Hakuba Nobuhiro, Hato Naoto, Shinomori Yusuke, Sato Hidemitsu, Gyo Kiyofumi
Department of Otolaryngology, Ehime University School of Medicine, Japan.
Otol Neurotol. 2002 Nov;23(6):832-5. doi: 10.1097/00129492-200211000-00003.
To evaluate the clinical features of labyrinthine fistulae occurring as a late complication of middle ear surgery using the canal wall down technique.
This was a retrospective study of the past 23 years, conducted at a single tertiary care center. The authors evaluated the backgrounds, clinical features, and surgical findings in 25 patients with labyrinthine fistulae, who had a history of ear surgery using the canal down technique and who underwent a second operation at their hospital.
All the patients underwent revision surgery because of persistent or recurrent vertigo caused by labyrinthine fistulae, circumscribed labyrinthitis, or suppurative labyrinthitis.
The clinical features of this disease entity were assessed by history, surgical findings, and the results of audiovestibular testing.
The patients had a long history of repetitive postoperative aural discharge before experiencing vertigo, which initially occurred 4 to 64 years (average, 20.2 years) after the previous operation. At the first visit to the authors' clinic, the results of a fistula test conducted with a Politzer's bulb were positive in 14 patients and negative in 5 patients. In the remaining 6 ears, pressure loading of the ear canal induced the sensation of vertigo without accompanying nystagmus. Surgical intervention showed that the fistulae were located at the lateral semicircular canal in 19 ears, at the footplate of the stapes in 4 ears, and at the promontory in 2 ears. Labyrinthine fistulae were closed with conchal cartilage, bone paste (bone dust mixed with fibrin glue), and/or temporalis fascia. In some patients, the fistulae were further covered with pedicled temporalis muscle. In 2 cases complicated by acute suppurative labyrinthitis, the mastoid cavity was obliterated after completion of the labyrinthectomy. The postoperative courses in all patients were uneventful.
A labyrinthine fistula may be created by repeated and insidious infection of a mastoid cavity that has been exposed to the outside during canal wall down surgery. Intensive care of the opened mastoid cavity is essential to avoid this late complication.
评估采用开放式乳突根治术作为中耳手术晚期并发症出现的迷路瘘管的临床特征。
这是一项在单一三级医疗中心进行的对过去23年的回顾性研究。作者评估了25例有迷路瘘管患者的背景、临床特征和手术发现，这些患者有开放式乳突根治术耳部手术史且在其医院接受了二次手术。
所有患者因迷路瘘管、局限性迷路炎或化脓性迷路炎导致的持续性或复发性眩晕而接受翻修手术。
通过病史、手术发现以及听前庭测试结果评估该疾病实体的临床特征。
患者在出现眩晕之前有长期反复术后耳漏病史，眩晕最初发生在前次手术后4至64年（平均20.2年）。在作者诊所首次就诊时，用波利策尔球囊进行的瘘管试验结果在14例患者中为阳性，5例患者为阴性。在其余6耳中，耳道加压诱发眩晕感但无伴随眼球震颤。手术干预显示，瘘管位于外半规管19耳、镫骨足板4耳、岬部2耳。迷路瘘管用耳甲软骨、骨糊（骨粉与纤维蛋白胶混合）和/或颞肌筋膜封闭。在一些患者中，瘘管进一步用带蒂颞肌覆盖。在2例并发急性化脓性迷路炎的病例中，在完成迷路切除术后闭塞乳突腔。所有患者术后病程平稳。
开放式乳突根治术中暴露于外界的乳突腔反复隐匿性感染可能导致迷路瘘管。对开放的乳突腔进行精心护理对于避免这种晚期并发症至关重要。
