Khoo Li-Ser, Tan Tiong-Yong
Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
Ear Nose Throat J. 2011 May;90(5):E28-31. doi: 10.1177/014556131109000515.
A penetrating ear injury with a perilymphatic fistula is not an uncommon occurrence in otolaryngologic practice, but stapes luxation is rare. We report the case of an 11-year-old boy who developed a traumatic perilymphatic fistula secondary to an atypical stapes luxation into the vestibule. After sustaining a penetrating injury to the right ear, the patient presented with otalgia, vertigo, vomiting, gait unsteadiness, and hearing loss. High-resolution computed tomography (HRCT) of the temporal bone detected pneumolabyrinth, indicating a perilymphatic fistula. The stapes had pivoted on the footplate at the oval window, and then it made an unusual 180° flip and luxated deeply into the vestibule, with the capitulum stapedis pointing medially. Conservative management was chosen in view of the high surgical risks posed by the deeply luxated stapes and the likelihood of a fracture of the stapes footplate. This case illustrates the importance of an accurate diagnosis and interpretation of a traumatic perilymphatic fistula and stapes luxation as seen on HRCT of the temporal bone.
伴有外淋巴瘘的穿透性耳部损伤在耳鼻喉科临床实践中并不少见，但镫骨脱位则较为罕见。我们报告一例11岁男孩，其因非典型的镫骨向前庭脱位继发外伤性外淋巴瘘。右耳遭受穿透性损伤后，患者出现耳痛、眩晕、呕吐、步态不稳及听力损失。颞骨高分辨率计算机断层扫描（HRCT）发现气迷路，提示存在外淋巴瘘。镫骨在椭圆窗的镫骨底板上发生枢转，然后进行了异常的180°翻转并深深脱位至前庭，镫骨头指向内侧。鉴于深部脱位的镫骨带来的高手术风险以及镫骨底板骨折的可能性，选择了保守治疗。该病例说明了颞骨HRCT所见的外伤性外淋巴瘘和镫骨脱位的准确诊断及解读的重要性。
