Clinical features, diagnosis and treatment for patients presenting with granulation tissue of the external auditory canal
-
摘要: 目的 探讨以外耳道肉芽为临床体征的耳科疾病特点及诊疗经验，以期提高临床诊治水平。方法 回顾性分析2015年1月—2020年6月空军军医大学第一附属医院耳鼻咽喉科手术治疗的71例以外耳道肉芽为临床体征的患者资料，结合患者主诉、专科查体、辅助检查及术前影像学，必要时行活组织检查以明确诊断。71例患者中，慢性中耳炎30例，外耳道胆脂瘤19例，外耳道癌5例，副神经节瘤6例，肉芽肿性血管瘤1例，第一腮裂瘘畸形1例，外耳道肉芽肿4例，外耳道血管瘤4例，外耳道异物1例。根据病变特点和范围制定个体化治疗方案。结果 术后随访12~74个月，平均(44±18.1)个月。70例(98.6%)患者术后无感音神经性聋、外耳道狭窄或周围性面瘫等并发症; 1例副神经节瘤患者术后面神经功能Ⅱ级，给予营养神经等治疗，3个月后面神经功能恢复至Ⅰ级。结论 以外耳道肉芽为临床体征的疾病多样，临床表现相似，需详细分析患者病史、结合影像学检查明确诊断，制定个体化治疗方案，减少误诊、漏诊。Abstract: Objective To explore the clinical characteristics and diagnosis and treatment in the patients presenting with granulation tissue of the external auditory canal.Methods The data of 71 postoperative patients presenting with granulation tissue of the external auditory canal in the Department of Otolaryngology, the First Affiliated Hospital of the Air Force Military Medical University from January 2015 to June 2020 were analyzed retrospectively, including the chief complaint, physical examination, auxiliary examination and preoperative imaging, biopsy was performed when necessary to confirm the diagnosis. Among the 71 patients, 30 cases were diagnosed as chronic otitis media, 19 cases were external auditory canal cholesteatoma, 5 cases were external auditory canal carcinoma, 6 cases were paraganglioma, 1 case was granulomatous hemangioma, 1 case was first branchial cleft fistula, 4 cases were granuloma of the external auditory canal, 4 cases were hemangioma of the external auditory canal, and 1 case was foreign body of the external auditory canal. Individualized treatment plans are made according to the characteristics and extent of the lesions.Results Postoperative follow-up was 12 to 74 months, with an average of (44±18.1) months. Seventy patients(98.6%) had no complications such as sensorineural deafness, external auditory stenosis or peripheral facial paralysis after surgery, and one patient with paraganglioma had postoperative neurological function grade Ⅱ, and was treated with nutritional nerves, and the postoperative neural function recovered to grade Ⅰ after 3 months.Conclusion The patients presenting with granulation tissue of the external auditory canal can be diagnosed as various diseases. It is necessary to analyze the patient's medical history in detail, confirm the diagnosis in combination with imaging examination, and formulate an individualized treatment plan to reduce misdiagnosis and missed diagnosis.
-
Key words:
- external auditory canal /
- granulation tissue /
- otitis media /
- diagnosis /
- therapy
-
-
图 1 例1患者资料 1a：术前右侧耳内镜检查; 1b：术前听力; 1c：术前颞骨轴位HRCT; 1d：术后3个月耳内镜检查; 1e：术后听力; 图 2 例2患者资料 2a：术前右侧耳内镜检查; 2b：术前听力; 2c：术前颞骨轴位HRCT; 2d：术后1年耳内镜检查; 2e：术后听力; 图 3 例3患者资料 3a：术前右侧耳内镜检查; 3b：术前颞骨轴位HRCT; 3c：术前冠状位增强MRI; 图 4 例4患者资料 4a：术前左侧耳内镜检查; 4b：术前颞骨轴位HRCT; 4c：术前轴位增强MRI;
-
[1] 楼响瑜, 高月秋, 施紫光, 等. 异种脱细胞真皮基质修复膜治疗外耳道及中耳肉芽的临床研究[J]. 中国耳鼻咽喉头颈外科, 2020, 27(5): 286-288. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202005014.htm
[2] 张全安, 候薇, 李荣. 中耳炎病理过程中肉芽组织的形成及病理影响和转归[J]. 中华耳科学杂志, 2011, 9(1): 113-116. doi: 10.3969/j.issn.1672-2922.2011.01.025
[3] da Costa SS, Paparella MM, Schachern PA, et al. Temporal bone histopathology in chronically infected ears with intact and perforated tympanic membranes[J]. Laryngoscope, 1992, 102(11): 1229-1236. doi: 10.1288/00005537-199211000-00005
[4] Jaisinghani VJ, Paparella MM, Schachern PA, et al. Tympanic membrane/middle ear pathologic correlates in chronic otitis media[J]. Laryngoscope, 1999, 109(5): 712-716. doi: 10.1097/00005537-199905000-00007
[5] Jung SY, Kim D, Park DC, et al. Immunoglobulins and Transcription Factors in Otitis Media[J]. Int J Mol Sci, 2021, 22(6): 3201. doi: 10.3390/ijms22063201
[6] Choi SA, Kang HM, Byun JY, et al. Analysis of differences in facial nerve dehiscence and ossicular injury in chronic otitis media and cholesteatoma[J]. Acta Otolaryngol, 2014, 134(5): 455-461. doi: 10.3109/00016489.2013.860654
[7] 韩宇, 张昌明, 凤娅妮, 等. 不同鼓室黏膜状态的湿耳施行鼓室成形术的疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(2): 100-105. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202002002.htm
[8] 李陈, 王冰, 王鑫, 等. 慢性中耳炎干耳和湿耳状态下行鼓室成形术(Ⅰ型)的近期效果观察[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(7): 617-620. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202107009.htm
[9] 戴畅, 史磊, 张磊, 等. 外耳道病变的HRCT诊断分析[J]. 现代医用影像学, 2015, 24(4): 658-660. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYY201504046.htm
[10] 彭哲, 王林娥, 王国鹏, 等. 149例外耳道胆脂瘤临床特点及外科治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(6): 516-520. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202006009.htm
[11] 黄晶, 李云, 彭涛, 等. 外耳道胆脂瘤的诊疗现状[J]. 中华耳科学杂志, 2020, 18(5): 957-961. doi: 10.3969/j.issn.1672-2922.2020.05.029
[12] Charlton A, Janjua N, Rejali D. Cotton bud in external ear canal causing necrotising otitis externa and subdural abscess[J]. BMJ Case Rep, 2019, 12(3): E227971. doi: 10.1136/bcr-2018-227971
[13] 赵海, 杨博文, 王效军, 等. 外耳道腺样囊性癌误诊为外耳道炎2例[J]. 中国耳鼻咽喉头颈外科, 2018, 25(11): 621-622. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201811017.htm
[14] Altuna Mariezkurrena X, Henríquez Alarcón M, Vea Orte JC, et al. [Malignant tumors of external ear. Review of cases in 1991-2001][J]. An Otorrinolaringol Ibero Am, 2003, 30(1): 83-94.
[15] Testa JR, Fukuda Y, Kowalski LP. Prognostic factors in carcinoma of the external auditory canal[J]. Arch Otolaryngol Head Neck Surg, 1997, 123(7): 720-724. doi: 10.1001/archotol.1997.01900070064010
[16] Valero C, Ganly I, Shah JP. Head and neck paragangliomas: 30-year experience[J]. Head Neck, 2020, 42(9): 2486-2495. doi: 10.1002/hed.26277
[17] 夏寅, 严旭坤. 颈静脉球副神经节瘤治疗策略[J]. 中华耳科学杂志, 2019, 17(3): 339-342. doi: 10.3969/j.issn.1672-2922.2019.03.012
[18] Neumann HPH, Young WF Jr, Eng C. Pheochromocytoma and Paraganglioma[J]. N Engl J Med, 2019, 381(6): 552-565. doi: 10.1056/NEJMra1806651
[19] Malla SR, Bhalla AS, Manchanda S, et al. Dynamic contrast-enhanced magnetic resonance imaging for differentiating head and neck paraganglioma and schwannoma[J]. Head Neck, 2021, 43(9): 2611-2622. doi: 10.1002/hed.26732
[20] 滕磊, 寻满湘. 耳廓肉芽肿型毛细血管瘤1例[J]. 中国耳鼻咽喉头颈外科, 2013, 20(8): 408-408. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201308006.htm
[21] 陈露, 万保罗, 臧艳姿, 等. 鼻腔肉芽肿型毛细血管瘤的临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(11): 875-877. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201811021.htm
[22] 韩宇, 李瑞, 杨润琴, 等. 早期外耳道癌的临床特点及预后相关因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(10): 874-879. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202110003.htm
[23] 杜雅丽, 段清川, 马芙蓉. 嗜酸性中耳炎的研究现状[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(6): 489-492. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201706021.htm
[24] Singh J, Patel U, Backous D. Primary external auditory canal meningioma: Case report and review of the literature[J]. Am J Otolaryngol, 2022, 43(1): 103215. doi: 10.1016/j.amjoto.2021.103215
[25] 柴贵娟, 孟颖迪, 刘悦, 等. 外耳道艾滋病相关型卡波西肉瘤1例[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(24): 1910-1911. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201824017.htm
-
下载:
图(2)
计量
- 文章访问数: 1696
- PDF下载数: 717
- 施引文献: 0