当今耳蜗透析治疗Méniére病

耳蜗透析的基本原理是应用高渗溶液灌注鼓阶,减轻内淋巴水肿。将1.31g甘露醇加入5％葡萄糖溶液至100ml时,即可制得透析液,消毒后备用。该透析液渗透浓度为350毫渗量/升,与蜗管内淋巴的300毫渗量/升相比,是高渗溶液。作者报道自1981～1986年采用此法治疗重度单侧Meniere病30例,疾病严重程度在术前可用250Hz～3KHz纯音听阈检查来估计,听阈大于70dB者20例,介于40～70dB者9例,仅1例为40dB。男13例、女17例。眩晕症状持续3～40年,平均10.5年。手术期年龄28～80岁,平均49.5岁。全部病例经各种内科治疗均     

总和电位与Méniére病

本文就耳蜗受强声刺激使听毛细胞产生的直流电位与Méniére病关系的有关资料进行综述,普遍认为Méniére病人耳蜗电图中总和电位有改变,对Méniére病的诊断及疗效评价可能有一定参考价值。     

Méniére病外科治疗的效果评价

美国耳鼻咽喉-头颈外科协会听力前庭平衡组于1985年提出了评价Meniere病疗效的修改标准,用一个公式对前庭症状做出评价。治疗后24个月内平均每月发作次数/治疗前6个月内平均每个月的发作次数,再乘以100,其得分0者为完全控制,1～40者为基本控制;41～80者为部分控制;81～120者为未控制;>120者为发作加剧。本文对1969年1月～1985年7月手术治疗的109例患者中84例进行回顾性分析。听力以治疗前6个月内最差听力水平及术后18～24个月内最差听力水平进行比较,(取500、1000、2000、3000Hz的平均听阈)。结果发现:①Cody-Tack术式,有68％的患者术后仍有相同     

Méniére病内淋巴囊的解剖学发现

内淋巴囊的形态易发生变异。作者等就46例Meniere病内淋巴囊手术时所见内淋巴囊的位置、大小、色泽、血管分布情况等进行了研究,并与12例急性乳突炎和胆脂瘤手术时所暴露的内淋巴囊作了对比。位置:按Arenberg对内淋巴囊位置的Ⅲ型分类(Ⅰ型,内淋巴囊的一部分或上端接水平半规管的延伸线;Ⅱ型,介于Ⅰ、Ⅲ型之间;Ⅲ型,内淋巴囊在后半规管的下方,近颈静脉球);大小:分为大、中、小;色泽:分为红色、中间(介于红、白色之间)、白色;血管分布:分为良好、中间、不良。结果发现:①内淋巴囊位置。Meniere病者Ⅰ型1例(2％)、Ⅱ型20例(44％)、Ⅲ型25例(54％);对照组Ⅰ型5例(42％)、Ⅱ型6例(50％)、Ⅲ型1例(8％)。②大小。Meniere病属大者11例(24％)、属中者19例(41％)、属小者16例(35％),其中有3例不能清楚确认者;对照组:大者5例(42％)、中者7例(58％)。③色泽。Meniere病者红色1例(2％)、中间9例(20％)、白色36例(78％);对照组:中间8例(67％)、白色4例(33％)。④血管分布。Meniere病者,良好7例(15％)、中间15例(33％)、不良24     

声创伤诱发Méniére综合征

目前声创伤作为Meniere病(MD)可能病因的报道甚少,作者研究了不同程度声创伤的患者1800例,其中诊断为Meniere综合征(MS)8例(1/225人),另有3例因不符合本文制定的MS标准而未列入研究。8例患者均为男性,平均年龄40.5岁,其中5例为现役军人,都遭受时间长短不一的高强度噪声暴露;另3例也曾受明显的噪声暴露。对所有患者都详细地询问了病史,并作了全面检查,包括血常规、肝肾功能试验、血清葡萄糖和电解质测定、甲状腺功能试验、病毒血清学检查、心电     

Méniére病前庭神经切断术后持久性眼震

前庭神经切断术用于治疗Meniere病已有60年,以往的随访资料多侧重于评价前庭症状的缓解和耳蜗残余功能,仅一篇文章提到术后出现自发性眼震且在2周内消失。最近,作者回顾了6例至少2.7年,平均3.5年前接受前庭神经切断术的病人,其中女5、男1,年龄33～66岁,平均49.9岁。所有病人临床上均有明显的持久性自发性水平性急跳性眼震,其中5例在视固定时仍出现快相向非手术侧的Ⅰ度眼震,均经3位医生各自观察证实;另1例于取消视固定后眼震始明显可见,且可由眼震电图     

庆大霉素等耳毒性抗生素鼓室给药治疗Méniére病

作者应用耳毒性抗生素经鼓室给药方法,治疗92例Meniere病患者。其中硫酸链霉素52侧,庆大霉素33例,妥布霉素7例。认为庆大霉素效果理想。报告如下。方法:常规鼓膜后方切开,插人大号通气管。注入0.3ml庆大霉素(含12mg),每天5次,间隔3小时,连续数日。给药前嘱患者头向健侧45°转位,使圆窗区向上。注药后用politzer's球轻加压使药液进入中耳,嘱其同时做吞咽动作。保持该头位30分钟。每天行纯音听力检查及Frenzel's镜观察眼震。如有眼震、眩晕等迷路反应则暂停治疗。中耳感染亦应停止给药,好转后继续治疗。结果:20年中治疗92人。90％患者前庭症状得到控制并无复发。76％的患者听力无进一     

氨基甙类耳毒性药物治疗Ménière病的研究进展

利用AmAn药物的前庭选择毒性作用控制严重的眩晕,是Ménière病治疗的重要进展之一。本文着重介绍了临床应用中适应症掌握,给药方法与剂量选择以及耳神经学监护等问题,并综述了有关的病理生理学研究进展。     

Ménière病前庭及听功能相关性分析

为了解Meniere病患者的位听功能，对按AAO－HNS标准诊断为Meniere病121例（166耳）患者的临床检查结果，进行追溯性研究。位听功能统计结果证明：①耳蜗与前庭受损程度有相关性，经趋势及x2检验为正相关（P＜0．01），即听力损失越重半规管不对称比值越大：②听力损失与ECochG优势－SP有关，听力损失越重，－SP／AP异常率越高，差异有显著性。③听力损失与甘油试验阳性率有关，轻度受损甘油试验阳性率低（22．2％），听力损失严重者甘油试验的阳性率增高（84．6％），差异有显著性，ECochG与甘油试验比较，前者更敏感；④各种听力图中上坡及峰型曲线甘油试验阳性率最高为69．0％，下坡及槽型曲线阳性率为33．3％，差异有显著性。诊断Meniere病客观依据不多，听力图、ECochG、前庭功能、甘油试验等联合检查是重要的诊断依据和选择治疗的准则。     

淋巴囊乳突分流术治疗Ménière病长期疗效观察

采用内淋巴囊乳突分流术治疗１０例Ｍｅｎｉｅｒｅ病患者，随访３～５年，术后眩晕控制满意，其中眩晕疗效值为０者３例，１～４０者７例；多数患者（７／１０）耳鸣减轻或消失，仅１例术后听力下降。该手术安全、并发症少、术后恢复快。对药物治疗无效，患耳尚有听力的Ｍｅｎｉｅｒｅ病患者可首选内淋巴囊乳突分流术。     

Ménière disease: diagnostic instrumental support

The current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery entrust the diagnosis of Ménière disease (MD) only to the clinical presentation and the pure tone audiometry. However, most otolaryngologists request a widened instrumental evaluation of the patients suspected of MD. The effective reliability of the further instrumental support for the diagnosis of MD is still debated in the literature because of nonstandardized procedures and sometimes incoherence among authors. New and more sophisticated diagnostic tests have been developed both in audiovestibology and in imaging in the last few years. A review of the recent literature on this controversial subject is provided.     

Ménière''''s病手术治疗的评价

报告1982年3月～1986年3月Meniere’s病手术治疗70例。提出Meniere’s病的治疗应以内科治疗为主,内科治疗失败再行手术治疗。首选的方法应为合乎生理的内淋巴囊造口引流术,手术失败可行迷路切除术或前庭神经切断术。本文对各种手术方式和疗效评价标准进行了讨论。     

半规管开窗冷冻术治疗Ménière病的远期疗效观察

本文报告半规管开窗冷冻术治疗20例Meniere病的远期疗效。术式为Wolfson的改良法。全部病例随访4～7年，按AAO－HNS（1985）疗效标准，效果为A级3例；B级9例；C级4例；D级4例；E和F级为0。有效率为80．0％。均无并发症发生。讨论了手术机理、远期与近期效果。作者认为，对经药物系统治疗无效又有手术适应证的少数Meniere病患者，采用本术治疗不仅可获得控制眩晕又可保存听力的良好远期效果，且安全性好，是一值得首选应用的手术。     

Application of autogenic training in patients with Ménière disease

Data are limited on the role of psychotherapy in the treatment of Ménière disease. We sought to document the effect of a psychotherapeutic technique known as autogenic training on clinical outcome in Ménière disease. Six patients with Ménière disease were studied. Retrospective chart review was conducted. All patients were refractory to conventional therapy and completed a course of autogenic training, which was offered as a complementary treatment. Autogenic training with initial psychological counseling was conducted by a clinical psychologist during 45-min sessions. Outcome measures assessed were the frequency of vertigo and functional levels 2 years after initiation of autogenic training. Functional levels were evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head Neck Surgery (AAO-HNS). As a personality measure, we used the Maudsley Personality Inventory (MPI), devised by Eysenck, which measures neuroticism (N), extraversion (E), and propensity to lie (L). Five of six patients showed improved functional level after three to eight sessions of psychotherapy; hearing level did not change. The score of the N scale of the MPI was closely related to the number of psychotherapy sessions. Prognosis was evaluated based on the AAO-HNS reporting guidelines, as follows: A = 3, B = 1, C = 1, F = 1. The value of N in MPI was closely related to the number of psychological counseling sessions (R = 0.97, P < 0.05). In conclusion, autogenic training may enhance the mental well-being of patients with Ménière disease and improve clinical outcome.     

新形隐球菌性脑膜脑炎误诊Ménière氏病一例

患者女,32岁,已婚。1966年6月27日因头晕,头痛,走路不稳,易向右侧偏倒。伴有耳鸣,听力下降,出汗及非喷射性呕吐一周。一天前头痛加重,收入院治疗。体检:一般状     

Association between Ménière’s disease and vestibular migraine

ObjectiveThe aim of the present study was to evaluate complaints in people with Ménière’s disease (MD) with and without migraine and headache to study the association between MD and Vestibular Migraine (VM). We believe this will help us understand if these two disorders represent a disease continuum in that they may share a common aetiology.MethodsThe study used a retrospective design and included data of 911 patients with MD from the Finnish Ménière Federation database. The study participants had a mean age of 60.2 years, mean duration of disease of 12.6 years, and 78.7% of the participants were females. The questionnaire data comprised of both disease specific and impact related questions. The data were analyzed using the Mann–Whitney U test, the Kruskal Wallis H test, logistic regression analyses, and decision tree analysis.ResultsMigraine and headache was reported by 190 subjects (20.9%) and 391 subjects (42.9%) respectively. We found that patients that could be classified as VM in the study (i.e., those with frequent vertigo spells associated with migraine) more often reported complaints of severe MD symptoms, had reduced health-related quality of life, suffered more from anxiety, had more neurological complaints, and experienced a reduced sense of coherence than the non-migraneous patients with MD. However, neither the decision tree analysis nor the logistic regression analysis could reliably discriminate VM from MD patients.ConclusionOur study results confirm that MD is frequently associated with headache and migraine. In addition, results also indicate that migraine provokes the severity of MD. We suggest that MD and VM may share similar pathophysiological mechanisms. Hence, the future MD classification systems should include a category referred to as ‘MD with migraine’ that will include patients with VM.     

Analysis of wideband tympanometry in Ménière’s disease

IntroductionEndolymphatic hydrops is the pathophysiological substrate of Ménière’s disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease.ObjectiveTo characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease.MethodsWe carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9).ResultsDifferent peak pressure values were found between the ears of the control group (0 daPa), the asymptomatic group (?11 daPa) and the symptomatic group (?192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction.ConclusionsThe Wideband Tympanometry test was capable of identifying the presence of Ménière´s disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.