先天性外耳道狭窄伴外耳道或中耳乳突胆脂瘤的手术治疗

Surgical treatment of congenital external auditory canal stenosis and middle ear deformities complicated cholesteatoma of external canal and middle ear

目的 :探讨先天性外耳道狭窄及伴中耳畸形外耳道、中耳乳突胆脂瘤病人的手术治疗方法。方法 :31例病人中 9例为单纯先天性外耳道狭窄伴发外耳道胆脂瘤 ,进行外耳道胆脂瘤根治术 ,并行外耳道成形术 ,其中 7例行外耳道成形 +鼓室成形术 ;2 2例为先天性外耳道狭窄伴发中耳畸形和中耳乳突胆脂瘤 ,在根治胆脂瘤的同时 ,行外耳道成形术 ,其中 13例进行鼓室成形术 ,随访 3个月到 1年。结果 :7例外耳道成形 +鼓室成形术者 ,成功率为 85 .7% (6 / 7) ;13例进行乳突根治术 +鼓室成形术者 ,成功率为 76 .9% (10 / 13)。凡鼓室成形术成功者听力均提高 15 d BHL(语言频率 5 0 0～2 0 0 0 Hz)以上。结论 :先天性外耳道狭窄伴发外耳道胆脂瘤或中耳胆脂瘤病人 ,在彻底清除胆脂瘤的基础上进行鼓室成形术 ,可以提高病人的听力 ;术中发现中耳畸形常有面神经遮盖卵圆窗或无卵圆窗者 。

Objective: To summarize the experience of surgical management of 31 patients with congenital external auditory canal stenosis and middle ear deformities complicated cholesteatoma of external canal and middle ear from 1993 to 2000 in our department. Method: Among 31 patients (31 ears, 17 males and 14 females, ranging in age from 5 to 37 years old), 9 ears were congenital external canal stenosis complicated external canal cholesteatoma alone, 22 ears were complicated middle ear cholesteatoma still. Thirty\|one patients were treated by surgery of cholesteatoma remove, and 7 of 9 ears were external canalplasty and tympanoplasty (group A), 13 of 22 ears were mastoidectomy and tympanoplasty (group B). Result: The successful rate was 85.7% (6/7) in group A, 76.9% (10/13) in group B, with period of 3 months to 1 year follow\|up. And the auditory levels were improved (over improve 15dB in 500~2000Hz) in 16 patients with successful tympanoplasty. Conclusion: The procedure of radical remove lesions and external canalplasty and tympanoplasty should be albe to improve auditory level of patients with congenital external ear canal stenosis and middle ear deformities complicated cholesteatoma.