摘要
背景：外耳道膽脂瘤較為少見，且臨床症狀常不明顯，不易發覺。故在此提出本院7例外耳道膽脂瘤之處理經驗，以期對此病有進一步的了解。 方法：1997年5月至1998年9月，本科共經歷7例外耳道膽脂瘤的患者，研究方法是根據病歷記載與電話查詢，將此7例患者作一系統性回溯分析與研究。 結果：7例外耳道膽脂瘤的患者，皆為單側耳病變，右耳有4例，左耳有3例，合併有慢性中耳炎者有3例。患者之臨床症狀以耳痛，耳漏，耳鳴最為常見。耳鏡檢查下，可發現外耳道有角質樣碎屑與骨質侵蝕者有5例，而病變處必須與外耳道腫瘤作一區別者有2例。手術時，發現膽脂瘤大都位於外耳道之後下壁。手術之方法依病變範圍大小而定，其中施以耳道刮除術者1例、耳道成型術者5例、乳突鑿開術者1例。病人術後定期接受追蹤檢查，並無復發之情形。 結論：外耳道膽脂瘤要及早發現或提高診斷率，必須先將外耳道清除乾淨，才能避免一些耳道膽脂瘤必須與閉鎖性角化症，惡性外耳炎，外耳道瘤作一鑑別診斷。對於慢性中耳炎的患者，也要將外耳道清除乾再作診斷，不要忽略合併有外耳道膽脂瘤之可能。外耳道膽脂瘤之治療以手術為主，視其病變之大小，採用直接刮除術或施以耳道成型術或乳突鑿開術。(中耳醫誌 1999;34:456-461)
並列摘要
BACKGROUND: External ear canal cholesteatoma (EECC) is an uncommon otologic entity. Erosion of the bony external ear canal and accumulation of keratindebris are the prominent findings. The purpose of this study is further understand the EECC by reporting our experience with seven cases. METHODS: Patient records and a telephone survey were used for data collection. A retrospective study of 7 patients with EECC was done from May 1997 to July 1998. RESULTS: All patients had unilateral cholesteatoma. The right ear was involved in 4 patients and the left in 3. Three of the 7 patients had chronic otitis media accompanied by EECC. The patients in this series presented chief complaints of otorrhea, otalgia and tinnitus. Otoscopic examination revealed an erosion of the bony canal with keratin debris in 5 of the 7 ears involved. In the other 2 patients EECC had to be differentiated from an external ear tumor. The bony erosion in all ears involved the inferior part of the bony external auditory canal. The management of EECC depends on the extent of involvement of the external ear canal. Curretage was percformed in 1 patients, canalplasty in 5 and mastoidectomy in 1. There was no recurrence in the post-operative follow-up. CONCLUSIONS: EECC is an uncommon but rare disease. Microscopic examination of the ear with meticulous cleaning of wax, especially in elderly patients, is useful in detecting early disease. EECC and chronic otitis media sometimes coexist. For limited lesion, curettage is effective. Canalplasty and tympanomastoidectomy should be performed for more extensive lesions.
延伸閱讀
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- 周家儀、徐銘燦、陳碧芳（2010）。顳骨骨性纖維瘤併發外耳道膽脂瘤。台灣耳鼻喉頭頸外科雜誌，45(4)，122-125。https://doi.org/10.6286/2010.45.4.122
- 林冠伶、徐銘燦（2011）。先天性外耳道狹窄併外耳道膽脂瘤。台灣耳鼻喉頭頸外科雜誌，46(6)，323-328。https://doi.org/10.6286/2011.46.6.323
- 楊尚融、沈炳宏、賴仁淙（2006）。先天性外耳道狹窄合併膽脂瘤。台灣耳鼻喉頭頸外科雜誌，41(1)，30-34。https://doi.org/10.6286/2006.41.1.30
- Lin, D. S., Pai, C. Y., Nieh, S., & Wang, H. W. (2006). External Auditory Canal Cholesteatoma. Journal of Medical Sciences, 26(6), 231-234. https://www.airitilibrary.com/Article/Detail?DocID=10114564-200612-201303260011-201303260011-231-234