外伤性外耳道狭窄与闭锁的临床特征及处理策略研究

Clinical characteristics and treatment strategies of traumatic external auditory canal stenosis and atresia

目的探讨外伤性外耳道狭窄与闭锁的临床特征,观察相应处理策略的效果。方法收集2004年1月~2020年9月因外伤性外耳道狭窄与闭锁在我院行外耳道成形术的患者共68例(70耳),治疗方式均为耳内耳甲切口外耳道成形术,术中尽可能保留原有外耳道皮肤。10例同期行鼓室成形、听骨链重建、面神经减压或脑脊液漏修补术等。术后常规行外耳道软性填塞半年以上。分析手术时机、手术方式及术后护理等处理策略在维系外耳道健康中的作用。结果所有病例中继发胆脂瘤41耳,病程越长继发胆脂瘤的概率越大,外伤后发现胆脂瘤的平均时间为(59.88±79.59)个月;病变仅累及外耳道55耳,范围超过外耳道15耳。术后平均随访(5.86±3.11)年,除1耳外耳道再次闭锁、2耳中耳乳突腔感染外,其余67耳外耳道上皮均健康,外耳道干洁。结论外伤性外耳道狭窄与闭锁患者应在病情稳定后及时行外耳道成形术,降低继发胆脂瘤的概率。病变仅累及外耳道者可单纯行外耳道成形术,如合并中耳等其他部位病变,在感染不严重时可根据病情同期处理。术后外耳道软性填塞压迫是避免外耳道再狭窄的有效措施。

Objective To investigate the clinical characteristics of traumatic external auditory canal(EAC)stenosis or atresia,and to analyze the efficacy of the treatment strategies.Methods From January 2004 to September 2020,the data of 68 patients(70 ears)with traumatic EAC stenosis or atresia in our hospital were collected.A modified canaloplasty procedure with an endoaural-conchal incision was used to widen the stenotic EAC.The original skin of the EAC was preserved during the external auditory canaloplasty.Ten cases had undergone tympanoplasty,ossicular chain reconstruction,facial nerve decompression or cerebrospinal fluid leakage repair at the same time.The external auditory meatus was filled with soft materials for more than half a year after the operation.The treatment strategies including operation timing,operation methods and postoperative nursing were analyzed for maintaining the health of ear canal.Results There were 41 cases with secondary EAC cholesteatoma among the patients.The longer the course of the disease,the higher was the probability of secondary cholesteatoma.The average time of detecting EAC cholesteatoma after trauma was 59.88±79.59 months.The stenosis or atresia only involved the EAC in 55 ears,while 15 ears beyond the EAC.The average follow-up time was 5.86±3.11 years.There was one ear with EAC restenosis and two ears infected in mastoid cavity.The remaining 67 ears had healthy EAC epithelium and dry ear canal.Conclusions Patients with traumatic EAC stenosis or atresia should undergo canaloplasty in time to reduce the probability of secondary EAC cholesteatoma.Those with EAC stenosis or atresia could be treated with canaloplasty alone.When the infection is not serious,the lesions beyond the EAC,such as in the middle ear,can be treated at the same time.Postoperative soft packing of EAC is an effective measure to avoid EAC restenosis.