Cmejrek Ryan C, Megerian Cliff A
Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106, USA.
Ear Nose Throat J. 2004 Nov;83(11):753-6.
In this retrospective case series and literature review, we demonstrate that temporal bone lesions that obstruct the endolymphatic sac or duct can cause symptoms of Ménière's disease. This finding is likely attributable to endolymphatic hydrops; initially, such cases typically masquerade as Ménière's disease. Between July 1995 and April 2002, a total of 379 patients were treated for an initial diagnosis of Ménière's disease at our institution. Among this group, 3 patients were found to have an obstructing lesion of the endolymphatic sac or duct that we felt was causally related to their Ménière's-like symptomatology. We reviewed these cases and noted the similarities in each patient's presentation, including a common pathophysiology. On imaging studies, each patient had a different pathologic lesion that involved the endolymphatic sac or duct: patient 1 had a jugular megabulb, and she was ultimately treated with vestibular nerve section; patient 2 had a cholesterol granuloma, which was treated with surgical excision; patient 3 had an endolymphatic sac tumor that was treated with surgical excision. As has been suggested in previous reports, not all cases of Ménière's disease are idiopathic. We conclude that obstruction of the endolymphatic sac or vestibular aqueduct by a mass lesion or vascular anomaly can lead to vestibulocochlear pathology that mimics Ménière's disease.
在这个回顾性病例系列研究及文献综述中，我们证明了阻塞内淋巴囊或内淋巴管的颞骨病变可导致梅尼埃病症状。这一发现可能归因于内淋巴积水；最初，此类病例通常表现为梅尼埃病。1995年7月至2002年4月期间，共有379例最初诊断为梅尼埃病的患者在我们机构接受治疗。在这组患者中，发现3例患者存在内淋巴囊或内淋巴管阻塞性病变，我们认为这与他们类似梅尼埃病的症状存在因果关系。我们回顾了这些病例，并注意到每位患者临床表现中的相似之处，包括共同的病理生理学。在影像学检查中，每位患者都有不同的累及内淋巴囊或内淋巴管的病理病变：患者1有颈静脉球膨大，最终接受了前庭神经切断术；患者2有胆固醇肉芽肿，接受了手术切除治疗；患者3有内淋巴囊肿瘤，接受了手术切除治疗。正如先前报告中所指出的，并非所有梅尼埃病病例都是特发性的。我们得出结论，占位性病变或血管异常对内淋巴囊或前庭导水管的阻塞可导致模拟梅尼埃病的前庭蜗器病变。
