Höhmann D, Dornhoffer J
Universitäts-HNO-Klinik Würzburg.
HNO. 1995 Feb;43(2):65-9.
Because several cases of cerebral-spinal fluid leakage (perilymph gushers) have been reported during stapedectomy for congenitally fixed stapes in children, many otologists advise against surgical intervention. The pathophysiologic mechanism of the gusher and its association with a congenitally fixed stapes is, however, poorly understood. This study was designed to examine the pre-operative presentation and hearing results of 10 children undergoing stapedectomies for congenital fixation. No perilymph gushers of significant sensorineural hearing loss was encountered. All but one case resulted in closure of the air-bone gap and speech frequencies to within 20 dB. The average air-bone gap was 11.2 dB. Minor congenital abnormalities of the stapes suprastructure were seen in 3 cases. Review of case reports in the literature indicate that gushers in association with surgical manipulation of the congenitally-fixed stapes occur almost exclusively in males and that pathophysiology involves a defect in the internal auditory canal (as opposed to a patent cochlear aqueduct). A pre-existing sensorineural hearing loss may also be a risk factor for perilymph gusher.
由于已有报道称，在为儿童先天性固定镫骨实施镫骨切除术期间出现了几例脑脊液漏（外淋巴瘘）的情况，许多耳科医生不建议进行手术干预。然而，外淋巴瘘的病理生理机制及其与先天性固定镫骨的关联仍知之甚少。本研究旨在检查10例因先天性固定镫骨而接受镫骨切除术的儿童的术前表现和听力结果。未出现显著感音神经性听力损失的外淋巴瘘情况。除1例病例外，所有病例的气骨导间距均缩小至20 dB以内。平均气骨导间距为11.2 dB。3例可见镫骨上部结构的轻微先天性异常。文献中病例报告的回顾表明，与先天性固定镫骨手术操作相关的外淋巴瘘几乎仅发生在男性身上，其病理生理学涉及内耳道缺陷（而非耳蜗导水管开放）。既往存在的感音神经性听力损失也可能是外淋巴瘘的一个危险因素。
