Singleton G T
Otolaryngol Head Neck Surg. 1986 Apr;94(4):426-9. doi: 10.1177/019459988609400403.
In 1978, I reported on the diagnostic criteria and therapy based on the treatment of 34 cases of perilymph fistula. Of that group, 20 patients had no hearing loss associated with the fistula. Since that time, an additional 30 cases of fistula--15 without hearing loss--have been seen and treated operatively. The 30 significant variables of history and physical findings identified in the first study were statistically reviewed, along with a new finding that seems highly significant. Twenty-three of the 26 new cases so evaluated had a positive "eyes-closed turning test" (staggering when turning to the side of the lesion after walking with eyes closed). A further finding has been the presence of an abnormally placed round window membrane, in most cases involving the round window. The total operative population of fistulas, both those with and without hearing loss, is reviewed to identify the operative technique best suited for each window and the graft material most likely to succeed. Perichondrium is the choice tissue for graft material, except for very small fistulas at the annular ligament. The graft must be held firmly in place, with either a prosthesis or appropriate packing, carefully avoiding adhesions between the round window and the tympanic membrane.
1978年，我报道了基于34例外淋巴瘘治疗的诊断标准和疗法。在该组病例中，20例患者的瘘并无听力损失。自那时起，又有30例瘘病例——其中15例无听力损失——被诊治。对首次研究中确定的30项重要病史和体格检查结果变量进行了统计学审查，同时还有一项新发现似乎非常重要。在接受评估的26例新病例中，有23例“闭眼转身试验”呈阳性（闭眼行走后转向病侧时出现蹒跚）。另一个发现是圆窗膜位置异常，多数情况下累及圆窗。对有听力损失和无听力损失的瘘手术病例总数进行了审查，以确定最适合每个窗的手术技术以及最有可能成功的移植材料。除了环状韧带处非常小的瘘外，软骨膜是移植材料的首选组织。必须用假体或合适的填充物将移植物牢固固定到位，小心避免圆窗与鼓膜之间形成粘连。
