Dubach Patrick, Mantokoudis Georgios, Caversaccio Marco
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Curr Opin Otolaryngol Head Neck Surg. 2010 Oct;18(5):369-76. doi: 10.1097/MOO.0b013e32833da84e.
We present an update on clinical evaluation, staging, classification and treatment of canal cholesteatoma, including a meta-analysis of clinical data of the last 30 years.
Ear canal cholesteatoma is frequently associated secondarily to other canal pathologies. The cause for the rare idiopathic form of the disease remains enigmatic. Epidemiologic and experimental studies of its pathogenesis have increased; however, the main explanatory theory of a deficient migratory capacity of the canal epithelium affected has been falsified only recently. Therefore, the debate on the pathogenesis has gained additional impetus and more data is needed.
Canal cholesteatoma is a rarity in otologic pathology, often leading to misdiagnosis as external otitis or otomycosis by physicians unfamiliar with the disease. It presents typically with otorrhea, focal erosion and keratin accumulation in the osseous ear canal and has to be distinguished from keratosis obturans, which leads to otalgia and bilateral conductive hearing loss by ceruminal plugs, with circumferential distention of the ear canal. Treatment by canaloplasty is curative and highly successful. Alternative conservative treatment is feasible, however, requiring long-term follow up, with often painful cleaning of the lesion.
我们对耳道胆脂瘤的临床评估、分期、分类及治疗进行了更新，包括对过去30年临床数据的荟萃分析。
耳道胆脂瘤常继发于其他耳道病变。该病罕见的特发性形式的病因仍不明。对其发病机制的流行病学和实验研究有所增加；然而，关于受影响的耳道上皮迁移能力不足的主要解释理论直到最近才被证伪。因此，关于发病机制的争论有了新的推动力，还需要更多数据。
耳道胆脂瘤在耳科病理学中较为罕见，不熟悉该病的医生常将其误诊为外耳道炎或耳真菌病。它通常表现为耳漏、骨耳道的局灶性侵蚀和角蛋白积聚，必须与外耳道阻塞性角化病相鉴别，后者由耵聍堵塞导致耳痛和双侧传导性听力损失，并伴有耳道周向扩张。耳道成形术治疗具有治愈性且非常成功。替代的保守治疗可行，但需要长期随访，且对病变的清理往往很痛苦。
