胆脂瘤型中耳炎并发迷路瘘管的手术治疗

目的探讨胆脂瘤型中耳炎并发迷路瘘管的临床特征及手术治疗方法。方法回顾性分析胆脂瘤型中耳炎并发迷路瘘管20例患者的临床资料,其中2例行开放式乳突根治及鼓室成形术,16例行开放式乳突根治术,2例行乳突再次根治术。结果全部患者一期修复瘘管,术后随访眩晕症状明显改善。纯音测听平均骨导阈值（0．5、1、2、4kHz）,12例术后听力无明显变化,2例术后听力有不同程度的提高,6例术后听力有轻度下降,平均下降15dB以上。结论对胆脂瘤型中耳炎患者应高度重视迷路瘘管存在的可能性,手术时应彻底清除瘘管区病变、修补瘘孔。     

迷路瘘管的诊断和手术治疗

目的：探讨胆脂瘤并发迷路瘘管患者的临床特点和治疗方法。方法：胆脂瘤并发迷路瘘管23例(6．6％)患者中,15例行开放式乳突根治术加鼓室成形术,6例行开放式乳突根治术,2例行乳突再根治术。结果：术后平均随访2年,21例干耳,22例眩晕消失,术后平均骨导听力无明显变化。结论：胆脂瘤中耳炎常并发迷路瘘管,术前尚无可靠确诊方法,颡骨高分辨CT对较大瘘管检出率高,最后确诊靠手术探查;对瘘管区病变的处理应彻底清除病变,修补瘘孔。     

慢性化脓性中耳炎合并迷路瘘管诊治体会(附32例报告)

目的探讨慢性化脓性中耳炎并发迷路瘘管的临床特征及其手术治疗方法。方法回顾分析我科2000—2007年收治的32例（36耳）手术证实的慢性化脓性中耳炎伴迷路瘘管患者的临床资料。其中有眩晕史者24例（75．0％）,诉耳呜者28例（87．5％）,瘘管试验阳性12例（37．5％）。对于小于2mm的骨性半规管瘘,在彻底清除病变后予肌筋膜覆盖。对瘘管大于2mm者,如迷路瘘管处病变难以清除,予保留一薄层胆脂瘤基质,行开放式乳突根治术;如能彻底清除病变者,予带筋膜的耳屏软骨片封闭瘘管,外面再覆盖-层肌筋膜。对瘘管破坏严重者。在彻底清除病变的同时行半规管阻塞术。22耳行开放式乳突根治术后Ⅰ期行鼓室成形术,14耳行改良乳突根治术。结果胆脂瘤型28耳,骨疡型8耳;瘘管位于外半规管30耳（83．4％）,上半规管3耳（8．4％）,两者同时有瘘管1耳（2．7％）,鼓岬部瘘管2耳f5．5％）;面神经骨管破坏致神经裸露16例,3例位于垂直段,7例位于水平段,同时合并有面神经水平段或锥曲段骨管部分缺损6例。30例患者于术后1～12天内（平均3．5天）眩晕缓解。2例行半规管填塞者,术后16天眩晕逐渐缓解。术后纯音测听平均骨导阈值（0．5kHz、1kHz、2kHz和4kHz）,12耳与术前相同,较术前下降10～20dB者16耳,较术前下降20dB以上者8耳。随访3月～6年,眩晕无复发。结论前庭症状存在与否,瘘管试验是否为阳性,以及影像学的改变等都不是术前确诊迷路瘘管的可靠指标,术中探查所见是确诊迷路瘘管最重要的依据。手术方法的选择及对瘘管区病变的处理应根据瘘管的部位、大小及患者听力状况和术者的手术经验而定。     

慢性化脓性中耳炎患者鼓室成形术后骨导听力的改变

目的探讨合并骨导听力下降的慢性化脓性中耳炎患者鼓室成形术后骨导听力的变化及其相关因素。方法回顾性分析54例（61耳）合并骨导听力下降的慢性化脓性中耳炎行鼓室成形术患者的临床资料,分析患者术前、术后0．5、1、2、4kHz骨导听力的变化及其与病程、是否合并胆脂瘤、术式、是否行听骨链重建的关系。结果61耳术前骨导平均听力在4kHz处损害最为严重,术后4个频率听力均有不同程度的提高,提高幅度以2kHz处最为显著,术后骨导改善阳性（4个频率无一频率骨导听力下降,且有至少二个频率的骨导听力提高10dB以上）有32耳,阳性率为52．5%。病程长短及是否伴有胆脂瘤与术后骨导听力改善与否无明显相关。行听骨链重建的病例骨导听力提高明显优于未行听骨链重建病例。未行乳突切开的鼓室成形术和保留外耳道后壁的乳突切开鼓室成形术患者术后骨导改善较切除外耳道后壁的乳突切开鼓室成形术患者明显。结论伴骨导听力下降的慢性化脓性中耳炎经鼓室成形术后部分患者骨导听力可以提高,其术后听力改善程度与病程长短及是否伴有胆脂瘤无关,与手术方式有关。     

慢性中耳炎并迷路瘘管的临床研究

目的探讨慢性中耳炎并发迷路瘘管的临床与影像学特征及处理策略。方法回顾性分析慢性中耳炎并发迷路瘘管89例(89耳)的手术资料,其中伴乳突切除的开放鼓室成形术77耳,其中Ⅰ期重建中耳传音结构65耳,改良乳突根治术12耳。结果术后听力提高50耳,其中气骨导差缩小<20dB28耳,21～40dB22耳,骨导改善11耳;听力下降32耳,全聋11耳中,术后全聋4耳,骨导下降8耳。术后有眩晕发作的34耳,术后随访眩晕均消失或改善。胆脂瘤母质均在手术显微镜下彻底清除,清除后有蓝线状或清亮淋巴液漏出。结论中耳乳突手术中应高度重视迷路瘘管存在的可能性,清除瘘口胆脂瘤母质应在手术最后阶段进行。冠状位CT显示水平半规管瘘有显著的临床意义。     

用耳后带蒂肌筋膜骨瓣修复听骨链的疗效

目的探讨用耳后带蒂肌筋膜骨瓣修复听骨链在听力重建手术中的应用。方法对47例（47耳）胆脂瘤中耳炎病人。在清除病变的同时一期行鼓室成形术。用耳后带蒂肌筋膜骨瓣修复听骨链进行听力重建。结果随访0．5～3年，全部病例均干耳。无一例胆脂瘤复发。术前临床测试平均气导51．93dB，平均骨导23．17dB；术后平均气导36．59dB。平均骨导24．23dB，术前、术后骨气导差距分别为28．76dB和12．36dB，骨气导差距改善了16．40dB。68％的病人骨气导差距缩小到20dB以内，无听力下降者。结论鼓室成形术中用耳后带蒂肌筋膜骨瓣修复听骨链行听力重建，能有效改善听力，降低胆脂瘤复发率，是一种较为实用的手术方法。     

耳内镜下鼓室探查和鼓室成形术可行性及疗效分析

目的　探讨耳内镜下鼓室探查和鼓室成形术治疗中耳常见病变的可行性及疗效。方法　30例耳漏伴听力下降患者,包括慢性单纯性中耳炎12例、粘连性中耳炎5例、鼓室硬化6例、中耳胆脂瘤7例。均行耳内镜下鼓室探查+鼓室成形术,根据病变情况行病变清除、外耳道重建、听骨链重建、鼓膜成形等。观察患者鼓膜愈合率、干耳率、听力效果等。结果　28例患者鼓膜修复良好,愈合率93.3%,2例遗留小穿孔,经搔刮穿孔边缘后愈合,均达到干耳。术前平均气导（52.41±19.89）dB,术后（38.11±18.36）dB,差异有统计学意义（t =9.221,P =0.000）;术前平均骨导（19.93±16.31）dB,术后（20.21±16.22）dB,差异无统计学意义（t =-2.623,P =0.014）;术前平均气骨导差（32.49±10.74）dB,术后（17.81±9.42）dB,差异有统计学意义（t =9.730,P =0.000）。对不同疾病分组,各组间术前的平均气导、骨导及气骨导差之间比较,差异均无统计学意义。各组间术后平均气导、骨导及气骨导差之间比较,差异均无统计学意义。30例患者保留鼓索神经21例,占70%;术后面瘫0例;术后眩晕3例,均为轻度;术后骨导明显提高者0例。结论　耳内镜手术适应证广,适应于各种中耳疾病,总体效果满意。耳内镜下手术具有微创、美观等特点,去除骨质较少,易于重建修复。耳内镜下外耳道、中耳手术具有良好的安全性及有效性,值得推广。     

自体软骨在听力重建手术中的应用

目的分析自体软骨在慢性化脓性中耳炎、中耳胆脂瘤听力重建手术中的应用及疗效。方法回顾性分析165例（173耳）采用自体软骨行听力重建的中耳手术患者的临床资料,其中单纯鼓膜穿孔43例（48耳）,中耳胆脂瘤61例（61耳）,鼓室硬化23例（23耳）,慢性化脓性中耳炎伴肉芽38例（41耳）。自体软骨材料用于修补鼓膜133例（139耳）,用于人工听骨赝复物上衬垫102例（104耳）,用于上鼓室、鼓窦重建31例（31耳）,用于外耳道后壁重建3例（3耳）。比较患者术前、术后1年随访时0．5、1、2、4 kHz的纯音平均听阈、平均气骨导差及局部修复成功率。结果鼓膜修补的133例139耳中,136耳修补成功,3耳出现移植物边缘小穿孔,一期鼓膜修补成功率97．84％（136/139）;听骨链重建的102例（104耳）中,无听骨赝复物脱出病例;31例（31耳）上鼓室、鼓窦重建的患者中,局部未见内陷、移位;3例（3耳）外耳道修复的患者未见外耳道后壁塌陷。43例（48耳）单纯鼓膜修补的患者术前、术后气骨导差分别为23．8±3．1和11．6±8．7 dB。61例（61耳）中耳胆脂瘤患者术前、术后气骨导差分别为39．2±24．7和19．0±12．1 dB。23例（23耳）鼓室硬化的患者术前、术后气骨导差分别为31．2±12．4和19．8±11．2dB。38例（41耳）慢性化脓性中耳炎伴肉芽患者术前、术后气骨导差分别为41．6±9．9和15．3±13．4dB。结论自体软骨在听力重建手术中应用价值大,特别适合于鼓膜复杂性穿孔、复发性穿孔的修复,有利于听骨链假体的固定及上鼓室、乳突术腔及骨性外耳道缺损修复。     

完整鼓室的乳突开放式鼓室成形术与开放式鼓室成形术的比较

目的探讨慢性中耳炎和胆脂瘤中耳炎手术方式及适应症的选择，比较完整鼓室的乳突开放式鼓室成形术与开放式鼓室成形术二种术式治疗慢性中耳炎的疗效。方法回顾性分析2005年1月-2007年5月期间97例（99耳），其中胆脂瘤中耳炎71耳，慢性中耳炎28耳，根据病灶范围选用完整鼓室的乳突开放式鼓室成形术（A组）22例（22耳）与开放式鼓室成形术（B组）75例（77耳）。对二组病例术前和术后纯音测听平均值PAT（500、1kHz、2kHz、4kHz）、气骨导差（ABG）等进行统计与比较。结果术后随访6个月～34个月，总干耳率93．9％（93／99），胆脂瘤复发率为7．0％（5／71）；术后气导（AC）提高值≥10dB为60．6％，气骨导差（ABG）≤20dB为29．3％；其中A组术后AC提高值≥10dB为90．9％，ABG≤20dB为54．5％；B组术后AC提高值≥10dB为51．9％，ABG≤20dB为22．1％。慢性中耳炎两组术后AC提高值及ABG经独立样本t检验，P〈0．05，具有统计学意义。结论完整鼓室的乳突开放式鼓室成形术较开放式鼓室成形术听力提高效果满意，干耳时间相似，但要选择适合病例。     

上鼓室外侧壁软骨重建技术在乳突根治鼓室成形术中的应用

目的：评价上鼓室外侧壁软骨重建技术应用于中耳胆脂瘤手术的远期疗效。方法回顾分析2010年2月～2012年7月57例（57耳）中耳胆脂瘤行乳突根治鼓室成形术并行上鼓室外侧壁软骨重建患者的临床资料,随访6～24个月,观察并分析术后干耳率及患者听力提高情况。结果所有患者均获得干耳,鼓膜愈合良好,干耳时间1～2个月,无一例复发。术前言语频率平均气骨导差41．2±15．8 dB,术后为17．0±12．4 dB,较术前明显缩小（P＜0．01）,其中术后言语频率平均气骨导差缩小15 dB 以上52例（52耳）,有效率91．23％。结论上鼓室外侧壁软骨重建技术在根除病灶的基础上有助于保存或提高患者的听力。     

A retrospective study on post-operative hearing of middle ear cholesteatoma patients with labyrinthine fistula

Conclusions: There is no significant change in bone conduction threshold after operation, so the tympanoplasty can be done to maintain hearing when conditions allow. Objective: To study the impact of surgical treatment on hearing of cholesteatoma patients with labyrinthine fistula. Methods: The clinical data of 35 patients (35 ears) with labyrinthine fistula, which were caused by cholesteatoma, were analyzed retrospectively. The hearing of 21 patients was followed up. Results: Three months to 5 years follow-up of 21 patients were accomplished by pure tone audiometry and other details. There was no recurrent cholesteatoma in the patients. Compared with pre-operative average bone conduction at 0.5, 1, 2, 4, and 8 kHz, 12 cases had a difference less than 5 dB, three patients’ hearing improved (more than 10 dB), and five cases declined (more than 10 dB). One patient received cochlear implantation 3 months after the surgery. The average bone and air conduction thresholds at 0.5, 1, 2, 4, and 8 kHz had no obvious change (p?>?0.05) in 11 patients managed by a canal wall down mastoidectomy with tympanoplasty.     

中耳胆脂瘤并发迷路瘘管的临床特征

目的 探讨中耳胆脂瘤并发迷路瘘管的诊断和处理方法.方法 回顾分析2012年9月至2018年9月在我院住院行中耳胆脂瘤手术患者658例,其中并发迷路瘘管52例(7.9％),收集其术前临床表现、纯音听阈结果、影像学表现,术中探查所见及处理方式,术后恢复情况等结果进行统计学分析.结果 52例迷路瘘管患者术前有眩晕症状32例(...     

Cholesteatoma labyrinthine fistula: prevalence and impact

Introduction

Labyrinthine fistula is one of the most common complications associated with cholesteatoma. It represents an erosive loss of the endochondral bone overlying the labyrinth. Reasons for cholesteatoma-induced labyrinthine fistula are still poorly understood.

Management of the labyrinthine fistula in cholesteatoma surgery

The presence of a labyrinthine fistula has remained one of the major problems in cholesteatoma surgery. Confronted with this problem, the surgeon may ultimately base his choice of procedure on four basic conditions: the size of the fistula, its location in the ear, the condition of the other ear, and the cochlear function. Our attitude has been changing, and currently we prefer to perform a staged closed tympanoplasty. When a closed technique is performed, we either remove the cholesteatoma matrix and then cover the fistula immediately or we leave the matrix in situ and re-explore the mastoid process 5 or 6 months later. The series consists of 88 cases out of a total of 701 patients with cholesteatoma operated on between January 1971 and June 1982. In 20 patients the matrix was left over the fistula at the first stage. The results suggest that a staged operation, i.e. closed tympanoplasty, is to be preferred even in cases with an extensive labyrinthine fistula.     

Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging investigation of inner ear disturbances in cases of middle ear cholesteatoma with labyrinthine fistula.

OBJECTIVE: To investigate the cause of inner ear disturbances in cases of middle ear cholesteatoma with labyrinthine fistula. SETTING: University hospital. STUDY DESIGN: Prospective case study. PATIENTS: Eight patients who were scheduled to undergo surgery for middle ear cholesteatoma with labyrinthine fistula were included in this study. INTERVENTION: Imaging analysis was performed using a 3-dimensional fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging sequence. MAIN OUTCOME MEASURES: Three-dimensional FLAIR findings were compared with clinical symptoms associated with inner ear disturbance and surgical observations of the fistula. RESULTS: Three-dimensional FLAIR in 6 patients revealed areas of high signal intensity in the inner ears on the affected sides and areas with increased signal after the administration of gadolinium, especially in cases accompanied by acute sensorineural hearing loss. These images were considered to be indicative of breakdown of the blood-labyrinth barrier due to middle ear cholesteatoma. This finding was also present in a patient with no clinical symptoms of inner ear disturbances. CONCLUSION: Three-dimensional FLAIR images of the inner ear are valuable in evaluating labyrinthine fistula in patients with cholesteatoma. Future studies are needed to better understand the role of 3-dimensional FLAIR in predicting the severity of inner ear disturbance.     

Surgical management of labyrinthine fistula with cholesteatoma

From 684 cases of ear surgery for cholesteatoma performed by one surgeon, 35 had labyrinthine fistulae (incidence 5.1 per cent). Of these fistulae, 79 per cent involved the lateral semicircular canal only; the other sites involved were the other semicircular canals and the cochlea. The fistula test was positive in 54 per cent of cases overall, but in 80 per cent with an extended site fistula (ESF). Three surgical approaches were employed sequentially--staged combined approach tympanoplasty (CAT), open cavity tympanoplasty and attico-antrotomy. Surgically-induced deafness occurred in 3.3 per cent. All surgical groups showed similar hearing results, except for less conductive deafness in the CAT group. Surgical management is discussed with reference to current theories of the erosive effects of cholesteatoma.     

一期手术清除胆脂瘤并发迷路瘘的疗效分析

目的 探索一期手术清除胆脂瘤并发迷路瘘的手术方法,评估一期手术清除胆脂瘤基质后的远期听力变化和手术疗效.方法 选取2014年8月—2019年8月收治的41例胆脂瘤并发迷路瘘患者,术前仔细询问症状,均行瘘管试验、耳内镜检查、纯音测听检查和高分辨率颞骨薄层CT检查提示有胆脂瘤并发迷路瘘.41例迷路瘘管覆盖的胆脂瘤基质进行一...     

123例不同术式乳突根治术后患者听力情况初步分析

目的 通过对施行乳突根治不同术式的123例患者术后听力情况进行分析,探讨手术方式对听力的影响.方法 123例中耳炎患者中28例行单纯开放式乳突根治术,40例行开放式乳突根治并Ⅰ期鼓室成形,35例行闭合式乳突根治并鼓室成形,20例行保留低位骨桥式乳突根治并鼓室成形.所有患者术后3个月复测听力并与术前进行比较.结果 单纯开放式乳突根治术患者听力均无提高,开放式乳突根治并鼓室成形术患者听力有提高,闭合式乳突根治并鼓室成形术患者听力均提高,保留低位骨桥式乳突根治术患者听力改善介于开放式并鼓室成形及闭合式并鼓室成形二种术式之间.结论 闭合式乳突根治术在4种术式中随访听力提高最理想     

Sensorineural high-frequency hearing loss after drill-generated acoustic trauma in tympanoplasty

Tympanoplasty can cause a sensorineural hearing loss by a mechanism of acoustic trauma. Although this lesion appears to be relatively infrequent in clinical practice, we believe that its low apparent incidence is caused when clinicians fail to assess the auditory frequencies above 8000 Hz. Twenty-four patients with normal bone-conduction audiometric thresholds scheduled for tympanoplasty were assessed with an electro-stimulation, bone-conduction high-frequency audiometer which can measure hearing frequencies up to 20 kHz before and after surgery. A measurable hearing loss was found in the upper limits of the audible frequencies in 9 patients (37.5%), and was considered important in 4 of them (16.7%). This hearing loss was recorded above the upper frequency limit of conventional audiometers. The findings in this study indicate that drilling of the temporal bone can impair the hearing level in the high frequencies in a significant number of patients. High-frequency audiometry is a very sensitive tool to assess any damage caused to the inner ear by surgical procedures carried out in the middle ear and temporal bone.     

Congenital aural cholesteatoma: Results of surgery in 60 cases

From 1978 to 1993, 59 patients (60 ears) with congenital middle ear cholesteatoma were treated at the House Ear Clinic. The median patient age at presentation was 5 years, and the period of postoperative follow-up was 4.8 years. An intact canal wall was maintained in 58 of 60 cases and a closed middle ear space in all cases. In 12 operations, lateral graft tympanoplasty eradicated the cholesteatoma in one stage; 32 patients required a second-stage surgery to rule out recurrence, and the remaining 16 cases required three or more operations to eradicate disease and reconstruct the hearing mechanism. Thirty-five (63%) of 56 patients had a postoperative air-conduction threshold pure-tone average (PTA) within 10 dB of the best bone-conduction PTA; 91% were within 20 dB. Average speech reception threshold improved from 32 dB hearing level (HL) preoperatively to 20 dB HL postoperatively.