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目的探讨慢性中耳炎并发迷路瘘管的临床与影像学特征及处理策略。方法回顾性分析慢性中耳炎并发迷路瘘管89例(89耳)的手术资料,其中伴乳突切除的开放鼓室成形术77耳,其中Ⅰ期重建中耳传音结构65耳,改良乳突根治术12耳。结果术后听力提高50耳,其中气骨导差缩小<20dB28耳,21～40dB22耳,骨导改善11耳;听力下降32耳,全聋11耳中,术后全聋4耳,骨导下降8耳。术后有眩晕发作的34耳,术后随访眩晕均消失或改善。胆脂瘤母质均在手术显微镜下彻底清除,清除后有蓝线状或清亮淋巴液漏出。结论中耳乳突手术中应高度重视迷路瘘管存在的可能性,清除瘘口胆脂瘤母质应在手术最后阶段进行。冠状位CT显示水平半规管瘘有显著的临床意义。
Objective To investigate the clinical and imaging features and treatment strategies of chronic otitis media complicated by fistula. Methods The data of 89 cases (89 ears) of chronic otitis media complicated with fistula were retrospectively analyzed. There were 77 open tympanoplasty with mastoid excision, including 65 cases of middle ear acoustic structure in stage Ⅰ reconstruction, 12 cases of modified mastoidectomy ear. Results The postoperative hearing was improved by 50 ears. The difference of airway conduction was less than 20dB28 ears, 21 ~ 40dB22 ears, 11 cases of bone conduction improvement, 32 ears hearing loss, 11 ears total deafness, 4 ears postoperative total deafness, 8 ears. Postoperative 34 cases of vertigo attack, postoperative vertigo were disappeared or improved. Cholesteatoma mother’s body were completely removed under a surgical microscope, cleared clear blue line or clear lymph leakage. Conclusions In the middle ear mastoid process, the possibility of labyrinthine fistula should be attached great importance. The removal of fistula cholesteatoma should be performed in the final stage of operation. Coronal CT showed horizontal semicircular canal fistula has a significant clinical significance.