慢性化脓性中耳炎并发迷路瘘管的手术治疗

目的探讨慢性中耳炎迷路瘘管的临床特点及手术方法.方法对63耳有迷路瘘管的胆脂瘤型和骨疡型中耳炎行乳突根治术的同时用颞肌筋膜或同种肋软骨片加筋膜一期修复瘘管.结果1718耳慢性中耳炎中并发迷路瘘管63耳,其中胆脂瘤型60耳,在各型中耳炎中发生率最高,骨疡型3耳.瘘管位于外半规管56耳(88.9%),耳蜗2耳,上半规管3耳,外半规管和上半规管同时有瘘管2耳.63耳中术前有眩晕症状的37耳(58.7%),其中瘘管试验阳性13耳(35.1%).有眩晕症状耳平均骨导阈值为40.1dB,无眩晕症状耳为33.2dB.除1耳外,全部病例行瘘管一期修复后,眩晕症状消失.结论用同种异体肋软骨片加筋膜修复慢性中耳炎迷路瘘管是较理想的方法,对瘘管大、病变重者应行二期手术.

Surgical treatment of labyrinthine fistula caused by chronic otitis media

Objective To evaluate clinical features and surgical treatment of labyrinthine fistula caused by chronic otitis media(COM). Method 63 ears with labyrinthine fistula caused by COM were managed by an extended modified radical mastoidectomy, and the fistulae were repaired in first-stage with homologous costal cartilage and temporalis fascia. Result 63 ears with labyrinthine fistula were found in 1718 ears with COM. Of the 63 ears, 60 ears had cholesteatoma, whose incidence of labyrinthine fistula was the highest among the all types of COM. 3 ears was COM with osteitis. The fistulae were located at the lateral semicircular canal in 56(88.9%) ears, at the cochlea in 2 ears , at the superior semicircular canal in 3 ears, and at both the lateral semicircular canal and superior semicircular canal in 2 ears. 37(58.7%)cases had vertigo before operation in whom the fistula. test was positive in 13(35.1%)cases. The preoperative average bone conduction thresholds of the cases with and without vertigo were 40.1dB and 33.2dB, respectively. All the ears with fistulae were repaired in first-stage, and all the cases but one had contol of vertigo. Conclusion The method of repairing the labyrinthine fistula caused by COM with double slices of homologous costal cartilage and temporalis fascia is an appropriate procedure. The second-stage operation should be carried out in the serious cases with a large labyrinthine fistula.