先天性内耳畸形伴发脑脊液耳鼻漏

The cerebrospinal otorhinorrhea in a patient with congenital inner ear dysplasia after recovery from purulent meningitis

目的探讨先天性内耳畸形合并化脓性脑膜炎后出现脑脊液耳鼻漏的诊断、治疗方法。方法回顾性分析1例临床病例。患者脑膜炎痊愈后发现左侧鼻腔清亮液体流出，经检验为脑脊液，结合颞骨CT发现左内耳畸形，包括共同腔、半规管及内听道扩大三种畸形，确诊为先天性内耳畸形伴脑脊液耳鼻漏。于全麻下行鼓室探查，修补瘘口，脑脊液漏停止。结果患者术后恢复良好，随访半年无复发。结论对于仅有一次脑膜炎发作，伴单侧或双侧感音神经性聋的患者出现鼻腔清亮分泌物，需警惕先天性内耳畸形合并脑脊液鼻漏，一旦发现，需根据听力情况选择手术方法，尽早封闭瘘口。

Objective To investigate the diagnosis and therapy of congenital inner ear dysplasia complicated with cerebrospinal fluid （CSF） otorhinorrhea after recovery from purulent meningitis. Methods A 36-year-old female was transferred to the Department of Otolaryngology because of clear watery nasal discharge. Laboratory studies showed that the nasal discharge was CSF. The temporal bone CT scan indicated a compound congenital inner ear dysplasia in her left inner ear. The diagnosis of congenital inner ear dysplasia complicated with CSF otorhinorrhea was made and surgical closure of the CSF fistula was performed through intra-aural approach. After the operation, the leakage stopped immediately. Results The patient had an uncomplicated hospital course and was discharged 7 days after the surgery. She was closely followed up as an outpatient for half a year and had no evident recurrence of the otorhinorrhea. Conclusion It is suggested that CSF otorhJnorrhea should be suspected when persistent clear fluid from the nostrils in patients with congenital hearing loss after purulent meningitis occurs. Proper surgical approach should be chosen to close the fistula according to the hearing conditions of the patients as soon as possible.