Repair of external auditory canal stenosis and atresia

There are two types of external auditory canal stenosis and atresia: ① secondary to trauma or infection, forming scar and fibrous tissue hyperplasia; ② It is caused by abnormal embryonic development. The latter type is often accompanied by auricle and middle ear malformation (Figure 1). The clinical manifestations are hypoplasia of auricle or small auricle, atresia of bony external auditory canal, contact between the head of temporomandibular joint and the anterior edge of mastoid, fusion and fixation of malleus and incus, while stapes comes from lingual arch, which is generally normal in development and movement. The inner ear rarely deforms at the same time because the embryos come from different sources.

Figure 1 atresia of external auditory canal

Fig. 2 Incision of external ear surgery

indicate

Stenosis and atresia of external auditory canal.

surgical instrument

In addition to general surgical instruments, there is also an ear microscope and a set of ear microsurgical instruments.

Preoperative preparation

X-ray should be taken before operation to understand the development of mastoid air cavity, the shadow of middle ear cavity and auditory bone, and the degree of osseous atresia of external auditory canal. Also do a hearing test to determine whether the cochlear function is good.

The principle of surgical treatment is to correct atresia, rebuild conduction system and improve hearing. Selection of operation age: Patients with binaural atresia should be operated at the age of 6-7, when cochlear function can be accurately measured and anesthesia can be tolerated for a long time. The operation time of single ear is better in adulthood.

Surgical method

The surgical method of external auditory canal atresia depends on the type.

1, there are three kinds of incisions. ① Cut in the ear and pull the deformed auricle back as far as possible. If there is no sign of ear canal, the position of incision should be determined by zygomatic root, anterior wall of mastoid process and mandibular condyle (Figure 2). ② Posterior auricular incision can avoid damaging the temporomandibular joint capsule. ③ If there is no original funnel-shaped ear canal, a cross incision is feasible, with a longitudinal incision of 3cm and a transverse incision of 1cm. Lift the quadrilateral skin graft and remove its subcutaneous tissue. Finally, the quadrilateral skin flap is turned inward and sewn on the periosteum, thus forming a round ear hole to prevent stenosis.

2. According to the nature of the lesion, there are three methods:

(1) directly enters the ear canal, which is mostly used when the auricle is still well developed, the position of the mandibular joint head is normal, or the ear canal may be closed due to trauma and inflammation, and there may be a complete tympanic membrane. When the cavity of bone ear canal is full of connective tissue and bone tissue, we should first explore the ear canal, remove the connective tissue, chisel out the closed ear canal and enlarge the ear canal cavity. If the eardrum is found to be intact, only ear canal plasty and implantation are needed.

(2) After mastoidectomy, make a transverse trapezium myoperiosteal flap to expose the mastoid, and grind off the mastoid cortex with an electric drill until the meninges and sigmoid sinus under the canopy are only protected by a thin layer of bone wall, and the redundant bones and the air bags or barrier bones in the mastoid are completely ground off along the way, that is, "outline", and enter the tympanic sinus along the meningeal angle of the sinus. When the mastoid is solid, it should be ground into the front of the mastoid near the temporomandibular joint, but it must be noted that a layer of bone wall should be reserved between the mastoid and the temporomandibular joint as the front wall of the artificial external auditory canal. For example, if the mastoid is well gasified, the surgical indications for entering the entrance of tympanic sinus, upper tympanum and tympanum are the same as those for normal gasified mastoid. When the ankle joint is fused and fixed, the ankle joint can be removed, and the temporalis myofascia or thin skin taken in advance can be implanted on the stapes footplate. TORP or semicircular canal can be placed to open the window, but it needs to be done by stages.

(3) Using the spacious mastoid cavity as a new external auditory canal, make a cross-shaped incision on the skin at the atresia of the ear canal, peel off the skin, trim the subcutaneous adipose tissue, and transfer it to the mastoid cavity to cover the mastoid wound, or select the mound-shaped residual ear in the flap area to trim the subcutaneous tissue and cartilage to form a long flap, transfer it to the mastoid cavity, and then fill it with gelatin sponge and gauze after dropping a small amount of fibrin glue.

Matters needing attention

1. Congenital complete atresia of external auditory canal is inevitable, often accompanied by facial nerve malformation. During the operation, we should always pay attention to the signs such as tympanic sinus, horizontal semicircular canal and stapes to avoid damaging the facial nerve. Generally, facial nerve is always adjacent to tympanic sinus and tympanic cavity. At this time, use a small cutting drill or diamond drill to avoid hurting the facial nerve or getting lost.

2. The pedicled flap of the ear canal must be thinned, turned into the mastoid cavity and stuffed with gelatin sponge and gauze for 2-3 weeks before it can be taken out.

3. The ear canal should be spacious to avoid hyperplasia and exudation of granulation in mastoid cavity and external auditory canal, and there should be enough flaps or flaps to prevent infection.

4. When reconstructing the anterior wall of the external auditory canal, the thin bone between the external auditory canal and the temporomandibular joint should not be broken, so as not to damage the mandibular joint capsule. If there is any damage, it must be repaired immediately. /medicine/medicine 02/ 15/ 15 1 15 . XML？ tmp=.7444422

chat history

[Guest Xu] A: Dear netizens, today I am a guest to discuss the issues of children's hearing screening, children's hearing impairment diagnosis, intervention and rehabilitation. There are nearly 30,000 hearing-impaired children among newborns every year. At present, there are 800,000 children under the age of seven and hearing-impaired children under the age of fifteen in China1700,000. If these children are not found in time, they will often become deaf-mute patients, which will cause great burden to society. So what we are discussing online this time is: how to find children's hearing problems early and intervene in time to prevent children from becoming deaf-mute patients. This is the topic we are going to discuss today. Therefore, Shanghai Children's Hearing Impairment Diagnosis and Treatment Center was established in Pediatric Hospital affiliated to Fudan University on June 26th, Shanghai time. Its purpose is to find children early, intervene and treat them in time, and recover. Therefore, this clinic is responsible for the technical guidance of newborn hearing screening in Shanghai, as well as the diagnosis, treatment and rehabilitation of children who failed hearing screening in all hearing screening points in Shanghai. At the same time, he is responsible for the hearing diagnosis and treatment of outpatient children.

[User jyy] Q: Will it be postponed if the newborn fails to pass the hearing deletion for 42 days, 3 months and 6 months?

[Guest Xu] A: The newborn hearing screening we conducted in Shanghai was the first screening three to five days after birth and the second screening forty-two days after birth. Generally speaking, we will make a diagnosis within six months. Once diagnosed, it is necessary to intervene in time. If it is diagnosed after one year old, it will take time, because the period from six months to one year old is the enlightenment stage of children's language development and an important critical period. If it is discovered and intervened after one year old, it will prolong and delay the development of children's hearing, language and other aspects.

[Netizen Nini] Q: My baby was born with hypoglycemia. After 4 days of treatment, it returned to normal. On the sixth day, I passed the hearing screening. In the third month, it failed to pass the otoacoustic emission review, and ABR passed. During these three months, I have observed that children will be awakened by loud door closing and coughing when sleeping, and babies will make (oh, different, ancient) noises when playing, and they will laugh at me when playing. My child has eczema of the external auditory canal and always scratches his ears. I am very anxious now, I don't know if my child has hearing problems, and I don't know if eczema in the external auditory canal will affect the examination results of otoacoustic reflex, and whether eczema will affect hearing, and I am eager to wait for an expert's answer! ! !

[Guest Xu] A: According to your child's current situation, it may be eczema of the external auditory canal, which causes the secretion inside to affect the passage of otoacoustic emissions. If ABR passes, generally speaking, listening is fine.

[User jijih] Q: Doctor: When I had a physical examination in August last year, the cardiovascular function test report said: 1, and the cardiac work and oxygen consumption increased. 2, arteriosclerosis. 3. Poor blood rheology. Tinnitus continued in mid-September this year, and I caught a cold on September 30 and suddenly became deaf. On April 4th, 65438, I was admitted to the Municipal ENT Department. After three courses of treatment, my hearing basically recovered. After oxygen cabin treatment, I am taking Stallone, Mecobalamin and Minzhilang tablets. Hearing has recovered, but I am still dizzy and afraid of noise. I can't go on the road. How long will it take? Doctor, is my sudden deafness related to cardiovascular abnormalities? Please tell me how to see a doctor and which hospital to go to.

[Guest Xu] A: There are two kinds of sudden deafness, one is hearing problems, and the other is hearing problems accompanied by dizziness. Among them, there are hearing problems, but vertigo may not be recovered. Sudden deafness may be related to cardiovascular diseases. After recovery, you must pay attention to rest to avoid recurrence. It is recommended that adults go to Fenyang Road Otolaryngology Hospital for treatment.

[User fdh] Q: Hello! The baby was born on165438+1October 28th. 10/30, the nurse finished feeding the baby, and the baby went to bed soon, so the baby returned to milk. When adults found that the milk flowed down the face to the auricle, they were not sure whether the milk had entered the ear canal, but in today's newborn physical examination, the doctor said that the baby had one. If so, is there any way to make up for it?

[Guest Xu] A: The doctor said that there was a baby with hearing problems, which may have been screened out. If you want to make a diagnosis, please go to Shanghai Children's Hearing Impairment Testing Center, which is located in the Department of Otolaryngology, Pediatric Hospital, to make a diagnosis to determine whether there is a hearing problem.

[Netizen landy] Q: The patient was deaf for three consecutive years due to a slight collision. Later, he was diagnosed as nervous deafness by Shanghai Otolaryngology Hospital. Now listen.

[Guest Xu] A: If your child is diagnosed with mental deafness, there may not be a good way to treat this kind of neurological deafness from the perspective of international and domestic treatment programs.

[Netizen child] Q: My child is in the second grade of primary school. I don't know why I always say that the teacher can't hear clearly recently ... and I said that sometimes my ears get stuck when I sneeze, and I can hear a loud voice when I listen to the teacher. I wonder if there is something wrong with the child's ears? What should I do? Besides, I had a cholesteatoma in my ear a long time ago, which was removed by surgery. I don't know if it is inherited from children. My son was in poor health when he was a child. He always has a cold and a high fever. I remember once otitis media. Does it have anything to do with this?

[Guest Xu] A: There may be a hearing problem, and this problem may be the inner ear. This phenomenon is called a severe earthquake, which means that there may be lesions in the inner ear.

[Netizen Begging] Q: Hello, doctor! My little niece is only five years old this year. After a fever this spring, she began to have ear pain. She didn't care at the time. After two or three months, she caught a cold and her ears hurt badly. She went to see a doctor and was diagnosed with chronic otitis media. Now, she is returning to the clinic every week and has been taking medicine, but she has not improved. It hurts for about an hour or two every day. What should I do, doctor? Can it be cured? Will there be sequelae? According to the doctor of the five senses hospital, this disease is very common in children, and it will be fine when she is fully developed. Is there such a saying?

[Guest Xu] A: I was diagnosed with chronic otitis media, which is often caused by a cold. If you want to prevent the recurrence of this disease, you must prevent colds. When you grow up, you will get better, which is related to your health.

[User yaya] Q: Dear doctor, I would like to ask: My child went to the Children's Medical Center for hearing examination when he was three months old. His ears were hearing 40 decibels in his left ear and 50 decibels in his right ear. After half a year's examination, he found that his binaural hearing was 50 decibels. Will it get worse? What should I pay attention to? What measures are taken?

[Guest Xu] A: After the examination in the Children's Medical Center, there are two possibilities: one is that he may reach normal with his development, and the other is acquired progressive hearing loss, which may reach 70 or 80 years old. Therefore, for your child, it is best to follow up regularly in Shanghai Children's Hearing Impairment Center of Pediatric Hospital.

[User a] Q: Hello! My daughter is now 18 months old, and still can't speak-occasionally she can make a "mother" voice, but the rest can't be said. Usually when she has something to say, she always says "ah-ah". We called her and she responded positively. Although I can't say it in my mouth, I know everything in my heart. The child walks well, nothing special except his height and weight. Please help!

[Guest Xu] A: Your child is 18 months, which shows that his language development is slow. There are two possibilities. One is that she can't speak because of her poor hearing. Another possibility is that her language development is slow, so you must go to a professional hospital, such as Shanghai Children's Hearing Impairment Clinic of Pediatric Hospital, for further hearing diagnosis and further examination of whether the language is mentally retarded.

[Netizen Gaga] Q: Now that the child is over 3 years old, he still can't talk very well. He occasionally speaks some syllabic words that we can't understand. Excuse me, what is this?

[Guest Xu] A: I can't speak at the age of 3, which means that language development is definitely backward. The reasons for the backward language development are: first, poor hearing; second, problems with language combing; we must go to the hospital for further examination, diagnosis and timely intervention and treatment.

[User sags] Q: My daughter is four years old and suffers from secretory otitis media. Last year, she had an operation, inserted a tube in her ear and removed the diffuser, and the situation improved. After half a year, the pipe was removed. This year, her hearing declined and she developed preoperative symptoms. Can this otitis media be cured? How? thank you

[Guest Xu] A: This may be because the hyperplastic body is not cut perfectly and the eustachian tube is blocked, so the hearing has dropped again. The effective method is to go to the pediatric otolaryngology department of our hospital for endoscopic examination and further confirm the operation.

[User Gaga] Q: The child 15 months, still can't speak. Is it too late to say now? Why is it too late? Is there something wrong with your hearing?

[Guest Xu] A: There may be hearing problems, so you need to go to specialized hospitals, such as pediatric hospitals and otolaryngology departments for further examination.

[User vip] Q: My son is deaf in his left ear. After taking mecobalamin and Danakang (Ginkgo biloba) for three months, his hearing improved 1.5 dB. I want him to take medicine, too. I wonder if these two drugs have any side effects after long-term use? In addition, in order to improve the curative effect and time, can mecobalamin be changed to intravenous drip? thank you

[Guest Xu] A: For sudden deafness, it is enough to take Micolamine for three months, and there is no need to take any more medicine.

[User Amore] Q: My child is in the second grade of primary school. I don't know why I always say that the teacher can't hear clearly recently ... and I said that sometimes my ears get stuck when I sneeze, and I can hear a loud voice when I listen to the teacher. I wonder if there is something wrong with the child's ears? What should I do? Besides, I had a cholesteatoma in my ear a long time ago, which was removed by surgery. I don't know if it is inherited from children. My son was in poor health when he was a child. He always has a cold and a high fever. I remember once otitis media. Does it have anything to do with this?

[Guest Xu] A: It means that there may be hearing problems and further examination is needed. Besides, you have cholesteatoma, which has been operated on and will not be passed on to your child.

[User jojo] Q: Symptoms: Three days after birth, the newborn found that the right ear had no ear canal (total ear canal) and the left ear was normal. Now the baby is two months old. According to family observation, there is hearing in the left ear. Excuse me: 1. How to check the development of baby's right ear, and when can I have surgery? 2. After screening for neonatal diseases, can the possibility of deafness and/or deafness be ruled out in the future? The baby is in the field and has not been carefully examined. What should I do now?

[Guest Xu] A: We can check it further. Generally, the hearing of children with auditory canal atresia should be checked first, and then CT films should be taken to make a diagnosis. When the child grows up, the operation can only be performed after 6 or 7 years old. The operation is mainly divided into two stages, the first stage is mainly ear canal plastic surgery, and the second stage is ossicular chain plastic surgery of the middle ear (the premise of doing this operation is that the inner ear is normal).

[User ttb] Q: I want to ask, if otitis media is not operated (eardrum is rotten), what is the impact? Sometimes there is tinnitus.

[Guest Xu] A: The eardrum has been perforated, which mainly affects hearing.

[User Rainy Day] Q: Excuse me, experts, what are the indications of cochlear implant and what is the prognosis? And related expenses?

[Guest Xu] A: Indications for cochlear implant: 1. Extremely severe sensorineural deafness in both ears is greater than 90 decibels; Second, the lesion is in the cochlea. Third, the age is about 18 months after birth. Fourth, there are no surgical contraindications for other diseases; Fifth, normal intellectual development; Sixth, hospitals with rehabilitation conditions generally spend about 200 thousand.

[User Plays] Q: My ears can listen to people, but I can't hear the sound of a mechanical stopwatch when I put it on my ear, and the ringtones of Nokia and other mobile phones are not very audible. Excuse me, is the doctor deaf? Can the doctor judge what kind of deafness it is according to the electrogram? Which doctor should I see if I want to improve my listening? I am eager to get the doctor's help. I look forward to your early reply. Thank you!

[Guest Xu] A: If you can hear it with a mechanical stopwatch, it may be a mild hearing impairment, and you need to go to the hospital for further hearing examination. Electrogram can judge the nature of deafness.

[User ly~] Q: Hello, expert: My daughter is six years old. She suffered from otitis media when she was very young. I don't know why she always calls it "earache". A few days ago, she had a fever (no other cold symptoms). She went to hospital with a fever. The doctor said it was caused by otitis media, and the examination said it was bleeding in her ear. In the long run, I'm afraid it will affect children's hearing, their health and their future study. I want to ask an expert how to treat my daughter's otitis media, how to prevent it, and what medicine is better to take?

[Guest Xu] A: Otitis media generally does not cause fever. Only a cold can cause a fever. If otitis media recurs, it may affect hearing and children. Treatment depends on the degree of otitis media, such as medication or surgery. To judge the degree of otitis media, you must go to a specialized hospital and do various hearing tests.

[Netizen Olay] Q: My son is now six months old and was diagnosed with otitis media with effusion when he was three months old. I want to ask: 1, did the baby's eardrum develop middle ear effusion when it was formed in his mother's body? 2. Now that my son is six months old, can I have an operation to remove the effusion? Does the operation require hospitalization? 3. Is it necessary to puncture the eardrum when removing hydrops? Will this affect your hearing more? Ask the experts to tell us, and we will decide the time for the next appointment according to your reply. thank you

[Guest Xu] A: When the baby's eardrum is formed in the mother's body, the middle ear effusion does not exist, but is caused by the negative pressure in the middle ear cavity, which is caused by the obstruction of the eustachian tube. Your child doesn't need a puncture to extract fluid. If not treated in time, it will really affect his hearing. I can tell you that my expert clinic is on Monday and Saturday morning, in the Department of Otolaryngology, Pediatric Hospital affiliated to Fudan University, at No.83/KLOC-0, LAM Raymond Road, Xuhui District. Not in the family center on Dongfang Road.

[User jyy] Q: Hello, I'm the questioner of the second question, because Professor Wang Zhengmin from the Otolaryngology Hospital asked my child to go back for a follow-up visit at the age of one. What should I do? Excuse me, Professor Xu, where is your current hospital address? Thank you.

[Guest Xu] A: My current hospital address is: Department of Otolaryngology, Pediatric Hospital Affiliated to Fudan University, and the address is: No.83, LAM Raymond Road, Xuhui District. The time of expert outpatient service is Monday and Saturday morning.

[Netizen Cao Qing] Q: My daughter was born in the Obstetrics and Gynecology Hospital affiliated to Fudan University in September this year. She had a newborn hearing screening within one week after birth, and all the results passed. So far, my daughter has been almost two months. The parenting book says that babies in this period should turn to find the sound source when listening to audio toys, but I found that my daughter didn't find the sound source when playing games, but when she heard the sound of suddenly closing the door and horn, there would be. Excuse me, is the hearing screening report enough to show that my daughter's hearing is ok? How should I check her hearing?

[Guest Xu] A: I suggest that she go to a specialized hospital for further diagnosis, because the newborn has passed the hearing screening, but there are still 0.2% hearing problems. If you are not at ease, go to the Shanghai Children's Hearing Impairment Diagnosis and Treatment Center of the Pediatric Hospital affiliated to Fudan University for further diagnosis and examination. Address: No.0/83, LAM Raymond Road, Xuhui District.

[Guest Xu] A: Today, I came to the chat room as a guest and read many questions about children's listening raised by netizens. Today, I am happy to answer your question. If you want to know more about children's hearing problems, you can come to me in the Department of Otolaryngology, Pediatric Hospital affiliated to Fudan University.

[Moderator]: If you have any questions, please call the hotline of Shanghai Medical Network: 1609 1985 or 9500 1 120. The guests in this issue are recommended by Shanghai Medical Network.

Don't worry, call and ask.