Weisert J U, Veraguth D, Probst R
Klinik für Hals-, Nasen-, Ohrenheilkunde, Hals- und Gesichtschirurgie, Universitätsspital Zürich, Frauenklinikstr 24, 8091 Zürich, Schweiz.
HNO. 2012 Feb;60(2):132-4. doi: 10.1007/s00106-011-2317-9.
Labyrinthitis with vestibulocochlear dysfunction in chronic inflammatory bowl disease is a rare but well described manifestation or complication. The diagnostic and therapeutic possibilities and limitations of this inflammatory otopathy are presented and discussed in the context of a case report. A bilateral loss of vestibular function and sensorineural hearing loss occurred in a 26-year-old male patient with previously diagnosed Crohn's disease. He was treated with immune suppressive therapy during the onset and development of cochleovestibular symptoms. Diagnostic tests included pure tone audiograms, speech audiometry, caloric tests, VEMPs, and MRI. Therapy included azathioprine, corticosteroids (systemic and intratympanic), monoclonal antibodies, and cochlear implants. Despite immunosuppressive therapy including monoclonal antibodies, the patient progressively lost his hearing. Finally, bilateral cochlear implantation was carried out with good results. The treatment of patients with systemic inflammatory or autoimmune disease affecting the cochlear-vestibular organ is challenging. An interdisciplinary approach is needed. In cases of bilateral deafness, cochlear implantation is a satisfactory treatment and should not be delayed unnecessarily.
慢性炎症性肠病伴迷路炎及前庭蜗神经功能障碍是一种罕见但有充分描述的表现或并发症。本文结合一例病例报告，介绍并讨论了这种炎性耳病的诊断和治疗可能性及局限性。一名先前诊断为克罗恩病的26岁男性患者出现双侧前庭功能丧失和感音神经性听力损失。在耳蜗前庭症状出现和发展期间，他接受了免疫抑制治疗。诊断测试包括纯音听力图、言语测听、冷热试验、前庭诱发肌源性电位和磁共振成像。治疗方法包括硫唑嘌呤、皮质类固醇（全身和鼓室内给药）、单克隆抗体和人工耳蜗植入。尽管接受了包括单克隆抗体在内的免疫抑制治疗，患者听力仍逐渐丧失。最后，患者接受了双侧人工耳蜗植入，效果良好。治疗累及耳蜗前庭器官的全身性炎症或自身免疫性疾病患者具有挑战性。需要采取多学科方法。在双侧耳聋的情况下，人工耳蜗植入是一种令人满意的治疗方法，不应不必要地延迟。
