中耳胆脂瘤并发迷路瘘管和迟发性膜迷路积水1例

A case report of middle ear cholesteatoma complicated with labyrinthine fistulaand delayed endolymphatic hydrops

迟发性膜迷路积水(delayed endolymphatic hydrops,DEH)是引起眩晕一种不常见的疾病,在临床上不受重视容易误诊其他眩晕疾病。本文报道了1例容易误诊的眩晕患者。患者为中耳胆脂瘤并发迷路瘘管,然而其眩晕为发作性眩晕,不能用迷路瘘管导致迷路炎作为解释,怀疑合并有膜迷路积水可能,并经内耳MRI钆造影证实为膜迷路积水。首次报道了中耳胆脂瘤并发迷路瘘管和DEH的病例,经手术切除胆脂瘤同期行三半规管阻塞,术后随访2年内未再发作眩晕。对眩晕疾病的诊断,细致的眩晕病史询问至关重要。

Delayed endolymphatic hydrops(DEH)is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases.This article reports on a patient with vertigo who was easily misdiagnosed.The patient was a middle ear cholesteatoma complicated by labyrinthine fistula(LF);however,his vertigo was episodic vertigo,which could not be explained solely by LF causing labyrinthitis.The possibility of endolymphatic hydrops was suspected,which was confirmed by inner ear magnetic resonance gadolinium imaging.This is the first reported case of middle ear cholesteatoma complicated by LF and DEH.The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time.During two years postoperative follow-up,the patient did not experience a recurrence of vertigo.When diagnosing vertigo diseases,a careful history of vertigo is of utmost importance.