongorora kubuda munzeve, otitis, homwe yekudzosera, kana cyst yeganda, iyo chete yekiriniki inosimbisa. kuvapo kwe cholesteatoma;
• audiogram, kana kuyerwa kwekunzwa. Pakutanga kwechirwere, kusanzwa kwekunzwa kunonyanya kuwanikwa pakati penzeve. Saka yakanyatsoonekwa yakachena conductive kunzwa kurasikirwa kwakabatanidzwa nekugadziriswa kwe tympanic membrane kana kuparadzwa kunofambira mberi kweketani ye ossicles munzeve yepakati. Bonzo conduction curve iro rinoedza mukati menzeve rinobva ranyatsoenderana. Zvishoma nezvishoma, nekufamba kwenguva uye kukura kwecholesteatoma, panogona kuonekwa kuderera kwepfupa conduction inokonzera iyo inonzi "musanganiswa" matsi (sensorineural kunzwa kurasikirwa kunobatanidza ne conductive kunzwa kurasikirwa) uye zvakanyanya mukufarira kutanga kwekuparadzwa. yemukati nzeve inoda kurapwa pasina kunonoka;
• a rock scan: inofanirwa kukumbirwa zvine hurongwa hwekuvhiya manejimendi. Nokuona opacity ine convex edges muzvikamu zvepakati nzeve nekuvapo kwekuparadzwa kwepfupa pakubata, iyi yekuongorora yeradiological inoita kuti zvikwanise kusimbisa kuongororwa kwecholesteatoma, kutsanangura kuwedzera kwayo uye kutarisa zvinogona kuitika;
• MRI inogona kukumbirwa kunyanya kana paine kusava nechokwadi nezvekudzokazve mushure mekurapa.

Kana kuongororwa kwecholesteatoma kuchisimbiswa, kurapwa kunogoneka chete ndiko kubviswa kwayo nekuvhiyiwa.

Zvinangwa zvekupindira

Chinangwa chekupindira ndechekuita kubviswa zvachose kwecholesteatoma, nekuchengetedza kana kuvandudza kunzwa, kuenzana uye basa rechiso kana nzvimbo yaro mukati menzeve inobvumira. Zvinodiwa zvine chekuita nekubviswa kwecholesteatoma dzimwe nguva zvinogona kutsanangura kusaita kwekuchengetedza kana kuvandudza kunzwa, kana kunyange kuderera kwekunzwa mushure mekuvhiyiwa.

Mhando dzinoverengeka dzekupindira kwekuvhiya dzinogona kuitwa:

• tympanoplasty mune yakavharwa nzira; 
• tympanoplasty mune yakazaruka nzira;
• petro-mastoid recess.

Sarudzo pakati peaya maitiro akasiyana inosarudzwa uye inokurukurwa nanachiremba weENT. Zvinoenderana nezvakawanda zvinhu:

• kuwedzera kwe cholesteatoma;
• mamiriro ekunzwa;
• anatomical conformation;
• chido chokutangazve mabasa emumvura;
• mikana yekuongororwa kwechiremba;
• operative risk etc.

Kuita kupindira

Izvi zvinoitwa pasi peanesthesia yakawanda, retro-auricular, kureva kuburikidza nekuseri kwenzeve, panguva yekugara muchipatara kwemazuva mashomanana. Iyo tsinga yechiso inotariswa nguva dzose mukati mekushanda. Kupindira kunosanganisira, mushure mekubviswa kwecholesteatoma yakatumirwa kuongororwa kweanatomo-pathological, kusiya zvishoma zvakasara sezvinobvira uye kuvakazve eardrum kuburikidza neshwashwa yakatorwa kubva munharaunda ye tragal, kureva kumberi kwenzira yekuongorora. kunze, kana kumashure kwe concha ye auricle.

Convalescence uye post-operative kutevera

Muchiitiko cheketani ye ossicles yakakuvadzwa necholesteatoma, kana nzeve isina hutachiona, kuvakwazve kwekunzwa kunoitwa panguva iyi yekutanga kupindira kwekuvhiya nekutsiva yakaparadzwa ossicle neprosthesis.

Clinical uye radiological monitoring (CT scan uye MRI) inofanira kuitwa nguva nenguva nekuda kwekugona kukuru kwekudzoka kwecholesteatoma. Izvo zvinodiwa kuona murwere zvakare mwedzi mitanhatu mushure mekuvhiyiwa uye kuronga zvakarongeka kuongororwa kwekufungidzira pa6 gore. Muchiitiko chekusadzoreredzwa kwekunzwa, kusava nechokwadi kweradiological mufananidzo kana kufarira kudzokorora, otoscopy isina kujairika kana kuderera kwekunzwa kunyangwe kuvakwazve kunogutsa kwekupedzisira, kupindira kwechipiri kwekuvhiya kunodiwa. kuronga mwedzi 1 kusvika ku9 mushure mekutanga, kuitira kutarisa kusavapo kwecholesteatoma yakasara uye kuedza kuvandudza kunzwa.

Muchiitiko chekuti hapana kupindira kwechipiri kunorongwa, kuongororwa kwekliniki yegore negore kunoitwa kwemakore akawanda. Definitive cure inofungidzirwa mukusavapo kwekudzokazve makore anopfuura 5 mushure mekupedzisira kupindira kwekuvhiya.