同种肋软骨外耳道后壁及听力重建术

目的：消灭乳突根治术后遗留的开放乳突腔及外耳道后壁缺损。方法：采用同种异体肋软骨对乳突根治术后１７耳行外耳道后重建及乳突腔充填,同时Ⅰ期进行传音结构重建,其中部分听骨替换假体术式８耳,全听骨替换假体术式９耳。结果：经６个月￣２年随访,全部病一壁接近正常生理结构,完全成功１４耳,部分成功２耳,失败１耳,术后３个月鼓膜重新穿孔流脓。结论：以同种异体肋软骨对乳突根治术后耳行外耳道后壁及听力重建术,是防止     

骨性外耳道后壁重建鼓室成形术治疗胆脂瘤型中耳炎的疗效观察

目的：探讨处理乳突根治术后遗留的外耳道后壁缺损及开放的乳突腔的方法。方法：应用骨性外耳道后壁重建鼓室成形术治疗胆脂瘤型中耳炎58例（58耳）,清除病变的同时以颞骨皮质骨行骨性外耳道后壁重建并Ⅰ期行鼓室成形术。结果：随访1～3年,仅有1例胆脂瘤复发（复发率1．72％）。外耳道接近正常形态,保留含气乳突腔。纯音听阈提高30dBHL以上者（极效）5耳,提高20～29dBHL者（显效）11耳,提高10～19dBHL者（有效）30耳,总有效率为79．31％（46／58）,〈10dBHL者（基本无效）8耳,无听力提高者（无效）4耳。术后平均气导听阈明显减少。结论：乳突根治术后以颞骨皮质骨行骨性外耳道后壁重建并Ⅰ期行鼓室成形术,有助于修复乳突根治术后遗留的外耳道后壁缺损及开放的乳突腔,改善听力,降低胆脂瘤复发率,是一种较为实用的手术方法。     

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     

软骨软骨膜在鼓膜修补中的应用

目的探讨鼓膜大穿孔采用软骨-软骨膜修补的方法及临床疗效。方法36例（40耳）鼓膜大穿孔（软骨-软骨膜组）采用软骨-软骨膜行鼓膜修补术并与同期46例（46耳）颞肌筋膜鼓膜修补术（颞肌筋膜组）进行比较。软骨-软骨膜组采用耳后切口,切取耳廓软骨-软骨膜,然后将软骨切成2～3条,将其相互部分重叠修复穿孔,修补鼓膜,同期行听骨链重建。结果随访1年,软骨-软骨膜组鼓膜穿孔愈合率为95.0%（38/40）;筋膜组鼓膜穿孔愈合率为89.1%（41/46）,两组相比无统计学意义（χ2=0.288,P=0.592）。颞肌筋膜组17耳鼓膜有钙化斑中,5耳穿孔未愈,占29.4%（5/17）;软骨-软骨膜组20耳鼓膜有钙化斑,其中1耳穿孔未愈,占5.0%（1/20）。两组鼓膜有钙化斑的病例鼓膜穿孔愈合率相比有统计学意义（χ2=4.031,P=0.045）。术后1年复查软骨-软骨膜组纯音听力平均气导听阈为36.9dB,平均骨气导差为17.8dB;筋膜组纯音听力平均气导听阈为35.5dB,平均骨气导差为15.9dB。两组比较无统计学意义（t=2.103,P=0.85）。结论软骨-软骨膜修补鼓膜穿孔是一种可靠的方法,其在修补鼓膜大穿孔和鼓膜伴有钙化斑的患者中有一定的优势。     

外耳道后壁和上鼓室外侧壁重建并鼓室成形术的临床应用

目的探讨外耳道后壁和上鼓室外侧壁同期重建在鼓室成形术中的意义。方法30例（31耳）慢性化脓性中耳炎患者,骨性外耳道预先取骨备用。清除病灶后进行外耳道后壁和上鼓室外侧壁重建,并行I期行鼓室成形术。结果术后随访3个月～1年,31耳均获得干耳;外耳道形态接近正常,保留含气乳突腔。术后平均气导听阈提高〉20dB以上者22耳,提高10-20dB者8耳,提高〈10dB者1耳。结论同期行外耳道后壁和上鼓室外侧壁重建并I期行鼓室成形术,有助于修复乳突根治术后遗留的乳突空腔或大外耳道,有助于改善听力。     

外耳道后壁重建及鼓室成形术新进展学习班通知

广州市耳鼻咽喉头颈外科医院（广州市第十二人民医院）将于2012年5月17～20日在广州市举办国家级继续医学教育项目“外耳道后壁重建及鼓室成形术新进展学习班”（编号：2012-07—01-102）。     

外耳道后壁重建及鼓室成形术新进展学习班通知

广州市耳鼻咽喉头颈外科医院（广州市第十二人民医院）将于2011年9月28～30日在广州市举办国家级继续医学教育项目＂外耳道后壁重建及鼓室成形术新进展学习班＂,编号：2011-07-01-102（国）。     

外耳道后壁重建式乳突切除术和鼓室成形术的临床疗效观察

目的初步探讨在部分乳突腔狭小而需行乳突切除术的慢性化脓性中耳乳突炎(主要为胆脂瘤型和骨疡型及两者兼有的混合型)患者,外耳道后壁重建式乳突切除术在既需彻底清除病灶、又应尽可能多地保留或改善听觉功能方面的临床价值和意义.方法对临床7例因中颅窝底低位和乙状窦壁前位而造成乳突腔狭小的胆脂瘤型和/或骨疡型中耳乳突炎患者,在行乳突切除术中采用外耳道后壁切除和重建技术,最终保持完整的鼓室和外耳道壁,再行Ⅰ期或Ⅱ期鼓室成形术重建鼓室传音结构,手术前后检查听觉功能,与同期进行的12例慢性化脓性中耳乳突炎而行经典的完壁式乳突切除术患者进行对照.结果外耳道后壁重建技术可有效地解决乳突腔狭小患者行完壁式乳突切除术中病灶清除困难、并发症发生率高、易致胆脂脂瘤等病变组织残留或复发等问题.本次观察的全部19例患者在行Ⅱ期鼓室成形术或鼓室探查术中均未发现胆脂瘤复发,术后平均气导听阈较术前明显降低,传导性聋的改善程度两组之间无显著性差异,未发生明显的手术并发症.结论采用外耳道后壁重建技术的完壁式乳突切除术可基本达到与经典的完壁式乳突切除术等同的听觉功能保留与提高效果,故对于有相关适应证患者,应作为常规选择手术方式.Ⅰ期或Ⅱ期鼓室成形术对于提高中耳传音功能(即听力水平)具有重要的临床价值和意义.     

保持外耳道后壁完整的上鼓室切开软骨重建技术在中耳炎手术中的应用

目的观察在保持外耳道后壁完整的情况下,上鼓室切开软骨重建技术在中耳炎手术中的应用及疗效。方法对45例（耳）中耳胆脂瘤和13例（耳）活动期中耳炎患者,在保留外耳道后壁乳突切开、上鼓室外侧壁切除或及经砧骨窝向下开放面隐窝,清除听骨链区（包括上鼓室、中后鼓室）及鼓窦乳突区病变后,行上鼓室软骨封闭重建术,术后随访12～36个月,观察术后中耳炎胆脂瘤复发、鼓膜形态及听力提高等情况。结果58例（耳）术后重建的上鼓室外侧壁与保留的外耳道后壁相连接。本组病例中6例术后外耳道后壁肿胀或皮肤缺损,继续换药4~5次后愈合良好;3例患者出院后仍有少量流脓,鼓膜边缘穿孔,门诊局部给药后延迟愈合;3例听骨脱出、2例鼓膜再穿孔、2例24个月后原胆脂瘤复发,行开放式手术后治愈。术后6个月复查纯音听力测试,并与术前进行比较,听力均有不同程度提高,0.5、1、2 kHz气骨导差平均减10 dB,气导听阈平均提高15 dB 左右。结论在保持外耳道后壁完整的情况下,上鼓室切开软骨重建技术在中耳炎外科手术中的应用,既能够充分暴露病变,病灶清除彻底,同时又保留了外耳道的形态,可有效防止鼓膜回缩袋的形成,降低了胆脂瘤的复发,又避免了开放式手术所残留的宽大术腔。术后鼓膜形态恢复良好,从而保持或提高了患者的听力。     

断桥式乳突根治术中用带蒂颞肌骨片重建外耳道后壁

目的 探讨在开放式鼓室成形术中，既能彻底清除病灶，又能恢复正常的中耳及外耳道解剖结构的方法，达到提高听力的目的。方法 用带蒂颞肌骨片对47例（耳）胆脂瘤型中耳炎病人于开放式鼓室成形术中，行外耳道壁修复重建术。结果 47例（耳）病人术后经0．5～3年随访，12耳听力提高15 dB （25．53％），15耳提高20dB（31．91％），7耳提高30dB（14．89％），3耳提高40dB（6．38％），2耳提高50dB（4．26％）；8耳提高小于15dB（17．02％）。所有重建的外耳道壁及中耳乳突腔均接近正常状态，无外耳道闭锁或塌陷。结论 利用带蒂颞肌骨片在开放式鼓室成形术中行外耳道壁重建，既能彻底清除中耳乳突腔内的胆脂瘤及肉芽组织，又能保证良好的外耳道和中耳的形态和功能。术后听力提高明显．是较为理想的手术方式。     

耳后带蒂复合皮瓣移植填塞乳突术腔 并重建外耳道后壁

目的探讨陈旧性根治性乳突术腔填塞及外耳道后壁缺损的修复方法。方法采用耳后带蒂复合皮瓣移植,对10例(11耳)行乳突根治术后1～6年的患者,行陈旧性乳突术腔填塞及外耳道后壁缺损重建术,并同期行鼓室成形术。结果术后随访3～30个月,全部患者乳突术腔消失,外耳道大小接近正常;术后干耳时间2～3周,“根治腔病”症状明显好转,平均听阈下降13.6dBHL。结论本方法缩短了术后干耳时间,对乳突根治术后的“根治腔病”具有明显的治疗效果,有利于鼓室成形术。     

保存骨性外耳道的乳突切除术及鼓室成形术失败病例分析

为总结清除中耳乳突病灶的同时保留外耳道骨性结构和重建鼓室手术的经验教训，列举4个失败病例，详细分析其临床特点及失败原因。手术失败原因包括适应证和手术分期选择不当，手术操作不慎，病灶处理不彻底及换药不够等。保存骨性外耳道有利于重建正常鼓室及传音结构，较之传统根治术有很多优点，但应严格把握适应征的选择，提高手术技巧。     

Mastoid obliteration combined with soft-wall reconstruction of posterior ear canal

To clarify the usefulness of modified soft-wall reconstruction method by combing with mastoid obliteration, 96 patients (98 ears) with their age ranging from 5 to 82 (average 51.3), including 62 ears with chronic otitis media (COM) with cholesteatoma, 18 ears with non-cholesteatomatous COM, 14 ears with postoperative cavity problem, and 4 ears with adhesive-type COM, who had soft-wall reconstruction of the posterior ear canal and mastoid obliteration using mainly bone powder following mastoidectomy, were evaluated their postoperative conditions more than a year after surgery. Overall success rate was 76.5% (75/98), and fresh cases showed better success rate (84.8%) than those with a history of multiple surgeries (69.2%). Among unsuccessful cases, crust and/or debris accumulation was observed most (nine ears), followed by persistent wet condition (seven ears), and exposure of the obliterated material (five ears), while only two ears showed a retraction pocket formation. The success rates remained almost the same among those who were followed for more than 2 and 3 years (46/61, 75% and 21/28, 75%, respectively). In 60 ears on which postoperative hearing was assessed, 41.7% showed less than 15 dB of air-bone gap (ABG), and 61.7% showed less than 20 dB of ABG. Mastoid obliteration with bone powder in combination with soft-wall reconstruction of the posterior ear canal appeared a useful method for obliterating mastoidectomized cavity especially for prevention of postoperative pocket formation. This paper was presented at the 139th Annual meeting of American Otological Society, in Chicago, IL, USA on May 20, 2006, and its abstract appeared in the Transactions of the American Otological Society, Inc.     

Cytokeratin expression patterns in the human tympanic membrane and external ear canal

Summary Immunohistochemical investigations were carried out to further reveal the pattern of cytokeratin (CK) expression in middle ear cholesteatoma. Using chain-specific monoclonal antibodies and the indirect immunoperoxidase technique, 10 out of 19 CK polypeptides were screened in cryoslices of fresh postmortem eardrums and external ear canal specimens. Our data, combined with those published before, indicate an intimate relationship between middle ear cholesteatoma lesions and epidermal tissues in the immediate vicinity. Our CK data do not favor the metaplastic origin of cholesteatoma, because the CK complement of cholesteatoma lesions does not include major and typical CK constituents of the middle ear mucosa.     

外耳道皮下组织压片行鼓膜穿孔修补术

目的探讨应用外耳道上壁中、外段皮下组织压片修补鼓膜穿孔的临床疗效。方法对65例（69耳）由中耳炎或外伤引起的鼓膜穿孔直径大于3 mm伴外耳道狭窄、弯曲患者,用此法行耳内切口、扩大外耳道,用外耳道上壁中、外段皮下组织压片行鼓膜修补术。结果67耳鼓膜穿孔修补术后愈合,穿孔愈合率97.1%。修补鼓膜愈合时间平均15.2 d。术后外耳道宽畅。随访0.5-3.5年,无鼓膜再穿孔。术后纯音测听（取0.5,1,2,4 kHz）气导听力提高10-30 dB（平均18.6 dB）者66耳,气骨导差距在10-20 dB,较术前平均缩小16.8 dB,听力改善率95.7%。另3耳听力无改善。结论用耳道上壁中、外段皮下结缔组织压片修补鼓膜穿孔是一种取材简便、术野显露好、愈合时间短、穿孔愈合率高的新术式,更适合鼓膜穿孔大、外耳道狭窄和弯曲者。     

Cavernous hemangioma of the external ear canal

OBJECTIVE: To document the occurrence of a cavernous hemangioma of the external ear canal and to review the relevant literature.STUDY DESIGN Case report and literature review. METHODS: Review of a patient chart, imaging studies, operative report, and histologic findings. RESULTS: A cavernous hemangioma of the external ear canal not involving the tympanic membrane was surgically excised without complication. This is the third documented cavernous hemangioma of the external ear canal without tympanic membrane involvement in the English literature. Computed tomography scan is invaluable to narrow the differential diagnosis. Complete removal is curative. CONCLUSIONS: Cavernous hemangioma of the external ear canal with or without tympanic membrane involvement is a rare otologic entity amenable to surgical treatment. Temporal bone computed tomography scan imaging is an important preoperative diagnostic tool.     

Cochlear implant after reconstruction of the external bony canal wall and tympanic cavity in radically mastoidectomized patients with cholesteatoma

One of the postoperative complications of cochlear implants in patients, who previously received radical mastoidectomy, is an exposure of electrode by breakdown of thin epithelium in the open mastoid cavity. To avoid such complications, in the first stage, radical mastoidectomy with the reconstruction of the posterior bony canal wall and mastoid obliteration with bone chips and plates and the creation of the new tympanic cavity, were performed. One or 3 years later, implantation of a 22-channel cochlear implant, as the second stage procedure, was successfully performed in three patients with profound sensorineural hearing loss, due to cholesteatoma in the side of the ear in which cochlear implantation was indicated. The advantages of this technique are as follows: (1) Electrode is protected from the cavity problems, such as chronic infection or erosion of the epithelium in the open mastoid cavity; and (2) reconstruction of the new tympanic cavity and tympanic membrane is beneficial for avoidance of electrode exposure in the mastoid and tympanic cavity.     

完整骨性外耳道鼓室成形术治疗胆脂瘤型中耳炎疗效观察

目的 探讨完整骨性外耳道鼓室成形术对骨性外耳道缺损重建及对听力、干耳、术后大术腔引起耳部不适症状的影响。方法 2006～2010年收治胆脂瘤型中耳炎72例,按手术方式分为两组：对照组为开放式,采用乳突根治术或改良乳突根治术;观察组为完整骨性外耳道鼓室成形术,术中在彻底切除病变组织的同时保留或重建骨性外耳道。结果 与传统乳突根治术或改良乳突根治术相比,完整骨性外耳道鼓室成形术在听力提高、干耳及消除不适症状方面有更好疗效。结论 胆脂瘤型中耳炎术中保留或重建骨性耳道对术后提高听力、尽早干耳及消除“根治腔病”疗效显著。