Prognostic indicators of hearing after complete resection of cholesteatoma causing a labyrinthine fistula
Prognostic indicators of hearing after complete resection of cholesteatoma causing a labyrinthine fistula
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DOI：
10.1007/s00405-011-1545-7
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发表时间：
2011-12-01
影响因子：
2.6
通讯作者：
Saliba, Issam
中科院分区：
文献类型：
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作者：
Stephenson, Marie-France;Saliba, Issam
本研究的目的是：（1）评估在瘘管的情况下完全切除中耳瘤后的听力变化，（2）评估术前CT扫描诊断瘘管的敏感性和特异性，（3）确定瘘管类型与其放射学大小之间的相关性。对2004年至2009年期间所有因中耳乳突瘤手术的患者进行了回顾性图表审查。主要结果被定义为骨传导阈值（BCT）的平均变化以及语音识别评分（SDS）后，全切除中耳瘤引起的中耳瘘。我们回顾了所有术前CT扫描和手术记录，以评估诊断膀胱瘘的敏感性和特异性。结果显示，317例中耳乳突瘤患者行乳突切除术。28例患者中发现32个由骨性中耳炎性疾病引起的瘘管，影响外侧半规管（SCC）（n = 25），上级SCC（n = 5），后部SCC（n = 1）和足板（n = 1）。术后BCT和SDS（24.5 dB; 86.6%）与术前水平（23.2 dB; 87.5%）无临床或统计学差异（p = 0.35）。术前高分辨率0.55 mm切口CT扫描的敏感性和特异性为100%。轴位上瘘管直径为3.55 mm时，怀疑膜性瘘管的敏感性为66%，特异性为71%。完全切除基质而不吸在现场的一个无泪囊瘤性肛瘘是一个安全和有效的管理选择。高分辨率术前CT扫描在诊断膀胱瘘方面非常精确，其影像学大小有助于预测瘘的类型。
The objectives of this study are (1) to evaluate hearing change after complete cholesteatoma resection in the setting of a labyrinthine fistula, (2) to assess the sensitivity and specificity of the preoperative CT-scan in diagnosing a labyrinthine fistula, and (3) to determine the correlation between the type of the labyrinthine fistula and its radiologic size. A retrospective chart review of all patients operated for cholesteatoma between 2004 and 2009 was conducted. Primary outcome was defined as the average variation in bone conduction thresholds (BCTs) as well as speech discrimination score (SDS) after total excision of cholesteatoma causing a labyrinthine fistula. We reviewed all preoperative CT-scans and operative notes to assess sensitivity and specificity for the diagnosis of a labyrinthine fistula. Results show that 317 patients underwent mastoidectomy for cholesteatoma. Twenty-eight patients were found to have 32 labyrinthine fistulas caused by cholesteatomatous disease affecting the lateral semi-circular canal (SCC) (n = 25), the superior SCC (n = 5), the posterior SCC (n = 1) and the footplate (n = 1). Postoperative BCT and SDS (24.5 dB; 86.6%) were neither clinically nor statistically different from preoperative levels (23.2 dB; 87.5%) (p = 0.35). Sensitivity and specificity of the preoperative high resolution 0.55 mm cuts CT-scan was 100%. With a fistula of 3.55 mm in the axial plan, a membraneous fistula must be suspected with a sensitivity of 66% and a specificity of 71%. Complete matrix resection without suctioning at the site of a cholesteatomatous labyrinthine fistula is a safe and effective management option. High-resolution preoperative CT-scan is very precise in diagnosing labyrinthine fistula and its radiologic size helps to predict the type of the fistula.