Stevens Shawn M, Crane Ryan, Pensak Myles L, Samy Ravi N
1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
2 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio, USA.
Otolaryngol Head Neck Surg. 2017 Mar;156(3):534-542. doi: 10.1177/0194599816678211. Epub 2016 Nov 17.
Outcome Objectives To (1) identify unique features of patients who underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Adults treated for spontaneous cerebrospinal fluid otorrhea from 2007 through 2015 were reviewed and stratified into 2 groups based on the surgery performed: (1) 11 patients underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal and (2) 26 patients underwent other procedures. Demographics, body mass index, revised cardiac risk index, Duke Activity Status Index scores, and anticoagulation use were documented. Audiologic data were gathered from pre- and postoperative visits. The primary outcome measure was leak recurrence. Complications were tabulated. Results Poor preoperative hearing was a relative indication for obliteration. Obliteration patients had higher body mass index (43.2 vs 34.9 kg/m2; P < .05), incidence of super-morbid obesity (45% vs 7.6%; P = .015), anticoagulation usage (36% vs 0%; P = .004), cardiac risk scores (1.2 vs 0.1 dB; P < .0004), and Duke Activity Status Index scores. There was 1 leak recurrence (9%). Major and minor complication rates were 9% and 36%, respectively. Mean follow-up was 30.8 ± 8.6 months. Conclusion Middle ear and mastoid obliteration with blind-sac closure of the external auditory canal is effective for treating spontaneous CSF otorrhea. The small cohort reviewed did not experience any major perioperative morbidity. The technique may be best suited for patients with poor hearing, the infirm, and those in whom craniotomy is contraindicated.
结果目标 （1） 确定因自发性脑脊液耳漏接受中耳/乳突闭塞并外耳道盲袋封闭术的患者的独特特征，以及（2） 探讨手术结果。研究设计 病例系列研究并进行图表回顾。研究地点 三级医疗中心。研究对象与方法 回顾性分析2007年至2015年因自发性脑脊液耳漏接受治疗的成年患者，并根据所施行的手术将其分为两组：（1）11例患者接受中耳/乳突闭塞并外耳道盲袋封闭术，（2）26例患者接受其他手术。记录患者的人口统计学资料、体重指数、修订心脏风险指数、杜克活动状态指数评分以及抗凝药物使用情况。收集术前和术后访视的听力学数据。主要观察指标为漏液复发情况。将并发症制成表格。结果 术前听力较差是闭塞术的相对指征。接受闭塞术的患者体重指数较高（43.2 vs 34.9 kg/m2；P < 0.05），超级肥胖发生率较高（45% vs 7.6%；P = 0.015），抗凝药物使用率较高（36% vs 0%；P = 0.004），心脏风险评分较高（1.2 vs 0.1 dB；P < 0.0004），杜克活动状态指数评分较高。有1例漏液复发（9%）。主要和次要并发症发生率分别为9%和36%。平均随访时间为30.8 ± 8.6个月。结论 中耳和乳突闭塞并外耳道盲袋封闭术治疗自发性脑脊液耳漏有效。本项回顾性研究的小样本队列未发生任何重大围手术期并发症。该技术可能最适合听力较差、身体虚弱以及禁忌开颅手术的患者。
