外耳道胆脂瘤32例治疗体会

目的根据外耳道胆脂瘤（external auditory canal cholesteatoma,EACC）的临床表现及颞骨CT特点进行分期,并探讨不同分期患者选择不同治疗方法的临床效果。方法回顾性分析2009年1月～2013年8月收治的32例（33耳）患者的临床资料并对其进行分期。其中Ⅰ期14耳,采用耳内镜下治疗,门诊局麻下一次或分次取出;Ⅱ期8耳,全麻显微镜下清除胆脂瘤后,再行外耳道成形术及耳甲腔成形术;Ⅲ期11耳,全麻下行改良乳突根治术,彻底清除外耳道、鼓室及乳突病变,视鼓室条件及听骨链受损情况选择一期或二期行鼓室成形术。结果Ⅰ期、Ⅱ期恢复良好,听力基本恢复正常;Ⅲ期恢复良好,择期行二期鼓室成形术,听力有不同程度提高。结论对EACC病变程度进行确切的分期,根据不同病变程度采取不同的治疗方法,可以获得较好的治疗效果。     

外耳道胆脂瘤临床特征及治疗

目的：探讨外耳道胆脂瘤的临床特点,为手术方式的选择提供参考。方法回顾性分析2006年8月～2014年12月住院手术治疗并经病理确诊的38例（39耳）外耳道胆脂瘤患者的临床资料,总结其症状、体征、术前CT表现、临床分期、手术方式及疗效。结果所有病例外耳道均可见灰白色物或肉芽样物阻塞,术前以听力下降为主要主诉（100％,39／39）,其次是耳闷涨感（79．49％,31／39）及耳痛（74．36％,29／39）。39耳外耳道胆脂瘤结合术前CT ,按 Holt分期：I期10耳,病变局限在外耳道,无骨质破坏;II期23耳,病变位于外耳道,伴骨质破坏,未累及中耳;III期6耳,病变破坏外耳道并累及中耳乳突和／或鼓室、鼓窦。I期行外耳道胆脂瘤切除术;II期行外耳道胆脂瘤切除术＋外耳道成形术和／或鼓室成形术;III期行外耳道胆脂瘤切除术＋鼓室成形术＋乳突切除术。术中见31耳鼓膜完整、内陷,8耳鼓膜松弛部穿孔,4耳听骨链砧镫关节破坏,1耳面神经垂直段裸露。所有病例均一次完成手术,听力恢复良好,无复发。结论外耳道胆脂瘤易误诊,根据临床分期选择合适手术方式可获得满意疗效。     

外耳道胆脂瘤诊疗进展

外耳道胆脂瘤(external auditory canal cholesteatoma,EACC)是一种少见的耳鼻喉科疾病,临床症状不具有特征性,早期病变容易误诊、漏诊,其病因和发病机制尚未完全明了,国际上尚无统一的分型和分期,治疗原则为保守或手术清理胆脂瘤组织,术式选择多样。本文对EACC的病因、发病机制、分型分期和诊断治疗进展做一综述,以期给临床提供一点帮助。     

外耳道胆脂瘤的临床特征及疗效分析

目的：研究外耳道胆脂瘤的临床特征及疗效分析。方法回顾性分析了106例（108耳）外耳道胆脂瘤患者的临床资料,主要包括病因、临床症状、耳内镜及颞骨CT检查结果及治疗方法。结果患者的平均年龄34.29岁（6～86岁）,男36例,女70例。单耳发病104例,其中右耳65例,左耳39例,双耳2例。临床表现主要以耳闷胀感、听力下降、反复耳痛多见,外耳道可见耵聍栓塞、肉芽、白色胆脂瘤团块。85例行耳内镜手术,11例行外耳道扩大术,10例行乳突改良根治术。术后随访6月～5年,所有病例均治愈。结论外耳道胆脂瘤主要发生在单耳,右耳多见。伴性别差异,本组病例女性﹥男性,40岁以下多见。主要病因考虑后天性阻塞为主,多合并耵聍栓塞。外耳道胆脂瘤应预防为主,早期诊断,早期治疗,手术治疗是唯一的方法,结合颞骨CT检查及术中情况决定手术方式,大多数病例可在耳内镜下完成,治疗效果显著。     

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。     

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32例治疗分析

外耳道胆脂瘤也称外耳道阻塞性角化症,有观点认为二者是不同的疾病,但仍存在争议,致病原因迄今尚未完全明确.我科自2006-02-2009-06共治疗病理确诊为外耳道胆脂瘤且资料完整的患者32例,现总结报告如下.1 资料与方法     

外耳道胆脂瘤1例

患者,女,33岁。既往体健,无中耳乳突炎病史,因左耳疼痛伴有分泌物半个月余来我科诊治。曾在其他两家医院以“急性中耳炎”治疗,效果不佳,并感病情逐渐加重,耳痛明显,有时伴有脓血性分泌物,具有臭味,听力轻度下降。体检：一般情况良好,左外耳道皮肤肿胀糜烂．有中量白色物质栓塞及少量脓血性分泌物。外耳道后下壁有肉芽组织生成,鼓膜窥不见,耳道物质活检提示,胆脂瘤样物质。术前CT检查提示：中耳及乳突结构正常,     

外耳道胆脂瘤的临床特征

外耳道胆脂瘤（external auditory canal cholesteatoma,EACC）是外耳道所积蓄的含有胆固醇结晶脱落上皮团块所致的外耳道疾病。本病既可以局限于外耳道,也会侵犯乳突及中耳,易与外耳道角化表皮栓及中耳胆脂瘤相混淆。     

Classification of External Auditory Canal Cholesteatoma by Computed Tomography

Objectives

We propose here a classification system for external auditory canal cholesteatoma (EACC). We classified the EACC by the computed tomography findings and clinical findings of the patients, and we evaluated the EACC characteristics by the proposed staging system.

Methods

Stage classification was done according to the results of temporal bone computed tomography and the clinical findings of the patients. Stage I indicates that the EACC lesion is limited to the external auditory canal. Stage II indicates that the EACC lesion invades the tympanic membrane and middle ear. Stage III indicates that the EACC lesion creates a defect of the external auditory canal and it involves the air cells in the mastoid bone. Stage IV indicates that the EACC lesion is beyond the temporal bone. Between 1996 and 2006, 29 patients with EACC and who underwent surgery were prospectively collected. This study was comprised of 16 males and 13 females with a mean age of 22.8±15.0 yr. We reviewed the characteristics and results of surgery by our proposed staging system.

Results

A total of 29 patients who underwent operation due to EACC were classified by this system, and the number of stage I, II, III, and IV cases was 14, 3, 10, and 2, respectively. Symptoms such as otorrhea, hearing impairment and otalgia occurred in 12, 17, and 17 cases, respectively. The most common wall invaded by EACC was the inferior wall. The number of cases that had a spontaneous, congenital, post-traumatic, post-inflammatory or tumorous origin was 14, 9, 2, 2, and 1, respectively. Cholesteatoma recurred in 2 patients after surgery. Both cases were stage 1 and both were caused by congenital disease. There were 3 cases with meatal stenosis after surgery, and their primary disease was congenital.

Conclusion

This proposed staging is simple and easily applicable for use when deciding the treatment plan for patients with EACC.     

外耳道胆脂瘤不同累及程度的临床特征分析

目的 收集、分析近5年不同累及程度的外耳道胆脂瘤(External Auditory Canal Cholesteatoma,EACC)患者临床特征,为临床早期诊断、治疗EACC提供依据及思路.方法 回顾性分析国内某知名三甲医院5年间收治的237例EACC患者的临床资料,将EACC患者分为:EACC局限于外耳道内且无明...     

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...     

外耳道胆脂瘤临床特点及不同分期方案的比较研究

目的探讨外耳道胆脂瘤的临床特征及不同分期方法的特点。方法回顾性分析我科诊治的51耳外耳道胆脂瘤临床资料,归纳分析其年龄、性别、侧别、症状、骨质破坏部位、听力及CT表现等临床特征。采用Holt、Naim、Shin、Chang、Kaneda、叶长发、雷雳、黄宏明提出的共8种不同的外耳道胆脂瘤的分期方案分别对上述病例进行分期,分析各分期方案的特点并比较各方案中困难或无法分期的病例比例。结果本组病例年龄7~80.2岁,中位数44.3岁;18耳为男性,33耳为女性;23耳为左耳病变,28耳为右耳病变;临床症状为听力下降或堵塞感47耳、耳痛45耳、耳漏36耳、耳鸣20耳、瘙痒感3耳;骨质破坏位于外耳道下壁42耳、后壁40耳、前壁33耳、上壁29耳;治疗前纯音测听(500、1K、2K Hz)骨导13.8±5.1 d B,气导30.3±8.3 dB。虽Holt、Naim、Shin的分期方案引用广泛,但均存在一定的缺陷,本研究显示分期方案中,困难或无法分期比例从高至低依次是Kaneda、雷雳、Naim、Chang、Holt、叶长发、Shin、黄宏明。结论黄宏明的分期方案操作简便,较好的反映了疾病的进展,对治疗方案的决策有一定指导意义,推荐临床使用。     

Ⅲ、Ⅳ级外耳道胆脂瘤的手术治疗

目的探讨Ⅲ、Ⅳ级外耳道胆脂瘤(Naim分级)临床特点、手术指征及手术方式,评价其疗效。方法回顾分析2003年10月～2011年3月住院的52例Ⅲ、Ⅳ级外耳道胆脂瘤(Naim分级)患者,共55耳手术。所有患者行外耳道胆脂瘤摘除同时行外耳道成形,术后外耳道置膨胀海绵。术后三个月门诊复诊,并行纯音测听检查,随后要求每年门诊复诊一次,如有明显不适可门诊随诊,本组病例随访时间为14至105月之间,平均45.17±3.23月。结果本组病例中,最常见的症状是听力下降(80.00%,44耳),55耳中有2耳分别于术后1年和2年后复发,1耳外耳道术后1年出现膜性闭锁,2耳分别于术后6月、1年出现外耳道深部狭窄,其余患者目前外耳道通畅,上皮化良好,干燥,鼓膜完整。结论外耳道胆脂瘤一旦破坏外耳道骨质,导致外耳道口狭小,胆脂瘤不能自行排空应行手术清除病灶,同时行外耳道+耳甲腔成形,建立通畅引流,消除胆脂瘤形成的因素。术后外耳道内填塞膨胀海绵能有利于上皮沿外耳道生长,防止外耳道闭锁。     

Microbiology of Normal External Auditory Canal

Objectives To isolate and characterize bacteria and fungi from the healthy ear and to obtain susceptibility profiles on each bacterial isolate. Study Design Prospective. Methods Specimens were collected from the external canals and cerumen of healthy subjects. Species‐level identification was obtained by combining phenotypic and genotypic data. End‐point minimal inhibitory concentration testing was performed using National Committee for Clinical Laboratory Standards recommended methods. Results One hundred sixty‐four subjects were cultured. Seventeen canal and 16 cerumen specimens showed no growth. One hundred forty‐eight cerumen specimens yielded 314 organisms, including 23 fungi. One hundred forty‐seven canal specimens yielded 310 organisms, including 7 fungi. Of 291 bacteria isolated from cerumen, 99% were Gram‐positive. Of 302 bacteria isolated from the canal, 96% were Gram‐positive. Staphylococci were 63% of both the cerumen bacteria and the canal bacteria. Coryneforms represented 22% of the bacteria in cerumen and 19% in the canal. Turicella otitidis was the primary coryneform isolated from both the canal and the cerumen. Streptococci‐like bacteria were 10% from the cerumen, 7% from the canal. In both cerumen and canal, Alloiococcus otitis was more than 95% of the streptococci‐like bacteria. Fifteen gram‐negative organisms were isolated from the canal and cerumen, including four Pseudomonas aeruginosa strains. The percentages of Staphylococcus epidermidis isolates that had high‐level resistance (≥8 μg/mL) were as follows: to neomycin, 28% from cerumen and 11% from the canal; to oxacillin, 28% from cerumen and 25% from the canal; and to ofloxacin, 15% from cerumen and 19% from the canal. Conclusions Turcella otitidis and A. otitidis were present with a much higher frequency than previously described, lending evidence that they be considered normal otic flora. Corynebacterium auris, previously reported only in children, was isolated from normal adults.