【摘要】 目的 :探讨慢性化脓性中耳炎并发迷路瘘管的临床特征及治疗方法。方法 :回顾性分析 1992～ 1999年收治的慢性化脓性中耳炎患者 45 0例的临床资料 ,全部病例均行乳突根治术。结果 :45 0例中并发迷路瘘管 2 0例 (4 .4% ) ,18例 (90 % )有主观听力下降 ,13例 (6 5 % )有眩晕史。 9例 (4 5 % )瘘管试验阳性。患耳全聋 2例 ,患耳纯音测听骨导平均听阈≤ 30 d B 11例 ,31～ 5 0 d B 3例 ,≥ 5 1d B 4例。瘘管试验阳性患者患耳听力较瘘管试验阴性者差 (P <0 .0 1)。 CT检查的 9例中 ,2例发现迷路瘘管。术中发现 18例 (90 % )为胆脂瘤性中耳炎 ,2例 (10 % )为骨疡型中耳炎 ,瘘管均发生在外半规管。结论 :迷路瘘管术前尚无可靠的诊断方法 ,最可靠的方法是在手术中探查。对迷路瘘管区的处理应视瘘管的大小、部位、病变性质及患者的具体情况而定。更多还原

【Abstract】 Objective:To study the clinical feature and surgical management of labyrinthine fistula caused by chronic suppurative otitis media (CSOM).Method:A retrospective study of 450 patients with CSOM who underwent radical mastoidectomy between the years 1992 to 1999 in Department of Otolaryngology, Xijing Hospital was conducted.Result:20 patients ( 4.4 %) with labyrinthine fistula caused by CSOM were found.The average history of ear drainage was 22 years, 18 patients (90%) had subjective hearing loss, and 13 patients (65%) had dizziness.The fistula test was positive in 9 patients (45%).2 paitents had anacusis in the affected ear.The preoperative pure tone average for bone conduction thresholds was less than 30 dB in 11 patients, between 31 and 50dB in 3 patients, and more than 51 dB in 4 patients.The ears with a positive fistula test had worse preoperative hearing than those with negative test (P< 0.01 ).The fistula was detected by CT in 2 of 9 patients.Cholesteatoma was present in 18 patients (90%) and granulation tissue was present in 2 patients (10%).The lateral semicircular canal was the site of labyrinthine fistula.The lesion at the site of fistula was completely removed in 17 patients and exteriorized in the remaining 3.Conclusion:There are no reliable methods at present for preoperative diagnosis of labyrinthine fistula, ultimately, the most reliable way to identify a fistula is during surgery.The method of manipulation of labyrinthine fistula is based on the concrete conditions of fistula and patient.更多还原