儿童外耳道胆脂瘤的临床特征分析

Clinical Characteristics of Pediatric External Auditory Canal Cholesteatoma

目的 对儿童外耳道胆脂瘤(external auditory canal cholesteatoma, EACC)的临床特征进行分析。方法收集并分析于2000年1月-2019年12月间在上海交通大学医学院附属新华医院耳鼻咽喉头颈外科住院治疗的41例EACC患儿的临床资料。结果 41例中幼龄组(2-5岁)13例14耳,大龄组(6-15岁)28例28耳,症状多为单侧发病的轻中度传导性听力下降、耳漏和耳痛,幼龄患儿患侧气导听阈和气骨导差明显高于大龄患儿(t=2.155, P=0.039;t=2.593, P=0.014),骨质破坏多累及耳道后壁和下壁,确诊时多为Kaneda分期0-II期。幼龄患儿以继发性EACC为主,主要与耳道狭窄(6耳)、第一鳃裂瘘管(4耳)等耳道结构异常有关;大龄患儿则以特发性EACC(17耳)为主,两组患儿在病因分类上有统计学差异(χ^(2)=5.775, P=0.016)。0期(8耳)行耳内单纯病灶切除;Ⅰ期(9耳)和Ⅱ期(16耳)行耳内径路病灶切除及耳道和/或耳甲腔成形术;Ⅲ期(9耳)在上述基础上,根据侵犯中耳结构的不同行完壁式或开放式鼓室成形术、听骨链重建术等。根据伴有的不同疾病,同时进行鳃裂瘘管切除、耳后脓肿清除、鼓膜切开探查置管术等手术治疗。结论 幼龄和大龄EACC患儿在病因、症状、听力及影像结果上均有相似和不同之处,对不同年龄段的儿童EACC及合并疾病,应采取不同的预防和诊疗措施。

Objective This study aimed to report clinical characteristics of external auditory canal cholesteatoma(EACC) in children. Methods Clinical data from 41 children with EACC admitted to the Department of Otolaryngology-Head & Neck surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, from January 2000 to December 2019 were collected and analyzed retrospectively. Results Of the 41 children, 13(14 ears) were 2-5 years old and 28(28 ears) were 6-15 years old. Unilateral mild to moderate conductive hearing loss, otorrhea and otalgia were common. Air conduction thresholds and air-bone gap were worse in younger children than in older children(t=2.155, P=0.039 and t=2.593, P=0.014, respectively). Kaneda’s staging was 0-Ⅱ in most cases. Bony destruction mostly involved the posterior and inferior canal wall. EACC was secondary to congenital EAC stenosis(6 ears) and first branchial fistula(4 ears) in most young children while idiopathic EACC was more predominant in the older children(17 ears)(χ^(2)=5.775,P=0.016). Trans-canal cholesteatoma removal(TCR) was performed on 8 ears for stage 0 diseases. Both TCR and the reconstruction of the EAC and/or concha cavity were performed on 9 ears for stage Ⅰ diseases and on 16 ears for stage Ⅱ diseases. Additionally, tympanoplasty(canal wall up or canal wall down) and ossicular chain reconstruction were performed to address middle ear lesions on 9 ears with stage Ⅲ diseases. Branchial fistula resection, retro-auricular abscess removal, tympanotomy and grommet insertion were performed at the same time if necessary. Conclusion There are similarities and differences in etiology, symptoms, hearing and imaging data between younger and older children with EACC. Different strategies should be adopted for the prevention, diagnosis and treatment of EACC in these pediatric patients.