| Objective: This article retrospectively studies the cases of cholesteatoma of the external auditory canal,explores the choice of surgical methods for cholesteatoma of the external auditory canal under endoscope and microscope,and compares the effects of observation.Design : A retrospective analysis of 40 patients(40 ears)diagnosed with external auditory canal cholesteatoma and surgically treated in the Department of Otolaryngology,Head and Neck Surgery of the First Affiliated Hospital of Dalian Medical University from September 2016 to December 2019,was given Shin according to preoperative examination.According to the classification,the appropriate surgical method was selected under the microscope or otoscopy,18 cases of type ?,13 cases of type ?,9 cases of type ?,and IV0 cases;operation method 1: simple EACC removal in 11 cases;operation method 2 : EACC removal + external auditory canalplasty in 14 cases;operation method 3: EACC removal + external auditory canalplasty + tympanoplasty;operation method 4: EACC removal + modified mastoidectomy + tympanoplasty + external auditory canalplasty.This article compares the data and follow-up data of 20 inpatients undergoing endoscopy and microsurgery operation.The surgical methods,operation time,dry ear time and symptom improvement at 2 months,3 months,and 6 months after follow-up are compared.The effects of hearing improvement,air-bone conduction difference(ABG),preoperative changes,and recurrence rate were compared and observed at 6 months after operation.Result: Statistical analysis of various data showed that the average operation time of the two groups of patients(71.75 ± 28.99 min in Otoscope group;93.00 ± 30.63 min in Microscope group)was significantly different(P <0.05).Among the Shin classification,type I(Otoscope group.51.87 ± 5.30min;Microscope group(69.00 ± 14.49min)had significant difference(P <0.05),type II(Otoscope group 65.00 ± 9.26min;Microscope group 98.00 ± 8.37min)had significant difference(P <0.05);type III(Otoscope group 125.00 ± 10.00min;Microscope group 136.00 ± 14.40min),no significant difference(P> 0.05).Compared with Microscope group,the type of Shin in type I and type II was significantly shorter than that in Microscope group.There was a significant difference in the average postoperative dry ear time between the two groups(2.03 ± 0.53 weeks in Otoscope group;2.90 ± 0.9 weeks in Microscope group),and Shin type I(1.98 ± 0.47 weeks in Otoscope group;2.78 ± 0.82 in Microscope group).There were significant differences in type II(Otoscope group 2.19 ± 0.37 weeks;Microscope group 3.20 ± 0.45 weeks);type III(Otoscope group 2.75 ± 0.29 weeks;Microscope group 4.20 ± 0.45 weeks).Compared with Microscope group,the recovery of Otoscope group was significantly accelerated.The preoperative and postoperative air-bone conductance difference(ABG)in the two groups was reduced by 10.30 ± 17.07 d B on average in Otoscope group and 14.35 ± 15.57 d B on Microscope group.The t test,P> 0.05,was not statistically significant.There was no significant difference in the air-bone conductance difference(ABG)before and after surgery in Shin classifications(P> 0.05).This shows that there is no significant difference in hearing improvement between two groups.Clinical efficacy The total effective rate of treatment in Otoscope group was 100.00%,which was significantly higher than 70.00% in Microscope group(P <0.05).Postoperative clinical symptoms The symptoms of tinnitus,ear pain,earplugs,and hearing improvement in Otoscope group were better than those in the control group after surgery(P <0.05).Recurrence The total recurrence rate in Otoscope group was 5,000%,which was significantly lower than the 15.00% in Microscope group(P <0.05).Conclusion: 1.According to the staging of the external auditory canal cholesteatoma,the appropriate surgical method can be used to achieve healing and hearing improvement regardless of endoscopic or microscopic surgical treatment.The effect of endoscopic ear surgery is better than that under microscope.2.Microsurgery is suitable for cases with extensive mastoid lesions or complications.3.Compared with microsurgery,the treatment of cholesteatoma of the external ear canal with endoscope has the advantages of easy observation,short operation time,thorough surgery,less trauma,fast postoperative healing,and low recurrence rate.With the continuous improvement of instruments and technology,endoscopic surgery for cholesteatoma of the external auditory canal has a tendency to gradually replace surgery under the microscope. |
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