Saim L, Nadol J B
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
Am J Otol. 1996 Mar;17(2):263-70.
Although several histopathologic studies have shown otosclerotic involvement of the vestibular apparatus in patients with otosclerosis, the pathogenesis of vestibular symptoms in otosclerosis remains unknown. A quantitative study of Scarpa's ganglion was performed in 217 temporal bones from 118 subjects with otosclerosis. Review of clinical records revealed an incidence of vestibular symptoms in 11.9% of these subjects. Scarpa's ganglion cell counts in temporal bones of subjects with otosclerosis and vestibular symptoms were lower than counts in temporal bones of subjects with otosclerosis but without vestibular symptoms and those of normal subjects. This difference in Scarpa's ganglion cell counts, adjusted for age, between the group with otosclerosis and vestibular symptoms and a group of normal subjects was highly significant (p = 0.0015), whereas the difference in Scarpa's ganglion cell count between a group with otosclerosis but without vestibular symptoms and a group of normal subjects was not significant (p = 0.53). There was also a significant correlation between elevation of the average bone-conduction threshold and the presence of vestibular symptoms in these subjects (p = 0.041). The endosteum of the perilymphatic space of the vestibule and the endosteum of the canal for the superior vestibular nerve or its cribrose area were the two most common sites of involvement by otosclerosis. However, there was no significant correlation between the presence of vestibular symptoms and otosclerotic involvement of any single site or the number of involved sites. Histologic examination of the vestibular nerve fibers and end organs subjacent to otosclerotic foci demonstrated no obvious degenerative changes. Thus our findings appear to suggest that the vestibular symptoms present in patients with otosclerosis are more common in patients with elevated bone conduction thresholds and are correlated with degeneration of the vestibular nerve, which appears to be independent of the severity of otosclerotic involvement of the vestibular end organs.
尽管多项组织病理学研究表明耳硬化症患者的前庭器官存在耳硬化病变，但耳硬化症患者前庭症状的发病机制仍不清楚。对118例耳硬化症患者的217块颞骨进行了斯卡帕神经节定量研究。回顾临床记录发现，这些患者中11.9%有前庭症状。有前庭症状的耳硬化症患者颞骨中的斯卡帕神经节细胞计数低于无前庭症状的耳硬化症患者颞骨以及正常受试者颞骨中的细胞计数。在调整年龄后，有前庭症状的耳硬化症患者组与正常受试者组之间斯卡帕神经节细胞计数的差异具有高度显著性（p = 0.0015），而无前庭症状的耳硬化症患者组与正常受试者组之间斯卡帕神经节细胞计数的差异不显著（p = 0.53）。这些受试者的平均骨导阈值升高与前庭症状的存在之间也存在显著相关性（p = 0.041）。前庭外淋巴间隙的内膜和上前庭神经管道或其筛状区的内膜是耳硬化症最常累及的两个部位。然而，前庭症状的存在与任何单个部位的耳硬化病变或受累部位数量之间均无显著相关性。对耳硬化病灶下方的前庭神经纤维和终器进行组织学检查未发现明显的退行性改变。因此，我们的研究结果似乎表明，耳硬化症患者出现的前庭症状在骨导阈值升高的患者中更为常见，并且与前庭神经退变相关，而这似乎与前庭终器耳硬化病变的严重程度无关。
