Dornhoffer J L, Milewski C
Department of Otolaryngology, Julius Maximilians University, Wuerzburg, Germany.
Otolaryngol Head Neck Surg. 1995 Mar;112(3):410-4. doi: 10.1016/S0194-59989570275-X.
Labyrinthine fistulas occur in approximately 5% of cholesteatoma cases, but the management of this difficult problem remains controversial. This study assessed the preoperative presentation and outcome in 37 patients operated on for cholestatoma complicated by labyrinthine fistula. Therapy involved removing the matrix from each fistula and reconstructing the bony wall of the labyrinth with bone dust, fibrin glue, and perichondrium. Corticosteroids were added to the management protocol in more recent cases. A fistula classification scheme was introduced to standardize the reporting of the extent of labyrinthine involvement and results of treatment. The most common preoperative symptoms, sensorineural hearing loss and vertigo, were notably lacking in more than 30% of patients. The fistula test was positive in only 32% of cases. Corticosteroids were seen to have a beneficial impact on postoperative outcome in those cases involving injury to the membranous labyrinth or removal of perilymph.
迷路瘘管在约5%的胆脂瘤病例中出现，但这个难题的处理仍存在争议。本研究评估了37例因胆脂瘤合并迷路瘘管而接受手术的患者的术前表现及预后。治疗方法包括从每个瘘管清除基质，并用骨粉、纤维蛋白胶和软骨膜重建迷路的骨壁。在最近的病例中，管理方案中加入了皮质类固醇。引入了一种瘘管分类方案，以规范迷路受累程度的报告及治疗结果。超过30%的患者明显缺乏最常见的术前症状，即感音神经性听力损失和眩晕。瘘管试验仅在32%的病例中呈阳性。在那些涉及膜迷路损伤或外淋巴清除的病例中，皮质类固醇对术后预后有有益影响。
