External auditory canal cholesteatoma
Introduction
Introduction of external auditory canal cholesteatoma External auditory cholesteatoma (EACC) is a capsular mass formed by skin desquamation of the external auditory canal, accumulation of cholesterol crystals, and epithelial wrapping. It is not a true tumor, so it is also called obstructive keratosis of the external auditory canal and epidermosis. The inner layer of the capsular mass is a stratified squamous epithelium (including basal layer, granular layer, spinous cell layer, keratinized layer), and the outer layer of the capsule is a layer of fibrous tissue of different thickness, adjacent to the surrounding The organization is closely connected. More common in middle-aged and elderly people, there is no significant difference in the incidence of men and women, more common on one side, can also occur in both ears. Due to the swelling growth of cholesteatoma, the surrounding bone is compressed, destroyed and absorbed for a long time, resulting in enlargement of the external auditory canal. The main hazard is extensive destruction of the external auditory canal, middle ear mastoid and adjacent bone, causing hearing loss, and even causing serious complications inside and outside the brain and endangering life. It should be taken out in time. Can be divided into two major categories of congenital and acquired. Congenital patients often have congenital external middle ear malformations, which are caused by embryonic ectodermal tissue during embryonic development. Acquired people can be divided into five categories according to different causes, including: self-style, traumatic type, postoperative iatrogenic type, external auditory canal stenosis and external auditory canal obstruction. According to Holt staging method, the disease was divided into three stages: one stage of external auditory canal was not or slightly enlarged, and localized small concave formation; the second stage external auditory canal was enlarged, bone destruction was serious, local cyst formation; 3 stage invasion of mastoid or (and) on the tympanum. basic knowledge The proportion of the disease: the probability of the population is 0.096% Susceptible people: more common in middle-aged and elderly Mode of infection: non-infectious complication:
Cause
Causes of external auditory canal cholesteatoma
The cause is not clear and the views are different. At present, most people think that the skin of the external auditory canal is affected by various diseases such as ear trauma, embolism, foreign body, inflammation, fungal infection, surgery, etc., and the integrity of the epithelium of the external auditory canal is destroyed. The growth of basal cells is active, the keratinized epithelial cells are abnormally increased, and chronic congestion is caused by poor stimulation of the external auditory canal, resulting in stenosis, which causes the exfoliated objects to migrate outward and be blocked, and accumulates in the external auditory canal to form a mass. The center of the long-term mass will be corrupted, decomposed, and denatured, eventually producing cholesterol crystals. It is closely related to local drainage and humidity.
Prevention
External auditory canal cholesteatoma prevention
1. Usually pay attention to ear hygiene, quit ear habits and other bad habits. Anyone with ear eczema, ear edema, suppurative otitis media should pay special attention to the cleanliness and dryness of the ear canal. Do not scratch when itching. You can use 3% boric acid alcohol ear drops to wipe the ear canal.
2. Do not wash when there is obstruction or inflammation in the ear. If there is dirt or suede accumulation, go to the hospital and find a specialist to take it out.
3. If the hearing is different on both sides and the ear is swelled, it is best to go to the hospital to check the ear canal and clean it up in time before swimming. Swimming is prohibited when the external auditory canal is blocked and the external auditory canal is inflamed.
Complication
External auditory canal cholesteatoma complications Complication
Skin abrasions and ulcers.
Symptom
Symptoms of external auditory canal cholesteatoma Common symptoms Earache facial nerve spasm ear suffocation hearing loss ear leak taste loss
In the early stages of the disease, if there is no infection, there is no special discomfort due to the small cholesteatoma. As the masses continue to accumulate, the volume of cholesteatoma continues to increase, and a series of clinical symptoms will appear:
1. Ear suffocation: When the volume of the external auditory canal cholesteat increases, the ear canal blockage will occur when the external auditory canal is blocked.
2. Hearing loss: When the diameter of the external auditory canal is blocked by 2/3 or more, hearing loss may occur. Clinically, the main manifestation is the decline in conductive hearing. Sometimes when local secondary inflammation, resulting in swelling of the skin of the external auditory canal, can cause hearing loss, should be identified with idiopathic axillary.
3. Earache: The external auditory canal cholesteatoma is destructive, often secondary to infection, and can cause severe earache.
4. Otorrhea: If the secondary infection can have pus in the ear, the pus has a special odor, or bloody secretions with blood.
5. Others: huge external auditory canal cholesteatoma can damage the lower and posterior wall of the external auditory canal, and further invade the mastoid, sinus and upper tympanic cavity through the destruction, extensive destruction of the mastoid bone, and cholesteatoma otitis media It can also invade the facial nerve mastoid segment to cause peripheral facial paralysis and invade the tympanic nerve to cause dysgeus. Cholesteatoma is further enlarged. In severe cases, there may be intracranial symptoms such as cervical abscess, fistula, dizziness, meningitis, and brain abscess.
Examine
Examination of external auditory canal cholesteatoma
During the examination, there may be grayish white or yellow keratin debris in the external auditory canal, and the epithelial sample is blocked. The surface is covered with multiple layers of scales. The external auditory canal is hyperemic, swollen and erosive, and may be accompanied by granulation. After the larger cholesteatoma is removed, the bone exposure of the external auditory canal can be seen, destroyed and absorbed, and the bone segment of the external auditory canal is obviously enlarged, and the cartilage segment generally has no obvious change. The tympanic membrane is generally intact, or congested, invaginated, and if destroyed by cholesteatoma, can cause perforation, atrophy, and adhesion.
Auxiliary inspection
1. Imaging features: CT of the humerus is characterized by soft tissue density in the external auditory canal, which is expansive growth, can invade the mastoid and middle ear, and destroy the smooth edge of the bone, similar to the performance of the middle ear cholesteatoma. However, the lesions of the external auditory canal cholesteatoma are first located in the external auditory canal and the lower ear and the posterior wall of the external auditory canal. The destruction can invade the mastoid cavity, causing massive bone damage of the mastoid, destruction of the vertical section of the facial nerve, and exposure of the dura mater. The mastoid air chamber away from the external auditory canal is often present, and the tympanic cavity structure remains intact.
2. Audiological examination: It is generally characterized by conductive paralysis, mainly because the sound waves are blocked by the external auditory canal and middle ear lesions when transmitted through the air conduction pathway, and the acoustic energy reaching the inner ear is weakened, resulting in different degrees of hearing loss. Sensory neuropathic fistula can also be present after the progression of the lesion involves the inner ear.
Diagnosis
Diagnosis and diagnosis of external auditory canal cholesteatoma
diagnosis
According to the history and physical signs, such as the examination of the ear canal, there is a characteristic white cholesteat-like mass incarceration in the external auditory canal, and the ear canal skin congestion, swelling, stenosis and granulation formation can be clearly diagnosed. In order to further clarify the stage and guide the treatment, high-resolution thin-layer CT examination of the tibia should be performed to understand the lesions of the external auditory canal and the extent of bone destruction, the damage of adjacent tissues, the relationship between the lesion and the surrounding tissue structure, especially the facial nerve mastoid segment. The relationship between external auditory canal cholesteatoma. After the operation, the cholesteatoma-like tissue was taken for pathological examination to confirm the diagnosis.
Differential diagnosis
Embolization
It means that the excessive secretion of the sputum in the external auditory canal or the discharge is blocked, so that the sputum gathers in the external auditory canal and blocks the external auditory canal, which may cause the ear swell and the hearing to be mildly reduced. It may also be painful after the external ear canal inflammation is caused by the swelling of the water. Forbearance, it is easy to be confused with it. However, there is no epithelial-like structure in the embolization plug, and there is no bone destruction. Most patients with sputum embolization can be removed at the outpatient clinic without serious residual lesions.
Middle ear cholesteatoma
When the middle ear cholesteatoma is destroyed to the external auditory canal or the formed granulation tissue prolapses and blocks the external auditory canal, the two are easily confused. High-resolution CT of the humerus showed bone destruction and enlargement of the bone ear canal for identification.
Chronic otitis externa
Due to hypertrophy, desquamation, and acute inflammation of the ear canal, the ear canal is swollen and narrow, and it is easy to be confused when the deep examination is difficult. Careful examination reveals that the tympanic membrane is normal and the hearing is generally unaffected. The external auditory canal of the humerus CT has no bone destruction, and the middle ear and mastoid are normal.
Necrotizing otitis externa
The onset is more urgent, the ear pain is severe, there are serous, purulent, bloody ear leaks, odor, hearing loss, and mandibular joint dyskinesia. Generally, anti-inflammatory treatment has no obvious effect. Often involved in the parotid gland, mandibular joint, mastoid, skull base, cranial nerves and adjacent large blood vessels. If you can't control it, it will endanger the patient's life due to bleeding, meningitis, and brain abscess. CT showed bone destruction. Pathological examination can confirm the diagnosis.
other
Foreign bodies in the external auditory canal, pigmented nevus or external ear canal, papilloma, etc. cause narrowing and obstruction of the ear canal, and deep epithelium accumulates. Combined with medical history, specialist examination, and CT and pathology of the tibia, the diagnosis can be confirmed.
External middle ear malignant tumor
The medical history is short, the age is relatively large, the secretion is bloody, the granulation is repeatedly proliferated, and the deep ear is persistently painful, but in the early stage, the mouth is difficult to open, the facial paralysis and other cranial nerves are invaded, and the hearing loss is obvious. A neck mass occurs during local lymph node metastasis. CT examination revealed significant and extensive bone-like damage. Pathological examination can confirm the diagnosis.
