高分辨率CT多平面重组对迷路瘘管的诊断价值

目的:探讨高分辨率CT(HRCT)多平面重组对半规管的显示能力及对慢性化脓性中耳炎并发迷路瘘管的诊断价值。方法:对86例(正常79耳,病变93耳)慢性化脓性中耳炎患者行HRCT扫描,正常耳行轴位、冠状位及各半规管多平面重组(s-MPR)图像整体显示半规管的形态和结构情况;病变耳观察各半规管的破坏情况,并与手术结果比较。结果:正常耳轴位仅部分能显示外半规管全程(仅显示外半规管68耳),冠状位各个半规管全程均不能完整显示,s-MPR可分别在同一层面上显示各半规管全程(上半规管73耳,外半规管79耳,后半规管77耳)。病变耳轴位显示外半规管瘘5耳,冠状位显示外半规管瘘4耳,两者均显示1耳上半规管瘘;s-MPR显示外半规管瘘6耳,上半规管瘘2耳。手术探查见外半规管破坏6耳,上半规管破坏2耳。结论:s-MPR可以完整显示各半规管全程,对迷路瘘管具有较高的诊断价值。     

高分辨CT斜矢状位对儿童大前庭水管的诊断价值

目的探讨高分辨CT（high resolution CT，HRCT）斜矢状位多平面重组对大前庭水管（1arge vestibular aqueduct，LVA）的诊断价值，寻求对前庭水管扩大的最佳诊断方法。方法对83例（166耳）感音神经性聋患者行HRCT横断位扫描，对原始数据行冠状位及斜矢状位的多平面重组，所得图像由2位影像学医师及1位耳科医师分别进行诊断，并比较作出诊断所需观察图像幅数。结果被三位医师诊断为LVA的耳数，轴位分别为23耳、20耳、21耳，冠状位分别为19耳、18耳、20耳，重组斜矢状位分别为27耳、27耳、27耳；轴位所需图像幅数平均为6幅。冠状位平均为9幅，斜矢状位为2幅。结论HRCT斜矢状位多平面重组为诊断LVA的最佳图像，所需图像幅数最少，诊断正确率高，可以提高感音神经性聋患者的病因检出率。     

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…     

内耳病变并发良性阵发性位置性眩晕

目的了解继发于几种内耳疾病的良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的发病情况，进一步了解BPPV的可能发病机制。方法观察眩晕诊疗中心2004年1月至2006年11月53例前庭神经炎、90例突发性聋（包括伴眩晕的突发性聋）、381例梅尼埃病BPPV等的发病情况，并与同期183例原发性BPPV比较。结果4种内耳疾病后可以出现BPPV，分别是前庭神经炎、突发性聋、梅尼埃病和Bell麻痹。前庭神经炎后出现BPPV为9．4％（5／53）；突发性聋后出现BPPV为38．9％（35／90）；梅尼埃病后出现BPPV为0．3％（1／381）；1例Bell麻痹后出现BPPV。其中外半规管BPPV5例；后半规管37例，其中1例后半规管BPPV在复位过程中出现同侧前半规管BPPV。管结石症39例，外半规管嵴顶结石症3例。内耳病变后出现BPPV在发病后半年内出现者占75．0％（27／36）。继发性BPPV的手法复位效果与原发性BPPV相似，大多都可1、2次就诊后治愈。结论内耳病突发性聋、前庭神经炎和梅尼埃病后可以出现BPPV。这种类型的BPPV主要表现为后半规管管结石，偶见外半规管嵴帽结石。原发性BPPV与内耳病变后出现的BPPV手法复位疗效相似。     

伴有眩晕的突发性聋患者内耳MRI水成像观察和研究

目的:观察伴有眩晕的突发性聋患者内耳膜迷路MRI的变化。方法:对伴有眩晕的突发性聋患者20例和单纯突发性聋患者27例及健康成年人23例进行内耳MRI水成像检查。使用东芝1.5T超导磁共振扫描仪,应用三维高级快速自旋回波重T2WI横断扫描,将原始图像行最大密度投影重建,多轴位旋转观察各半规管、耳蜗管及前庭的变化。结果:正常人内耳MRI水成像可清晰地显示内耳诸结构为不规则形高信号,多轴位旋转观察各半规管呈“C”形或“U”形,边缘光滑,均匀一致,耳蜗管三维立体感强,球囊和椭圆囊分别呈球形和圆弧管形高信号。伴有眩晕的突发性聋内耳MRI水成像表现轻者半规管呈边缘毛糙不光滑,局限性轻度扩张,耳蜗管和前庭呈轻度粗细不均匀现象;严重者显示3个半规管同时呈囊状扩张,甚或呈“串珠”样改变,耳蜗管底转亦呈“串珠”样粗细不均匀现象。随访5～7个月,复查内耳MRI水成像与首次检查相比,均无明显改变。结论:伴有眩晕的突发性聋患者内耳膜迷路发生了各种形态的结构改变。     

视频头脉冲试验在急性单侧外周前庭功能下降疾病中的应用进展

视频头脉冲试验(video head impulse test, vHIT)可定量评价受试者各半规管高频角前庭-眼动反射(vestibulo-ocular reflex, VOR)功能。临床发现, vHIT在不同急性外周前庭功能下降疾病中的结果可表现出异质性。如在前庭神经炎和亨特综合征患者中, 病理性vHIT发生率最高的是水平半规管, 且在前庭神经炎患者的前庭代偿期间, 病理性vHIT的增益和回复性扫视表现为不同的恢复特征;而在突发性聋伴眩晕患者中, vHIT异常发生率最高的是后半规管, 且后半规管的损伤与突发性聋患者的听力预后有关。vHIT与其他前庭功能检查技术(如前庭诱发肌源性电位)的综合应用可以为临床相关眩晕疾病的诊断、分型、预后评估和前庭康复治疗提供更多依据。     

特发性突发性感音神经性聋患者耳石器损伤对行走平衡的影响

目的:本研究以特发性突发性感音神经性聋(ISSNHL)患者为外周前庭功能异常疾病的模型,在应用视频头脉冲试验(vHIT)、颈性前庭诱发肌源性电位(cVEMP)测试、眼性前庭诱发肌源性电位(oVEMP)测试定位前庭病变部位的基础上,探讨半规管、球囊和椭圆囊功能对行走平衡的影响.方法:对23例单侧ISSNHL患者(其中14...     

前庭功能检查对突发性聋预后评估的意义

目的 评估突发性聋患者的前庭功能状况，探讨前庭功能与突聋预后的关系。方法 运用视频眼震图（video—nystagmograpy，VNG）技术检查50例突发性聋患者的前庭功能。结果 眼视动系统检查出现一项或以上异常共17例（34％）；变位试验诊断为后半规管良性位置性眩晕3例（6％）；温度试验单侧减弱23例（46％），伴优势偏向15例（30％）。无固视抑制失败。前庭功能与突发聋预后关系：伴发眩晕与否，其预后差异无统计学意义（P〉0．05）；伴单侧半规管功能受损者高频及重度听力损失高于半规管功能正常者，其预后亦差，差异均有显著统计学意义（P〈0．05）。结论 前庭功能检查对突发性聋预后评估具有一定的价值。突聋伴前庭功能损害者其高频或重度听力损失发生率高于突聋且前庭功能正常组，预后亦差。     

后半规管开窗和闭塞术治疗良性发作性位置性眩晕

对15例病期持续一年以上的良性发作性位置性眩晕(BPPV)病人施行后半规管开窗和闭塞术(FOP);其中男性5例,女性10例,年龄31～64岁,平均49.5岁;全部均患有与头运动有关的位置性眩晕;病期1～10年,平均5.5年。听力正常有10例,感音神经性聋2例,老年聋、混合聋及传导聋各1例。手术进路取耳后切口,钻开乳突,先找到水平半规管,在     

突发性聋继发良性阵发性位置性眩晕的临床观察

目的了解继发于突发性聋的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的发病情况并探讨其治疗策略。方法观察眩晕门诊及耳内科病房中心2004年1月-2010年1月收治的210例突发性聋患者（包括伴有眩晕的突发性聋）合并BPPV的发病情况,并与同期183例原发性BPPV相比较。结果本组突发性聋病例并发BPPV为19．0％（40／210）;40例患者均为高频感音神经性聋或平坦型感音神经性聋。本文40例继发于突发性聋的BPPV,出现时间均在突发性聋发病后t周内。继发性BPPV的手法复位效果与原发性BPPV相似,大多数都于1～2次就诊后治愈。结论突发性聋继发的BPPV是临床常见的现象;继发于突聋的BPPV与原发性BPPV都是以后半规管BPPV多见,并与原发性BPPV手法复位的疗效相似。     

高分辨率CT容积重建对内耳畸形的诊断价值

目的：通过高分辨率CT（HRCT）容积重建（VR）对正常内耳形态的观察,探讨其对先天性内耳畸形的诊断价值。方法：对10例（20耳）无耳部疾患者（对照组）和7例（11耳）先天性内耳畸形患者（病变组）行HRCT扫描,利用容积漫游技术对内耳骨迷路重建。对照组观察内耳骨迷路的正常结构,病变组观察内耳畸形情况。结果：正常耳VR图像不但显示了内耳骨迷路的细微结构,而且还反映了各结构之间的关系;病变耳立体显示了畸形部位及程度。11耳患耳中Mondini型7耳次;前庭及半规管畸形3耳次;前庭导水管扩大7耳次,其中6耳次伴随其他畸形;内耳道畸形2耳次且均伴随其他畸形。11耳畸形中9耳HRCT横断面图像和平面重建（MPR）冠状位图像、VR图像均可以清晰地显示畸形的部位和程度,其中VR图像可以直观、立体地显示畸形的空间形态结构;2耳水平半规管短小畸形患者VR图像较断面图像更好地显示了畸形的部位和程度。结论：VR三维重建可以立体显示正常内耳骨迷路的形态,直观显示内耳畸形的程度及病变位置,对内耳畸形的诊断具有重要的辅助价值。     

Semicircular canal function before and after surgery for superior canal dehiscence.

OBJECTIVE: To characterize semicircular canal function before and after surgery for superior semicircular canal dehiscence (SCD) syndrome. STUDY DESIGN: Prospective unblinded study of physiologic effect of intervention. SETTING: Tertiary referral center. PATIENTS: Patients with SCD syndrome documented by history, sound- or pressure-evoked eye movements, vestibular-evoked myogenic potential testing, and high-resolution multiplanar computed tomographic scans. INTERVENTION: Nineteen subjects with SCD had quantitative measurements of their angular vestibulo-ocular reflexes (AVOR) in response to rapid rotary head thrusts measured by magnetic search coil technique before and after middle fossa approach and repair of the dehiscence. In 18 subjects, the dehiscence was plugged; and in 1, it was resurfaced. MAIN OUTCOME MEASURES: The AVOR gains (eye velocity/head velocity) for excitation of each of the semicircular canals. RESULTS: Vertigo resulting from pressure or loud sounds resolved in each case. Before surgery, mean AVOR gains were normal for the ipsilateral horizontal (0.94 +/- 0.07) and posterior (0.84 +/- 0.09) canals. For the superior canal to be operated on, AVOR gain was 0.75 +/- 0.13; but this was not significantly lower than the gain for the contralateral superior canal (0.82 +/- 0.11, p = 0.08). Mean AVOR gain decreased by 44% for the operated superior canals (to 0.42 +/- 0.11, p < 0.0001). There was a 13% decrease in gain for the ipsilateral posterior canal (p = 0.02), perhaps because plugging affected the common crus in some cases. There was a 10% decrease in gain for excitation of the contralateral posterior canal (p < 0.0001), which likely reflects the loss of the inhibitory contribution of the plugged superior canal during head thrusts exciting the contralateral posterior canal. Mean AVOR gain did not change for any of the other canals, but two subjects did develop hypofunction of all three ipsilateral canals postoperatively. CONCLUSION: Middle fossa craniotomy and repair of SCD reduce the function of the operated superior canal but typically preserve the function of the other ipsilateral semicircular canals.     

Planer orientation of the bilateral semicircular canals in dizzy patients

Objective

Recent development of 3-dimensional analysis of eye movement enabled to detect the eye rotation axis, which is used to determine the responsible semicircular canal(s) in dizzy patients. Therefore, the knowledge of anatomical orientation of bilateral semicircular canals is essential, as all 6 canals influence the eye movements.

Subjects and methods

Employing the new head coordinate system suitable for MR imaging, we calculated the angles of semicircular canal planes of both ears in 11 dizzy patients who had normal caloric response in both ears.

Results

The angles between adjacent canal pairs were nearly perpendicular in both ears. The angle between the posterior canal planes and head sagittal plane was 51° and significantly larger the angle between the anterior canal planes and head sagittal plane, which was 35°. The angle between the horizontal canal plane and head sagittal plane was almost orthogonal. Pairs of contralateral synergistic canal planes were not parallel, forming 10° between right and left horizontal canal planes, 17° between right anterior and left posterior canal planes and 19° between the right posterior and left anterior canal planes.

Conclusion

Our measurement of the angles of adjacent canal pairs and the angle between each semicircular canal and head sagittal plane coincided with those of previous reports obtained from CT images and skull specimens. However, the angles between contralateral synergistic canal planes were more parallel than those of previous reports.     

190例特发性良性阵发性位置性眩晕患者半规管功能分析

目的 分析特发性良性阵发性位置性眩晕(benign paroxysmal position vertigo,BPPV)患者半规管功能的特征,为患者的治疗提供进一步帮助.方法 选择本院2019年8月至2020年2月收治的单侧特发性BPPV患者190例,包括后半规管BPPV患者162例,水平半规管BPPV患者28例.行冷热...     

45例先天性内耳畸形的高分辨率CT特征

目的：探讨先天性内耳畸形的高分辨率CT(HRCT)特征及其在先天性内耳畸形诊治中的意义。方法：总结45例先天性内耳畸形的临床资料．分析颞骨HRCT所见。结果：45例耳聋多起于幼儿．呈缓慢进行性感音神经性听力减退，波动性者15耳；17耳半规管麻痹。HRCT显示：Michel型3例(4耳)；Mondini型25例(39耳)；不伴内耳畸形的前庭水管扩大13例(23耳)；内耳道发育畸形4例(5耳)。伴中、外耳畸形13耳。结论：HRCT对先天性内耳畸形具有重要的诊断价值，并为临床治疗、特别是人工耳蜗植入术适应证的选择提供了重要的依据。     

HRCT and MRI findings in X-linked non-syndromic deafness patients with a POU3F4 mutation

Objective

The aim of this study was to analyze HRCT and MRI findings in patients with X-linked non-syndromic deafness and a POU3f4 mutation.

Methods

HRCT and MRI data of four patients (males, 2–19 years old) with a POU3f4 mutation were collected and a retrospective review was performed. Cochlea, internal auditory canal (IAC), vestibule, semicircular canals, vestibular aqueduct, nerve canals in the IAC fundus, stapes and cochlear nerve were evaluated on 2D images (multi-planner reformation, MPR) and cochlear foramen on 3D images (CT virtual endoscopy, CTVE). Ten cases with normal hearing subjected to CT and MR exams served as controls.

Results

Inner ear malformations were bilateral and symmetrical. Cochlear malformation was shown to consist of as a relatively normal outer coat shape, absence of a cochlear modilous, and a direct intercommunication between the IAC and cochlear inner cavity. The lateral portion of the IAC was dilated. A spiral cochlear inner cavity was observed with CTVE images versus a helical cochlear nerve foramen as seen in controls. The labyrinthine facial nerve canal and superior vestibular nerve canal were enlarged. The Bill's bar was hypertrophic and partially pneumatized. A thickened stapes footplate was present and a fissura ante fenestram was absent in seven ears examined. A column shaped stapes was observed in one ear.

Conclusions

The absence of a cochlear modilous with a dilated lateral IAC and thickened stapes footplate were the remarkable features observed with imaging these in X-linked non-syndromic deafness patients with a POU3F4 mutation. Preoperative recognition of the image features in these patients is important because it precludes stapedectomy and indicates the risks in the surgery of cochlear implantation including CSF gusher and electrode insertion into IAC.     

HRCT imaging characterized of congenital abnormalities of the inner ear in 45 cases]

OBJECTIVE: To explore the high resolution CT (HRCT) image characterized of congenital abnormalities of the inner ear(CAIE), and its value in the diagnosis and treatment of CAIE. METHOD: The clinic data and axial HRCT scans of CAIE in 45 cases were analyzed. RESULT: In 45 CAIE patients, most of them were frequently associated with slowly progressive sensorineural hearing loss in childhood, 15 ears were fluctuating hearing loss. Seventeen ears were unilateral semicircular canal paralysis. HRCT showed that Michel type 3 cases(4 ears), Mondini type 25 cases(39 ears). Large vestibular aqueduct malformation not associated with anomalies of inner ears 13 cases(23 ears), anomalies of internal auditory canal 4 cases (5 ears). Thirteen ears were associated with outer and middle ear malformation. CONCLUSION: HRCT image has the important value in the diagnosis and treatment of CAIE, especially for the excerpt of indication of cochlear implantation.     

Semicircular canal orientation in the adult resting rabbit

Photographs of rabbits in the alert resting position were used to record head position. Semicircular canals were surgically exposed and points measured along each canal were used to compute the best-fit plane using a least-squares method. Computations of mean best-fit planes showed that the horizontal canals were not carried horizontally in the rabbit. The anteromedial edges were superior by 16 degrees. The anterior canals were vertically oriented and made an angle of 43 degrees to the sagittal plane. The posterior canal was tipped in the anterior direction slightly and also made an acute angle (26 degrees) with the frontal plane. Rabbit semicircular canals deviated significantly from orthogonality. The range was 86 degrees (anterior canals) to 133 degrees (posterior canals). Thus, there were no co-planar canals. Such semicircular canal geometry has implications for the neural circuitry controlling posture in the rabbit.     

Temporal bone histopathologic findings in Alagille's syndrome

Six temporal bones obtained from four individuals with Alagille's syndrome, aged 4 months and 3, 6, and 7 years, were studied histopathologically. The external auditory canals and tympanic membranes were normal. Although the stapes, the interossicular joints, and the subarcuate fossae were slightly underdeveloped in the majority of cases, the other structures in the middle ear were almost normal. However, severe anomalies were observed in structures in the inner ear. In all cases, both the bony and membranous structures of the posterior semicircular canal were partially or totally absent, and, in three ears, those of the anterior semicircular canal were also partially absent; the lateral semicircular canal, however, was normal in all cases. The cochlea was observed to be shortened in only one case.