经水平半规管前庭入路治疗Mondini畸形伴脑脊液耳鼻漏的临床探讨

目的:探讨Mondini畸形伴脑脊液耳鼻漏的临床表现及经水平半规管前庭入路修补治疗的可行性。方法:回顾性分析4例经水平半规管前庭入路进行修补的Mondini畸形伴脑脊液耳鼻漏患者。结果:4例患者均一次性修补成功,随访6个月以上无复发。讨论:反复发作的脑膜炎患者要高度警惕是由Mondini畸形所致,纯音测听及颞骨CT或MRI检查可明确诊断,经水平半规管前庭入路修补Mondini畸形伴脑脊液耳鼻漏是一种简便有效的术式,值得推广。     

梅尼埃病的半规管开窗冷冻术治疗

应用半规管开窗冷冻术治疗梅尼埃病６例。参照Ｗｏｌｆｓｏｎ的经乳突径路法，开窗、冷冻，部位改在水平半规管隆起部上方，其冷冻温度、时间剂量采用－８０℃６分钟（２分钟×３）。所有病例随访１年５个月以上，按ＡＡＯＯ（１９７２）疗效标准，６例中５例获得眩晕控制，１例失败，无并发症发生。并讨论了手术适应证、方法和效果，认为本术有效率高，并发症少，术后反应轻，且大多可保存听力，值得推广应用。     

上半规管裂一例

患者女,14岁.1984年发现右耳听力下降,经颞骨CT证实为双侧大前庭水管综合征(图1),并配带助听器.后因听力渐进性下降,当右耳增益放大时,患者出现眩晕,故复诊.检查:双侧鼓膜完整,纯音测听右耳250～500Hz残余听力,左耳重度聋(见图2),左、右耳250～500Hz存在明显的气-骨导差;声导抗检查左耳AD型鼓室曲线,右耳A型鼓室曲线;前庭双温试验显示右侧水平半规管功能低下,CP(右)=70%;前庭诱发的肌源性电位(vestibular evoked myogenic potential,VEMP)显示双侧球囊声敏感(Tullio现象),VEMP阈值为50dB(图3),该电位的检测参照作者以往的工作[1-2].复诊时冠状位CT显示右侧上半规管有骨裂(图4).     

上半规管裂隙综合征一例

MINOR等[1]在1998年首先报道了8例上半规管裂隙综合征患者,是由于上半规管位于中颅窝部位缺乏骨质覆盖。我科最近诊治1例上半规管裂隙综合征患者,报道如下。患者女,54岁,因反复发作眩晕伴左耳听力下降半年于2004年12月就诊。患者半年前因突发眩晕、左耳听力下降在外院诊断为“左耳突发性聋”,行高压氧治疗2个疗程,病情无缓解。患者仍反复发作眩晕,被诊断为梅尼埃病,继续对症治疗,病情仍无缓解,来我科求诊。经仔细询问病史,患者主诉听到高频强声、马路上的助动车声、用力屏气时均可导致眩晕发作,持续时间为30MIN到2H不等。体检发现患者用…     

闭合性颅外伤脑脊液耳漏与脑脊液耳鼻漏

颞骨骨折的纵形骨折病例,约占70—80％,横形骨折为20％。亦有二者合并发生和其中之一呈粉碎状者。纵形骨折的力量来自颞或顶部,是颅底的一种前后方向裂伤、横贯外耳道后上部及鼓室盖的颞骨鳞部垂直骨折,岩部的纵形裂口。可沿咽鼓管和颈动脉管终止于棘孔或破裂孔之颅中凹,外耳道皮肤及鼓膜可被撕裂,听骨脱位或骨折导致传音性聋。横形骨折是由枕或额的力量作用于枕骨大孔与岩锥长轴的垂直破裂,骨折线     

颅底骨折所致脑脊液鼻漏及耳漏120例

目的：总结３年来１２０例颅底骨折所致的脑脊液漏的治疗经验。方法：分为保守治疗和手术治疗,手术治疗主要是针对具有颅内血肿同时又有耳、鼻道漏液的患者。对于不易操作和难以处理的缺损用ＥＣ脑胶进行粘合修补。结果：保守治疗７９例,手术治疗４１例,除６例死于原发性脑损伤外,１１４例经临床观察尚未发现再漏现象。结论：保守治疗应注意将头部放置在不易漏液的位置上,同时应保持耳鼻道通畅和洁净;手术８治疗应严密修补颅底     

自发性脑脊液耳漏的诊断和治疗

脑脊液(CSF)从蛛网膜下腔流入颞骨的气化空间,最常见于伴有硬脑膜和蛛网膜撕裂的骨折,其次是经过颞骨的颅内手术,感染或新生物较少见,自发性者更少。本文报告两例CSF耳漏,介绍一种修补方法,并讨论瘘孔定位问题。两例均为成人,因大量CSF从外耳道流出就诊,无感染、严重外伤史或先天性畸形。第1例第一次手术时怀疑CSF从圆窗流出,用耳屏软骨膜覆盖无效。第二次手术取耳后进路凿开上鼓室和乳突,经面神经隐窝进入中耳,见鼓窦天盖有一3×4mm裂隙及硬脑膜缺损,约3×4×3mm之     

自发性脑脊液耳漏4例临床分析

目的探讨自发性脑脊液耳漏的临床特点及治疗。方法回顾性分析2015年7月—2016年12月手术治疗的4例自发性脑脊液耳漏患者的临床病例资料,4例患者均有细菌性脑膜炎病史,2例为内耳畸形（内耳不完全分隔Ⅰ型）,漏点均位于镫骨足板;行耳后切口鼓室探查术,术中见镫骨足板缺损有清亮液体涌出,去除镫骨及砧骨,以颞肌筋膜、耳廓软骨及纤维蛋白胶封堵前庭窗。另2例漏点位于后颅窝硬脑膜,其中1例位于弓状隆起至总角水平,1例位于圆窗至外耳道下壁水平;此2例患者均行完壁式乳突开放术,显露后颅窝骨质缺损处,可见脑脊液流出,以颞肌筋膜、耳廓软骨、乳突皮质骨骨粉及纤维蛋白胶封堵缺损。结果4例患者术后随访23~39个月,脑脊液耳漏及脑膜炎均无复发。结论自发性脑脊液耳漏发病率低,容易漏诊、误诊,以致脑膜炎反复发作。听力下降伴脑膜炎的患者应高度怀疑自发性脑脊液耳漏的可能。     

自发性脑脊液耳鼻漏伴内耳畸形的诊断及治疗

目的 探讨自发性脑脊液耳鼻漏伴内耳畸形患者的临床表现及外科治疗方法.方法 对我院10例自发性脑脊液耳鼻漏伴内耳畸形患者资料进行回顾.有两种手术方法:一种为后鼓室探查、镫骨底板切除后行前庭窗填塞术;另一种是经乳突面隐窝径路探查后鼓室、水平半规管开窗(迷路开窗)后行前庭池填塞术.结果 术前所有患者患耳听力完全丧失,10例均...     

内耳畸形伴脑脊液耳漏的高分辨率CT特征

目的:探讨先天性内耳畸形伴脑脊液耳漏的高分辨率CT(HRCT) 特征.方法:回顾性分析11例先天性内耳畸形伴脑脊液耳漏患者的HRCT表现.结果:共11例患者,耳蜗未发育4例,共腔畸形2例,耳蜗未未分隔型3例,耳蜗不全分隔型2例.内耳道底骨质缺损8例.所有患者患侧乳突气化和发育程度与对侧一致,前庭窗处都有软组织影.结论:内耳畸形伴脑脊液耳漏患者常存在内耳道底骨质缺损.前庭窗是脑脊液由内耳进入中耳腔的好发部位.HRCT能为先天性内耳畸形伴脑脊液耳漏患者的诊断及治疗提供可靠依据.     

A new biochemical assay in the diagnostic management of nasal cerebrospinal fluid leakage

A new method for the detection of cerebrospinal fluid (CSF) leakage is described, and is a refinement of the method originally reported by Oberascher and Arrer in 1986. Immuno-electrophoretic measurements are performed in a two-buffer system, making the test easier to do and providing qualitatively better images. Genetic variants of transferrin (which has a general population incidence of 2–4%) can be discriminated from false-positive test results in affected families. The test described is recommended as the method of choice for initial screening of suspected CSF leakage.     

Mondini畸形伴脑脊液耳漏的外科治疗

目的：探讨Mondini畸形伴脑脊液耳漏患者的外科治疗方法及预防措施。方法：对我院确诊为Mondini畸形伴脑脊液耳漏的15例患者采用鼓室探查并经卵圆窗、圆窗及其他漏孔进行填塞修补。结果：手术探查发现卵圆窗处有脑脊液漏出，圆窗及附近其他部位也有漏孔发生。15例患者中，10例经漏孔填塞修补1次治愈；5例经2次或3次填塞术后治愈。术后随访10个月～7年无脑脊液漏或脑膜炎复发。结论：经鼓室进路手术修补为该病的有效治疗方法，避免致畸因素的影响是预防本病发生的重要措施，佩带助听器是治疗手段之一，部分患者可考虑电子耳蜗植入。     

Mondini畸形伴脑脊液耳鼻漏的外科处理

目的：探讨Mondini畸形伴脑脊液耳鼻漏的临床表现及外科手术方法。方法：对3例Mondini型内耳畸形伴自发性脑脊液耳鼻漏患儿，均采用经卵圆窗内耳填塞方法修补。结果：3例皆一次手术修补成功，随访半年以上无脑脊液漏或脑膜炎复发。结论：幼儿自发性脑脊液耳鼻漏应警惕Mondini型内耳畸形，颞骨薄层CT扫描可明确诊断，经鼓室进路手术修补为有效方法。     

Amino acid profiles in inner ear fluids and cerebrospinal fluid

The levels of 19 amino acids in utricular endolymph, vestibular and cochlear perilymph, and cerebrospinal fluid of guinea pigs were determined using gradient elution reverse phase high performance liquid chromatography of the o-phthaldialdehyde-ethanethiol adducts with fluorescence detection. Aspartate and glutamate were significantly higher in endolymph than in perilymph, in agreement with earlier results on cochlear fluids based on enzymatic fluorometric techniques. All other amino acids tested were significantly lower in the endolymph, in most cases by an order of magnitude. Vestibular perilymph and perilymph of scala vestibuli are virtually identical. Amino acid levels were all higher in perilymph of scala vestibuli than in cerebrospinal fluid; two by an order of magnitude. All differences were statistically significant, with the exception of aspartate. Amino acid levels in perilymph of scala tympani were highly variable, dependent upon sampling technique, and no definite values are therefore presented. Comparisons with results from other laboratories, technical pitfalls, and possible implications and interpretations of the results are presented.     

Spontaneous cerebrospinal fluid leakage and middle ear encephalocele in seven patients

Isolated cases of spontaneous cerebrospinal fluid (CSF) leakage with and without middle ear encephalocele have been reported. These leaks are usually accompanied by episodes of recurrent meningitis, hearing loss, or chronic headache. In this article, we report seven new cases of spontaneous CSF leakage. Six of these patients had conductive hearing loss and serous otitis media, and three had recurrent meningitis. Prior to a definitive diagnosis, six patients had received myringotomy tubes, which produced profuse clear otorrhea. Three patients had positive beta-2 transferrin assays. Computed tomography and magnetic resonance imaging confirmed a defect in the temporal bone tegmen. A combined transmastoid and middle fossa surgical approach with a three-layer closure was used to repair the tegmen defect. All patients had a lumbar drain placed prior to surgery. In addition to describing the seven new cases, we review the history of CSF leakage and discuss diagnostic methods, surgical findings, and our recommendations for management.     

The new classification system for inner ear malformations: the INCAV system

Conclusions: The proposed INCAV system standardizes reporting of inner ear malformations; gives adequate information about the structures of inner ear; defines the ears which could not be classified before; and helps in the selection of the ear as the cochlear implant candidate. Also it is easy-to-use for radiologists, and useful to the referring otolaryngologists.

Objective: This study was conducted to explore a more specific, definitive classification system which was based on radiological criteria for inner ear malformations.

Method: This study found 43 patients who had inner ear malformations, magnetic resonance (MR), and computed tomography (CT) imaging, together with the retrospective evaluation of the medical records between August 2010 and February 2015. It analyzed inner ear structures by dividing five sub-groups and each sub-group was given a letter: internal acoustic canal (I), cochlear nerve (N), cochlea (C), vestibular aqueduct (A) and vestibule (V). Based on their malformations, these anatomical structures have been assigned grades and have been classified by using increasing numbers which were dependent to increasing order of severity of the malformation.

Results: Among these 43 patients, there were six normal (I₀N₀C₀A₀V₀) and 80 inner ear malformations. All of the ears were defined successfully by the INCAV system.     

Minor congenital ear malformations: surgical management and results

The study present the results of surgical treatment of minor congenital anomalies of the middle ear in children. The ossiculoplastic procedures and the different types of stapedectomy carried out in the Department of Otolaryngology of Institute of the "Polish Mother's Hospital" in ?ód? on 18 patients (11 girls and 7 boys) aged 5-16 years, with minor congenital anomalies of the middle ear. One month after the surgical procedure a lasting hearing improvement averaging 21.69 +/- 10.00 dB and 6 month after operation hearing improvement 21.91 +/- 9.75 dB was gained. The results of surgical procedures in minor congenital anomalies of the middle ear are not so good as in otosclerosis.