8例内耳病变导致患耳气骨导差的临床分析

张茹;张裔良;戴春富;

1:复旦大学眼耳鼻咽喉科医院耳神经-颅底外科

摘要
目的探讨内耳病变导致患耳气骨导差的临床特点。方法回顾性分析8例内耳病变导致患耳气骨导差的临床资料。所有患者行音叉、纯音测听和声反射检查,同时行颞骨CT扫描。结果5例患者颞骨CT扫描及上半规管重建提示上半规管裂孔存在,诊断为上半规管裂综合征,主诉听力下降,时间2个月到10年不等,音叉检查患耳Rinne试验阴性,Weber试验偏向患侧,纯音测听提示低频听力下降,气导平均听阈(0.5、1、2kHz)为50.25dBHL,骨导平均听阈为28.48dBHL;声反射均能引出。其中,3例患者强声能诱导出眩晕和眼震,2例患者变压试验能诱导出眩晕和眼震。其余3例患者为大前庭水管综合征,颞骨CT均证实前庭导水管扩大,中耳乳突无积液,听骨链无畸形,外耳和鼓膜正常,音叉检查患耳Rinne试验阴性,纯音测听患耳有明显的气骨导差,声反射均能引出;均采用激素和高压氧治疗,2例听力明显好转,1例听力无改善。结论上半规管裂和前庭导水管扩大等内耳疾病可导致患耳气骨导差,临床上应予以关注。
关键词
内耳病变;气骨导差;上半规管裂综合征;大前庭水管综合征
基金项目(Foundation):
教育部新世纪优秀人才支持计划项目(编号NCET-06-0369);; 国家自然科学基金项目(编号30772398);; 国家科技部“十五”攻关资助项目(编号2004BA702B04)联合资助
作者
张茹;张裔良;戴春富;
参考文献

1Merchant S,Halpin C,Chien W,et al.Non Middle ear cause of air bone gapes[J].Abstract Association Research of Otola-ryngology,2007,30:528.

2Minor LB,Solomon D,Zinreich JS,et al.Sound and/or pres-sure induced vertigo due to bone dehiscence of the superior semicircular canal[J].Arch Otolaryngol Head Neck Surg,1998,124:249.

3Minor LB.Clinical manifestations of superior semicircular ca-nal dehiscence[J].Laryngoscope,2005,115:1717.

4Minor LB,Carey JP,Cremer PD,et al.Dehiscence of bone o-verlying the superior canal as a cause of apparent conductive hearing loss[J].Otol Neurotol,2003,24:270.

5Mikulec AA,Mckenna MJ,Ramsey MJ,et al.Superior semi-circular canal dehiscence presenting as conductive hearing loss without vertigo[J].Otol Neurotol,2004,25:121.

6Minor LB.Superior canal dehiscence syndrome[J].Am J Otol,2000,21:9.

7Rosowski JJ,Songer JE,Nakajima HH,et al.Clinical experi-mental and theoretical investigations of the effect of superiorsemicircular canal dehiscence on hearing mechanisms[J].Otol Neurotol,2004,25:323.

8Mikulec AA,Poe DS,Mckenna MJ.Operative management of superior semicircular canal dehiscence[J].Laryngoscope,2005,115:501.

9Songer JE,Rosowski JJ.The effect of superior cannal dehis-cence on cochlear potential in response to air conducted stimuli in chinchilla[J].Hearing Res,2005,210:53.

10House J W,Sheehy JL,Antunez JC.Stapedectomy in chil-dren[J].Laryngoscope,1980,90:1804.

11Levenson MJ,Parisier SC,Jacobs M,et al.The large vestib-ular aqueduct syndromein children.Areviewof12cases and the description of a newclinical entity[J].Arch Otolaryngol Head Neck Surg,1989,115:54.

12Jackler RK,De La Cruz A.The large vestibular aqueduct syndrome[J].Laryngoscope,1989,99:238.

13Nakashima T,Ueda H,Furuhashi A,et al.Air-Bone gap and resonant frequencyinlarge vestibular aqueduct syndrome[J].AmJ Otol,2000,21:671.

14Govaerts PJ,Cassel man J,Daemers K,et al.Audiological findings in large vestibular aqueduct syndrome[J].Interna-tional Journal of Pediatric Otolaryngology,1999,51:157.