外耳道成形术失败原因分析

长期以来外耳道成形术的远期疗效一直不够理想，常因皮瓣挛缩致狭窄或闭锁。本文将我科1990年2月～1997年5月经治的外耳道成形术11例12耳光后两次手术的临床资料进行分析，旨在找出失败原因。亚临床资料11例中男4例，女7例；年龄2～74岁。第2次与第1次手术时间相距4个月～1年8个月。第1次手术时病因：先天性耳园畸形伴外耳道闭锁6耳，外伤性外耳道闭锁或狭窄2耳，外耳道乳头状瘤切除术后外耳道闭锁4耳。第1次手术术式：行骨性外耳道扩大加置游离皮瓣8耳，采用耳后皮瓣前移加游离皮瓣覆盖4耳。第2次手术发现：外耳道内段闭锁5耳，外耳道口及…     

根治性外耳道成形术治疗严重慢性外耳道炎

多数慢性外耳道炎通过保守治疗及外科手术可得到控制。在某些特别严重的病例 ,这些方法还不足以改善外耳道的通畅和引流。该作者介绍了一种应用根治性手术处理严重慢性外耳道炎的新方法 ,共 2例患者。1例 5 2岁男性 ,双耳痒伴耳流脓 ,右耳确诊为慢性中耳炎行右侧单纯乳突凿开术 ,因外耳道炎住院保守治疗 3次 ,并行左耳乳突根治及外耳道扩大手术 ,效果不佳。另 1例 4 9岁女性 ,耳痒 2 0年 ,病理检查示轻度银屑病改变 ,保守治疗 3年无明显疗效。手术方法 :耳后“C”形切口 ,预留耳后肌瓣 ,将外耳道后壁磨低至鼓环水平 ,充分磨除乳突气房形成…     

外耳道成形术在筋膜外植法鼓室成形术中的应用

目的：观察在筋膜外植法鼓室成形术中施行外耳道成形木的作用。方法：在筋膜外植法鼓室成形术同时行外耳道成形术59耳（部分伴完壁式乳突根治术）,通过耳道内和耳后联合切口,分离外耳道后壁皮瓣并向前上翻起固定,游离外耳道前壁皮肤,磨除外耳道前下方悬骨及周边骨质,扩大骨性外耳道,开放鼓沟,充分暴露鼓环,鼓膜彻底去上皮化。清除中耳病变后,外植铺放颞筋膜,回复外耳道前壁皮肤和后壁皮瓣,明胶海绵固定。术后1周开始滴耳,外耳道明胶海绵4～6周自然排空。结果：随访0．5～3．5年,所有患者切口Ⅰ期愈合,外耳道宽敞,鼓膜形态好,无皮瓣坏死、外耳道狭窄和胆脂瘤珠形成等并发症。结论：外耳道成形术是筋膜外植法鼓室成形术的必备步骤,有助于鼓膜彻底去上皮化、筋膜铺放及避免胆脂瘤珠形成,并且便于术后观察。     

夹层法鼓膜成形术中外耳道成形术的应用

目的:探讨外耳道成形术在夹层法鼓膜成形术中的作用。方法:在慢性化脓性中耳炎手术中应用外耳道成形术结合夹层法鼓膜成形术。经耳后切口,分离外耳道后壁皮瓣和鼓膜上皮层,磨除部分外耳道后壁、上壁、下壁骨质,并继续向前上掀起外耳道前壁皮肤,直至形成外耳道皮筒,以金属片保护皮筒,磨除外耳道前下方突出骨质,充分显露鼓环。探查听骨链活动情况后,以颞肌筋膜覆盖外耳道骨质和残余鼓膜纤维层表面,复位外耳道皮筒,以止血纱布和止血海绵填塞外耳道。术后1周拆线,术后2周拆除外耳道填塞物,改换无菌纱条直至痊愈。结果:125例(130耳)患者切口Ⅰ期愈合,鼓膜成活率为100%;平均骨气导差距缩小8.9dB。无外耳道狭窄和前壁钝角愈合情况。随访1～3年,3耳感染后出现再次穿孔,8耳鼓膜内陷,15耳随访中出现鼓膜炎而再次耳漏,经局部应用糖皮质激素软膏治愈。结论:外耳道成形术是夹层法鼓膜成形术中的重要步骤,它可使狭窄、弯曲的外耳道变宽敞并消除前壁突出骨质,充分暴露穿孔缘;可提高移植筋膜的成活率,便于术后护理。     

鼓膜成形术失败的原因分析

1988年12月至2002年12月对98例(102耳)慢性单纯型化脓性中耳炎施行了鼓膜成形术，其中有26例(26耳)手术失败。现分析报告如下。     

直入式径路外耳道鼓室成形术治疗先天性外耳道闭锁

探讨直入式路手术治疗先天性外耳道闭锁及中耳畸形的疗效和适应证。方法分析了１９８８年１月－１９９７年１２月１０年间经直入式径径路手术治疗的患者５３耳。按患者术前高分辨率颞同ＣＴ图像中外耳道区内骨质结构的不同,将其分为硬化型,松质型、气化型和混合型４个类型。     

外耳道成形术与鼓膜成形术-House与Fisch比较

外耳道成形术是鼓膜成形术的有机组成部分,鼓膜成形术是修补鼓膜的技术。实施外耳道成形术时House与Fisch在耳后切口、耳后骨膜瓣、外耳道内切口、外耳道后壁及前壁皮肤的处理等方面均有差异;实施鼓膜成形术时House与Fisch在内植与外植概念、常用植入筋膜方式、颞肌筋膜处理方式、鼓环的处理、外耳道皮瓣制作、筋膜放置方式、皮瓣复位等方面各有不同。     

乳突根治术后外耳道后壁重建并Ⅰ期鼓室成形术的疗效观察

目的：探讨处理好乳突根治术后遗留的外耳道后壁缺损及开放的突腔的方法。方法：以乳突根治术治疗胆脂瘤型中耳炎３１耳,骨疡型３耳。并行外耳道后壁中Ⅰ期鼓室成形术,修补外耳道后壁缺损及开放的乳突腔。结果：经５年随访观察,外耳道接正常形态,保留含气突腔,达社交听力者１６耳,达实用听力者１６耳。结论：乳突根治术后外耳道后壁重建并Ⅰ期鼓室成形订,对解决乳突根治后遗留乳突腔或大外耳道,改善听力,是一种较为实用的手     

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。     

Isolated myxoma of the external auditory canal

The majority of neoplasms within the external auditory canal are benign. Management of these primary tumors and their local recurrences are discussed herein. We present a case of an isolated myxoma of the external auditory canal with a review of the common histopathological and radiographic features. Although rare, this highlights the possibility of encountering benign tumor types that carry associated morbidity or mortality due to manifestations outside of the head and neck. Laryngoscope, 124:1220–1222, 2014     

外耳道狭窄或闭锁的手术治疗

目的：探讨外耳道狭窄手术治疗的经验及体会。方法：回顾性分析我科10例外耳道狭窄或闭锁患者的临床资料,其中单纯骨部狭窄1例、软骨部病变3例、软骨部＋骨部病变2例、外耳道及中耳病变4例。本组6例患者采用耳道内切口入路或（和）耳后切口入路去除狭窄性病变,扩大外耳道腔;4例合并慢性中耳炎患者则同时行鼓室成形术。结果：所有患者随访8~50个月,8例患者恢复良好,2例患者再次出现外耳道狭窄或闭锁。结论：外耳道成形术要选择合适的手术入路,彻底清除狭窄性病变。     

Post-inflammatory acquired atresia of the external auditory canal

Acquired atresia of the external auditory canal (EAC) is a rare cause of conductive hearing loss. It has been traditionally classified into 4 categories: traumatic, post-operative, neoplastic and inflammatory.Post-inflammatory acquired auditory canal atresia is thought to be the result of chronic and repetitive infectious bouts affecting the auditory canal. Nevertheless, the underlying pathophysiology of this disorder is yet to be fully elucidated. Current data fail to clearly state the impact that certain underlying systemic disorders may have on the EAC. The possible association to metabolic disturbances such as iron deficiency is also emphasized.In the light of these findings, this analysis can be used to improve the classification of this entity thereby standardizing the assessment of therapeutic approaches.     

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。     

外耳道完整切除术治疗早期外耳道癌的临床研究

目的：提高早期外耳道癌诊断和手术治疗效果，介绍外耳道完整切除的手术方法。方法：回顾性分析12例早期外耳道癌的临床表现，所有患者均采用外耳道完整切除、颞骨侧切除和腮腺浅叶切除，随访1～3年。结果：男7例，女5例；年龄28～75岁，其中T1 4例，T2 8例。8例患者术前耳部疼痛或胀痛。6例患者术前有耳流水，其中3例患者有血性分泌物。查体外耳道可见大小不等的新生物，6例患者术前活检而被诊断，另6例以外耳道新生物为主诉，行外耳道肿块切除后病理确诊。术后病理诊断：腺样囊性癌6例，鳞状细胞癌5例，耵聍腺癌1例。腮腺组织和腮腺表面淋巴中未见有肿瘤累及，外切缘足够，向内未突破鼓膜。5例鳞状细胞癌，1例耵聍腺癌和3例腺样囊性癌患者术后接受放射治疗。所有患者在随访期间无瘤存活。有6例患者术后出现术侧不完全性面瘫，House—Brackmann评分为3～4级，均在术后1～3个月内完全恢复。12例患者术前平均听阈（500，1000，2000 Hz）为38dB，术后平均听阈（500，1000，2000 Hz）为65dB，均为传导性听力下降。1例患者术后出现腮腺涎漏，经加压包扎后痊愈。结论：及时的病理活检是诊断早期外耳道癌的关键。具有安全边缘的外耳道的完整切除是提高手术效果的有效途径。     

Fibro-osseous lesions of the external auditory canal

OBJECTIVES: To differentiate a novel type of benign circumscribed bone lesion of the external auditory canal from those described previously, such as exostoses and osteomas. STUDY DESIGN: Information was obtained from computed tomography (CT) images, surgical findings, and pathologic study. METHODS: Five patients (26 to 82 years old) who presented a hard, round, unilateral, skin-covered mass occluding the external auditory canal to varying degrees were studied. A CT study carried out before resection of the lesions by curettage disclosed the absence of a bony connection to the underlying structures. All the tissue specimens underwent pathologic study. RESULTS: CT and surgical findings demonstrated the absence of a connective pedicle. The pathologic findings showed lesions consisting of an osteoma-like bone formation with sparse osteoblastic areas; mature lamellar bone was observed in three cases, bone marrow containing adipose tissue and hematopoietic remnants in two, and a dense, collagenous stroma in another. They all showed irregular trabeculae, bordered by osteoid osteoblasts. In no case was there evidence of a relationship to the cartilaginous tissue or to the bony structures of the external auditory canal. CONCLUSIONS: The data obtained from the clinical, CT, surgical, and pathologic findings suggest the existence of a lesion unlike those previously known, possibly related to ossifying reactions in other parts of the organism.     

外耳道胆脂瘤(附29例临床分析)

目的 探讨外耳道胆脂瘤的病因及骨破坏的机理。方法 采用回顾性研究方法，总结分析经临床和病理确诊的29例(30耳)外耳道胆脂瘤的临床诊治情况。结果 本组除9例(9耳)为外耳道狭窄所致，其余均为自发性外耳道胆脂瘤；本组病例均有不同程度、不同方向的骨性外耳道侵蚀扩大。其中15例侵入乳突鼓窦及上鼓室，6例面神经垂直段骨管破坏，2例面神经部分裸露伴轻微面瘫，2例外耳道前壁死骨形成，2例伴有脑板破坏；18例(19耳)鼓膜完整，11耳鼓膜紧张部穿孔，3例昕骨链破坏。本组均采用了显微镜下病灶清除术，未发生并发症，术后随访半年～5年无复发。结论 外耳道胆脂瘤发病率明显低于胆脂瘤性中耳炎，两者具有相同的组织来源为鳞状上皮过度增生，具有骨质破坏等生物学行为；自介素-I(IL-I)、肿瘤坏死因子-α(TNF-α)及多种免疫细胞等可能直接参与鳞状上皮的过度增生和骨破坏。早彻底清除病灶是根治本病、防止并发症发生的唯一手段。     

Adenoid cystic carcinoma of the external auditory canal

Objective/Hypothesis: To describe the clinical history and outcome of patients with adenoid cystic carcinoma (ACC) of the external auditory canal (EAC). Study Design: Retrospective case series. Methods: A search of our institution's tumor registry identified 22 patients with ACC of the EAC. Both clinical histories and pathology slides, when available, were reviewed. Results: The mean age at diagnosis was 42 years (median, 38.5 years), and the most common presenting complaints were otalgia and ear canal mass. Nine patients (41%) developed recurrences at a mean of 8 years (median, 8 years) after initial diagnosis, six died of ACC, and three were living with distant metastases at their last follow-up. The mean duration of symptoms at the time of diagnosis was 7.7 years (range, 2–30 years) for patients who developed a recurrence after treatment vs. 1.2 year (range, 0–2 years) for patients who remained disease-free (P = .137). Every patient who had recurrent disease reported a duration of symptoms of ≥2 years (P = .013), and every patient with a duration of symptoms >2 years recurred (P = .002). There was a trend for more local recurrences after limited resection (P = .061). Conclusions: ACC of the EAC often recurs many years after definitive treatment. Although our sample size was too small to make definitive conclusions, we recommend aggressive local therapy with lateral temporal bone resection and adjuvant postoperative radiotherapy. In addition to successful local therapy, early diagnosis may be the only other effective means of preventing distant metastases.