Mondini内耳畸形合并反复化脓性脑膜炎5例报告

Inner ear Mondini malormation complicated with recurrent purulent meningitis

目的探讨Mondini内耳畸形合并脑脊液耳漏、耳鼻漏同时并发脑膜炎时的诊断、治疗方法。方法早期2例,在行中耳探查时发现瘘孔在畸形的镫骨足板,采用肌肉、筋膜等材料从中耳腔侧覆盖前庭窗瘘孔。后期3例则在术中摘除镫骨,用筋膜等组织由前庭窗向前庭池填塞。结果采用从中耳腔侧覆盖瘘孔的早期2例术后失败,改用前庭池填塞后未再复发。后期由前庭窗向前庭池作填塞的3例皆一次手术成功。结论Mondini内耳畸形合并脑脊液耳漏、耳鼻漏时需及时行中耳探查术、封闭瘘管。术中摘除畸形镫骨,以筋膜等材料从前庭窗向前庭池填塞则术后不易复发。

Objective To explore the diagnosis and therapy of Mondini malormation complicated with cerebrospinal fluid（CSF） rhinorrhea or otorhinorrhea and recurrent purulent meningitis. Methods In the initial 2 cases a fistua of the stapes footplate found during an exploratory tympanotomy was sealed from the middle ear cavity with pieces of muscle, fascia, et cetera. In the later 3 cases, the stapes was removed and the vestibule was packed with fascia through the oval window. Results In the inicial 2 cases the primary surgery failed to seal the fistula. Then the vestibule was packed in a revision surgery with no recurrence of CSF fistula. All the later 3 cases succeeded in stopping CSF rhinorrhea or otorhinorrhea by packing the vestibule and obturating the oval window during the primary surgery. Conclusion It is needed to explore middle ear cavity and to pack the fistula when Mondini malormation complicated with CSF rhinorrhea or otorhinorrhea was diagnosed. Post-operetive recurrence can be avoided by removing stapes and packing the vestibule and obturating the oval window.