Jang C H, Merchant S N
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA.
Am J Otol. 1997 Jan;18(1):15-25.
The objective of this study was to describe the light microscopic pathology of labyrinthine fistulae in chronic otitis media (COM) in seven temporal bones and to discuss clinical and surgical implications. In COM, labyrinthine fistulae are usually caused by cholesteatoma, with the lateral semicircular canal being the most commonly affected site. Some fistulae are asymptomatic, whereas, others affect the auditory and vestibular systems to varying degrees. Surgical removal of cholesteatoma matrix over a fistula carries a risk of sensorineural hearing loss. Knowledge of the pathology of fistulae may provide a better understanding of their clinical manifestations and may allow a more rational approach to surgical management. The Massachusetts Eye and Ear Infirmary temporal bone collection contains 115 specimens with COM, of which seven specimens show pathologic fistulization of the bony labyrinth. Histologic sections from these seven bones were evaluated with respect to type of COM, location and size of fistula, changes in the inner ear adjacent to the fistula, middle ear and mastoid disease, and pathology in the vestibular and cochlear sense organs. The following conclusions are presented (a) Labyrinthine fistulae can be caused not only by cholesteatoma, but also by granulomatous COM without cholesteatoma and even by localized infection within a canal-down mastoid cavity. (b) Cholesteatoma matrix or inflammatory tissue usually becomes apposed to the endosteum or membranous labyrinth within the fistula. In most cases, reactive inner ear changes do not occur at the fistula site. Occasionally, there is thickening of the endosteum or chronic localized labyrinthitis. (c) Most bones do not show any alterations of the vestibular and cochlear sense organs. Occasionally, there is serous labyrinthitis, which might lead to partial sensorineural hearing loss. (d) A protective "walling-off" phenomenon in the labyrinth is not common. Therefore, if overwhelming infection or surgical trauma breaches the natural barriers of the endosteum/membranous labyrinth, then the fistula may allow rapid dissemination of infection throughout the inner ear.
本研究的目的是描述七例颞骨中慢性中耳炎（COM）迷路瘘管的光镜病理，并探讨其临床和手术意义。在COM中，迷路瘘管通常由胆脂瘤引起，外侧半规管是最常受累的部位。一些瘘管无症状，而另一些则不同程度地影响听觉和前庭系统。手术切除瘘管上的胆脂瘤基质有导致感音神经性听力损失的风险。了解瘘管的病理可能有助于更好地理解其临床表现，并可能使手术管理方法更合理。马萨诸塞州眼耳医院颞骨标本库中有115例COM标本，其中七例标本显示骨迷路有病理瘘管形成。对这七块骨头的组织学切片进行了评估，内容包括COM的类型、瘘管的位置和大小、瘘管附近内耳的变化、中耳和乳突疾病以及前庭和耳蜗感觉器官的病理。得出以下结论：（a）迷路瘘管不仅可由胆脂瘤引起，也可由无胆脂瘤的肉芽肿性COM引起，甚至可由耳道向下型乳突腔内的局部感染引起。（b）胆脂瘤基质或炎性组织通常与瘘管内的骨内膜或膜迷路相邻。在大多数情况下，瘘管部位不会发生内耳反应性改变。偶尔会有骨内膜增厚或慢性局限性迷路炎。（c）大多数骨头的前庭和耳蜗感觉器官没有任何改变。偶尔会有浆液性迷路炎，这可能导致部分感音神经性听力损失。（d）迷路中的保护性“隔离”现象并不常见。因此，如果严重感染或手术创伤突破骨内膜/膜迷路的天然屏障，那么瘘管可能会使感染迅速扩散至整个内耳。
