Garov E V, Kryukov A I, Zelikovich E I, Kurilenkov G V, Moseykina L A, Zelenkova V N, Mishchenko V V, Omarova M M
Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.
Pirogov Russian National Research Medical University, Moscow, Russia.
Vestn Otorinolaringol. 2021;86(5):75-81. doi: 10.17116/otorino20218605175.
The article presents a brief review of the literature on the anatomy and physiology of the round window (RW) niche, the causes of occlusion, the diagnosis of this pathology, the features of auditory disorders and tactics when it is detected in patients with otosclerosis (OS). A clinical case of diagnosis and effective surgical treatment for obliteration of RW in a patient with advanced OS, which occurred in 2019 in 0.7% of cases, is described. Removal of RW niche obliteration was carried out with a curette and microcresis by smoothing the canopy over RW until partial visualization of the secondary membrane. It was this stage of the operation that made it possible to restore the normal hydrodynamics of the inner ear fluids and contributed to a functional result. Thus, the diagnosis of RW obliteration in patients with OS is difficult, but possible when using computed tomography of the temporal bones and assessing the mobility of the RW membrane or analyzing changes in hearing at the end of the operation, if it is performed under local anesthesia. The simultaneous performance of stapedoplasty and the removal of bone obliteration of RW makes it possible to safely achieve functional rehabilitation in patients with OS.
本文简要回顾了关于圆窗龛的解剖学和生理学、阻塞原因、该病理的诊断、听觉障碍特征以及在耳硬化症(OS)患者中检测到圆窗龛时的治疗策略的文献。描述了一例2019年发生的晚期OS患者圆窗闭塞的诊断及有效手术治疗的临床病例,该病例发生率为0.7%。用刮匙和微切割器去除圆窗龛闭塞,通过打磨圆窗上方的覆盖物直至部分可见次生膜。正是手术的这一阶段恢复了内耳液体的正常流体动力学并促成了功能结果。因此,OS患者中圆窗闭塞的诊断很困难,但使用颞骨计算机断层扫描并评估圆窗膜的活动度,或者如果在局部麻醉下进行手术,则在手术结束时分析听力变化时是有可能诊断出来的。同时进行镫骨手术和去除圆窗的骨闭塞能够使OS患者安全地实现功能康复。