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。

Clinical analysis of spontaneous cerebrospinal fluid otorrhea in 4 cases

ObjectiveTo study the clinical features and treatment of spontaneous cerebrospinal fluid otorrhea.MethodsClinical data of 4 patients suffering from spontaneous cerebrospinal fluid otorrhea surgically treated in our department between July 2015 and Dec. 2016 were analyzed retrospectively.ResultsAll the 4 patients had a history of bacterial meningitis. Of them, 2 patients had inner ear malformation (incomplete partition type I) with round defect on stapedial footplate and 2 had posterior fossa bone defect with conductive hearing loss. The two patients with inner ear malformation underwent exploratory tympanotomy, during which the cerebrospinal fluid was pulsated from the defect of the stapedial footplates. Incus and stapes were removed, and the vestibular windows were sealed with temporalis fascia, auricle cartilage and fibrin glue. The other two patients with posterior fossa bone defect underwent simple mastoidectomy to expose the bone defects which were sealed with temporalis fascia, auricle cartilage, bone dust and fibrin glue. All patients were followed up for 23 to 39 months without recurrence of cerebrospinal fluid otorrhea and meningitis.ConclusionWith low morbidity, spontaneous cerebrospinal fluid otorrhea is easy to be missed and misdiagnosed, resulting in recurrent meningitis. The possibility of spontaneous cerebrospinal fluid otorrhea should be highly suspected in patients with hearing loss associated with meningitis.