外耳道胆脂瘤的临床特征及治疗

Clinical characteristics and treatment of external auditory canal cholesteatoma

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。

OBJECTIVE To explor e the characteristics, the therapeutic methods and effects of external auditor y canal cholesteatoma（EACC）. METHODS The clinical records of 66 cases diagnosed with EACC between January 2014 and January 2016 were retrospectively reviewed. Their ages ranged from 3 to 75 years （average 32.5±1.68 years） . There were 32 men and 34 women. According to Holt’s grading criteria for EACC, there were 10 ears of phaseI, 26 ears of phase II, and 30 ears of phase Ⅲ. The phaseIears were treated by removing cholesteatoma from the external auditory canal. Canaloplasty and/or tympanoplasty were performed in phase Ⅱ ears. The phase Ⅲ ears were managed by canaloplasty and tympanoplasty or radical mastoidectomy. The duration of follow-up ranged from 6 months to 2 years. RESULTS In the present study, hearing impairment was the most common symptoms（61 ears, 92.42%）, other symptoms include ear fullness（49 cases, 74.24%）, otalgia（45 cases, 68.18%）, otorrhea（44 cases, 66.67%）, per ipheral facial paralysis（1case, 1.52%）. There were 2 recurrences at 11 and 14 months postoperatively. All the other ears remained patent and dry with good skin coverage. Apart from 5 patients who underwent radical mastoidectomy, the rest of patients obtained intact tympanic membranes and impoved hearing. Facial nerve function of 1 patient with peripheral facial paralysis returned to normal6 months after operation. CONCLUSION The EACC can easily damage the bony meatus of external auditory canal and the adjacent structure. The clinical stages can help identify the primary lesions and determine the choice of the best treatment approach.