Gibson W P
Department of Surgery, University of Sydney, NSW, Australia.
Am J Otol. 1993 May;14(3):273-7.
The case against the occurrence of spontaneous perilymphatic fistulas is presented. Electrophysiologic findings both in animals and in man suggest that small holes in either the round or oval window are not associated with any significant hearing loss. Removal of perilymph may cause some changes in the electrocochleogram that can be reversed when the perilymph is replaced. Tympanotomy surgery, especially when performed with the injection of local anesthetic solutions may result in transudates in the middle ear that are difficult to differentiate from perilymph leaking out from the inner ear. Perilymphatic fistulas were excluded by performing a posterior myringotomy under general anesthesia in 162 congenitally deaf ears. If fluid was present it was suctioned, and if no change occurred on the intraoperative electrocochleogram, it was concluded that no fistula existed. Based on the electrophysiologic findings and the clinical observations in over 240 ears, it was concluded that spontaneous perilymphatic fistulas do not exist. The author accepts that perilymphatic fistulas occur after surgery, especially after stapedectomy, and that they can occur after head injury or barotrauma. However, these should heal readily; persistent or intermittent fistulas are an otologic rarity.
本文提出了反对自发性外淋巴瘘发生的观点。动物和人类的电生理研究结果表明，圆窗或卵圆窗上的小孔与任何显著的听力损失无关。抽取外淋巴可能会使耳蜗电图发生一些变化，但当外淋巴重新补充后这些变化可以逆转。鼓膜切开术，尤其是在注射局部麻醉剂溶液的情况下进行时，可能会导致中耳出现渗出液，这些渗出液很难与从内耳漏出的外淋巴区分开来。通过在全身麻醉下对162只先天性聋耳进行后鼓膜切开术排除了外淋巴瘘。如果有液体存在，将其吸出，如果术中耳蜗电图没有变化，则得出不存在瘘管的结论。根据对240多只耳朵的电生理研究结果和临床观察，得出结论认为自发性外淋巴瘘不存在。作者承认外淋巴瘘在手术后会发生，尤其是在镫骨切除术后，并且在头部受伤或气压伤后也可能发生。然而，这些瘘管应该很容易愈合；持续性或间歇性瘘管在耳科学中是罕见的。
