乙状窦-乳突相关的血管性搏动性耳鸣临床分析

Clinical analysis of the vascular pulsatile tinnitus associated with sigmoid sinus-mastoid

目的:探讨乙状窦-乳突相关的血管性搏动性耳鸣(PT)临床诊疗特点。方法:回顾性分析自2013—2020年间由同一医生收治的45例PT患者的临床资料,观察运用手术治疗和非手术治疗的疗效。术式:经乳突入路乙状窦前壁骨壁重建术,以及乳突导血管结扎术;非手术治疗方法有抗贫血治疗和观察。门诊随访。结果:全部患者中,女43例,男2例;2例女性为客观性耳鸣,其余均为主观性耳鸣;平均年龄42.7岁。共有40例选择手术,其中38例选择经乳突入路乙状窦前壁骨壁重建术,内有6例同期行乳突导血管结扎术;其他2例行单纯乳突导血管结扎术。5例选择了非手术治疗,其中2例抗贫血治疗,3例观察。最长随访7年半,最短6个月。1例失访。总治愈率80.0%(36/45),手术治愈率82.5%(33/40),非手术治愈率60.0%(3/5)。结论:该PT致病机制复杂且至今尚不清楚,下述几点可能在病因中发挥重要作用:女性、共同的解剖异常影像特征及血流动力学变化。确定PT的责任部位或主要致病因素是一个关键点。尽管术式相对简单,效果显著且并发症轻微,但是手术可能并不是唯一的治疗选择。

Objective:To probe the clinical characteristics of diagnosis and therapy of vascular pulsatile tinnitus(PT)associated with sigmoid sinus-mastoid.Methods:Retrospectively analyzed the clinical data of the hospitalized 45 PT patients of an ear surgeon in one hospital between January 2013 to January 2020,and observed the effectiveness with surgery and non-surgery therapy.Surgical procedures include reconstruction the bone wall of sigmoid sinus by transmastoid approach and ligation of mastoid emissary vein.Non-surgery therapy includes anti-anemia therapy and observation.All patients have been followed-up in ENT outpatient.Results:Of 45 cases,female:male was 43:2,the mean age was 42.7 years old.The other PT patients were the subjective tinnitus except two females were the objective tinnitus.Of 40 cases,38 patients underwent transmastoid approach to reconstructed sigmoid sinus bone wall,including 6 patients with the ligated mastoid emissary vein at the same period.The other 2 cases with the ligated mastoid emissary vein only.Five cases were treated by non-surgery therapies,including 2 cases anti-anemia therapy and 3 cases observation.The longest follow-up period was seven and a half years,the shortest was six months.One case was lost to follow up.The total cure rate was 80.0%(36/45),the surgery cure rate was 82.5%(33/40),the non-surgery cure rate was 60.0%(3/5).Conclusion:The pathophysiologic mechanism of the PT is still complex and unclear until now.However,the following conditions probably play an important role in the etiology:female,common features of anatomy anomalies,hemodynamic variations.It is a key point to confirm the responsible site or the main cause of the PT.Although the surgery is relatively simple,the effect is remarkable and no major postoperative complications,surgery could not be a only choice.