慢性非胆脂瘤中耳炎并耳蜗瘘管

Cochlear fistula in chronic otitis media without cholesteatoma

目的探讨慢性非胆脂瘤中耳炎引起的耳蜗瘘管的病因、临床表现、诊断和手术处理。方法结合文献复习,回顾性分析1例非胆脂瘤中耳炎引起的耳蜗瘘管。结果非胆脂瘤中耳炎所致的耳蜗瘘管骨导下降不明显,无眩晕,瘘管实验为阴性。瘘口骨内膜完整,术后骨导均仅有轻度下降。结论机械因素可能不是骨质破坏的必要因素,术前研究全系列高分辨率图像有利于避免漏诊耳蜗瘘管,应尽量清除瘘口的病变上皮或肉芽,通过仔细操作能够保存耳蜗功能。

Objective To investigate the etiology,clinical features,diagnosis and treatment of cochlear fistula due to noncholesteatomatous chronic otitis media.Method A retrospective investigation of a case of cochlear fistula due to noncholesteatomatous chronic otitis media and review of two cases（3 ears） previously reported in literatures were conducted.Results There was no obvious decrease of bone conduction in these cases with cochlear fistula due to noncholesteatomatous chronic otitis media.No vertigo was complained by these cases and the results of fistula test were all negative.The endosteums in fistula were found to be intact during surgery.The bone conductions were slightly decreased after surgery.Conclusions Mechanical pressure might not be essential to bone resorption,complete images of HRCT should be used to investigate the bone lesion in chronic otitis media to avoid missed diagnosis of cochlear fistula,complete removal of the lesion above the endosteum in cochlear fistula is necessary,and cochlear function is quite possible to be preserved by careful operation.