胆脂瘤型中耳炎并发迷路瘘管38例临床分析

目的分析胆脂瘤型中耳炎并发迷路瘘管的临床特征,总结其诊治经验和体会。方法回顾性分析我科2000年7月至2010年12月收治的38例经手术证实为胆脂瘤型中耳炎并发迷路瘘管患者的临床资料,38例患者均在全麻下行乳突根治术,术中一期清除瘘管处胆脂瘤及肉芽,Ⅰ型、Ⅱ型瘘管取双层颞肌筋膜覆盖封闭瘘口,Ⅲ型瘘管行半规管阻塞术。结果胆脂瘤型中耳炎并发迷路瘘管的发生率为8.2%(38/464),术中发现瘘管全部位于水平半规管,术后所有患者均获干耳,眩晕未再发作,干耳后平均骨导听阈与术前相比无明显差异。结论迷路瘘管的确诊有赖于手术中发现证实;只要术中精细操作并采用合适的方法修补瘘管,一期彻底清除瘘管处病变可以同时有效地保存耳蜗功能;对于病变广泛的Ⅲ型瘘管,半规管阻塞术是一个安全、有效的治疗方法。     

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手术方法与疗效。方法对1998年1月-2007年1月手术治疗的胆脂瘤型中耳炎并发迷路瘘管20例（耳），全部病例行一期修复瘘管，其中行单纯筋膜修复9耳，行自体骨粉加筋膜修复11耳。结果术后随访1-10年，单纯筋膜修复术后转动头部仍有眩晕者2耳，自体骨粉加筋膜修复者术后无眩晕发生。结论胆脂瘤型中耳炎并发迷路瘘管，清除病灶后可以一期修复，用自体骨粉加筋膜修复迷路瘘管是较理想的方法。     

前庭疾病的手术治疗

少数前庭疾病由于眩晕致残 ,药物无效 ,需手术治疗。本文就前庭疾病的手术治疗作一简介。1　外淋巴1 .1 　 慢性中耳炎并发迷路瘘管手术的目的是清除胆脂瘤病灶 ,可保留外半规管瘘表面胆脂瘤基质 ( Matrix)。因上迷路及下迷路之间有天然屏障 ,对外半规管瘘可进行填塞处理 :清除瘘管病变 ,磨去瘘周炎性骨质 ,如膜迷路受损 ,亦可切除 ,用筋膜等封闭瘘孔 (图 1 )。静脉滴注广谱抗生素及类固醇激素 1周 ,可防治感音神经性聋。图 1　筋膜覆盖外半规管瘘 ,防止外淋巴溢出1 .2 　 颞骨创伤与前庭症状创伤性外淋巴瘘 :头部挫伤可致迷路窗膜损伤 ,产…     

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。     

迷路瘘管

迷路瘘管是慢性化脓性中耳炎较常见的并发症之一。本病处理不当将导致前庭及耳蜗功能完全丧失。国内有关迷路瘘管的资料不多,特将近年来部份国外资料作一综述。【发病率及瘘管部位】慢性中耳炎合并迷路瘘管的发病率,自1923年Nylen报告为7.4%以来,至今数十年文献中发病率无大变化。除个别报道发病率低至3.6%和高至13%者外,根据大多数作者的资料来看,中耳乳突手术中迷路瘘管的发生率大约在10%左右。抗生素应用以后某些颅内并发症有所减少,但迷路瘘管的发病率并无下降。慢性中耳炎以胆脂瘤型并发迷路瘘管最为多见。如斋藤氏报告41例迷路瘘管病例,其中33例(80.5%)为胆脂瘤合并瘘管。有一些报道全部迷路瘘都发生在胆脂瘤病例,因而认为迷路瘘管是胆脂瘤型中耳炎的常见并发症。瘘管部位绝大多数发生于水平半规管,少数     

迷路瘘管的治疗

迷路瘘管常位于水平半规管处,其形成原因多与胆脂瘤内胶原酶的活性和受压程度有关。病变发展过程大致为患处骨质变薄,骨质吸收,瘘管形成,但外淋巴间隙与外界不沟通。当胆脂瘤基质侵及膜迷路,为削除胆脂瘤病变,可能导致外淋巴间隙与外界相通。为争取较理想的治疗效果,作者对迷路瘘管的治疗进行讨论。认为,手术治疗胆脂瘤性中耳炎时,应仔细检查水平半规管,以便了解有无迷路瘘管存在。为减少冲洗、吸引等操作对内耳的刺激,术时应先以显微剪刀将水平半规管处的胆脂瘤组织与鼓室等处病变分开,在清除病灶后,术野清洁,干燥时,于高倍显微镜下,清理瘘管处的胆脂瘤基质,并与膜迷路分离,     

迷路瘘管22例临床分析

目的探讨慢性化脓性中耳炎并发迷路瘘管的临床特点、诊断要点和治疗方法。方法回顾性分析我院1999年6月~2004年6月收治的22例慢性化脓性中耳炎并发迷路瘘管的临床资料,全部病人均行开放性乳突根治术。结果22例均有耳流脓史,20例(90.9%)有主观听力下降,17例(77.3%)有眩晕史,13例(59.1%)瘘管试验阳性,12例(54.6%)行颞骨CT扫描时发现瘘管。结论迷路瘘管术前尚无可靠的诊断方法,最可靠的方法是手术探察,对于半规管瘘管无论大小均可Ⅰ期清除胆脂瘤基质。     

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(...     

炎性迷路开放与迷路瘘管填塞术

1　 概述炎性迷路开放即迷路瘘管 (ＬＦ)是指迷路骨壁破损 ,骨内膜直接与胆脂瘤病变接触 ,或骨内膜破损 ,内外淋巴液溢至中耳乳突腔〔1〕。内外淋巴系统受损可致感音神经性聋 ,ＬＦ感音神经性聋的发生率为 2 6%～ 5 1 % 〔1〕。新近报道胆脂瘤中耳炎并发ＬＦ发生率为 4%～ 1 2 % 〔2〕。临床上对ＬＦ的处理存在分歧 ,Ｖａｒｔｉａｎｅｎ( 1 992 )认为瘘管表面的胆脂瘤基质 (ｍａｔｒｉｘ)不应剥除 ,以免并发迷路炎造成全聋 ;有人主张分期手术处理 ,Ⅰ期清除乳突病灶 ,保留瘘管表面的胆脂瘤基质 ,Ⅱ期处理瘘管〔3〕。鉴于胆脂瘤基质可产生胶…     

Labyrinthine fistulas: Surgical outcomes and an additional diagnostic strategy

PurposeTo evaluate perioperative findings and audiological and vestibular outcomes in patients operated for cholesteatoma with labyrinthine fistulas. Also to assess radiological fistula size.Materials and methodsPatients who underwent surgery for a labyrinthine fistula caused by a cholesteatoma between 2015 and 2020 in a tertiary referral center were retrospectively investigated. Fistula size was determined on preoperative CT scan. Bone and air conduction pure tone average thresholds were obtained pre- and postoperatively. Clinical outcomes, such as vertigo and otorrea were also evaluated. Main purpose was to determine whether there is a correlation between fistula size and postoperative hearing. Furthermore, perioperative findings and vestibular outcomes are evaluated.Results21 patients (22 cases) with a labyrinthine fistula were included. There was no significant change after surgery in bone conduction pure tone average (preoperatively 27.6 dB ± 26.7; postoperatively 30.3 dB ± 34.3; p = 0.628) or air conduction pure tone average (preoperatively 58.7 dB ± 24.3; postoperatively 60.2 dB ± 28.3; p = 0.816). Fistula size was not correlated to postoperative hearing outcome. There were two patients with membranous labyrinth invasion: one patient was deaf preoperatively, the other acquired total sensorineural hearing loss after surgery.ConclusionsSensorineural hearing loss after cholesteatoma surgery with labyrinthine fistula is rare. Fistula size and postoperative hearing loss are not correlated, however, membranous labyrinthine invasion seems to be related to poor postoperative hearing outcomes. Therefore, additional preoperative radiological work up, by MRI scan, in selected cases is advocated to guide the surgeon to optimize preoperative counselling.     

Clinical presentation and management of labyrinthine fistula caused by chronic otitis media.

To describe the clinical presentation and surgical management of patients with chronic otitis media complicated by labyrinthine fistula and to determine clinical indicators that predict postoperative hearing outcome, I performed a retrospective analysis at an academic tertiary care center. Thirty-four patients with labyrinthine fistula as a complication of chronic otitis media, documented at mastoidectomy, underwent postoperative audiometry. The median age was 50 years, and the duration of otologic symptoms ranged from 2 months to more than 40 years. On presentation, 3 patients had anacusis in the affected ear, while in the others, the pure tone average for bone conduction at the 0.5-, 1-, 2-, and 4-kHz frequencies was 34 dB hearing level. Nineteen patients (56%) complained of dizziness on presentation. The fistula test was positive in 14 of 28 patients (50%). The fistula was detected radiologically in 10 of 24 patients (42%). Cholesteatoma was present in 33 of 34 patients (97%). The lateral semicircular canal was the most common site of labyrinthine fistula. The cholesteatoma matrix was completely removed in 29 of 33 cases and exteriorized in the remaining 4. Of the 31 patients with measurable hearing preoperatively, anacusis occurred in 8 (26%). In 6 of these, the preoperative pure tone average for bone conduction was greater than 50 dB hearing level, and cholesteatoma matrix and granulation tissue invading the membranous labyrinth were found at surgery. I concluded that in chronic otitis media, labyrinthine fistulas occurred almost exclusively in the presence of a cholesteatoma. Postoperative hearing outcome correlated with the size of the fistula and the presence of granulation tissue invading the labyrinth. which could be predicted by the preoperative audiometry.     

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.     

中耳炎手术中迷路瘘管的再讨论

文中对1990～1997年耳科住院手术病例中51例迷路瘘管进行了讨论,迷路瘘管的位置除一例合并后半规管瘘管外,其余病例均为外半规管瘘,而且瘘管大小和术前骨导听力无明显关系.其中有34例是胆脂瘘.所有病例中除一例胆脂瘤上皮残留术后骨导听力有下降外,其余都保持了术前的骨导听力.     

Prognostic indicators of hearing after complete resection of cholesteatoma causing a labyrinthine fistula

The objectives of this study are (1) to evaluate hearing change after complete cholesteatoma resection in the setting of a labyrinthine fistula, (2) to assess the sensitivity and specificity of the preoperative CT-scan in diagnosing a labyrinthine fistula, and (3) to determine the correlation between the type of the labyrinthine fistula and its radiologic size. A retrospective chart review of all patients operated for cholesteatoma between 2004 and 2009 was conducted. Primary outcome was defined as the average variation in bone conduction thresholds (BCTs) as well as speech discrimination score (SDS) after total excision of cholesteatoma causing a labyrinthine fistula. We reviewed all preoperative CT-scans and operative notes to assess sensitivity and specificity for the diagnosis of a labyrinthine fistula. Results show that 317 patients underwent mastoidectomy for cholesteatoma. Twenty-eight patients were found to have 32 labyrinthine fistulas caused by cholesteatomatous disease affecting the lateral semi-circular canal (SCC) (n = 25), the superior SCC (n = 5), the posterior SCC (n = 1) and the footplate (n = 1). Postoperative BCT and SDS (24.5 dB; 86.6%) were neither clinically nor statistically different from preoperative levels (23.2 dB; 87.5%) (p = 0.35). Sensitivity and specificity of the preoperative high resolution 0.55 mm cuts CT-scan was 100%. With a fistula of 3.55 mm in the axial plan, a membraneous fistula must be suspected with a sensitivity of 66% and a specificity of 71%. Complete matrix resection without suctioning at the site of a cholesteatomatous labyrinthine fistula is a safe and effective management option. High-resolution preoperative CT-scan is very precise in diagnosing labyrinthine fistula and its radiologic size helps to predict the type of the fistula.     

Labyrinthine fistulae caused by cholesteatoma. Improved bone conduction by treatment

In five cases of labyrinthine fistulae caused by extensive cholesteatoma, more than 30-dB improvement in bone conduction was observed in four postoperative cases and in one case after preoperative administration of antibiotics. In each case, a fistula of more than 2 mm in length was present at the lateral semicircular canal, and membranous labyrinthine wall was exposed when the cholesteatoma membrane was removed. These five cases were considered to be in the stage of serous labyrinthitis. The experience with these cases shows that emergent antibiotic treatment and surgery are appropriate for cases with reduced bone conduction in which labyrinthine fistula caused by cholesteatoma is suspected. In addition, as the reduction of bone conduction does not necessarily preclude the possibility of good postoperative hearing, tympanoplasty may be appropriate even for cases with markedly reduced bone conduction due to labyrinthine fistulae.     

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.

Surgical management of labyrinthine fistula in chronic otitis media with cholesteatoma

Objective

To present the surgical outcomes of complete removal of the matrix of labyrinthine fistulas in a large series of middle ear cholesteatomas.

Patients and methods

This is a retrospective study. We analyzed 38 of 778 patients who were operated on for cholesteatoma and were proved to have labyrinthine fistula from 1991 to 2007. For this study, a more aggressive strategy was adopted that compromised immediate total removal of the matrix, regardless of size. To evaluate the safety and efficacy of the procedure, pre and postoperative pure-tone audiometry were compared and the recurrence rate was analyzed. Relevant data from the literature using a wide array of strategies were compared with our results.

Results

Only two patients suffered from postoperative hearing deterioration of bone conduction of more than 10 dB HL. There was no relationship between the size of labyrinthine fistulas and postoperative hearing deterioration. Recurrence of labyrinthine fistulas was not found.

Conclusions

Total removal of the cholesteatoma matrix in one step is a safe and effective method for the treatment of labyrinthine fistulas.     

Effects of Betahistine Metabolites on Frog Ampullar Receptors

Conclusion. Our technique can decrease the formation of retraction pockets and improve hearing function. The wheel-shaped cartilage-perichondrium composite graft (Wheel CPCG) can be considered a good material for a drum graft, and it is easy to insert a ventilation tube, in case of initial drum retraction. Objective. The purpose of this study was to introduce the novel surgical technique of a Wheel CPCG with one-stage ossiculoplasty to prevent a retraction pocket and subsequent cholesteatoma after intact canal wall tympanomastoidectomy. Patients and methods. A total of 47 patients were reviewed; 43 cases were selected for audiologic testing. The results of operations were evaluated by comparing preoperative and postoperative hearing results and postoperative drum findings. Results. A retraction pocket was observed in three cases (6.7%). Slight protrusion of partial ossicular replacement prosthesis (PORP) and lateral healing of drum was observed in one case each, and there were two cases of postoperative infection. The number of cases with an air–bone gap (ABG)<20 dB increased from 9 (23%) cases before operation, to 20 cases (51%) after operation. The ABG average statistically decreased from 30.0 dB to 24.0 dB, and the mean air conduction thresholds decreased from a preoperative level of 47.3 dB to a level of 35.7 dB.     

Labyrinthine fistula after cholesteatomatous chronic otitis media

OBJECTIVES: To report on cases of labyrinthine fistula diagnosed in an ear, nose, and throat department and to study the incidence, location, pre- and postoperative symptoms (hearing loss, tinnitus, vertigo, facial palsy), preoperative diagnostic imaging, and surgical treatment of two types of cholesteatomatous labyrinthine fistulae-the extensive fistula that erodes both the bony and membranous labyrinths and the bone fistula that affects only the bony labyrinth. STUDY DESIGN: Retrospective case review. PATIENTS: Fifty-four patients with cholesteatomatous chronic otitis media with labyrinthine fistulae. SETTING: Tertiary referral center. INTERVENTIONS: Diagnosis and treatment. MAIN OUTCOME MEASURES: Clinical, imaging, and surgical correlation of extensive fistulae and bone fistulae. RESULTS: The incidence of labyrinthine fistulae was 7% in all patients who underwent surgery for chronic otitis media. The bone type (66%) is more common than the extensive type (33%). Compared with bone fistulae, the outcome for extensive fistulae is more severe in terms of hearing loss, vertigo, and facial palsy. In terms of preoperative diagnosis, computed tomography imaging ensured early diagnosis in 89% of extensive cases and in 28% of bone cases. For extensive fistulae, the surgical technique was more radical, requiring an open technique in 66% of cases versus 22% of the bone fistulae cases. The most common location is the lateral semicircular canal (61%). CONCLUSIONS: The breach in the membranous labyrinth is consistent with a more aggressive pathology, causing more severe pre- and postoperative symptoms. Preoperative computed tomography is more sensitive for diagnosing extensive fistulae, which also require a more radical treatment.