慢性化脓性中耳炎并发迷路瘘管的手术治疗

目的探讨慢性中耳炎迷路瘘管的临床特点及手术方法.方法对63耳有迷路瘘管的胆脂瘤型和骨疡型中耳炎行乳突根治术的同时用颞肌筋膜或同种肋软骨片加筋膜一期修复瘘管.结果1718耳慢性中耳炎中并发迷路瘘管63耳,其中胆脂瘤型60耳,在各型中耳炎中发生率最高,骨疡型3耳.瘘管位于外半规管56耳(88.9%),耳蜗2耳,上半规管3耳,外半规管和上半规管同时有瘘管2耳.63耳中术前有眩晕症状的37耳(58.7%),其中瘘管试验阳性13耳(35.1%).有眩晕症状耳平均骨导阈值为40.1dB,无眩晕症状耳为33.2dB.除1耳外,全部病例行瘘管一期修复后,眩晕症状消失.结论用同种异体肋软骨片加筋膜修复慢性中耳炎迷路瘘管是较理想的方法,对瘘管大、病变重者应行二期手术.     

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。     

中耳炎合并迷路瘘管治疗方法的回顾分析

目的探讨治疗中耳炎合并迷路瘘管简单易行的处理方法。方法回顾性分析我科在2004年6月~2010年6月间中耳炎手术1226例,其中54例55耳伴迷路瘘管,分析其临床特点、手术方式、效果。术后随访1~5年,观察病人有无复发及听力、平衡障碍的变化。结果在1226例中耳炎患者中合并迷路瘘管的54例55耳(4.4%),54例患者均一期手术,根据情况选择筋膜覆盖或者筋膜填塞。术后3个月,所有病例均干耳,术腔上皮化(100%);手术后无眩晕发作9例(16.7%),眩晕持续1周以内缓解19例(35.2%),2周以内23例(42.6%),眩晕持续3月3例(5.6%)。有术后半年纯音听阈记录的患者38例,与术前比较听力无变化的18耳(47.4%),较术前提高的有9耳(23.2%),术后随访1~5年胆脂瘤及瘘管均无复发。结论单纯筋膜填塞迷路瘘管的方法,与文献中介绍的方法比较,简单易行,风险小,手术并发症少,对听力无明显干扰,值得推广应用。     

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。     

慢性化脓性中耳炎并发迷路瘘管的临床特征和手术治疗

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 回顾性分析1996～2003年经手术确诊的慢性化脓性中耳炎并发迷路瘘管的22例(23耳)患者的临床资料。结果 22例(23耳)中,术前主诉眩晕者 9 例(39.1 %),瘘管试验阳性 8例(34.8 %),薄层颞骨CT扫描提示迷路瘘管10 例(50 %)。术中见胆脂瘤型中耳炎 22耳(95.7 %),骨疡型中耳炎1耳(4.3 %)。瘘管发生于外半规管19耳(82.6 %),后半规管3耳(13.0 %),同时累及上半规管和外半规管1耳(4.3 %),同时累及上半规管和后半规管1耳(4.3 %)。结论 迷路瘘管术前缺乏可靠的依据诊断。几乎是胆脂瘤型中耳炎独有的并发症,最常见于外半规管。术中对瘘管的处理应根据瘘管的大小、类型、部位及患者术前听力状况而定。     

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。     

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...     

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。     

慢性中耳炎迷路瘘管的分型与处理方法探讨

目的 探讨慢性中耳炎迷路瘘管的临床分型方法及相关处理原则.方法对2001年12月～2005年11月诊治的21例慢性中耳炎迷路瘘管患者,根据瘘管破坏深度的不同进行临床分型:Ⅰ型:迷路骨质被吸收但膜迷路完整;Ⅱ型:骨迷路与膜迷路同时破坏,形成瘘口,瘘口深度小于半规管直径的1/2;Ⅲ型:骨迷路与膜迷路同时破坏,形成瘘口,深度大于半规管直径的1/2直至离断.Ⅰ型用颞肌筋膜、Ⅱ型及Ⅲ型用耳屏软骨和颞肌筋膜覆盖瘘管.同时周围用生物蛋白胶固定等方法行一期修补.结果 术中发现Ⅰ型迷路瘘管6例.Ⅱ型14例.Ⅲ型1例,均一期修补成功,术后无听力下降患者.结论 慢性中耳炎迷路瘘管依据瘘管深度进行分类对临床手术有一定的临床指导意义,一般可一期修复.     

Closed versus open technique in the management of labyrinthine fistulae

A labyrinthine fistula is the most common complication of cholesteatomatous chronic ear disease. Its treatment remains a controversial subject. The present paper reports our approach to the management of this complication. Operations were performed on 1,226 cases of chronic otitis media with cholesteatoma between January 1971 and December 1985. A labyrinthine fistula was detected in 158 cases. We favor intact canal wall tympanoplasty even in the presence of medium or large fistulas: in the latter case, the matrix is not removed but is trimmed to cover only the bony defect and it is left in place. Open procedures with the preservation of the matrix over the fistula are done in an only-hearing ear with fistula, in ears with a wide defect of the posterior canal wall, and in ears with multiple labyrinthine fistulas. The management of the matrix over the fistula and the anatomic and functional results following each type of procedure are presented and discussed.     

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.     

Surgical management of labyrinthine fistulae in chronic otitis media with cholesteatoma by a one-stage closed technique

Twenty cases of labyrinthine fistulae have been reviewed. From 1979 to 1987, 234 patients with cholesteatomatous ears were operated on by one surgeon, 20 of these had a labyrinthine fistula (incidence 8.6%). In 75% only the lateral semicircular canal was involved and in 25% the other semicircular canals and/or the cochlea were involved. The fistula test was positive in 50% of the cases. The surgical technique used in all 20 cases was a one-stage closed tympanoplasty, i.e. removal of the cholesteatoma matrix, covering of the fistula with fascia and bone, obliteration of the cavity and reconstruction of the meatal wall. 76% of the patients achieved a hearing improvement, while 1 patient had anacusis (5%). The results indicate that it is possible in one stage to remove the cholesteatoma matrix from the fistula and still be able to restore useful hearing in the majority of the patients.     

高分辨率CT对慢性化脓性中耳炎和胆脂瘤中耳炎软组织分型的诊断价值

目的 探讨高分辨率CT(high-resolution CT,HRCT)检查在慢性化脓性中耳炎及胆脂瘤中耳炎软组织分型中的诊断价值.方法 对120例153耳慢性化脓性中耳炎和胆脂瘤中耳炎患者行HRCT检查,以原始轴位图像为基础,分别行轴位、冠状位多平面重建(multiplanar reconstructtion,MPR)及最大密度投影(maximum intensity projiection,MIP),观察软组织生长特点、窗宽窗位对软组织显影的影响、邻近主要解剖结构改变情况并与手术结果进行对比.结果 120例153耳中经HRCT诊断为胆脂瘤中耳炎109耳,其中27耳合并肉芽组织;慢性化脓性中耳炎44耳,其中合并肉芽组织形成33耳,仅有分泌物11耳.术后诊断为胆脂瘤中耳炎107耳,其中25耳合并肉芽组织;慢性化脓性中耳炎46耳,其中35耳合并肉芽组织,仅有分泌物11耳.HRCT诊断胆脂瘤中耳炎和慢性化脓性中耳炎的符合率为98.6%,对胆脂瘤、肉芽组织、分泌物诊断的约登指数分别为0.98、0.98、1.00.结论 HRCT轴位、冠状位MPR及MIP图像相结合对慢性化脓性中耳炎软组织诊断分型具有重要的价值,可常规应用于慢性化脓性中耳炎及胆脂瘤中耳炎的鉴别诊断,并制定相应手术计划.

Abstract：

Objective To evalute the efficacy of high-resolution CT(HRCT) in differential diagnosis and treatment of chronic suppurative otitis media and cholesteatoma otitis media by soft-tissue shadows. Methods HRCT scanning was performed in 120 cases, 153 ears, with chronic otitis suppurative media and cholesteatoma otitis media, of which original data were processed with multi-planar reconstructtion (MPR) and maximum intensity projection ( MIP) , the characteristics of the soft-tissue shadows' growth, window width or window leveling and bony destruction were respectively observed, as well as compared with the surgery findings. Results In 120 patients (133 ears), 109 ears were diagnosed as cholesteatoma otitis media, and 44 ears were diagnosed as chronic suppurative otitis media, among which 33 ears had granulation tissue and 11 ears had secretion. One hundred and seven ears were postoperatively diagnosed as cholesteatoma otitis media, among which 25 ears had granulation tissue. Among 46 ears of chronic suppurative otitis media, 35 ears had granulation tissue, and only 11 ears had secretion. A 98. 6% diagnostic accuracy can be reached with HRCT in diagnosing cholesteatoma otitis media and chronic suppurative otitis media. The Youden's index was 0. 98, 0. 98 and 1. 00 respectively with HRCT in diagnosing cholesteatoma, granulation tissue and secretion. Conclusions Combination of the three different imaging methods, axial images, coronal MPR images and MIP images, can improve the efficacy of the HRCT diagnosis and definite chronic otitis media, which can be routinely used for surgery plan.     

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.