ICholesteatoma iqukethe inqwaba yamangqamuzana e-epidermal, atholakala ngemuva kolwelwesi lwe-tympanic, olungena kancane kancane ezinhlakeni zendlebe ephakathi, lubalimaze kancane kancane. I-cholesteatoma ivame ukulandela ukutheleleka okungapheli okungazange kubonwe. Uma ingalashwa ngesikhathi, ingabhubhisa indlebe ephakathi futhi iholele ekubeni isithulu, ukutheleleka, noma ukukhubazeka ebusweni. Ingasabalala futhi iye endlebeni yangaphakathi futhi ibangele isiyezi, ngisho nasezakhiweni zobuchopho (meningitis, abscess). Ukuxilongwa kusekelwe ekubonisweni kwesisindo esimhlophe emgodini wokuhlola wangaphandle. I-rock scan iqeda ukuhlolwa ngokugqamisa ukunwetshwa kwalesi sisindo ngaphakathi kwezakhiwo zendlebe. I-cholesteatoma idinga ukwelashwa ngokushesha. Lokhu kususwa ngokuphelele ngesikhathi sokuhlinzwa, kudlule ngemuva kwendlebe. Ukungenelela kwesibili kokuhlinzwa kungakhonjiswa ukuqinisekisa ukungabikho kokuphindaphinda nokwakha ama-ossicles kude.

ICholesteatoma yachazwa okokuqala ngonyaka we-1683 ngaphansi kwegama elithi “ukubola kwezindlebe” nguJoseph Duverney, ongubaba wezifo zomzimba, igatsha lezokwelapha eligxile kakhulu ekwelapheni nasekwelapheni izifo. yendlebe yomuntu.

I-Cholesteatoma ichazwa ngokuba khona kwe-epidermis, okusho isikhumba, ngaphakathi kwemigodi yendlebe ephakathi, ku-eardrum, ngemuva kolwelwesi lwe-tympanic kanye / noma ku-mastoid, izindawo ngokuvamile ezingenasikhumba.

Lokhu kwanda kwesikhumba, okubukeka njenge-cyst noma iphakethe eligcwele izikali zesikhumba, kuzokhula kancane ngosayizi okuholele ekuthelelekeni okungapheli kwendlebe ephakathi nokubhujiswa kwezakhiwo zamathambo ezizungezile. Ngakho-ke, i-cholesteatoma ibizwa ngokuthi i-otitis engapheli eyingozi.

Kunezinhlobo ezimbili ze-cholesteatoma:

• wathola i-cholesteatoma: lena ifomu evame kakhulu. Yakha ephaketheni elihoxisayo lolwelwesi lwe-tympanic, oluzohlasela kancane kancane i-mastoid nendlebe ephakathi, kuqede izakhiwo ezihlangana nayo;
• i-cholesteatoma yokuzalwa: lokhu kumelela amacala we-cholesteatoma ayi-2 kuya ku-4%. Kuqhamuka kunsalela yesikhumba embundwini endlebeni ephakathi. Lokhu kuphumula kuzokhiqiza kancane kancane imfucumfucu yesikhumba ezoqoqana endlebeni ephakathi, imvamisa engxenyeni engaphandle, bese kuqala ikhiqize inqwaba yokubukeka okumhlophe, ngemuva kolwelwesi lwe-tympanic oluye lwahlala lunganyakazi, imvamisa ezinganeni noma kubantu abadala, ngaphandle izimpawu ezithile. Uma ingatholakali, le nqwaba izokhula kancane kancane futhi iziphathe njenge-cholesteatoma etholakele, ibangele ukulahleka kokuzwa bese kuba nezinye izimpawu ngokuya ngomonakalo owenziwe endlebeni. Lapho i-cholesteatoma ibangela ukuphuma, isivele ifinyelele ezingeni eliphakeme.

I-Cholesteatoma ivame ukulandela ukutheleleka okuphindelela kwezindlebe ngenxa yokungasebenzi kahle kweshubhu le-eustachian elibhekele isikhwama sokubuyisa i-tympanic. Kulokhu, i-cholesteatoma ihambelana nomvuthwandaba wokuvela kwesikhwama sokuhlehlisa esingazinzile.

Ezinye izimbangela ezingavamile kakhulu ze-cholesteatoma zikhona njenge:

• ukugcotshwa okulimazayo kwe-eardrum;
• ukuhlukunyezwa kwezindlebe njengokuqhekeka kwedwala;
• ukuhlinzwa endlebeni njengokuhlinzwa kwe-tympanoplasty noma i-otosclerosis.

Ekugcineni, kuyaqabukela, esimweni se-cholesteatoma yokuzalwa, ingaba khona kusukela ekuzalweni.

I-Cholesteatoma ibhekele lokhu:

• ukuzwa kwendlebe evinjiwe;
• ukuphindaphinda kwe-otilitis okungajwayelekile kubantu abadala noma ezinganeni;
• I-otorrhea ephindaphindekayo, okungukuthi, ukukhishwa endlebeni okungapheli, okugqamile ngombala ophuzi nephunga elibi (iphunga “loshizi wakudala”), okungadanjiswa ukwelashwa noma ukuvimbela amanzi aqinile;
• indlebe, okubuhlungu endlebeni;
• i-otorrhagia, okungukuthi, ukuphuma endlebeni;
• polyp ukuvuvukala eardrum;
• ukwehliswa okuqhubekayo kokuzwa: noma ngabe kuvela ekuqaleni noma ngabe kungokuguquguquka okuguqukayo, ukukhubazeka kokuzwa kuvame ukuthinta indlebe eyodwa kuphela, kepha kungaba okuhlangene. Lesi sithulu siqala ngokuvela ngesimo se-serous otitis. Kungaba kubi njengomphumela wokubhujiswa kwethambo okuhamba kancane kochungechunge lwama-ossicles lapho kuthintwa nephakethe lokuhoxa eliqala libe yicholesteatoma. Ekugcineni, esikhathini eside, ukukhula kwe-cholesteatoma kungabhubhisa indlebe yangaphakathi ngakho-ke kube nesibopho sokuzwa ngokuphelele noma i-cophosis;
• ukukhubazeka kobuso: akuvamile, kufana nokuhlupheka kwemizwa yobuso lapho ihlangana ne-cholesteatoma;
• ukuzwa isiyezi nokukhathazeka kokulinganisela: okungajwayelekile, zixhunyaniswa nokuvulwa kwendlebe yangaphakathi yi-cholesteatoma;
• ukutheleleka okungathi sína okufana ne-mastoiditis, i-meningitis, noma ithumba lobuchopho, kulandela ukukhula kwe-cholesteatoma esifundeni sobuchopho besikhashana eduze kwendlebe.

Ukuxilongwa kwe-cholesteatoma kusekelwe ku:

• i-otoscopy, okusho ukuthi ukuhlolwa komtholampilo, okwenziwa kusetshenziswa imicroscope ngungcweti we-ENT, okwenza kube lula ukuthola ukukhishwa endlebeni, i-otitis, iphakethe lokubuyisa, noma i-cyst yesikhumba, okuwukuphela kwesici somtholampilo esiqinisekisa ukutholakala kwe-cholesteatoma;
• i-audiogram, noma isilinganiso sokuzwa. Ekuqaleni kwesifo, ukukhubazeka kokuzwa kutholakala kakhulu endlebeni ephakathi. Ngakho-ke kutholwa ngokweqile ukulahleka kokuzwa okumsulwa okuxhumene nokuguqulwa kolwelwesi lwe-tympanic noma ukubhujiswa okuqhubekayo kochungechunge lwama-ossicles endlebeni ephakathi. Ijika lokuqhuba amathambo elihlola indlebe yangaphakathi libe selivamile. Kancane kancane, ngokuhamba kwesikhathi nokukhula kwecholesteatoma, kungahle kubonakale ukwehla kokuqhutshwa kwamathambo okunomthelela walokho okubizwa ngokuthi “ukuxubana” ukungezwa (ukulahleka kwezindlebe kokuzwa okuhambisana nokulahleka kokuzwa) futhi kuthakazelisa ukuqala kokubhujiswa. yendlebe yangaphakathi edinga ukwelashwa ngaphandle kokulibala;
• i-rock scan: kufanele icelwe ngokuhlelekile ukuphathwa kokuhlinzwa. Ngokubona ukungabonakali okunemiphetho eguquguqukayo ezingxenyeni zendlebe emaphakathi lapho kukhona khona ukubhujiswa kwamathambo lapho kuthintwa, lokhu kuhlolwa kwemisebe ye-radiological kwenza kube nokwenzeka ukuqinisekisa ukutholakala kwe-cholesteatoma, ukucacisa ukunwetshwa kwayo nokubheka izinkinga ezingaba khona;
• kungacelwa i-MRI ikakhulukazi uma kwenzeka kuba nokungabaza mayelana nokuphindeka emuva kokwelashwa.

Lapho kutholakala ukuxilongwa kwe-cholesteatoma, okuwukuphela kwendlela yokwelashwa ukususwa kwayo ngokuhlinzwa.

Izinhloso zokungenelela

Inhloso yokungenelela ukwenza ukukhishwa okuphelele kwe-cholesteatoma, ngenkathi kugcinwa noma kuthuthukiswa ukuzwa, ukulinganisela nokusebenza kobuso uma indawo yayo endlebeni ephakathi ikuvumela. Izidingo ezihlobene nokususwa kwe-cholesteatoma kwesinye isikhathi zingachaza ukuthi akunakwenzeka ukugcina noma ukuthuthukisa ukuzwa, noma ukuwohloka kokuzwa ngemuva kokuhlinzwa.

Izinhlobo eziningi zokungenelela kokuhlinzwa zingenziwa:

• i-tympanoplasty ngenqubo evaliwe; 
• i-tympanoplasty ngenqubo evulekile;
• ikhefu le-petro-mastoid.

Ukukhetha phakathi kwalezi zinqubo ezahlukahlukene kunqunywa futhi kuxoxwe ngakho nodokotela ohlinzayo we-ENT. Kuya ngezici eziningana:

• ukunwetshwa kwe-cholesteatoma;
• isimo sokuzwa;
• ukuguqulwa kwe-anatomical;
• isifiso sokuqalisa kabusha imisebenzi yasemanzini;
• amathuba okubhekwa kwezokwelapha;
• ingozi yokusebenza njll.

Ukwenza ukungenelela

Lokhu kwenziwa ngaphansi kwe-anesthesia ejwayelekile, i-retro-auricular, okungukuthi ngemuva kwendlebe, ngesikhathi sokuhlala esibhedlela isikhashana izinsuku ezimbalwa. Inzwa yobuso ihlolwe ngokuqhubekayo kulo lonke uhlelo lokusebenza. Ukungenelela kuqukethe, ngemuva kokukhishwa kwe-cholesteatoma ethunyelwe ukuhlolwa kwe-anatomo-pathological, ukushiya izinsalela ezincane ngangokunokwenzeka nokwakha kabusha i-eardrum nge-cartilage ethathwe esifundeni se-tragal, okungukuthi ngaphambili komsele wokuzwa. ngaphandle, noma ngemuva kwe-concha ye-auricle.

Ukulandelelwa kwe-Convalescence nokulandela ukusebenza

Uma kwenzeka uchungechunge lwama-ossic olonakaliswe yi-cholesteatoma, uma indlebe ingathelelekile kakhulu, ukwakhiwa kabusha kokuzwa kwenziwa phakathi nalokhu kungenelela kokuqala kokuhlinzwa ngokufaka i-prosthesis esikhundleni se-ossicle ebhujisiwe.

Ukuqapha kwe-Clinical and radiological (i-CT scan ne-MRI) kufanele kwenziwe njalo ngenxa yamandla aphezulu wokuphindaphinda kwe-cholesteatoma. Kuyadingeka ukuthi uphinde ubone isiguli izinyanga eziyi-6 ngemuva kokuhlinzwa futhi uhlele ngokuhlelekile ukuhlolwa kwe-imaging ngonyaka ongu-1. Uma kwenzeka kungabuyiswa ukuzwa, isithombe esingathandabuzeki semisebe ye-radiology noma esivuna ukuphindeka, i-otoscopy engajwayelekile noma ukuwohloka kokulalela yize kwakhiwa kabusha okwenelisayo kwalokhu kwamuva, kudingeka ukungenelela kwesibili kokuhlinzwa. ukuhlela izinyanga eziyi-9 kuya kwezingu-18 ngemuva kokuqala, ukuze kubhekwe ukungabi bikho kwe-cholesteatoma eyinsalela nokuzama ukwenza ngcono ukuzwa.

Uma kwenzeka ukuthi kungabikho ukungenelela kwesibili okuzohlelwa, ukuhlolwa komtholampilo minyaka yonke kwenziwa eminyakeni eminingana. Ukwelashwa okucacile kubhekwa ngokungabikho kokuphindaphinda eminyakeni engaphezu kwengu-5 ngemuva kokungenelela kokuhlinzwa kokugcina.