先天性外耳道狹窄併外耳道膽脂瘤

External Auditory Canal Cholesteatoma in Congenital Aural Stenosis

林冠伶(Kuang-Ling Lin) ； 徐銘燦(Min-Tsan Hsu)

《台灣耳鼻喉頭頸外科雜誌》 46卷6期 (2011/12) Pp. 323-328

https://doi.org/10.6286/2011.46.6.323

摘要

背景：外耳道狹窄已知為外耳道膽脂瘤的危險因子。本研究主要探討近8年來台北馬偕先天性外耳道狹窄併外耳道膽脂瘤的病人，在臨床症狀及電腦斷層影像上之表現。方法：以回溯性方式，從2002年6月到2010年8月的病歷紀錄中，取先天性外耳道狹窄併外耳道膽脂瘤的病人為研究對象，共12例12耳。分析的項目包括病人求診之主訴、電腦斷層中外耳道狹窄位置及程度、膽脂瘤侵犯範圍。結果：12名病人的平均年齡為15.6歲，分別為5名男性，7名女性；4例為右耳， 8例為左耳。病人求診的主訴，12例中5例為耳後膿瘍，3例為耳痛，2例為聽力喪失，2例為耳漏。顳骨電腦斷層方面，12例中11例的外耳道最狹窄處於軟骨－硬骨交界處，1例位於軟骨部。膽脂瘤多侵犯外耳道壁的多個象限，且若以乳突、中耳腔、顏面神經管（facial canal）及鼓室（tegmen tympani）為四項標的，可發現外耳道瞻脂瘤於小於12歲的病人仍可有乳突和中耳腔的侵犯。若侵犯至顏面神經管，則以乳突段為主。結論：在先天性外耳道狹窄併外耳道膽脂瘤的病人中，耳後膿瘍是常見的起始表徵。利用顳骨電腦斷層可協助了解膽脂瘤侵犯範園、外耳道狹窄位置及決定治療方式。（台耳醫誌 2011；46：323－328）

關鍵字

先天性外耳道狹窄 ； 外耳道膽脂瘤

並列摘要

BACKGROUND: External auditory canal cholesteatoma (EACC) was not common, and congenital aural stenosis was one of the risk factors. There was little information exclusive for patients with EACC and congenital aural stenosis . An analysis was conducted to review the clinical presentation and image findings in these patients.METHODS: 12 cases with EACC and congenital aural stenosis from June, 2002 to August, 2010 were retrospectively reviewed. Clinical data included chief complaints, temporal bone CT and operative findings. Temporal bone CT scans were arranged to survey the extent and position of external auditory canal stenosis. Adjacent structures including middle ear cavity, mastoid, facial canal, and tegmen tympani were also evaluated for EACC involvement.RESULTS: The 12 patients included in our study were aged from 3 years to 44 years, with a median age of 15.6. Postauricular abscess was the most common complaint for admission. In temporal bone CT scan, the most stenotic site of external auditory canal was the junction between bony and cartilage portion in 11 cases, except 1 case in cartilaginous portion, Most EACCs involved multiple walls of external auditory canal, including circumferential involvement. EACC in patients younger than 12 years old still can involve middle ear cavity and mastoid. No patients had pre-operative facial palsy. Facial canal involvement was noted in 3 patients, and all of them were in mastoid segment.CONCLUSION: External auditory canal cholesteatoma must be considered when we found postauricular abscess in patients with congenital aural stenosis. Temporal bone CT is necessary because recognition of the entity of EACC and its extension can determine further management. (J Taiwan Otolaryngol Head Neck Surg 2011; 46:323-328)

並列關鍵字

congenital aural stenosis ； external auditory canal cholesteatoma