Oney Rebecca M, Sloneker Del R, Bloom Ashlie G, Avillion Michael P, Crawford James V, Chen Brian S
Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
Department of Otolaryngology-Head and Neck Surgery, Womack Army Medical Center, Fort Bragg, NC, USA.
Ear Nose Throat J. 2025 Aug;104(8):NP490-NP496. doi: 10.1177/01455613211039045. Epub 2022 Nov 8.
To review the literature on Hyrtl fissure (HF) and contribute our experience with a 2-year old who developed cerebrospinal fluid (CSF) otorrhea during routine tympanostomy tube placement.
Pubmed and Google Scholar searches were conducted of articles in the English language literature from all time periods using the words Hyrtl, Hyrtl's fissure, HF, and tympanomeningeal fissure. All relevant articles were reviewed to identify cases of HF.
Nineteen cases, including ours, are described. Patient characteristics, method(s) of diagnosis and repair, and outcomes are reported. Computed tomography and intraoperative endoscopic images from our case are included. Presentation is more common in children (66.7% of cases where age was stated, n = 10) than in adults (33.3%, n = 5), and is most commonly unilateral (89.5%, n = 17). Cerebrospinal fluid otorrhea was the most common presentation. Six were discovered after tympanostomy tube placements while 3 were identified during cochlear implant work-up or after device failure. Surgical approaches described include endaural, transcanal, retrosigmoid, postauricular, and posterior fossa endoscopic. Multiple materials including bone wax, bone pate, fascia, muscle, and tissue sealant have been used. Our case describes an endoscopic repair in a child, which was successful at a 2-year follow-up. The small number of cases limits the utility of statistical analysis (n = 19).
Hyrtl fissure is a rare but important entity that may be discovered when routine procedures have unexpected results. Hyrtl fissure should be included in the differential diagnosis when there is persistent clear otorrhea after a tympanostomy tube, cochlear implant misinsertion, meningitis, or unexplained middle ear effusion in an adult.
回顾有关希尔特尔裂（HF）的文献，并分享我们在一名2岁儿童身上的经验，该儿童在常规鼓膜置管期间出现脑脊液（CSF）耳漏。
使用“希尔特尔”“希尔特尔裂”“HF”和“鼓室脑膜裂”等关键词，对英语文献中各个时期的文章进行了PubMed和谷歌学术搜索。对所有相关文章进行了综述，以确定HF病例。
共描述了19例病例，包括我们的病例。报告了患者特征、诊断和修复方法以及结果。其中包含了我们病例的计算机断层扫描和术中内镜图像。该病症在儿童中比成人中更常见（在报告年龄的病例中，儿童占66.7%，n = 10；成人占33.3%，n = 5），且最常见为单侧（89.5%，n = 17）。脑脊液耳漏是最常见的表现形式。6例是在鼓膜置管后发现的，而3例是在人工耳蜗检查期间或设备故障后发现的。所描述的手术入路包括耳内入路、经耳道入路、乙状窦后入路、耳后入路和后颅窝内镜入路。已经使用了多种材料，包括骨蜡、骨块、筋膜、肌肉和组织密封剂。我们的病例描述了一名儿童的内镜修复手术，术后2年随访成功。病例数量较少限制了统计分析的效用（n = 19）。
希尔特尔裂是一种罕见但重要的病症，可能在常规手术出现意外结果时被发现。当鼓膜置管后出现持续清亮耳漏、人工耳蜗误植入、脑膜炎或成人不明原因的中耳积液时，应将希尔特尔裂纳入鉴别诊断。
