Рубцовые процессы в наружном слуховом проходе и методы их коррекции

Аникин И.А., Еремин С.А., Шинкарева А.Е. Рубцовые процессы в наружном слуховом проходе и методы их коррекции. Consilium Medicum. 2018; 20 (3): 61–66. DOI: 10.26442/2075-1753_20.3.61-66

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Anikin I.A., Eremin S.A., Shinkareva A.E. Cicatricial processes in the external auditory canal and methods of their correction. Consilium Medicum. 2018; 20 (3): 61–66. DOI: 10.26442/2075-1753_20.3.61-66

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Аннотация

В литературном обзоре рассмотрены рубцовые процессы наружного слухового прохода (НСП) с точки зрения нарушения их формирования, хирургической коррекции и консервативного лечения. Приведены разные хирургические техники, формирующие представление об устранении атрезии НСП. Поскольку резекция атретической ткани связана с рисками рестенозирования, представлены разные методики пластики НСП, снижающие возможность повторного заращения. Несмотря на успехи хирургии, процент рецидивов по-прежнему остается высок, поэтому мы предлагаем собственную модификацию существующей методики, что позволяет сократить число реопераций до 10%. Рассмотрены существующие виды стентирующих материалов НСП. Использование стентов позволяет сохранить размеры НСП после операции. Приведены варианты консервативного лечения: инъекционные глюкокортикостероиды, факторы роста, перспективные препараты, физиолечение. Несмотря на достижения современной медицины, проблема повторного возникновения атрезии сохраняет свою актуальность и требует дальнейшей разработки комплексных подходов в ее лечении.

Ключевые слова: атрезия, наружный слуховой проход, рубцы, хирургическая коррекция, глюкокортикоиды, стенты.

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In the literature review, the scar processes of the external auditory canal (EAC) are examined from the point of view of their formation, their surgical correction and conservative treatment. Various surgical techniques are presented that form an idea of the elimination of atresia of the EAC. Since resection of atretic tissue is associated with the risk of restenosis, various techniques for the plasticization of the EAC are presented, which reduce the possibility of restenosis. Despite the success of surgery, the percentage of relapses is still high, so we propose our own modification of the existing technique, which reduces the number of re-operations to 10%. Existing types of stenting materials of the EAC are considered. The use of stents allows you to keep the size of the EAC after surgery. The variants of conservative treatment are given: injectable glucocorticosteroids, growth factors, promising drugs, laserotherapy. Despite the achievements of modern medicine, the problem of repeated occurrence of atresia remains relevant and requires further development of integrated approaches in its treatment.

Key words: atresia, external auditory meatus, scars, surgical correction, glucocorticoids, stents.

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Список литературы

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2. Namysłowski G, Scierski W, Mrówka-Kata K et al. Surgical treatment of acquired external auditory canal atresia. Otolaryngol Pol 2002; 56 (1): 63–7.
3. Droessaert V, Vanspauwen R, Offeciers E et al. Surgical Treatment of Acquired Atresia of the External Auditory Ear Canal. Int Arch Otorhinolaryngol 2017; 21 (4): 343–6.
4. Munteanu AD, Bedereag Helvetica LightI, NiHelvetica Lightescu C, Florescu IP. Anatomopathological findings in scar: comparative study between different specimens. Rom J Morphol Embryol 2015; 56 (1): 283–8.
5. Bonding P, Tos M. Postinflammatory acquired atresia of the external auditory canal. Acta Otolaryngol 1975; 79: 115–23.
6. Luong A, Roland PS. Acquired external auditory canal stenosis: assessment and management. Cur Opin Otolaryngol Head Neck Surg 2005; 13 (5): 273–6.
7. Rex S. Haberman II. Middle ear and mastoid surgery. New York: Thieme, 2004; p. 177–88.
8. Tos M. Руководство по хирургии среднего уха. Т. 3. Томск: СибГМУ, 2007. / Tos M. Rukovodstvo po khirurgii srednego ukha. T. 3. Tomsk: SibGMU, 2007. [in Russian]
9. Paparella MM, Kurkjain JM. Surgical treatment for chronic stenosing external otitis. Laryngoscope 1966; 56: 232–45.
10. Dhooge I, D'hoop M, Loose D, Acke F. Acquired atresia of the external auditory canal: long-term clinical and audiometric results aftersurgery. Otol Neurotol 2014; 35 (7): 1196–200.
11. Jacobsen N, Mills R. Management of stenosis and acquired atresia of the external auditory meatus. J Laryngol Otol 2006; 120 (4): 266–71.
12. Steffensen WH. А method of correcting atresia of the ear canal. J Plast Reconstr Surg 1946; 1: 329–31.
13. Eichel BS, Simonton KМ. Stenosis of the external auditory meatus secondary to chronic external otitis treated by a simplified surgical method: report of case. Laryngoscope 1965; 75: 16–21.
14. Chao-Yin Kuo, Hsin-Chien Chen, Cheng-Ping Shih, Chih-Hung Wang. A Composite Foley Catheter Stent Used to Successfully Manage Recurrent Canal Stenosis Caused by Fibrous Dysplasia of the Temporal Bone. J Int Adv Otol 2014; 10 (2): 194–6.
15. Keller RG, Ong AA, Nguyen SA et al. Postinflammatory medial canal fibrosis: An institutional review and meta-analysis of short- and long-term outcomes. Laryngoscope 2017; 127 (2): 488–95.
16. Bajin MD, Yılmaz T, Günaydın RÖ et al. Management of Acquired Atresia of the External Auditory Canal. J Int Adv Otol 2015; 11 (2): 147–50.
17. Еремин С.А., Аникин М.И., Салихова Г.С. Способ хирургического лечения приобретенной мягкотканой атрезии костного отдела наружного слухового прохода. Материалы V Петербургского форума оториноларингологов России и IV Всероссийского конгресса по слуховой имплантации с международным участием. 2016; с. 97–8. / Eremin S.A., Anikin M.I., Salikhova G.S. Sposob khirurgicheskogo lecheniia priobretennoi miagkotkanoi atrezii kostnogo otdela naruzhnogo slukhovogo prokhoda. Materialy V Peterburgskogo foruma otorinolaringologov Rossii i IV Vserossiiskogo kongressa po slukhovoi implantatsii s mezhdunarodnym uchastiem. 2016; s. 97–8. [in Russian]
18. Аникин И.А., Еремин С.А., Салихова Г.С. Способ хирургического лечения приобретенных атрезий перепончато-хрящевого отдела наружного слухового прохода. Материалы XIX Съезда оториноларингологов России. 2016; с. 208–9. / Anikin I.A., Eremin S.A., Salikhova G.S. Sposob khirurgicheskogo lecheniia priobretennykh atrezii pereponchato-khriashchevogo otdela naruzhnogo slukhovogo prokhoda. Materialy XIX S"ezda otorinolaringologov Rossii. 2016; s. 208–9. [in Russian]
19. Астащенко С.В., Аникин И.А., Еремин С.А., Аникин М.И. Способ устранения латерализации неотимпанальной мембраны у пациентов, перенесших тимпанопластику. Рос. оториноларингология. 2012; 2 (57): 19–23. / Astashchenko S.V., Anikin I.A., Eremin S.A., Anikin M.I. Sposob ustraneniia lateralizatsii neotimpanal'noi membrany u patsientov, perenesshikh timpanoplastiku. Ros. otorinolaringologiia. 2012; 2 (57): 19–23. [in Russian]
20. Tziotzios C, Profyris C, Sterling J. Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics. Part II. Strategies to reduce scar formation after dermatologic procedures. J Am Acad Dermatol 2012; 66 (1): 13–24; quiz 25–6.
21. Stojadinovic O, Lee B, Vouthounis C et al. Novel genomic effects of glucocorticoids in epidermal keratinocytes: inhibition of apoptosis, interferon-gamma pathway, and wound healing along with promotion of terminal differentiation. J Biol Chem 2007; 282: 4021–34.
22. Trisliana Perdanasari A, Torresetti M, Grassetti L et al. Intralesional injection treatment of hypertrophic scars and keloids: a systematic review regarding outcomes. Burns Trauma 2015; 26 (3): 14.
23. Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc 2014; 64 (9): 1003–7.
24. Maguire HCJr. Treatment of keloids with triamcinolone acetonide injected intralesionally. JAMA 1956; 192: 325–6.
25. Adhershitha AR, Anilkumar S, Rajesh C, Mohan DC. Prosthetic management of posttraumatic external auditory canal atresia: A rare cause of conductive hearing loss. J Indian Prosthodont Soc 2016; 16 (4): 390–4.
26. Tirelli G, Nicastro L, Gatto A, Boscolo F. Strenching stenosis of the external auditory canal: report of four causes and brief review of the literature. Acta Otorhinolaryngol Ital 2015; 35 (1): 34–8.
27. Berman B, Perez OA, Konda S et al. A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 2007; 33: 1291–303.
28. Lecl FM, Mordon SR. Twenty-five years of active laser prevention of scars: what have we learned. J Cosmet Laser Ther 2010; 12: 227–34.
29. Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet 1995; 345: 1198–200.
30. Occleston NL, Fairlamb D, Hutchison J et al. Avotermin for the improvement of scar appearance: a new pharmaceutical in a new therapeuticarea. Expert Opin Investig Drugs 2009; 18 (8): 1231–9.
31. Viera MH, Amini S, Valins W, Berman B. Innovative therapies in the treatment of keloids and hypertrophic scars. J Clin Aesthet Dermatol 2010; 3: 20–6.
32. Lo JF, Tsang WS, Yu JY et al. Contemporary hearing rehabilitation options in patients with aural atresia. Biomed Res Int 2014; 2014: 761579.
33. Farnoosh S, Mitsinikos FT, Maceri D, Don DM. Bone-anchored hearing aids vs. reconstruction of the external auditoary canal in children and adolescents with congenital aural atresia: a comparison study of outcomes. Front Pediatr 2014; 2: 1–7
34. Manrique M, Sanhueza I, Manrique R, de Abajo J. A new bone conduction hearing implant: surgical tecnique and results. Otol Neurotol 2014; 35 (2): 216–20.
35. Chihiro M, Tadashi N, Hiroshi H et al. Sound transmission by cartilage conduction in ear with fibrotic aural atresia. J Rehabil Res Dev 2014; 51 (2): 325–32.
36. Shimokura R, Hosoi H, Iwakura T et al. Development of monaural and binaural behind-the-ear cartilage conduction hearing aids. Appl Acoust 2013; 74 (11): 1234–40.

________________________________________________

1. Anikin I.A., Eremin S.A. Osobennosti priobretennykh atrezii pereponchato-khriashchevogo otdela naruzhnogo slukhovogo prokhoda i effektivnost' novogo khirurgicheskogo lecheniia. RMZh. 2017; 23: 1703–6. [in Russian]
2. Namysłowski G, Scierski W, Mrówka-Kata K et al. Surgical treatment of acquired external auditory canal atresia. Otolaryngol Pol 2002; 56 (1): 63–7.
3. Droessaert V, Vanspauwen R, Offeciers E et al. Surgical Treatment of Acquired Atresia of the External Auditory Ear Canal. Int Arch Otorhinolaryngol 2017; 21 (4): 343–6.
4. Munteanu AD, Bedereag Helvetica LightI, NiHelvetica Lightescu C, Florescu IP. Anatomopathological findings in scar: comparative study between different specimens. Rom J Morphol Embryol 2015; 56 (1): 283–8.
5. Bonding P, Tos M. Postinflammatory acquired atresia of the external auditory canal. Acta Otolaryngol 1975; 79: 115–23.
6. Luong A, Roland PS. Acquired external auditory canal stenosis: assessment and management. Cur Opin Otolaryngol Head Neck Surg 2005; 13 (5): 273–6.
7. Rex S. Haberman II. Middle ear and mastoid surgery. New York: Thieme, 2004; p. 177–88.
8. Tos M. Руководство по хирургии среднего уха. Т. 3. Томск: СибГМУ, 2007. / Tos M. Rukovodstvo po khirurgii srednego ukha. T. 3. Tomsk: SibGMU, 2007. [in Russian]
9. Paparella MM, Kurkjain JM. Surgical treatment for chronic stenosing external otitis. Laryngoscope 1966; 56: 232–45.
10. Dhooge I, D'hoop M, Loose D, Acke F. Acquired atresia of the external auditory canal: long-term clinical and audiometric results aftersurgery. Otol Neurotol 2014; 35 (7): 1196–200.
11. Jacobsen N, Mills R. Management of stenosis and acquired atresia of the external auditory meatus. J Laryngol Otol 2006; 120 (4): 266–71.
12. Steffensen WH. А method of correcting atresia of the ear canal. J Plast Reconstr Surg 1946; 1: 329–31.
13. Eichel BS, Simonton KМ. Stenosis of the external auditory meatus secondary to chronic external otitis treated by a simplified surgical method: report of case. Laryngoscope 1965; 75: 16–21.
14. Chao-Yin Kuo, Hsin-Chien Chen, Cheng-Ping Shih, Chih-Hung Wang. A Composite Foley Catheter Stent Used to Successfully Manage Recurrent Canal Stenosis Caused by Fibrous Dysplasia of the Temporal Bone. J Int Adv Otol 2014; 10 (2): 194–6.
15. Keller RG, Ong AA, Nguyen SA et al. Postinflammatory medial canal fibrosis: An institutional review and meta-analysis of short- and long-term outcomes. Laryngoscope 2017; 127 (2): 488–95.
16. Bajin MD, Yılmaz T, Günaydın RÖ et al. Management of Acquired Atresia of the External Auditory Canal. J Int Adv Otol 2015; 11 (2): 147–50.
17. Eremin S.A., Anikin M.I., Salikhova G.S. Sposob khirurgicheskogo lecheniia priobretennoi miagkotkanoi atrezii kostnogo otdela naruzhnogo slukhovogo prokhoda. Materialy V Peterburgskogo foruma otorinolaringologov Rossii i IV Vserossiiskogo kongressa po slukhovoi implantatsii s mezhdunarodnym uchastiem. 2016; s. 97–8. [in Russian]
18. Anikin I.A., Eremin S.A., Salikhova G.S. Sposob khirurgicheskogo lecheniia priobretennykh atrezii pereponchato-khriashchevogo otdela naruzhnogo slukhovogo prokhoda. Materialy XIX S"ezda otorinolaringologov Rossii. 2016; s. 208–9. [in Russian]
19. Astashchenko S.V., Anikin I.A., Eremin S.A., Anikin M.I. Sposob ustraneniia lateralizatsii neotimpanal'noi membrany u patsientov, perenesshikh timpanoplastiku. Ros. otorinolaringologiia. 2012; 2 (57): 19–23. [in Russian]
20. Tziotzios C, Profyris C, Sterling J. Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics. Part II. Strategies to reduce scar formation after dermatologic procedures. J Am Acad Dermatol 2012; 66 (1): 13–24; quiz 25–6.
21. Stojadinovic O, Lee B, Vouthounis C et al. Novel genomic effects of glucocorticoids in epidermal keratinocytes: inhibition of apoptosis, interferon-gamma pathway, and wound healing along with promotion of terminal differentiation. J Biol Chem 2007; 282: 4021–34.
22. Trisliana Perdanasari A, Torresetti M, Grassetti L et al. Intralesional injection treatment of hypertrophic scars and keloids: a systematic review regarding outcomes. Burns Trauma 2015; 26 (3): 14.
23. Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc 2014; 64 (9): 1003–7.
24. Maguire HCJr. Treatment of keloids with triamcinolone acetonide injected intralesionally. JAMA 1956; 192: 325–6.
25. Adhershitha AR, Anilkumar S, Rajesh C, Mohan DC. Prosthetic management of posttraumatic external auditory canal atresia: A rare cause of conductive hearing loss. J Indian Prosthodont Soc 2016; 16 (4): 390–4.
26. Tirelli G, Nicastro L, Gatto A, Boscolo F. Strenching stenosis of the external auditory canal: report of four causes and brief review of the literature. Acta Otorhinolaryngol Ital 2015; 35 (1): 34–8.
27. Berman B, Perez OA, Konda S et al. A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 2007; 33: 1291–303.
28. Lecl FM, Mordon SR. Twenty-five years of active laser prevention of scars: what have we learned. J Cosmet Laser Ther 2010; 12: 227–34.
29. Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet 1995; 345: 1198–200.
30. Occleston NL, Fairlamb D, Hutchison J et al. Avotermin for the improvement of scar appearance: a new pharmaceutical in a new therapeuticarea. Expert Opin Investig Drugs 2009; 18 (8): 1231–9.
31. Viera MH, Amini S, Valins W, Berman B. Innovative therapies in the treatment of keloids and hypertrophic scars. J Clin Aesthet Dermatol 2010; 3: 20–6.
32. Lo JF, Tsang WS, Yu JY et al. Contemporary hearing rehabilitation options in patients with aural atresia. Biomed Res Int 2014; 2014: 761579.
33. Farnoosh S, Mitsinikos FT, Maceri D, Don DM. Bone-anchored hearing aids vs. reconstruction of the external auditoary canal in children and adolescents with congenital aural atresia: a comparison study of outcomes. Front Pediatr 2014; 2: 1–7
34. Manrique M, Sanhueza I, Manrique R, de Abajo J. A new bone conduction hearing implant: surgical tecnique and results. Otol Neurotol 2014; 35 (2): 216–20.
35. Chihiro M, Tadashi N, Hiroshi H et al. Sound transmission by cartilage conduction in ear with fibrotic aural atresia. J Rehabil Res Dev 2014; 51 (2): 325–32.
36. Shimokura R, Hosoi H, Iwakura T et al. Development of monaural and binaural behind-the-ear cartilage conduction hearing aids. Appl Acoust 2013; 74 (11): 1234–40.

Авторы

И.А.Аникин*, С.А.Еремин, А.Е.Шинкарева

ФГБУ «Санкт-Петербургский научно-исследовательский институт уха, горла, носа и речи» Минздрава России. 190013, Россия, Санкт-Петербург, ул. Бронницкая, д. 9
*dr-anikin@mail.ru

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I.A.Anikin*, S.A.Eremin, A.E.Shinkareva

Saint Petersburg Research Institute of Ear, Nose, Throat and Speech of the Ministry of Health of the Russian Federation. 190013, Russia, Saint Petersburg, ul. Bronnitskaia, d. 9
*dr-anikin@mail.ru

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