静脉源性搏动性耳鸣的手术治疗(附13例报告)

Surgical treatment of venous pulsatile tinnitus(a report of 13 cases)

目的观察静脉源性搏动性耳鸣的手术治疗效果,总结有效手术治疗方法。方法13例静脉源性搏动性耳鸣患者均接受手术治疗,其中7例乙状窦憩室伴发乙状窦骨质缺损患者接受乙状窦憩室回纳+骨壁重建术治疗,2例岩上窦憩室患者接受岩上窦憩室回纳+骨壁重建术治疗,2例乙状窦骨质菲薄患者接受乙状窦骨壁加强术治疗,2例颈静脉球窝高位患者接受鼓室探查术+下鼓室封闭术+外耳道成形术治疗。结果13例患者均完成手术治疗,术中及术后均未见并发症。患者均进行术后随访,7例乙状窦憩室伴发乙状窦骨质缺损患者术后6例耳鸣缓解,1例术后2个月再次出现搏动性耳鸣;2例岩上窦憩室患者术后耳鸣均缓解;2例乙状窦骨质菲薄患者术后耳鸣均消失;2例颈静脉球窝高位患者术后1例耳鸣消失,1例耳鸣无改善。结论憩室回纳+骨壁重建术对乙状窦憩室和岩上窦憩室患者疗效较好,乙状窦骨质菲薄患者可行乙状窦骨壁加强术治疗,颈静脉球窝高位患者手术治疗需谨慎。

Objective To explore the surgical treatment effect of venous pulsatile tinnitus(PT)and to summarize the effective surgical treatment method.Methods Thirteen patients with venous PT received surgical treatment,of whom,7 patients with sigmoid sinus diverticulum and sigmoid sinus bone defect were treated with sigmoid sinus diverticu⁃lum+bone wall reconstruction,and 2 patients with superior petrosal sinus diverticulum were treated with superior petrosal sinus diverticulum+bone wall reconstruction,2 patients with weak sigmoid sinus bone received sigmoid sinus bone wall enhancement,and 2 patients with high jugular bulb received tympanic cavity exploration+lower tympanic cavity sealing+external ear canal plasty treatment.Results All the 13 patients had surgical treatment and no complications were ob⁃served during and after surgery.All the patients were followed up after surgery.In 7 cases of sigmoid sinus diverticulum with sigmoid sinus bone defect,6 cases had PT relief after surgery,and 1 case had PT again two months after surgery.PT was relieved in 2 patients with suprasicular sinus diverticulum.PT disappeared in 2 patients with weak sigmoid sinus bone.In one of the two patients with high jugular bulb,PT disappeared after operation,while the other had no improve⁃ment.Conclusion Diverticulum retraction and bone wall reconstruction have good effect on patients with sigmoid sinus diverticulum and supralicular sinus diverticulum,sigmoid sinus bone wall reinforcement is feasible for patients with weak sigmoid sinus bone,and surgical treatment for patients with high jugular bulb should be cautious.