Audiovestibular manifestations of sarcoidosis: a review of the literature

OBJECTIVE/HYPOTHESIS: Sarcoidosis is a multisystem disease of unknown etiology. Audiovestibular involvement is rare but has been reported in a number of cases. The objective of this review is to provide an evidence-based summary of the audiovestibular manifestations of sarcoidosis by collating the findings of these case reports. STUDY DESIGN: Retrospective review of 48 published case reports and 2 cases recently encountered in audiovestibular medicine clinics. METHODS: Case reports were identified using a key word search of Medline database. Clinical details, audiovestibular test results, and radiological findings were recorded for each patient when available. RESULTS: When type of hearing loss (HL) was recorded, all losses were sensorineural, with only two patients found to have an additional conductive loss. The severity of HL ranged from mild to profound. Median thresholds were moderately raised. The HL was bilateral in 75% of patients and asymmetrical in 75% of these cases. Seventy percent of HLs demonstrated some recovery. Many of the patients with recovery were treated with corticosteroids, but no statistically significant association between treatment and HL outcome was observed. Symptoms of vestibular impairment were common. Vestibular testing was performed in 24 cases and was abnormal in 23. Eighty-one percent of patients had additional features of neurosarcoidosis. Six patients had radiological evidence of a retrocochlear lesion. CONCLUSION: In taking into account the evidence from the clinical features, audiovestibular testing, radiological investigations, and postmortem findings, it is concluded that the audiovestibular manifestations of sarcoidosis are likely to be primarily a result of vestibulocochlear nerve neuropathy.     

Sinonasal sarcoidosis: review and report of fifteen cases

OBJECTIVES: Sinonasal sarcoidosis remains a poorly understood and uncommon chronic granulomatous disease of unclear origin. We have attempted to characterize the main clinical and radiologic criteria for diagnosis and to discuss the treatment. METHODS: A retrospective study of 15 cases of chronic, symptomatic, and biopsy-proven sinonasal sarcoidosis and a review of the literature are realized. RESULTS: Among the 15 patients, there were 8 women and 7 men with a mean age of 44 years. The most frequent presentation was a chronic, often crusty, rarely destructive inflammatory rhinosinusitis with nodules on the septum and/or the turbinates. Pulmonary sarcoidosis was associated in 12 cases. Involvement of the nasopharynx, the pharyngolarynx, the skin, the lachrymal and salivary glands, and the liver was associated in some cases. Levels of angiotensin-converting enzyme were elevated in 10 cases and normal in 3 cases. Gallium scan performed in three cases was positive. Radiologic studies showed nodules on the septum and/or the turbinates in 14 cases, complete or subtotal opacification of the sinuses and/or the nasal cavities in 13 cases, and nasopharyngeal or pharyngolaryngeal lesions in 4 cases. Treatment with corticosteroids, methotrexate, azathioprine, and surgery appear globally disappointing in view of the side effects and the relapses during a long follow-up (3-15 yr; mean, 6 yr). CONCLUSION: On the basis of this study, we propose the following diagnostic criteria: 1) histopathologic confirmation of noncaseating granuloma; 2) chronic rhinosinusitis poorly responsive to conventional treatment and radiologic evidence of rhinosinusitis, often with nodules on the septum and/or the turbinates; 3) elevated level of angiotensin-converting enzyme; 4) positive gallium scan (if performed); 5) frequent evidence of systemic, especially pulmonary, sarcoidosis; 6) no evidence of other granulomatous diseases, such as Wegener granulomatosis.     

平阳霉素瘤内注射治疗口腔颌面部淋巴管瘤长期临床观察

自1987年11月至1995年9月采用平阳霉素瘤体内注射治疗口腔颌面部各种类型淋巴管瘤208例，随访1～8年200例，其中5年以上80例，总有效率97．5％，治愈率86．5％。未出现肺炎及纤维化等严重并发症。本文对疗效与分型，瘤体大小及年龄的关系，药物作用机制及其副反应作了详细分析。     

Dentigerous cyst: A rare presentation

Though Dentigerous cysts are encountered not so frequently by the otolaryngologist, a giant dentigerous cyst causing facial deformity and requiring a major reconstructive surgery is very rare. One such case is described.     

颞骨骨折性面瘫的临床和实验观察

为探讨影响颞骨骨折性面瘫预后的主要因素和面神经减压术的意义，总结分析了６４例面瘫预后的主要相关因素。制作面瘫实验西式，测定面神经骨管开放组和非开放线面神经膨胀率，并行电镜观察。结果表明，影响预后的主要因素是否行面神经减主及手术时机。骨管开放组面神经膨胀率显著大于非开放组，非开放组纤维损伤谋生时机提示早期行面神经减压术有 利于面神经功能恢复。     

脑桥显微血管减压术治疗特发性半面痉挛及其机理探讨

目的进一步探讨特发性半面痉挛（ｉｄｉｏｐａｔｈｉｃｈｅｍｉｆａｃｉａｌｓｐａｓｍ，ＩＨＦＳ）的病因、发病机理及手术方法。方法对８个（１６侧）经甲醛固定的脑桥行矢、冠状面常规冰冻切片、染色，观测脑桥内面神经核的位置及面神经纤维行走方向、方位。对２５例ＩＨＦＳ面神经入脑段（ｒｏｔｅｘｉｔｚｏｎｅ，ＲＥＺ）无血管压迫者做了脑桥显微血管减压术。结果面神经核距脑桥腹侧表面距离为１２．０～１２．５ｍｍ，距中线为６．０ｍｍ，距脑桥腹外侧表面为７．５～９．０ｍｍ；面神经纤维在距脑桥出口部４．０ｍｍ之内这一段，距脑桥表面为１．０～２．０ｍｍ，平均１．６５ｍｍ。２５例ＩＨＦＳ术中见血管压迫部位在ＲＥＺ前上方４ｍｍ之内脑桥表面，压迫血管为小脑前下动脉及其分支。８例术后症状即消失，１７例于１周内消失，随访６个月～５年未见复发。结论ＩＨＦＳ病因主要为血管压迫，而ＲＥＺ无血管压迫者面神经核功能异常可能为原因之一，ＲＥＺ前上方脑干表面有血管压迫者，脑桥显微血管减压术治疗有效。     

Surgical timing for facial paralysis after temporal bone trauma

Objectives

To explore surgical timing of facial paralysis after temporal bone trauma.

A型超声波检查诊断上颌窦病变

用ＥＣＨＯ－ＴＥ－１１型鼻窦超声波诊断装置对上颌窦病变９１例患者进行了观察和分析，并与正常对照组６９例进行对比。对照组中检查结果示正常上颌窦图像者占８９．９％，上颌窦炎患者８７例，确诊率为９１．９％。对术后上颌窦囊肿、上颌窦良、恶性肿瘤等病例也做了观察。同时对Ａ型超声波测试法的有关注意事项等进行了讨论。     

乙状窦后进路面神经干梳理术治疗半面痉挛

２２例半面痉挛患者行乙状窦后进路面神经干梳理术治疗，均取得良好近期疗效。其中１６例术后观察１～４年，痊愈１１例，显效３例。术中观察面神经有动脉袢压迫者１２例。该手术安全可靠，适应证宽，术后不遗有面瘫，无死亡。对术后听力减退、复发及其他问题进行了讨论。     

伴或不伴轻微面神经麻痹的面神经鞘瘤的诊治分析

目的 探讨伴或不伴轻微面神经麻痹的面神经鞘瘤的临床表现、诊断及治疗.方法 回顾性分析8例资料完整、面神经功能House-Brackmann分级(HB)≤Ⅱ级的面神经鞘瘤患者诊断及治疗过程.结果 8例患者均不以面神经麻痹为首发症状且均有误诊史,其中6例存在误治史.术前均行CT和(或)MRI检查,证实肿瘤位于面神经的不同位置.4例术中保留面神经行肿瘤切除术,术后随访17～180个月,面神经功能(HB)Ⅱ～Ⅲ级;2例术中发现肿瘤侵犯广泛,破坏耳蜗及前庭,与面神经无法分离,予以牺牲神经切除肿瘤,行耳大神经移植术,术后分别随访56和79个月,面神经功能(HB)Ⅳ级;1例拒绝牺牲面神经,术中行面神经减压术,术后11个月面神经功能Ⅱ级,肿瘤无增大;1例术中发现肿瘤来源于鼓索神经,予以牺牲面神经分支,并行面神经减压术,术后11个月面神经功能Ⅱ级.结论 面神经功能分级(HB)≤Ⅱ级的面神经鞘瘤多不以面神经麻痹为首发症状,诊断困难.手术方法取决于肿瘤的特点、范围和患者的意愿.对明确面神经来源的肿瘤,如果肿瘤与面神经之间容易分离,可以保留面神经行肿瘤切除;如果不易分离,当肿瘤侵犯桥小脑角、内听道、耳蜗、前庭时,可以考虑牺牲面神经;对拒绝牺牲面神经者,可行面神经减压术,并定期影像学随访.     

面神经瘤误诊分析

目的总结分析面神经瘤误诊的原因，提高对面神经瘤的认识。方法1993年1月至2006年9月手术治疗的28例面神经瘤患者，11例有误诊的经历。所有患者均行CT或MRI检查、纯音测听，面神经功能的评估采用House-Brackman（HB）系统。结果11例患者被误诊。2例术前被误诊为腮腺肿块，行腮腺浅叶切除术，术中发现肿块来自面神经。4例单侧面神经麻痹长期外院误诊为贝尔面神经麻痹，病史1至8年。由于长期面神经麻痹无好转，行影像学检查发现面神经占位病变。2例复发性面神经麻痹误诊为贝尔面神经麻痹，行影像学检查发现均为面神经膝状神经节占位。1例因左耳渐进性听力下降，体检见外耳道新生物，诊断为外耳道新生物，行活组织检查示神经鞘瘤，进一步影像学检查提示为面神经瘤。1例右耳流脓数年，面神经麻痹1个月。查体示右鼓膜穿孔，CT检查诊断为慢性中耳炎行手术，术中见上鼓室肿块同面神经关系密切，取部分组织送病理，术后病理为面神经鞘瘤。另1例面神经麻痹1年半，CT检查误诊为先天性胆脂瘤，入院后发现乳突肿块同面神经关系密切，MRI证实为面神经肿瘤并且侵及腮腺内面神经。11例均经手术和病理证实。结论面神经瘤较罕见，不为大多数临床耳科医生熟悉，在临床中易被漏诊和误诊。临床中，如贝尔面神经麻痹半年内无好转现象或患者表现为反复面神经麻痹，应行影像学检查排除面神经瘤的可能。如患者出现面神经麻痹，CT示中耳占位并同面神经关系密切时，行MRI检查可同中耳胆脂瘤、肉芽、胆固醇肉芽肿等区分。腮腺肿块同面神经总干关系密切者应警惕面神经可能。     

面神经减压术治疗颞骨骨折性面瘫的手术时机

目的 :探讨颞骨骨折性面瘫面神经减压术的手术时机及减压面神经的范围。方法 :将重度面瘫、失神经支配Ⅲ度适合面神经减压术 1 6 8例颞骨骨折性面瘫病例 ,分别于伤后 2个月内和 2个月外行面神经减压术 ,并分为 2个月内组和 2个月外组进行疗效对比。采用组间 χ2 检验。结果 :2个月内组治愈率显著高于 2个月外组 (P <0 .0 1 )。结论 :早期行面神经减压术治疗重度颞骨骨折性面瘫 ,可以明显提高临床治愈率     

A study of temporal bone fractures

Many young adults are now killed and injured in accidents than from another causes. More than 75% of these injuries are to the head, and the ear being the most frequently injured sensory organ of the body. Temporal bone or basilar skull fractures are extremely common in any head injury. Injuries to the temporal bone may be considered in three groups: Those affecting the external auditory meatus (extralabyranthine fractures), those largely affecting middle ear cleft (tympanolabyranthine) and those affecting the internal ear (labyrinthine fractures). Many injuries, however, involve all these structures.The sudden onset of facial paralysis, vertigo and hearing impairment after a head injury is a matter of great concern for the patients and clinicians. Presence of cerebrospinal fluid leak (CSF Otorrhoea) can be a challenge for both the neurosurgeons and otologists. We hereby present 86 patients of temporal bone fractures who presented in the departments of emergency, Neurosurgery or ENT of Himalayan Institute of Medical Sciences, Dehradun during last 10 years (1996–2006).     

迷路上间隙和后鼓室联合径路面神经减压术治疗 颞骨骨折所致周围性面瘫的临床分析

摘要：目的探讨迷路上间隙和后鼓室联合径路面神经减压术治疗颞骨骨折面瘫的临床疗效。方法对2013年5月~2015年7月收治的11例颞骨骨折引起的周围性面瘫患者进行迷路上间隙、后鼓室联合径路面神经减压术。按House Brackmann分级标准进行面神经功能评价,术前Ⅲ级1例,IV级6例,Ⅴ级4例;术前平均听阈为（54.4±9.6）dB;术中见听骨链中断者5例,所有病例镫骨未见损伤。结果11例均在受伤后4周内手术,术后随访0.5~2年均获得较好的恢复。术后面瘫恢复至I、II、Ⅲ级的分别为4、4、3例。术后平均听阈为(38.0±12.0)dB。5例听骨链中断患者中3例用自体听小骨,2例应用钛合金听小骨,其余6例患者听骨链活动良好,5例保留了后拱柱。结论迷路上间隙和后鼓室联合径路面神经减压术对面神经功能及听力恢复均获满意疗效。     

A 型肉毒毒素治疗半面痉挛及眼睑痉挛

目的观察Ａ型肉毒毒素治疗半面痉挛及眼睑痉挛的效果。方法Ａ型肉毒毒素局部注射（每点２．５～５Ｕ）治疗眼睑痉挛１２例（１５侧）及半面痉挛３８例。结果完全缓解分别为１０例（１３侧，占８６．７％）及３２例（８４．２％），明显缓解分别为２例（１３．３％）及５例（１３．２％），部分缓解分别为０例及１例（２．６％）。总有效率１００％。药效作用时间分别为１０～２４周（平均１８周）及１４～３２周（平均２２周）。局部副反应轻微、短暂，包括轻度面瘫８例、眼睑下垂４例、流泪４例，无全身反应及过敏反应。结论Ａ型肉毒毒素局部注射是治疗眼睑痉挛及半面痉挛的一种安全、有效、简便方法。     

颅内面神经根梳刮术治疗面肌痉挛

目的：探讨治疗面肌痉挛疗效确切、安全可靠的面神经根显微术式。方法：采用颅内面神经根梳刮术治疗面肌痉挛患者25例。术中见明显血管压迫且易于分离者行血管移位隔垫,同时对面神经根进行适当梳理、刮剥以减少复发;未发现明显责任血管或遇穿通动脉、面神经根被动脉包绕不易移位隔垫血管者,行面神经根梳刮并剪断一小束神经纤维（1／6～1／5）。结果：术后面肌抽搐消失22例（88％）,症状明显减轻2例（8％）,无效1例（4％）。无术后感音神经性聋、颅内出血等严重并发症发生。25例患者术后均出现不同程度面瘫。随访2～8年,面瘫均在1～6个月内恢复,面部肌力基本恢复正常。2年内复发2例（8％）。结论：颅内面神经根梳刮术是治疗面肌痉挛有效的综合显微手术,其并发症少、适应证广且操作简便安全,术中根据不同情况采取相应处理可提高疗效、降低手术风险。