Kesser Bradley W
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Curr Opin Otolaryngol Head Neck Surg. 2011 Oct;19(5):341-7. doi: 10.1097/MOO.0b013e328349a125.
Chronic otitis externa (COE) remains a frustrating problem for both patient and physician. The end stage of disease, medial fibrosing otitis externa, is very challenging to repair. New and old therapies and promising approaches to the treatment of this often recalcitrant problem are presented in this review.
Tacrolimus, a nonsteroidal immunosuppressant, and fluocinolone acetonide oil 0.01%, a medium-high potency steroid preparation, may offer additional therapeutic options in the struggle against this inflammatory ear canal/skin condition of often unknown cause. Relative potencies of many steroid preparations will be presented along with several treatment strategies for controlling COE. Underlying autoimmune problems such as Sjögren's disease, sarcoidosis, and amyloidosis must be searched and, if present, addressed and treated for resolution of symptoms. Cutting edge therapies, including use of bacteriophages and inflammatory proteases, will also be reviewed.
No single therapy will be successful for every patient with COE. The search for an underlying cause, the removal of all possible irritants to the ear canal skin (e.g. Q-tips, water), debridement, and both topical and occasionally, systemic therapy will control (not cure …) the disease process in the vast majority of patients.
慢性外耳道炎（COE）对患者和医生来说仍然是一个令人沮丧的问题。疾病的终末期，即内侧纤维性外耳道炎，修复起来极具挑战性。本文综述了治疗这一常常难以治愈的问题的新旧疗法及有前景的方法。
他克莫司，一种非甾体类免疫抑制剂，以及0.01%的醋酸氟轻松油，一种中高效力的类固醇制剂，可能为对抗这种病因往往不明的炎性耳道/皮肤疾病提供更多治疗选择。将介绍多种类固醇制剂的相对效力以及控制COE的几种治疗策略。必须排查潜在的自身免疫问题，如干燥综合征、结节病和淀粉样变性，如果存在，要针对这些问题进行处理和治疗以缓解症状。还将综述前沿疗法，包括噬菌体和炎性蛋白酶的使用。
对于每位COE患者，没有单一疗法会取得成功。寻找潜在病因、去除所有可能刺激耳道皮肤的因素（如棉签、水）、清创以及局部和偶尔的全身治疗将在绝大多数患者中控制（而非治愈……）疾病进程。
