Kusuma Shashidhar, Liou Steve, Haynes David S
Vanderbilt Bill Wilkerson Center for the Hearing and Communication Sciences, Division of Otology/Neurotology, Nashville, TN 37205, USA.
Laryngoscope. 2005 Jan;115(1):25-6. doi: 10.1097/01.mlg.0000150680.68355.cc.
Cochlear implantation has become a safe and effective method for the auditory rehabilitation of the profoundly hearing impaired. Incidence of disequilibrium and vertigo after cochlear implantation ranges from 13% to 74% in the literature. Most patients report resolution of these symptoms with medical therapy and vestibular rehabilitation. We present a case of persistent disequilibrium after cochlear implantation. Further workup of this patient revealed radiographic findings suggestive of a perilymphatic fistula, with immediate and complete resolution of symptoms after exploratory tympanotomy and packing around the cochleostomy.
Case report.
A retrospective chart review of a patient with postoperative disequilibrium unresponsive to maximal medical and vestibular rehabilitation therapy.
Diagnostic workup of the patient included a temporal bone computed tomography (CT) scan, which revealed air in the vestibule and the ampulla of the superior and lateral semicircular canals. After failure of 5 months of conservative therapy, the patient was taken to the operating room for middle ear exploration and repacking of the cochleostomy site. The patient reported immediate and complete resolution of vertigo postoperatively.
We present a case of disequilibrium as a result of an apparent perilymphatic fistula after cochlear implantation that was refractory to standard therapy. In such cases, appropriate workup should include a temporal bone CT scan to look for air in the vestibule or other abnormalities that may indicate potential etiology. Surprisingly, this patient had immediate and complete resolution of symptoms after surgery. If conservative therapy fails, middle ear exploration by way of an exploratory tympanotomy and packing of the cochleostomy with periosteum and muscle is a viable option and may lead to resolution of symptoms.
人工耳蜗植入已成为极重度听力障碍患者听觉康复的一种安全有效的方法。文献报道人工耳蜗植入后失衡和眩晕的发生率在13%至74%之间。大多数患者报告经药物治疗和前庭康复后这些症状得到缓解。我们报告一例人工耳蜗植入后持续性失衡的病例。对该患者的进一步检查发现影像学结果提示存在外淋巴瘘，在进行探查性鼓室切开术并在蜗窗造瘘口周围填塞后，症状立即完全缓解。
病例报告。
对一名术后失衡患者进行回顾性病历审查，该患者对最大程度的药物和前庭康复治疗无反应。
对该患者的诊断性检查包括颞骨计算机断层扫描（CT），结果显示前庭以及上半规管和外半规管壶腹内有气体。在5个月的保守治疗失败后，该患者被送往手术室进行中耳探查并重新填塞蜗窗造瘘部位。患者术后报告眩晕立即完全缓解。
我们报告一例人工耳蜗植入后因明显的外淋巴瘘导致失衡的病例，该病例对标准治疗无效。在这种情况下，适当的检查应包括颞骨CT扫描，以寻找前庭内的气体或其他可能提示潜在病因的异常情况。令人惊讶的是，该患者术后症状立即完全缓解。如果保守治疗失败，通过探查性鼓室切开术进行中耳探查并用骨膜和肌肉填塞蜗窗造瘘口是一种可行的选择，可能会使症状得到缓解。
