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。

Clinical characteristics and treatment of external auditory canal cholesteatoma

Objectives To identify the clinical characteristics of and assess the therapeutic options for external auditory canal cholesteatoma(EACC).Methods The clinical data of 47 cases of external auditory canal cholesteatoma operated at our hospital from January 2015 to December 2016 were retrospectively analyzed.Results All patients underwent pre-operative audiometry,otoendoscopy,and computed tomography(CT)imaging of the temporal bones.All patients pres-ented with an external ear canal full of yellow-white squamous material or granulation tissue.Aural fullness,otalgia,and purulent otorrhea were the commonly reported symptoms.Bony erosions were noted in 41 patients on CT.The stag-ing according to Holt disclosed that 6 patients had stageⅠEACC,29 had stageⅡ,and 12 had stageⅢ.The six pa-tients diagnosed as having stage Ⅰ EACC and 5 teenagers diagnosed as having stage Ⅱ EACC were treated by chol-esteatectomy and/or resecting granulation tissue from the external auditory canal.The 24 adults diagnosed as having stage Ⅱ EACC were treated with combined cholesteatectomy and canaloplasty.Nine of 12 patients diagnosed as having stage Ⅲ EACC were managed via modified radical mastoidectomy and/or tympanoplasty,and 3 patients were treated with radical mastoidectomy.All patients had dry ear at 2 weeks,which completely epithelialized in 3 months post-sur-gery.The hearing loss showed partial recovery in most patients except in the three patients who underwent radical mas-toidectomy.The patients were followed up from 3 to 24 months,and no recurrence was observed.Conclusion EACC could be misdiagnosed.Bone erosion is the most important characteristic of EACC.A CT scan of the temporal bone is useful for staging and surgical planning.The surgical procedures are selected according to the disease stage,age,and hearing level.Complete removal of cholesteatoma and adequately opening the auditory canal are crucial for prevention of recurrence.