外耳道膽脂瘤

External Auditory Canal Cholesteatoma

陳俊維(Chun-Wei Chen) ； 林永松(Ryan Y. S. Lin)

《台灣耳鼻喉頭頸外科雜誌》 38卷5期 (2003/10) Pp. 202-207

https://doi.org/10.6286/2003.38.5.202

摘要

背景：外耳道膽脂瘤(external auditory canal cholesteatoma)是外耳道的一種少見疾病，其發生率約為每1000名耳科新病人中會發現1名外耳道膽脂瘤。外耳道膽脂瘤除了上皮皮屑的堆積，也會於外耳道壁形成局部的骨質腐蝕(bone erosion)，甚至侵犯至鄰近的顳顎關節及乳突腔，臨床上必須與閉塞性角化症(keratosis obturans)鑑別診斷。
方法：以病歷回顧的方式，收集1992年1月至2001年12月診斷為外耳道膽脂瘤的病患共43例，其中有7例為兩側性的病灶，共50耳。
結果：原發性外耳道膽脂瘤有34例病患40耳，以耳漏及耳痛的症狀最常見，最常侵犯外耳道的下壁及前壁，沒有侵犯至中耳或耳膜，聽力通常不受影響。次發性外耳道膽脂瘤9例病患10耳（8耳為先天性狹窄或閉鎖，2耳為後天性狹窄），以聽障及耳痛的症狀最常見，膽脂瘤通常充滿了狹窄內側的外耳道，聽力因耳道阻塞之故，有不同程度的傳導性聽障。共有44患耳接受膽脂瘤清除及耳道形成術，沒有患耳需接受乳突鑿開術，有6耳尚未接受手術或拒絕接受手術，僅於門診追蹤治療。有4例因再度狹窄而需再接受耳道形成術；於門診追蹤，所有接受手術的44耳皆無膽脂瘤的復發。
結論：診斷外耳道膽脂瘤主要是靠病史及理學檢查，侵犯的範圍則需要電腦斷層的幫助，對於耳道中的耳垢及皮屑皆需仔細的清除。次發性外耳道膽脂瘤必須以手術清除膽脂瘤及重建外耳道的暢通，以恢復外耳道原有的上皮移行性(epithelial migration)。原發性外耳道膽脂瘤也建議積極地以手術清除膽脂瘤及腐骨，以避免進一步潛在性的侵犯。

關鍵字

外耳道膽脂瘤 ； 閉塞性角化症 ； 上皮移行性

並列摘要

BACKGROUND: The cholesteatoma is a rare lesion affecting the external auditory canal. The prevalence is estimated to be 1/1000 in new ENT patients. In addition to epithelial debris accumulation and local bone erosion affecting the canal wall, a cholesteatoma can invade the neighboring temporo-mandibular joint and mastoid cavity. Clinically, it must be distinguished from keratosis obturans.
METHODS: Between January 1992 and December 2001, 50 ears in 43 patients diagnosed with external auditory canal cholesteatomas were reviewed.
RESULTS: Primary external auditory canal cholesteatomas were noted in 40 ears of the 34 patients. The most common symptoms were otorrhea and otalgia without hearing loss. Such cholesteatomas most frequently invade the inferior and anterior walls of the canal rather than the middle ear or tympanic membrane. Secondary external auditory canal cholesteatomas were seen in 10 ears of nine patients (eight ears with congenital stenosis or atresia; two ears with aquired stenosis) whose most common symptoms were hearing loss and otalgia. Such cholesteatomas most frequently obstructed the external canal and caused conductive hearing loss. Amongst the 50 ears, 44 underwent removal of the cholesteatoma as well as canaloplasty and experienced no recurrence, while the other s ix ears received close follow up.
CONCLUSION: The diagnosis of external auditory canal cholesteatoma is based on history and physical examination. Computed tomography is useful for defining the extent of the les ion. Removal of cerumen and epithelial debris from the canal is important. Surgery is indicated for secondary external auditory canal cholesteatomas, which require eradication of the cholesteatoma and canal reconstruction to enable epithelial recovery and migration. To prevent further occult invasion in primary external auditory canal cholesteatomas, aggressive surgery is also required so that the cholesteatoma and eroded bone can be excised.

並列關鍵字

external auditory canal cholesteatoma ； keratosis obturans ； epithelial migration