虹膜周围瘘的诊断和治疗:一项前瞻性临床研究

IF 2.1 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY
I. Saliba, Naif Bawazeer, S. Belhassen
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引用次数: 0

摘要

背景:自从发现咽周瘘管(PLF)以来,诊断和治疗一直存在争议。如果能成功识别咽周瘘,就可以通过手术修复瘘管部位。成功的治疗可改善患者的听力和前庭症状,从而对其生活质量产生重大影响。研究目的对中耳探查并堵塞圆窗和卵圆窗后怀疑有 PLF 的患者的临床和听力变化进行前瞻性研究。研究设计:前瞻性比较研究。研究地点三级医疗中心。研究方法患者分为两组:第一组包括术中在椭圆窗和/或圆窗未发现 PLF 的患者,第二组包括已发现瘘管的患者。患者评估包括既往病史、是否存在任何危险因素、耳蜗和前庭症状、体格检查、颞骨成像、听力图和视震图(VNG)。结果共有 98 名患者被分为两组:第一组 62 人,第二组 36 人。第二组的性别差异有统计学意义(男性占 83.3%,女性占 16.7%,P = 0.008)。共有 14 例患者(第一组和第二组分别为 4 例和 10 例)因复发性 PLF 而接受了手术。他们之前的手术大多使用了脂肪移植材料,但在比较脂肪和其他材料时并未发现差异。此外,I 组和 II 组在术前和术后 12 个月的易感因素、影像学、VNG、症状演变或体格检查方面均无统计学差异。不过,两组患者的听力和前庭均有明显改善。另一方面,两组患者术前各频率的空气传导(AC)和骨传导(BC)均无统计学差异,但在术后 12 个月时,两组患者的听力均有显著改善,尤其是频率为 250 Hz (p = 0.02)、500 Hz (p = 0.0008) 和 1000 Hz (p = 0.04) 的 BC。结论无论何时怀疑有咽周瘘管,都应毫不犹豫地对中耳进行探查,并使用耳廓软骨材料进行开窗阻塞术。我们的数据显示,无论是否发现瘘管,耳蜗和前庭症状都有所改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Suspicion and Treatment of Perilymphatic Fistula: A Prospective Clinical Study
Background: Since the discovery of the perilymphatic fistula (PLF), the diagnosis and treatment remain controversial. If successfully recognized, the PLF is surgically repairable with an obliteration of the fistula site. Successful treatment has a major impact on patient’s quality of life with an improvement in their audiological and vestibular symptoms. Objective: To prospectively investigate patients’ clinical and audiological evolution with PLF suspicion after middle ear exploration and obliteration of the round and oval window. Study Design: Prospective comparative study. Setting: Tertiary care center. Methods: Patients were divided into two groups: Group I consisted of patients where no PLF had been identified intraoperatively at the oval and/or at the round window, and Group II consisted of patients where a fistula had been visualized. Patient assessment was a combination of past medical history, the presence of any risk factors, cochlear and vestibular symptoms, a physical examination, temporal bone imaging, audiograms, and a videonystagmogram (VNG). Results: A total of 98 patients were divided into two groups: 62 in Group I and 36 in Group II. A statistically significant difference regarding gender was observed in Group II (83.3% of males vs. 16.7% of females, p = 0.008). A total of 14 cases (4 and 10 in Groups I and II, respectively) were operated for a recurrent PLF. Fat graft material was used in the majority of their previous surgery; however, no difference was found when comparing fat to other materials. In addition, no statistically significant difference was noted between Groups I and II concerning predisposing factors, imaging, VNG, symptom evolution, or a physical exam before the surgery and at 12 months post-operative. However, both groups showed statistically significant hearing and vestibular improvement. On the other hand, the air conduction (AC) and bone conduction (BC) at each frequency were not statistically different between the two groups before surgery but showed statistically significant improvement at 12 months post-operatively, especially for the BC at the frequencies 250 (p = 0.02), 500 (p = 0.0008), and 1000 Hz (p = 0.04). Conclusions: Whenever you suspect a perilymphatic fistula, do not hesitate to explore middle ear and do window obliterations using a tragal perichondrium material. Our data showed that cochlear and vestibular symptoms improved whether a fistula had been identified or not.
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来源期刊
Audiology Research
Audiology Research AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-
CiteScore
2.30
自引率
23.50%
发文量
56
审稿时长
11 weeks
期刊介绍: The mission of Audiology Research is to publish contemporary, ethical, clinically relevant scientific researches related to the basic science and clinical aspects of the auditory and vestibular system and diseases of the ear that can be used by clinicians, scientists and specialists to improve understanding and treatment of patients with audiological and neurotological disorders.
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