外耳道瘢痕狭窄或闭锁致外耳道胆脂瘤6例分析

外耳道胆脂瘤在临床并非罕见,多属先天性原发性外耳道胆脂瘤,而由耳外伤后外耳道瘢痕狭窄或闭锁所致外耳道胆脂瘤形成,尚未见文献报道.本文报道我科自1995～2000年共收治外伤耳后外耳道瘢痕狭窄或闭锁所致外耳道胆脂瘤形成6例,现分析报告如下.     

外耳道胆脂瘤取出致外耳道闭锁1例

1临床资料病人,女,32岁。因左耳堵塞感,听力下降进行性加重6个月,于2003年8月25日就诊于我科。病人发病前无明显诱因,无耳痛、耳流脓病史及左外耳道异物史。专科检查见左侧外耳道深部一白色上皮状物质包裹的团块,初步诊断为左侧外耳道胆脂瘤。鉴于病人对疼痛敏感且位置深在,故先以2%的利多卡因阻滞麻醉下颌神经耳颞支、迷走神经耳支,待麻醉成功后予以取出,约1.1 cm×0.75 cm大小,将其送病检,病理结果支持术前诊断。胆脂瘤取出过程中软骨部皮肤擦伤,少量出血,干棉球压迫止血,未进行其他处理。1个月后病人复诊,诉左耳堵塞感加重,听力较前下降…     

先天性外耳道闭锁或狭窄伴胆脂瘤19例报告

Schuknecht( 1 989)报告先天性外耳道闭锁或狭窄伴胆脂瘤的发病率为 8% ,我科 1 985～ 1 997年收治 68例先天性耳畸形患者 ,伴有胆脂瘤者 1 9例 ,发病率为 2 7.9% ,临床误诊 1 5例。为使同道重视 ,现将其临床资料报告如下。1　资料和方法1 .1 　 临床资料1 9例先天性外耳道闭锁     

外耳道胆脂瘤误诊二例

外耳道胆脂瘤是一种由外耳道骨段所蓄积的含有胆固醇结晶的脱落上皮团块所致的外耳道疾病，较为少见。患者主诉及临床表现与慢性化脓性中耳炎（胆脂瘤型）十分相似，临床诊断较易混淆。１ 临床资料 例１ 女，５８岁，因右耳反复流脓伴听力下降３个月，患耳触痛明显，经保守治疗无效，于１９９９年９月２５日收住院。专科检查：右外耳道可见胆脂瘤样分泌物，清理后见外耳道骨段近鼓膜端扩大，外耳道后上壁和上鼓室外侧壁部分似已破溃；纯音测听检查，呈轻度传导性听力下降，以低频为主（２５０、５００ Ｈｚ处气导听阈均为 ３０ ｄＢ ＨＬ，…     

先天性小耳畸形合并外耳道胆脂瘤及耳后骨膜下脓肿一例

<正>先天性小耳畸形除表现为耳廓先天性发育不良外,还常伴有外耳道闭锁及中耳畸形。先天性外耳道闭锁由于胚胎发育过程中有上皮残留,可并发胆脂瘤[1]。先天性小耳畸形伴外耳道闭锁容易诊断,但合并外耳道胆脂瘤及并发感染时临床上常发病较隐匿,易合并颅内外并发症。现报道一例先天性小耳畸形伴外耳道闭锁合并胆脂瘤及耳后骨膜下脓肿一例的临床资料,对本病的病因和治疗方案进行探讨。1临床资料患者女性,28岁,主因右耳先天性耳廓畸形伴听     

外耳道胆脂瘤49例临床特点及诊治分析

目的 探讨外耳道胆脂瘤的临床特点及诊治方法 .方法 回顾性分析武汉大学人民医院耳鼻咽喉-头颈外科2000～2005年收治的49例外耳道胆脂瘤患者的临床资料.结果 术前所有患者外耳道均见灰白色或黄白色软组织充填,外耳道皮肤可见慢性炎症.所有病例病变以外耳道为中心,外耳道均有不同程度的侵蚀扩大;其中8例患者病变向远深部扩展侵犯乳突和/或鼓膜、上鼓室;2例面神经垂直段骨质破坏.根据病变范围.10例患者直接在手术显微镜下彻底清除病变;31例患者行耳内切口显微镜下彻底清除病变,术中见鼓膜紧张部穿孔5例,术后均行Ⅱ期鼓膜修补术;4例患者行乳突根治术,术中见鼓膜缺如,听骨链残缺;4例患者行改良乳突根治术,术中见听骨链完整,2例松弛部穿孔,术后行Ⅱ期鼓室成型术.术前45例(91.8%)患者为传导性聋,言语频率平均气导听阈为49.3±9.1 dB HL;4例(8.2%)为混合性聋,言语频率平均气导听阈为65.2±10.7 dB HL,平均骨导听阈为50.5±11.3 dB HL.除4例行乳突根治术的患者以外,其余患者术后气导听阈均有较大提高,言语频率平均气导听阈提高15～23 dB.随访18个月～6年未见复发.结论 外耳道胆脂瘤可以造成广泛破坏,术前颢骨薄层CT扫描对诊断有较大帮助.其治疗应根据病变范围、局部感染与否选择合适术式尽早彻底清除病灶.术后患者气导听力多有较大提高.     

食管异物致食管瘘并发纵膈感染1例

患者男,51岁,2015年5月17日入院,患者7 d前误食鱼骨头后出现吞咽困难、吞咽疼痛,可进流食,一直未予诊治,5 d后出现高热、吞咽疼痛加重而于28日就诊于我院消化内科,行食管钡餐检查,结果示：＂食管颈段异物,考虑局部食管溃疡形成,请结合临床＂（图1）。随即行胃镜下食管异物取出术,异物未能取出,遂转来我科,我科门诊医师以＂食管异物、食管穿孔＂收入院。     

颈部外伤致气管食管瘘伴脓胸一例

患者男，36岁。左参见部外伤17日伴进食呛咳及食物自左颈漏出于2003年8月27日入院。患者于2003年8月11日被铁钩击伤颈部，当即颈部左侧距中线4cm平甲状软骨下缘处有一小裂口，伴少量活动性出血．数分钟后感胸闷、气急．半小时后被送至当地医院救治，予以清创缝合。数小时后出现呼吸困难，并有颈部血肿及皮下气肿，当即行气管切开，呼吸困难有所缓解。1d后检查示“右侧胸腔积液”，     

鼻中隔血管平滑肌瘤一例

患者男，73岁，因鼻塞伴流涕2年于2004年9月入院。患者无局部疼痛及鼻出血史，无鼻部外伤史，查体见左中鼻道有一淡红色肿物。CT扫描见左中鼻道有一种物，起源于鼻中隔，充满左侧鼻腔，未延及鼻咽部，窦壁完整，无明显骨质破坏和增生（图1）。     

腮腺恶性肿瘤合并居泉沙雷菌感染一例

居泉沙雷菌(serratia fonticola)属沙雷菌属,近年其少见的人体感染与部分多重耐药已引起临床重视。恶性肿瘤合并居泉沙雷菌的报道罕见。2019年4月我院收治1例巨大腮腺恶性肿瘤合并居泉沙雷菌感染的病例。入院后根据药敏结果,选用哌拉西林钠舒巴坦钠静脉滴注,单次剂量3 g,每8小时1次抗感染治疗;联合局部伤口换药,每天2次。局部感染控制后手术治疗,患者术后恢复良好出院。术后2个月于当地医院行三维适型放射治疗,左侧术区+双侧颈部Ⅰ~Ⅴ区共放疗50 Gy。术后6个月复查,头颈部及全身无肿瘤复发。     

Spontaneous cholesteatoma of the external auditory canal

Spontaneous cholesteatoma of the external auditory canal is a rare disease which may also be under diagnosed. Few cases have been reported even in major otology centers. Possible theories as to the aetiology are based on observation of these few cases. The correct diagnosis allows the proper treatment avoiding the progression of the cholesteatoma and further hearing loss or other complications. The authors review five cases and discuss the possibility that it is the anatomic structure of the bony external auditory canal bone that might contribute to the etiopathogenesis of these cholesteatomas.     

Classification of the external auditory canal cholesteatoma

OBJECTIVES/HYPOTHESIS: The external auditory canal cholesteatoma (EACC) is a rare disease in the field of otolaryngology. Only 1 in 1,000 new otologic patients present with this entity, which was first described by Toynbee. The aim of this article is to classify EACC by different histopathologic and clinical findings of patients presenting to the Department of Otolaryngology at the University of Mannheim, Germany. METHODS: From 2000 to 2004, 17 patients presented to our clinic with EACC. The cholesteatoma were treated surgically, and the specimens were investigated histologically. Clinical findings were also recorded. We classified four stages: stage I with hyperplasia of the canal epithelium, stage II including periosteitis, Stage III including a defective bony canal, and stage IV showing an erosion of adjacent anatomic structure. RESULTS: Eight patients presented with stage II, five patients with stage III, three with stage I, and only one patient presented with erosion of the mastoid cells, which was determined as stage IV. CONCLUSION: In summary, our classification serves to describe the different histopathologic and clinical stages of EACC.     

Post-traumatic cholesteatoma of the external auditory canal

Post-traumatic cholesteatoma of the external auditory canal is a rare condition which is not mentioned in any of the American or British otological reference works. Three cases are described, and the pathogenesis, management, and medico-legal implications discussed.     

A case of osteoma with cholesteatoma in the external auditory canal

Osteoma in the external auditory canal (EAC) is an uncommon benign lesion, which presents as a solitary, unilateral, and slow-growing pedunculated mass in the outer half of the bony canal. It is usually asymptomatic; but symptoms can arise if a canal obstruction occurs. External canal cholesteatoma is also a rare lesion of the external auditory canal. Cholesteatoma of the external auditory canal may arise via several mechanisms. However, an occlusion or narrowing of the external auditory canal is the basic pathogenesis. The association of an osteoma with a cholesteatoma is extremely rare, and there have been very few reports published. We encountered a rare case of a 49-year-old man with an osteoid osteoma that was complicated by a cholesteatoma in the external auditory canal. The canal wall down mastoidectomy and tympanoplasty successfully removed the osteoma and the cholesteatoma, and no recurrence or complications had occurred in the first 6 months postoperatively.     

Surgical treatment of external auditory canal cholesteatoma

The authors present a series of 12 ears in 10 patients ranging from 18 to 72 years old with external auditory canal cholesteatomas (EACC) seen over an 8 year period. Males and females were equally involved. The left ear was involved 3 times as frequently as the right. No association with sinus or bronchial diseases was seen. Two cases were examined, 3′i and 7 years before the development of any external auditory canal symptoms, and were normal. Two cases of bilateral involvement by EACC were reported. The clinical findings of EACC in this series are discussed. The authors describe a method of surgical treatment used in 12 ears with an average 3 year follow-up and excellent results. The technique involves the excision of the involved skin and periosteum followed by bone debridement. Fascia was used when 1. a large amount of skin had been removed, 2. mastoid air cells were exposed, 3. a soft tissue graft was used to fill a bony defect, or 4. when a portion of the tympanic membrane was sacrificed or its continuity interrupted.     

Congenital primary cholesteatoma of external auditory canal

A 2-year-old female child is reported with congenital cholesteatoma of the right external auditory canal. We describe the clinical features, computed tomography finding and surgical treatment. Congenital cholesteatomas can occur within the temporal bone. Congenital cholesteatoma of the external auditory canal is rare. Generally, it appears in the canal floor. Treatment consists of the resolution of granulation and removal of debris.     

Keratosis obturans and external auditory canal cholesteatoma

Keratosis obturans and external auditory canal cholesteatoma (EACC) have previously been considered to represent the same disease process. However, review of the literature and our cases reveal these to be two different clinical and pathological processes. Keratosis obturans presents as hearing loss and usually acute, severe pain secondary to the accumulation of large plugs of desquamated keratin in the ear canal. External auditory canal cholesteatoma presents as otorrhea with a chronic, dull pain secondary to an invasion of squamous tissue into a localized area of periosteitis in the canal wall. The treatment previously recommended for both of these conditions has been conservative debridement of the external canal and application of topical medication. While this remains the treatment of choice for keratosis obturans, surgery may be required to eradicate EACC.     

易延误诊治的耳外伤后外耳道胆脂瘤

目的探讨耳外伤后外耳道胆脂瘤的临床特点,避免误诊。方法回顾分析11例外伤后外耳道胆脂瘤患者的临床资料,从病史、耳内镜检查、听功能检测、颞骨CT及手术所见等方面总结分析其特征。结果所有患者均有不同程度的头颅外伤史,其中车祸伤致颞骨骨折7例,工地砸伤颞骨骨折3例,狗咬伤1例,均以听力下降为主要症状,伴不同程度的耳闷、耳流脓、耳痛、耳鸣等症状。外伤时间3个月至4年,纯音听阈显示患耳为传导性听力损失,0.5～4 kHz气导平均听阈为（42.10±3.50）dBHL,治疗后3、6、9、12个月,患者纯音听阀评分均低于治疗前,治疗前后进行比较,差异具有统计学意义（P均﹤0.05）;颞骨CT显示,11例患者外耳道均有密度增高影,其中6例上鼓室、鼓窦、乳突区见密度增高影。手术清除病变,通畅引流,11例均治愈。随访3个月至1年,无复发。结论对于外耳道损伤后逐渐有原因不明的听力下降要警惕外耳道胆脂瘤的发生,除脑脊液耳漏外,外耳道裂伤建议碘仿纱条填压并定期追踪观察,防治瘢痕狭窄发生。     

外耳道胆脂瘤的诊断和治疗

目的探讨外耳道胆脂瘤的临床特征和治疗方法。方法回顾性分析1990年1月至2005年1月期间共42例（44耳）外耳道胆脂瘤的临床资料。结果本组因外耳道骨性狭窄所致2耳，骨瘤阻塞所致2耳，其余主要与炎症、耵聍、挖耳损伤等有关。按Holt分期，Ⅰ期7耳．Ⅱ期22耳，Ⅲ期15耳。单纯外耳道胆脂瘤清除术25耳（门诊20耳）中．随访1-5年，外耳道胆脂瘤复发3耳，1耳上鼓室侵犯行改良乳突根治术；9耳伴有外耳道肉芽者，行外耳道肉芽切除术及外耳道胆脂瘤清除术后恢复良好，2耳伴有外耳道狭窄行外耳道成形术；改良乳突根治术5耳．乳突根治术2耳，随访6月～11年，无胆脂瘤复发，1耳术后外耳道口狭窄；先天性外耳道狭窄行外耳道成形术1耳，外耳道骨瘤切除及鼓膜成形术1耳，乳突骨瘤切除并外耳道成形术1耳。结论外耳道胆脂瘤多为自发性．具有破坏性，治疗原则是早期彻底清除胆脂瘤。     

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。