Jeong Hamin, Lee Dong-Han, Shin Jung Eun, Kim Chang-Hee
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.
Med Hypotheses. 2020 Nov;144:110223. doi: 10.1016/j.mehy.2020.110223. Epub 2020 Aug 28.
Chronic otitis media with cholesteatoma can cause erosion of the dense labyrinthine bone overlying the inner ear organs, and this labyrinthine fistula allows pressure or mass-induced motion of the underlying perilymphatic and endolymphatic compartment, evoking vestibular symptoms. While the mechanism of a positive fistula test, which is conducted by increasing or decreasing the external auditory canal pressure, has been well established, the mechanism underlying positional nystagmus in labyrinthine fistula has not been discussed yet. In the present study, we propose a new hypothesis accounting for positional nystagmus in labyrinthine fistula involving the lateral semicircular canal (LSCC), i.e., the change in intracranial cerebrospinal fluid pressure by position change is transmitted to the perilymphatic space, causing ampullopetal (excitatory) or ampullofugal (inhibitory) deflection of the LSCC cupula.
胆脂瘤型慢性中耳炎可导致覆盖内耳器官的致密迷路骨侵蚀，这种迷路瘘管使得内耳外淋巴和内淋巴腔室在压力或肿物作用下产生运动，从而引发前庭症状。虽然通过增加或降低外耳道压力进行的瘘管试验阳性的机制已得到充分证实，但迷路瘘管中位置性眼球震颤的潜在机制尚未见讨论。在本研究中，我们提出了一个新的假说，用以解释涉及外侧半规管（LSCC）的迷路瘘管中的位置性眼球震颤，即体位改变引起的颅内脑脊液压力变化传递至外淋巴间隙，导致LSCC壶腹嵴向壶腹侧（兴奋性）或离壶腹侧（抑制性）偏移。
