先天性自发性脑脊液耳鼻漏临床分析

Diagnosis and Treatment of Congenital Spontaneous Otorrhea and Rhinorrhea of CSF

目的探讨自发性脑脊液耳鼻漏的病因特点、诊断及治疗方法。方法回顾性分析1986年6月-2001年7月收治的13例先天性自发性脑脊液耳鼻漏经手术治愈的临床资料。结果13例均伴有复发性脑膜炎发作,9例表现为脑脊液鼻漏,13例均为全聋,CT检查显示13例均为内耳发育畸形,前庭囊性扩大,经行鼓室探查,11例为前庭窗漏,1例为圆窗漏,1例为前庭窗和圆窗同时漏,其中1例为双耳前庭窗漏,经采用筋膜、肌肉、脂肪呈哑铃状封堵前庭窗及圆窗,全部治愈。结论对复发性脑膜炎伴耳聋和鼻流清水史的患者应行颞骨CT和鼓室穿刺检查进行及时的正确诊断,鼓室探查脑脊液漏修补是本病治疗的主要方法,瘘口周围黏膜的处理及哑铃状封堵瘘口等方法是手术成功的关键。

Objective To investigate causal features, diagnosis and treatment of spontaneous otorrhea and rhinorrhea of cerebrospihal fluid （CSF）. Methods Thirteen postoperative cases of congenital otorrhea and rhinorrhea of CSF from July, 1986 to December, 2000 were reviewed. Results All the 13 cases were complicated with recurrent meningitis. CSF rhinorrhea were detected in 9 cases. Complete deafness or severe deafness were reported in the 13 cases. CT scanning showed inner ear malformation and vestibular cystic enlargement in all cases. By tympanotomy, oval window leakage was found in 11 cases, and round window leakage, both oval and round window leakage and two-ear oval window leakage respectively in 1 cases. All the patients in the cases recovered by dumbbell blockade in oval and round window with fascia, muscle and fat. Conclusion CT scanning of temporal bone and tympanocentesis should be performed in recurrent meningitis with otorrhea and running nose in order that prompt and correct diagnosis will be made. Tympanotomy and neoplasty of CSF leakage are the main therapeutic methods to the diseases. Management of peripheral mucosa and dumbbell blockade in fistula act as the key to success.