Dähn Jörg, Anschuetz Lukas, Konishi Masaya, Sayles Mark, Caversaccio Marco, Dubach Patrick
*Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital, and University of Bern †Department of Otorhinolaryngology, Head and Neck Surgery, Bürgerspital Solothurn, Solothurn, Switzerland ‡Department of Otorhinolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Hirakata, Osaka, Japan §Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.
Otol Neurotol. 2017 Jun;38(5):e34-e40. doi: 10.1097/MAO.0000000000001386.
Treatment of external auditory canal cholesteatoma (EACC) has been a question of debate. To our knowledge and according to a systematic review of endoscopic ear surgery (EES) in 2015, this study describes for the first time the technique and outcome by solely transcanal EES for EACC.
Retrospective case series, level of evidence IV.
Between October 2014 and December 2016, nine patients with unilateral EACC have been treated by EES. Using a bimanual technique, canaloplasty has been performed using tragal perichondrium, cartilage, or artificial bone. Symptoms, signs, and reconstruction technique have been assessed and the primary endpoint: healing time was compared with benchmark values in the literature.
During the 26 months study period all of our nine Naim stage III EACCs were successfully treated by EES with median healing time of 23.8 days. EACC limited to the external auditory canal (Naim stage III) represented an ideal target for EES minimizing tissue damage and thus median healing time compared with retroauricular (42-56 d) or endaural (59 d) surgical techniques.
Shorter healing time helped to reduce skepticism toward a surgical treatment of EACC from the patient's perspective. Moreover, EES relied on reduced bulky equipment, dressing time, and complex maintenance compared with microscopic techniques.
Transcanal endoscopic surgery is a valid treatment option for EACC up to Naim stage III. Moreover, the described procedure fosters in our eyes the teaching of our residence to get familiar with the basic steps of EES.
外耳道胆脂瘤（EACC）的治疗一直是一个有争议的问题。据我们所知，根据2015年对耳内镜手术（EES）的系统评价，本研究首次描述了单纯经耳道耳内镜手术治疗EACC的技术及结果。
回顾性病例系列研究，证据等级为IV级。
2014年10月至2016年12月期间，9例单侧外耳道胆脂瘤患者接受了耳内镜手术治疗。采用双手操作技术，使用耳屏软骨膜、软骨或人工骨进行外耳道成形术。评估了症状、体征和重建技术，并将主要终点指标愈合时间与文献中的基准值进行了比较。
在26个月的研究期间，我们的9例Naim III期外耳道胆脂瘤均通过耳内镜手术成功治疗，愈合时间中位数为23.8天。局限于外耳道的外耳道胆脂瘤（Naim III期）是耳内镜手术的理想目标，与耳后（42 - 56天）或耳内（59天）手术技术相比，可将组织损伤降至最低，从而缩短愈合时间。
从患者的角度来看，较短的愈合时间有助于减少对外耳道胆脂瘤手术治疗的疑虑。此外，与显微镜技术相比，耳内镜手术所需的设备体积更小、包扎时间更短且维护更简单。
经耳道内镜手术是治疗Naim III期以下外耳道胆脂瘤的有效选择。此外，我们认为所描述的手术方法有助于我们的住院医师熟悉耳内镜手术的基本步骤。
