背景:上半规管裂开(SSCD)的特征是CT证实的上半规管骨侵蚀,产生前庭和听觉症状.内淋巴积水(EH)的特征是MRI证实的scala介质内的内淋巴过多,使膜状迷宫变形。虽然症状有重叠,这两种疾病是由不同的病理生理导致的,需要不同的干预措施。
方法:在加州大学进行了回顾性图表审查,洛杉矶有270名成年SSCD患者的数据库,聚集在2011年3月至2020年2月之间。回顾临床笔记,术后发现,对16例经CT证实的SSCD和内听道(IAC)MRI的患者进行了影像学检查。发现3例并发SSCD和EH。病史和手术史,手术前后症状进展,收集治疗结果。一名患者的症状通过霉酚酸酯得到缓解,另一个通过氢氯噻嗪,第三种是通过氢氯噻嗪和双侧助听器。
结论:与EH共同存在的SSCD症状的术后持续性是医师应对并发EH进行调查的最强指标。在这些情况下,VEMP和听力图测试可能具有误导性,不应将其作为规则测试或排除测试。
结论:SSCD和EH并发是一种罕见但可治疗的实体。如果SSCD患者手术成功后症状持续或复发,医师应考虑订购IACMRI检查。
BACKGROUND: Superior semicircular canal dehiscence (SSCD) is characterized by CT-confirmed bony erosion over the superior semicircular canal, creating vestibular and auditory symptoms. Endolymphatic hydrops (EH) is characterized by an MRI-confirmed excess of endolymph within the scala media that distorts the membranous labyrinth. While there is overlap in symptoms, the two diseases result from different pathophysiologies and require different interventions.
METHODS: A retrospective chart review was conducted at the University of California, Los Angeles on a database of 270 adult SSCD patients, gathered between March 2011 and February 2020. A review of clinical notes, post-operative findings, and imaging was performed for 16 patients who had both CT-confirmed SSCD and an MRI of the internal auditory canal (IAC). Three cases of concurrent SSCD and EH were identified. Medical and surgical history, symptom progression pre- and post-operatively, and treatment outcomes were gathered. One patient\'s symptoms were resolved via mycophenolate mofetil, another\'s via hydrochlorothiazide, and the third\'s via hydrochlorothiazide and bilateral hearing aids.
CONCLUSIONS: Post-surgical persistence of SSCD symptoms that are mutually shared with EH is the strongest indicator that a physician should investigate for concurrent EH. VEMP and audiogram testing in these cases can be misleading and should not be relied on as rule-in or rule-out tests.
CONCLUSIONS: Concurrent SSCD and EH is a rare but treatable entity. Physicians should consider ordering an MRI of the IAC if SSCD patients\' symptoms persist or recur after a successful surgery.