外耳道胆脂瘤的分型与手术选择

外耳道胆脂瘤多发生于成人。对于外耳道骨壁、鼓室及乳突遭破坏的病例,则常需手术治疗。目的是清除胆脂瘤病变,防止复发。1983年10月～2001年8月,我们对外耳道骨质遭破坏吸收、甚至乳突广泛破坏的患者43例43耳,根据胆脂瘤侵及的范围不同进行分型,选择不同术式进行治疗,收到较为理想的效果。报告如下。     

耳内镜在治疗外耳道胆脂瘤的临床应用

目的 探讨耳内镜下治疗外耳道胆脂瘤的优越性.方法 利用耳内镜对35例外耳道胆脂瘤患者进行治疗.结果 35例中治愈33例(94.3%),无效复发2例(5.7%),有效率为94.3%.结论 在耳内镜下治疗外耳道胆脂瘤具有视野图像清晰、操作简便、损伤小等优点,值得推广.     

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。     

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。     

外耳道胆脂瘤临床分析

外耳道胆脂瘤是一种阻塞于外耳道骨部的含有胆固醇结晶的脱落上皮团块,病变不仅限于外耳道,部分病变可侵及乳突或鼓室等。现将我科2004年1月～2008年1月收治的24例外耳道胆脂瘤患者资料报道如下。     

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。     

耳内镜下经外耳道切除上鼓室胆脂瘤35例疗效分析

目的探讨耳内镜下经外耳道入路治疗上鼓室胆脂瘤的可行性、手术方法及疗效。方法回顾分析2014年1月～2017年1月在徐州市中心医院接受耳内镜手术的35例（35耳）中耳上鼓室胆脂瘤患者的临床资料。35例患者中男20例,女15例;年龄22～66岁,平均年龄42.8岁;病程2～20个月,平均10个月。所有患者均在全麻耳内镜下手术,根据胆脂瘤大小决定手术范围。12例行上鼓室重建,10耳听骨链破坏或缺失者,行部分人工听骨重建（partial ossicular replacement prosthesis,PORP）。结果35耳上鼓室胆脂瘤病灶均彻底清除,未出现面瘫及脑脊液漏等并发症。所有患者术后随访1年以上,患者鼓膜愈合良好,移植物形态良好。耳内镜检查或者颞骨薄层CT检查未见胆脂瘤复发,术后听力提高22例（62.8%）,听力无变化10例（28.6%）,听力下降3例（8.6%）,平均气导听阈与气骨导差均有改善,术后0.5、1、2、4 kHz平均气导听阈为（29.234±8.38）dB,与术前的（43.64±8.38）dB比较差异具有统计学意义（P<0.05）;术后0.5、1、2、4 kHz平均气骨导差值为（15.27±6.74）dB,与术前的（28.27±5.94）dB比较差异具有统计学意义（P<0.05）。结论耳内镜下经外耳道上鼓室胆脂瘤切除术是有效的手术方法,复发率低,听力改善明显,与传统显微镜手术相比有优越性。     

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。     

外耳道胆脂瘤的临床特征及治疗

目的　探讨临床各期外耳道胆脂瘤的特征及治疗方法的选择,并评估其疗效。方法　回顾性分析2014年1月～2016年1月,第四军医大学唐都医院耳鼻咽喉头颈外科,住院治疗66例外耳道胆脂瘤患者临床资料。其中男性32例,女性34例;年龄3～75岁,平均（32.5±1.68）岁,均为单侧耳发病。所有患者术前均行耳内镜检查及纯音测听,并行颞骨高分辨CT检查。根据病变范围按照Holt分期,Ｉ期10耳,Ⅱ期26耳,Ⅲ期30耳。Ｉ期行外耳道胆脂瘤摘除术;Ⅱ期行外耳道胆脂瘤摘除术＋外耳道成形术,如鼓膜被侵及破坏时加行鼓室成形术（Ⅰ型）;Ⅲ期行外耳道胆脂瘤摘除术＋外耳道成形术及鼓室成形术（Ⅰ、Ⅱ、Ⅲ型）或乳突根治术。所有患者术后随访6个月～2年。结果　听力下降为本组患者首要症状（61例,92.42%）,其他症状包括耳闷胀感（49例,74.24%）、耳痛（45例,68.18%）、耳漏（44例,66.67%）、周围性面瘫（1例,1.52%）。66例患者中2例分别于术后11个月和14个月复发,其余患者均外耳道通畅,上皮化良好。除行乳突根治术的5例患者外,其余均鼓膜完整,听力不同程度提高。1例周围性面瘫患者,术后6个月面神经功能恢复正常（HB分级Ⅰ级）。结论　外耳道胆脂瘤易破坏外耳道骨质,并侵犯临近结构。根据临床分期选择合适手术方式可获得满意疗效。     

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.     

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。     

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.     

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.     

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.     

III型外耳道胆脂瘤手术治疗的术式选择

目的　探讨骨性外耳道后壁和乳突遭不同程度破坏的III型外耳道胆脂瘤的治疗选择及疗效。方法　收集44例（共45耳）临床诊断为III型外耳道胆脂瘤患者,根据乳突破坏程度的不同采用不同的术式进行手术：27耳乳突破坏未达鼓窦患者（A组）,采用单纯乳突修理+外耳道成形术+必要时行耳甲腔成形术治疗;18耳乳突破坏达鼓窦患者（B组）,采用乳突切开+乳突填充+外耳道成形+耳甲腔成形术治疗。结果　所有患者术后随访1～2年,均无胆脂瘤复发,无外耳道塌陷、狭窄或闭锁,听力有不同程度的提高。其中A组患者术后干耳率为100%,平均干耳时间（12.1±2.3）d,具有光滑外耳道以及良好自净作用的占100%;B组患者术后干耳率为94.4%,平均干耳时间（28.1±3.5）d,具有光滑外耳道以及良好自净作用的占88.9%。结论　III型外耳道胆脂瘤可根据乳突破坏是否达鼓窦而采用不同的术式：破坏未达鼓窦患者,采用单纯乳突修理+外耳道成形术+必要时行耳甲腔成形术;破坏达鼓窦患者,采用乳突切开+乳突填充+外耳道成形+耳甲腔成形术,疗效均显著。