Jia Minghui, Qin Zhaobing
Department of Otolaryngology-Head and Neck Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2005 Jul;19(13):592-3.
To describe the clinical presentation and surgical management of patients with labyrinthine fistula caused by cholesteatoma.
Retrospective study of the clinical presentation, surgical technique and hearing outcomes based on 350 cases of chronic otitis media with cholesteatoma was carried out. Twenty three patients (6.6%) with labyrinthine fistula were found, in 9 ears (39.1%) the preoperative pure tone average for bone conduction was greater than normal, including 2 cases of analysis. Subjective vertigo or dizziness occurred in 11 patients (47.8%), the fistula test was positive in 5 patients (21.7%). Preoperative high resolution computed tomography (HRCT) scans were performed on all patients and 13 patients (57%) were detected to be with labyrinthine fistula in imaging. During the operation we found the lateral semicircular canal was the most commonly affected site (20/23), at the same time dehiscence of the facial canal was observed in 8 patients.
The patients were followed-up for an average time of 2 years, dizziness disappeared completely in 22 cases and there were no significant changes in their bone conduction thresholds.
Labyrinthine fistulae are usually caused by cholesteatoma. There are no reliable methods at present for preoperative diagnosis HRCT is useful but its limitations should also be recognized. The verification of a labyrinthine fistula can be definitively established only at the time of surgery. Completely remove the cholesteatoma matrix can be the treatment of choice in these cases.
描述胆脂瘤引起的迷路瘘管患者的临床表现及外科治疗。
对350例慢性胆脂瘤型中耳炎患者的临床表现、手术技术及听力结果进行回顾性研究。发现23例（6.6%）有迷路瘘管，9耳（39.1%）术前骨导纯音平均听阈高于正常，其中2例进行了分析。11例患者（47.8%）出现主观眩晕或头晕，5例患者（21.7%）瘘管试验阳性。所有患者术前行高分辨率计算机断层扫描（HRCT），13例患者（57%）影像学检查发现迷路瘘管。术中发现外半规管是最常受累部位（20/23），同时8例患者观察到面神经管裂。
患者平均随访2年，22例头晕完全消失，骨导阈值无明显变化。
迷路瘘管通常由胆脂瘤引起。目前尚无可靠的术前诊断方法，HRCT虽有用但也应认识到其局限性。迷路瘘管只有在手术时才能明确证实。彻底清除胆脂瘤基质是这些病例的首选治疗方法。
