临床上外耳道检查时常能发现什么病变?

2025-04-07 23:09:29
推荐回答(1个)
回答(1):

(1)耵聍栓塞。外耳道软骨部的皮肤具有类似汗腺构造的耵聍腺可分泌耵聍,即人们常说的耳垢或耳屎,具有保护外耳道皮肤和黏附外物的作用。正常情况下,可借咀嚼、张口等运动而排出耳外。

但如果耵聍分泌过多或排出受阻就会逐渐积结成团而形成耵聍栓塞。

引起的常见症状是堵塞外耳道而导致听力减退,并可能有耳痛;部位过深刺激鼓膜者可发生耳鸣、眩晕。检查时可见外耳道内有黑色或棕褐色耵聍块,质软如蜡,或坚硬如石。

(2)外耳道异物。多见于小儿,成人也可发生。多因挖耳或外伤遗留,以及虫类侵入而造成。异物可分为非生物类、植物类和动物类。若异物小而无刺激者,可久存而无症状。异物大者可阻塞耳道引起听力下降及发胀感。有时引起眩晕、耳鸣和耳痛,或造成皮肤破损。一般情况下,检查较易发现异物。

(3)外耳道红肿溃烂。常见病变为外耳道疖和弥漫性外耳道炎,中医学分别称之为耳疖和耳疮。前者表现为局限性红肿,疼痛明显,突起如椒目或顶现脓点,后者则为弥漫性红肿、溃烂,黄白色分泌物较多。

(4)外耳道积脓。脓液可能由于外耳道本身病变所致,也可能由于中耳病变脓液自鼓膜穿孔处流出积留于外耳道内形成。一般说来,脓液质黏者,多为中耳疾病;不黏者,多属外耳疾病。外耳疾病见于外耳道疖、弥漫性外耳道炎和外耳湿疹,中耳疾病主要是急慢性化脓性中耳炎。

(5)外耳道狭窄。除先天性原因外,常由于弥漫性外耳道炎和外耳湿疹之慢性者,导致外耳道皮肤增厚而发生狭窄,常会影响听力。

(6)外耳道骨段后上壁塌陷。常提示为外耳道胆脂瘤存在,或慢性化脓性中耳乳突炎形成。

(7)外耳道新生物。良性肿瘤有外耳道乳头状瘤、外耳道胆脂瘤、外耳道骨疣、血管瘤、纤维瘤、耵聍腺瘤等;恶性肿瘤有腺癌、肉瘤、恶性黑色素瘤等。另外,慢性化脓性中耳炎可导致鼓室内有息肉生长,息肉从鼓膜穿孔处脱出形成外耳道赘生物。

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