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中耳和乳突癌在诊断和治疗方面有很大的困难,因它多伴发于慢性炎症和胆脂瘤,其早期表现常仅为慢性炎症,待侵及颅底及其邻近软组织时治疗便十分棘手。在一般情况下,中耳癌常呈脓性肉芽组织或耳道内息肉,伴有鼓膜穿孔和大量流脓,X线相40%有骨质破坏,因此易被误诊而行乳突根治术,待作常规病理检查才发现为癌。更重要的问题是常规X线相和断层相,甚至CT扫描也难以查明有无颅内或颅底侵犯,但血管造影从静脉相可明确乙状窦是否受侵。对于中耳癌患者,还应详查鼻咽部有无原发病灶,颈及腮腺区有无淋巴转移。治疗方面的困难除因警惕性不高、诊断较晚致癌瘤侵犯颅底及邻近软组织难获满意疗效外,还在于颞骨处于颅底最复杂的解剖
The diagnosis and treatment of middle ear and papillary carcinoma is very difficult, because it is often associated with chronic inflammation and cholesteatoma, and its early manifestations are often only chronic inflammation. When the skull base and adjacent soft tissue are to be treated It is very tricky. Under normal circumstances, the middle ear cancer often shows purulent granulation tissue or polyps within the ear canal, accompanied by perforation of the tympanic membrane and massive pus, 40% of X-rays have bone destruction, so it is easy to be misdiagnosed and mastoid radical resection. Only routine pathological examination was found to be cancer. More important issues are the conventional X-ray and CT scans. Even CT scans are difficult to detect if there is intracranial or skull base invasion. However, angiography can determine whether the sigmoid sinus is invaded from the venous phase. For patients with middle ear cancer, we should also investigate whether the primary lesion of the nasopharynx, whether there is lymph node metastasis in the neck and parotid gland. Difficulties in treatment are not due to poor vigilance, late diagnosis of cancer causing invasion of the skull base and adjacent soft tissue is difficult to obtain satisfactory results, but also in the most complex anatomy of the skull in the skull base