■特发性外淋巴瘘(PLF)可能难以诊断,因为患者出现突发性感觉神经性听力损失(SSHL)和/或前庭症状而没有任何先前事件。在这种情况下,我们目前检测cochlin-tomoprotein(CTP)以确认特发性PLF的诊断,因为CTP仅在外淋巴液中检测到.在这项研究中,我们报告了5例明确诊断为特发性PLF的患者的临床过程,这些患者使用经耳道内窥镜手术(TEES)进行了PLF修复手术.
■五名患者最初接受了鼓室内地塞米松治疗SSHL,此时还进行了CTP测试(术前CTP测试).由于难治性听力损失和/或波动不平衡,使用TEES进行PLF修复手术以使用结缔组织和纤维蛋白胶密封椭圆形和圆形窗口。这些患者根据术前或术中CTP测试结果(阴性,<0.4ng/mL;中间体,0.4-<0.8ng/mL;阳性,>0.8ng/mL)。我们评估了术前和术中CTP值,通过放大的内窥镜视图发现术中手术结果,以及平均听力水平和前庭症状的术前和术后变化。
■3例患者术前和术中CTP值呈阳性和中等,一名患者的阳性和阴性,一名患者呈阴性和阳性。没有患者的术中发现与内耳和中耳之间的瘘管或外淋巴液渗漏一致。只有两名患者在术后听力略有恢复。四名患者术前抱怨不平衡,其中两人在术后有不平衡的解决。
■CTP试验阳性证实患者无明显术中发现PLF。CTP测试被认为比内镜下瘘确认更敏感。我们认为CTP检测结果是决定特发性PLF修复手术指征的重要指标。根据我们对这五个案例的经验,其中两个显示听力和前庭症状均得到改善。
UNASSIGNED: An idiopathic perilymphatic fistula (PLF) can be difficult to diagnose because patients present with sudden sensorineural hearing loss (SSHL) and/or vestibular symptoms without any preceding events. In such cases, we currently test for cochlin-tomoprotein (CTP) to confirm the diagnosis of idiopathic PLF because CTP is only detected in the perilymph. In this study, we report the clinical course of five patients definitively diagnosed with idiopathic PLF who underwent PLF repair surgery using transcanal endoscopic ear surgery (TEES).
UNASSIGNED: Five patients were initially treated with intratympanic dexamethasone for SSHL, at which time a CTP test was also performed (preoperative CTP test). Due to refractory hearing loss and/or fluctuating
disequilibrium, PLF repair surgery using TEES was performed to seal the oval and round windows using connective tissue and fibrin glue. These patients were diagnosed with definite idiopathic PLF based on pre- or intra-operative CTP test results (negative, < 0.4 ng/mL; intermediate, 0.4-< 0.8 ng/mL; and positive, > 0.8 ng/mL). We evaluated pre- and intra-operative CTP values, intraoperative surgical findings via a magnified endoscopic view, and pre- and post-operative changes in averaged hearing level and vestibular symptoms.
UNASSIGNED: Pre- and intra-operative CTP values were positive and intermediate in three patients, positive and negative in one patient, and negative and positive in one patient. None of the patients had intraoperative findings consistent with a fistula between the inner and middle ears or leakage of perilymph. Only two patients showed a slight postoperative recovery in hearing. Four patients complained of
disequilibrium preoperatively, of whom two had resolution of
disequilibrium postoperatively.
UNASSIGNED: A positive CTP test confirms PLF in patients without obvious intraoperative findings. The CTP test is considered more sensitive than endoscopic fistula confirmation. We consider that CTP test results are important indicators to decide the surgical indication for idiopathic PLF repair surgery. In our experience with the five cases, two of them showed improvements in both hearing and vestibular symptoms.