Magliulo G, Terranova G, Varacalli S, Sepe C
Department of IV ENT, University La Sapienza, Rome, Italy.
Am J Otol. 1997 Nov;18(6):697-701.
The objective of this study was to present the authors' experience in the management of labyrinthine fistula caused by cholesteatoma.
The clinical charts of 92 patients who underwent surgical procedures for cholesteatoma complicated by labyrinthine fistula between 1979 and 1975 were reviewed retrospectively. In this period, 1,205 patients were operated on for cholesteatoma. In each patient, the site and size of the fistula were evaluated during surgery and the hearing thresholds were compared before and after surgery.
The fistula involved the lateral semicircular canal in 71 patients. Multiple fistulas were observed in nine patients. Postoperative hearing levels were unchanged or improved in 83.7% of patients. Comparison between hearing outcomes and size of the fistula showed better findings when smaller size fistulas were found. No significant differences between open and closed techniques were detected. Favorable outcomes were obtained in patients treated with surgical obliteration of the interrupted labyrinth.
The current study confirmed that careful manipulation of the labyrinthine fistula is mandatory to preserve hearing functions for these patients. According to the authors' experience, the future trend for fistula treatment could be directed toward less conservative techniques compared with the previous indications favoring methods of interruption and subsequent obliteration of the semicircular canals.
本研究的目的是介绍作者在胆脂瘤所致迷路瘘管治疗方面的经验。
回顾性分析1975年至1979年间92例因胆脂瘤合并迷路瘘管而接受手术治疗患者的临床病历。在此期间，1205例患者接受了胆脂瘤手术。对每例患者，术中评估瘘管的部位和大小，并比较手术前后的听力阈值。
71例患者的瘘管累及外侧半规管。9例患者观察到多个瘘管。83.7%的患者术后听力水平未变或改善。听力结果与瘘管大小的比较显示，瘘管较小时结果更好。未发现开放技术与封闭技术之间存在显著差异。采用手术封闭中断的迷路治疗的患者获得了良好结果。
本研究证实，对于这些患者，谨慎处理迷路瘘管对于保留听力功能至关重要。根据作者的经验，与之前倾向于中断并随后封闭半规管方法的指征相比，瘘管治疗的未来趋势可能是采用不太保守的技术。
