外耳道胆脂瘤侵蚀乳突(附3例报告)

目的 :提高临床对外耳道胆脂瘤 (EACC)侵蚀乳突的认识。方法 :回顾性分析 3例EACC侵蚀乳突患者的临床资料。结果 :3例外耳道后壁破坏 ,并有外耳道后壁 乳突腔瘘形成 ;2例面神经骨管破坏 ,面神经及迷路完整 ;经手术治疗 ,随访 6个月～ 9年 ,无复发迹象。结论 :临床上易将外耳道栓塞性角化病 (KO)误诊为EACC ;EACC侵蚀乳突者临床并不多见 ;治疗原则是彻底清除胆脂瘤和死骨 ,并根据病变程度决定手术方式。     

外耳道胆脂瘤的临床特点及误诊分析

目的:分析外耳道胆脂瘤(EACC)的临床特点及误诊原因。方法:对1993～2003年收治的经临床和病理确诊的18例EACC患者,根据病变的范围和程度,采取不同的治疗方法,其治疗原则是彻底清除EACC和肉芽组织、促进创面愈合。结果:外耳道骨质破环13例,外耳道深部为白色或黄色上皮角化物或耵     

外耳道胆脂瘤的临床特点及误诊分析

目的：分析外耳道胆脂瘤（EACC）的临床特点及误诊原因。方法：对1993～2003年收治的经临床和病理确诊的18例EACC患者，根据病变的范围和程度，采取不同的治疗方法，其治疗原则是彻底清除EACC和肉芽组织，促进创面愈合。结果：外耳道骨质破坏13例，外耳道深部为白色或黄色上皮角化物或耵聍样团块阻塞18例，外耳道口肉芽阻塞、皮肤红肿或外耳道狭窄15例，EACC侵犯乳突和上鼓室4例，鼓膜穿孔2例。随访1～6年，无复发。结论：EACC是以疼痛、间歇耳漏和骨质破坏为其特征的外耳道疾患，其治疗原则是彻底清除胆脂瘤囊袋、肉芽组织，促进创面愈合。     

外耳道胆脂瘤修订手术的临床病例分析

目的分析外耳道胆脂瘤(EACC)修订手术病例的临床特点、处理及预后。方法回顾性分析2011-2019年EACC术后因外耳道狭窄、闭锁伴外耳道胆脂瘤复发10例(8名患者)于我院行修订手术的临床特征、修订手术要点。结果10例修订手术中,5例为外耳道狭窄,5例为外耳道闭锁。3例术中发现外耳道骨质增生。修订手术与前次手术间隔0.5年~20年,平均5.3年±5.9年。行修订式手术前诊断:3例为单纯EACC,7例为EACC侵犯中耳。单纯EACC 3例均行胆脂瘤清理术,其中1例行耳甲腔成形术,2例行外耳道骨性扩大术。侵犯中耳7例中有3例行开放式乳突根治术,其他为单纯鼓室探查或完壁式鼓室成形术,但均在术中磨宽骨性外耳道。术中2例行自体皮移植术,1例植入脱细胞异体真皮,其他未植皮。术后再随访时间3个月~9年,平均2.8±2.9年。再随访病例中4例(2人)出现再次粘连闭锁,其中1例门诊处理后恢复可;其他6例(6人)随访期内无狭窄或闭锁。所有病例在最后一次手术后随访期内均未见胆脂瘤复发。我院2011-2019年诊断为EACC并手术病例总数为230例。上述10例病例中,5例由外院完成首次手术。故我院EACC手术再手术率为2.17%(5例/230例)。结论EACC术后有一定的再狭窄率,EACC广泛破坏外耳道皮肤,甚至环周皮肤缺损,是再狭窄的可能原因。年轻患者组织生长旺盛,较年老患者更易发生再狭窄。皮肤损失严重病例,进行适当的植皮十分必要,可能会减少再狭窄的发生。     

外耳道胆脂瘤的影像学特征和处理方法的选择

目的：探讨外耳道胆脂瘤（EACC）的表现特征和处理方法。方法：对17例（21耳）入院手术治疗的EACC患者的临床资料进行回顾性研究,分析其病因、病史、临床表现和影像学特点,探讨这些特点对临床处理方法的影响。结果：8耳行外耳道成形和EACC切除;1耳术中仅行外耳道成形和EACC切除,待二期行鼓室成形手术;3耳清理鼓室内病变后将颞肌筋膜内植,行鼓膜修补。9耳采用耳后切口,行开放式乳突根治。结论：EACC的病因学特点和病变的范围决定其处理方式,颞骨CT有助于了解病变的范围,制定手术计划。     

外耳道胆脂瘤19例临床分析

目的：探讨外耳道胆脂瘤(EACC)的临床特征，提高其临床诊治水平。方法：回顾分析19例手术治疗后经病理检查证实为EACC患者的临床资料。对9例骨质破坏局限于外耳道且范围小者，行外耳道病灶清除术加外耳道耳甲腔成形术；对10例胆脂瘤侵入上鼓室或乳突累及中耳者，采用耳后或耳内进路，行乳突根治术5例，改良乳突根治术5例，病变清除后，均行外耳道成形术。结果：术后听力较术前提高10～20dB9例，无变化10例。随访1～12年，无复发。结论：详细的病史询问和仔细的耳镜检查及颞骨CT扫描，在EACC的诊断中有着十分重要的价值。治疗原则是彻底清除胆脂瘤和死骨，防止胆脂瘤残留和复发，并根据病变程度决定手术方式。     

外耳道胆脂瘤的临床特征及疗效评估

目的 探讨外耳道胆脂瘤(EACC)的临床特点,并评估其治疗效果。 方法 回顾性分析2015年1月至2016年12月47例(47耳)EACC的临床资料,所有患者术前接受听力学检查,耳内镜及颞骨CT检查。 结果 所有患者外耳道均可见黄白色鳞状或肉芽样物阻塞。耳闷胀感、耳痛及耳流脓是EACC常见症状。CT显示41耳有骨破坏。按Holt分期:47耳中,Ⅰ期6耳,Ⅱ期29耳,Ⅲ期12耳。对Ⅰ期6耳及Ⅱ期5例儿童患者行EACC和/或肉芽去除术;对24例Ⅱ期成人患者联合行胆脂瘤清除及外耳道成形术;12例Ⅲ期患者中,9例行乳突改良根治术和/或鼓室成型术,3例行乳突根治术。所有患者术后2周干耳,3个月内术腔完全上皮化。除3例行乳突根治术的患者术后听力无改善,其余44耳都有不同程度的提高。所有患者术后随访3~24个月,未见EACC复发者。 结论 EACC可被误诊,骨质破坏是其最重要的特征。颞骨CT有助于EACC的分期及制定治疗方案,应根据疾病分期、患者年龄及听力水平选择手术方法。彻底清除胆脂瘤及保持外耳道宽敞是治愈该疾病及预防复发的关键。     

儿童外耳道胆脂瘤累及中耳乳突(附3例报告)

外耳道胆脂瘤(extemal auditory canalcholesteatoma,EACC)多发于成年人,老年人更为多见.儿童EACC临床不多见,有关儿童EACC累及中耳乳突的报告更为少见.本文结合我科从1997年8月～2001年11月间收治的3例儿童EACC累及中耳乳突的临床资料和有关文献,对该病进行分析讨论,以期提高临床对儿童EACC的认识.     

外耳道胆脂瘤的临床分期与治疗方法的选择(附22例报告)

外耳道胆脂瘤(external auditory canal cholesteatoma,EACC)是一种由各种原因引发的外耳道脱屑、胆固醇结晶堆积、上皮块包裹所致的慢性炎性疾病,病变不仅限于外耳道,也可侵及鼓室或乳突等.现将我科2000年1月～2006年12月治疗的22例EACC患者的资料进行回顾性分析,报告如下.     

外耳道胆脂瘤CT分期及手术方式

目的探讨外耳道胆脂瘤(external auditorycanal cholesteatoma,EACC)的CT分期方法和手术方式。方法对66例(66耳)EACC手术病例进行回顾性分析,根据颞骨CT中EACC的侵犯范围进行分期,并对不同分期EACC的手术方式进行分析。结果 66例EACC中,I期13例(19.7%),II期35例(53.0%),III期18例(27.3%)。13例I期病例中,11例行胆脂瘤清除术,2例行外耳道成形术;35例II期病例中,34例行外耳道成形术,1例行乳突切开术+外耳道成形术;18例III期病例中,10例行鼓室成形术+外耳道成形术,2例行乳突切开术+外耳道成形术,6例行乳突切开术+鼓室成形术+外耳道成形术。随访6个月～3年,61例无复发,2例复发,3例失访。结论 EACC的CT分期有助于选择正确的EACC手术方式。     

急性化脓性耳廓软骨膜炎手术疗效分析

目的 探讨能够缩短化脓性耳廓软骨膜炎疗程,降低耳廓畸形发生率且具个体化的局部治疗方法.方法 回顾分析1 989年4月～2010年2月我科诊治的25例化脓性耳廓软骨膜炎的临床资料.除进行抗生素治疗外,局部治疗方法包括清创术后重新行耳甲腔成行术;脓腔穿刺置静脉留置针进行持续负压引流;清创后创腔置管引流.结果 自定义疗效评定...     

耳廓开放性外伤的治疗方法探析

目的 探讨耳廓开放性外伤的治疗方法。方法 23耳耳廓开放性外伤经彻底清创，肝素生理盐水冲洗伤口后，对位缝合。术后用抗生素抗感染、丹参扩张血管、罂粟碱改善微循环。结果 23耳中2耳失访，18耳完全成活，1耳部分成活，2耳完全坏死。结论 耳廓撕裂伤、断伤、带有皮蒂的耳廓离断伤，由于断端双侧血管丰富，经对位缝合后容易成活。但耳廓完全离断伤由于缺乏血供，经对位缝合后不易成活，可采用去皮血管植入包埋法，带肌蒂皮瓣移植法或尝试显微外科技术施行血管吻合，以提高耳廓完全离断伤的成活率。     

诊治7例鼻腔嗅神经母细胞瘤的体会

目的：提高临床对鼻腔嗅神经母细胞瘤的认识及治疗效果。方法：７例患者按Ｋａｄｉｓｈ分期，Ｂ期２例，Ｃ期５例，单纯放疗３例，术前放疗４例，放射剂量为５０００￣７０００ｃＧｙ。均随访至１９９７年１２月，结果：存活５例，存活时间分别为２０，２２，２３，２９及７６个月；结论：放疗对该肿瘤有效；放疗与化疗结合的方法值得探讨，该瘤病理上可能存在不同的亚型。     

Scales of degree of facial paralysis: analysis of agreement

IntroductionIt has become common to use scales to measure the degree of involvement of facial paralysis in phonoaudiological clinics.ObjectiveTo analyze the inter- and intra-rater agreement of the scales of degree of facial paralysis and to elicit point of view of the appraisers regarding their use.MethodsCross-sectional observational clinical study of the Chevalier and House & Brackmann scales performed by five speech therapists with clinical experience, who analyzed the facial expression of 30 adult subjects with impaired facial movements two times, with a one week interval between evaluations. The kappa analysis was employed.ResultsThere was excellent inter-rater agreement for both scales (kappa > 0.80), and on the Chevalier scale a substantial intra-rater agreement in the first assessment (kappa = 0.792) and an excellent agreement in the second assessment (kappa = 0.928). The House & Brackmann scale showed excellent agreement at both assessments (kappa = 0.850 and 0.857). As for the appraisers’ point of view, one appraiser thought prior training is necessary for the Chevalier scale and, four appraisers felt that training is important for the House & Brackmann scale.ConclusionBoth scales have good inter- and intra-rater agreement and most of the appraisers agree on the ease and relevance of the application of these scales.     

术前使用布地奈德对声带息肉手术疗效的影响

目的 研究术前使用布地奈德雾化吸入治疗对手术疗效的影响。方法 按病程将3个月以内和1年以上患者随机分为两组,一组术前给予布地奈德雾化治疗,一组没有,术后两周复诊。分别于初诊、手术前和复诊时使用嗓音测试仪对病人进行测试并记录参数。结果 病程3个月以内患者术前给予雾化治疗后,其术后声学参数明显改善。结论 病程3个月以内患者术前给予雾化治疗能缩短术后恢复时间。     

Effects of time of contact and concentration of caustic agent on generation of injuries

OBJECTIVES: Solid caustic soda (CS) ingestion levels continue high in Brazil. The aggressiveness of a caustic agent depends, among other factors, on its concentration and time of contact with mucosa. However, the interdependence of these factors in the production of caustic lesion in the esophageal mucosa is not known, especially regarding CS as the strongest corrosive agent. We analyze the effects of concentration and time of contact on the aggressiveness of CS to the esophagus of live animals. STUDY DESIGN/METHODS: One milliliter of CS at concentrations between 1.83% and 73.33% was applied to rats. The solution was kept in contact with the mucosa for 10 to 120 minutes. Internal and external organ aspects were analyzed and the epithelium, submucosa, muscle layer, and adventitia were analyzed microscopically RESULTS: Epithelial necrosis was observed at all concentrations. Among the necrotic layers, the submucosa was observed starting at the 7.33% concentration, and the muscular layer and adventitia were observed at 14.66% concentration. Damage to the pulmonary parenchyma and trachea occurred at 33.66% after 10 minutes, and perforation of the esophagus was observed only after 120 minutes. After 10 minutes, important corrosive lesions installed in the esophageal layers, expanding in depth and superficial extension. The use of heparin had no effect on the production of lesions. CONCLUSIONS: Ten minutes were sufficient to provoke necrosis, and longer contact increased the area of necrosis. Solution concentration levels were more important in damage production: 1.83% was sufficient for epithelial necrosis, 7.33% caused submucosal necrosis, and 14.66% muscle and adventitia necrosis; 33.66% solutions caused lung and trachea damage after 10 minutes and esophageal perforation after 120 minutes.     

前壁切除法治疗耳廓假性囊肿的临床应用

我们采用前壁切除法治疗耳廓假性囊肿143例,取得了良好效果,现报告如下。1资料与方法1.1临床资料2001-2010年我科收治初次就诊的耳廓假性囊肿患者143例,男84例,女59例;年龄17～57岁,平均36.5岁;病程5d～9个月。囊肿最长径18～37mm,平均28mm。病变部位分别位于舟状     

Effect of the loss of auditory feedback on segmental parameters of vowels of postlingually deafened speakers

Objective: The most obvious and best documented changes in speech of postlingually deafened speakers are the rate, fundamental frequency, and volume (energy). These changes are due to the lack of auditory feedback. But auditory feedback affects not only the suprasegmental parameters of speech. The aim of this study was to determine the change at the segmental level of speech in terms of vowel formants. Methods: Twenty-three postlingually deafened and 18 normally hearing speakers were recorded reading a German text. The frequencies of the first and second formants and the vowel spaces of selected vowels in word-in-context condition were compared. Results: All first formant frequencies (F1) of the postlingually deafened speakers were significantly different from those of the normally hearing people. The values of F1 were higher for the vowels /e/ (418±61 Hz compared with 359±52 Hz, P=0.006) and /o/ (459±58 compared with 390±45 Hz, P=0.0003) and lower for /a/ (765±115 Hz compared with 851±146 Hz, P=0.038). The second formant frequency (F2) only showed a significant increase for the vowel/e/(2016±347 Hz compared with 2279±250 Hz, P=0.012). The postlingually deafened people were divided into two subgroups according to duration of deafness (shorter/longer than 10 years of deafness). There was no significant difference in formant changes between the two groups. Conclusion: Our report demonstrated an effect of auditory feedback also on segmental features of speech of postlingually deafened people.     

A national audit of sinus surgery. Results of the Royal College of Surgeons of England comparative audit of ENT surgery

The results of a national audit of sinus surgery are presented. Forty-six consultant ENT surgeons reported on over 2500 sinus procedures. There has been an exponential rise in the number of surgeons in England and Wales performing functional endoscopic sinus surgery (FESS) in recent years. Sixty-five per cent of surgeons in our study used the FESS technique and 81% had formal or other training. Outpatient sinus endoscopy and CT scans have become more routine pre-operative investigations, whilst the use of plain films has waned. There was a wide variation in the numbers of FESS procedures performed by individual surgeons in the 6-month period (between 5 and 85). The overall complication rate was 0.75% for conventional surgery and 1.41% for functional surgery but no major complications were recorded. The primary symptom of blockage was most successfully treated by both conventional and functional surgery (70% and 84% asymptomatic or improved at 6 months). Pain was relieved in 75% of functional procedures and 47% of conventional procedures and discharge relieved in 76% of FESS procedures and 47% of conventional procedures.