慢性中耳炎并发迷路瘘管的手术诊治体会

目的 探讨慢性化脓性中耳炎并发迷路瘘管的临床特点和手术处理方法.方法 回顾分析18例(18耳)并发迷路瘘管的慢性中耳炎手术患者的临床资料.术前有眩晕发作史10例(55.6％).在薄层水平+冠状位CT扫描的10例患者中,有9例(90％)术前诊断有瘘管.术前并发面瘫1例.所有患者均行开放式乳突根治术.术中均对瘘口处的病变组织进行清理,然后用筋膜覆盖瘘口,再填骨粉加固,筋膜外覆.结果除术前1例和术后1例因耳廓铜绿假单胞菌(绿脓杆菌)感染致全聋外,其余16例术后骨导好转2例、下降3例、无明显变化11例.术后14例出现眩晕,随访3个月内,13例眩晕消失或改善,1例半年后好转.合并面瘫者,术后3个月恢复,无新增面瘫病例.结论 中耳炎乳突手术中应重视迷路瘘管存在的可能性,颞骨薄层水平+冠状位CT扫描在术前检查具有重要意义.术中及术后预防细菌感染极其重要.

Diagnosis and treatment of chronic otitis media complicated by labyrinthine fistula

Objective To investigate the clinical features and surgical management of chronic ctitis media complicated by labyrinthine fistula. Methods Data of 18 patients （18 ears） complicated by labyrinthine fistula were ana- lysed retrospectively. Vertigo history was confirmed in 10 cases （55.6%） and facial paralysis in one case preoperatively. Fistula was ascertained in 9 patients （90%） from 10 patients who had accepted the horizontal and coronal CT scan. Open radical mastoidectomy was performed in all patients. During the operation, surgeon removed the abnormal tissue sur- rounding the fistula, repaired the fistula with temporalis fascia, then strengthened with bone meal, covered with fascia. Results Except for 2 patients （including one case preoperatively and one postoperatively） with total deafness caused by Pseudomonas aeruginosa infection, bone conduction thresholds improved in 2 cases, descended in 3 cases and had no re- markable change in 11 cases postoperatively. Vertigo occurred in 14 patients, which were eliminated or alleviated in 13 cases 3 months after the operation and improved in one case 6 months postoperatively. Conclusions Attention should be paid for the possibility of labyrinthine fistula during mastoidectomy for chronic otitis media. Horizontal and coronal CT scan was helpful to the preoperative diagnosis. Bacterial infection must be prevented pre- and postoperatively.