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目的 :探讨慢性化脓性中耳炎并发迷路瘘管的临床特征及治疗方法。方法 :回顾性分析 1992～ 1999年收治的慢性化脓性中耳炎患者 45 0例的临床资料 ,全部病例均行乳突根治术。结果 :45 0例中并发迷路瘘管 2 0例 (4 .4% ) ,18例 (90 % )有主观听力下降 ,13例 (6 5 % )有眩晕史。 9例 (4 5 % )瘘管试验阳性。患耳全聋 2例 ,患耳纯音测听骨导平均听阈≤ 30 d B 11例 ,31～ 5 0 d B 3例 ,≥ 5 1d B 4例。瘘管试验阳性患者患耳听力较瘘管试验阴性者差 (P <0 .0 1)。 CT检查的 9例中 ,2例发现迷路瘘管。术中发现 18例 (90 % )为胆脂瘤性中耳炎 ,2例 (10 % )为骨疡型中耳炎 ,瘘管均发生在外半规管。结论 :迷路瘘管术前尚无可靠的诊断方法 ,最可靠的方法是在手术中探查。对迷路瘘管区的处理应视瘘管的大小、部位、病变性质及患者的具体情况而定。
Objective: To investigate the clinical features and treatment of chronic suppurative otitis media complicated by fistula. Methods: The clinical data of 45 0 patients with chronic suppurative otitis media who were admitted from 1992 to 1999 were retrospectively analyzed. All patients underwent radical mastectomy. Results: Among 450 cases, 20 cases (4. 4%) had fistulas, and 18 cases (90%) had subjective hearing loss, and 13 cases (65%) had history of vertigo. 9 cases (45%) fistula test was positive. There were 2 cases of total deafness in the affected ear, and the average hearing threshold of the affected ear was 11 cases ≤ 30 d B, 3 cases of 31 ~ 50 days B, 4 cases ≥ 5 1 d B. Fistula patients with positive test ear hearing fistula test was negative (P <0. 01). Of the 9 cases examined by CT, 2 had fistulas. Eighteen cases (90%) were cholesteatoma otitis media, and two cases (10%) had otic type otitis media. Fistula occurred in the lateral semicircular canal. Conclusion: There is no reliable method for diagnosis of labyrinthine fistula, and the most reliable method is to probe into the operation. The treatment of labyrinth fistula area should be fistula size, location, nature of the disease and the specific circumstances of the patient may be.