耳内镜下鼓膜张肌腱切断治疗梅尼埃病术中新发现及短期疗效分析

New discovery and short-term effect analysis of tensor tympani muscle tenotomy for Meniere's disease under otoscope

目的观察耳内镜下鼓膜张肌腱切断治疗梅尼埃病的术中所见以及短期疗效,初步探讨其可行性及相关机制。方法收集2020年7—12月9例行耳内镜下鼓膜张肌腱切断治疗的梅尼埃病患者的临床资料,其中男2例、女7例,右侧5例、左侧2例、双侧2例,年龄(56.3±10.6)岁(38~75岁)。术中观察术腔情况及圆窗膜有无破裂。术后2周、1个月、3个月时随访,评估耳闷、耳鸣、听力恢复以及眩晕发作情况。结果9例患者在全身麻醉下通过耳内镜完成鼓膜张肌腱切断手术。术中发现圆窗膜破裂1例,圆窗膜及卵圆窗附近严重纤维增生并与听骨链粘连1例,卵圆窗和圆窗膜附近纤维条索及膜性增生1例,圆窗膜附近纤维增生粘连2例,单纯卵圆窗周围膜性增生和粘连1例,中耳鼓室内未见纤维增生3例。术中圆窗膜能显露4例,不能显露5例。手术无严重并发症,术后随访3个月,耳闷症状消失5/5例,耳痛消失2/2例,耳鸣改善3/8例、无变化5/8例,听觉过敏改善3/3例,听力提高4/9例、无变化5/9例;9例患者中8例眩晕无发作,1例患者术后3个月内眩晕发作2次(该患者为圆窗膜破裂者)。结论耳内镜下鼓膜张肌腱切断治疗梅尼埃病3个月内疗效显著。术中发现多数病例有内耳窗膜附近纤维条索增生,可能为内耳窗膜反复破裂修复后的表现。

Objective To explore the feasibility and short-term effect of tensor tympani muscle Tenotomy in the treatment of Meniere's disease under otoscope.The possible pathogenesis was discussed and our views were put forward.Methods The clinical data of 9 cases of Meniere's disease treated by otoscopic Tenotomy were analyzed retrospectively,including 2 males,7 females,5 right ones,2 left ones and 2 bilateral ones.The average age was(56.33±10.56)years,ranging from 38 to 75 years.We evaluated intraoperative findings and short-term postoperative efficacy,respectively evaluated postoperative aural fullness,tinnitus and hearing recovery,and evaluated postoperative vertigo attack in a short time.Results Nine patients were completed the operation under general anaesthesia and otoscopy,and no serious complications occurred.We found new pathological changes in tympanic cavity in some cases during operation.There were rupture of round window membrane in 1 case,severe fibrous hyperplasia near the round window membrane and vestibular window and adhesion with ossicular chain in 1 case,fibrous cord and membranous hyperplasia near vestibular window and round window membrane in 1 case,fibrous hyperplasia and adhesion near the round window membrane in 2 cases,membranous hyperplasia and adhesion around vestibular window in 1 case.No fibrous hyperplasia was found in 3 cases in the tympanic cavity.The round window membrane can be exposed in 4 cases and failed in 5 cases.After 3 months of follow-up,we found that we found that 5/5 cases of aural fullness disappeared,2/2 cases of earache disappeared,3/8 cases of tinnitus improved,5/8 cases presented with improvement and no aggravation,3/3 cases of hearing allergy improved,4/9 cases of hearing improved,and 5/9 cases showed no improvement or decrease.9 patients were followed up for 3 months,of whom 8 patients had no vertigo,one patient suffered from vertigo twice within 3 months after operation,and the patient suffered from rupture of round window membrane.Conclusions Endoscopic Tenotomy for Meniere's disease has obvious curative effect and quick recovery after operation.During the operation,we find that most of Meniere's patients have fibrous cord hyperplasia near the inner ear window membrane,which may be the pathological manifestation after repeated rupture and repair of the inner ear window membrane.The vertigo of Meniere's disease may be related to the destruction and repair of inner ear membrane structure caused by improper contraction or spasm of tympanic tensor muscle.