Lamm K
HNO-Klinik, Medizinischen Hochschule Hannover.
HNO. 1992 Oct;40(10):374-80.
Previous and current studies of experimentally induced fistulas in the round window membrane (RWM) are reviewed. After puncture (or "micro-perforation") of the RWM leaking perilymph was not been observed and auditory evoked potentials have remained unaltered. In contrast, most publications have reported that gross incisions ("macro-perforations") of the RWM have resulted in the deterioration of auditory evoked potentials, with leaking perilymph and/or cerebrospinal fluid and/or with entrance of air bubbles into the scala tympani depending on the site of the perforation. Spontaneous healing was then observed within 4 to 8 days and was associated with normalization of the auditory evoked potentials. In a very few experimental studies pathophysiological mechanisms were simulated that may be involved clinically in patients with RWM fistulas, i.e. implosive rupture of the RWM due to an acute increase in middle ear pressure or explosive rupture of the RWM that may occur in patients trying to use forced Valsalva maneuvers to equalize decreased middle ear pressures due to blocked Eustachian tubes.
本文综述了以往及当前关于圆窗膜（RWM）实验性瘘管的研究。在对RWM进行穿刺（或“微穿孔”）后，未观察到外淋巴漏出，听觉诱发电位也未改变。相比之下，大多数出版物报道，RWM的大切口（“大穿孔”）会导致听觉诱发电位恶化，根据穿孔部位的不同，会出现外淋巴和/或脑脊液漏出，和/或气泡进入鼓阶。随后在4至8天内观察到自发愈合，且与听觉诱发电位的恢复正常有关。在极少数实验研究中，模拟了临床上可能与RWM瘘管患者有关的病理生理机制，即由于中耳压力急性升高导致的RWM内爆性破裂，或在试图通过强迫瓦尔萨尔瓦动作来平衡因咽鼓管堵塞导致的中耳压力降低的患者中可能发生的RWM爆炸性破裂。
