乙状窦异常搏动性耳鸣50例临床病例分析  

Clinical analysis of 50 patients with abnormal pulsatile tinnitus in sigmoid sinus

作　　者：李莉[1] 韩月臣[1] 孙鹏程[1] 胡娜[2] 毛彦妍[1] 侯志强[1] 王海波[1] 樊兆民[1] Li Li;Han Yuechen;Sun Pengcheng;Hu Na;Mao Yanyan;Hou Zhiqiang;Wang Haibo;Fan Zhaomin(Department of Otology Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan 250021,China;Department of Medical Imaging Center,Shandong Provincial ENT Hospital,Jinan 250021,China)

机构地区：[1]山东大学山东省耳鼻喉医院耳外科,济南250021 [2]山东大学山东省耳鼻喉医院医学影像中心,济南250021

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第8期792-796,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析乙状窦异常搏动性耳鸣的疾病特点、诊疗方法。方法回顾性分析山东大学山东省耳鼻喉医院2014年2月至2020年7月经乙状窦手术治疗的50例单侧静脉源性搏动性耳鸣患者的病例资料,其中女49例,男1例;年龄17~67岁,中位年龄44岁;右侧耳鸣45例,左侧耳鸣5例。术前耳鸣程度Ⅱ级4例,Ⅲ级11例,Ⅳ级22例,Ⅴ级13例。记录其耳鸣的特点、影像学检查结果、手术方法、术中所见及术后耳鸣变化。术后随访6~12个月。采用SPSS 26.0软件对手术前后耳鸣分级的差异进行符号秩和检验。结果50例耳鸣患者术后痊愈37例,术后无效(耳鸣无变化)8例,术后显效(耳鸣分级下降2级或以上)3例,术后有效(耳鸣分级下降1级)2例。经符号秩和检验,手术前后耳鸣分级的差异有统计学意义(Z=-5.70,P<0.05)。颞骨CT发现36例乙状窦憩室(其中17例合并乙状窦壁缺失)、12例乙状窦壁缺损、2例与乙状窦邻近的颞骨局部缺失。行乙状窦憩室封闭35例,乙状窦壁重建4例,乙状窦缩窄5例,单纯行乙状窦前乳突气房开放4例,行乙状窦前乳突气房开放联合乙状窦缩窄1例,行乙状窦前乳突气房开放联合乙状窦憩室封闭1例。结论静脉源性搏动性耳鸣多见于女性,常见原因可能为乙状窦憩室、乙状窦周骨质缺损等乙状窦壁异常,影像学检查有助于诊断,可以采用手术治疗。ObjectiveTo analyze the disease characteristics,diagnosis and treatment methods of venous pulsatile tinnitus treated by intervention of sigmoid sinus.MethodsFifty patients(from Shandong Provincial ENT Hospital,Shandong University between February 2014 and July 2020)with venous pulsatile tinnitus treated by sigmoid sinus surgery were analyzed retrospectively.The tinnitus characteristics,imaging findings,surgical methods,intraoperative findings and postoperative tinnitus changes were recorded.The patients were followed up for 6-12 months.The sign rank sum test was used to analyze the difference in tinnitus grading before and after surgery.There were 50 patients with unilateral venous pulsatile tinnitus,including 49 females and 1 male.The age ranged from 17 to 67 years,with a median age of 44 years.There were 45 cases of right tinnitus and 5 cases of left tinnitus.The degree of tinnitus before operation was gradeⅡor above,including 4 cases of gradeⅡ,11 cases of gradeⅢ,22 cases of gradeⅣand 13 cases of gradeⅤ.ResultsThirty-seven cases were cured,8 cases were ineffective(no change in tinnitus),3 cases were markedly effective(tinnitus grade decreased by 3 in 2 cases,4 in 1 case),and 2 cases were effective(tinnitus grade decreased by 1).The difference of tinnitus grade before and after operation was statistically significant(Z=-5.70,P<0.05).Temporal bone CT showed 36 cases of sigmoid diverticulum(including 17 cases with sigmoid sinus dehiscence),12 cases of sigmoid sinus dehiscence and 2 cases of absence of the temporal bone cortex abutting to sigmoid sinus.Thirty-five cases were performed with closure of sigmoid sinus diverticulum,4 cases were performed with resurfacing of the sigmoid plate,5 cases were performed with narrowing of sigmoid sinus,4 cases were performed with simple opening of pre sigmoid mastoid air chamber,1 case of opening was performed with pre sigmoid mastoid air chamber combined with narrowing of sigmoid sinus,and 1 case was performed with opening of pre sigmoid mastoid air chamber combined

关 键 词：耳鸣 搏动性 乙状窦 耳外科手术 治疗结果 

分 类 号：R764.45[医药卫生—耳鼻咽喉科]