成人自发性脑脊液耳漏的临床诊治分析

Clinical diagnosis and treatment analysis of spontaneous cerebrospinal fluid otorrhea in adults

摘要:

目的 探讨成人自发性脑脊液耳漏（SCSFO）的早期临床表现、诊断及治疗方法。方法 结合文献分析1例61岁成人（病例1）和1例58岁成人（病例2）SCSFO患者的临床表现、听力及影像学等检查结果、手术方法及预后。结果 病例1表现为长期双耳听力下降、耳闷、鼻塞、流涕，内镜检查发现双耳鼓室积液、下鼻甲肥大、鼻咽部脓涕，经双侧咽鼓管球囊扩张术、双耳内镜下鼓膜置管术联合鼻内镜双侧下鼻甲等离子射频消融术治疗后，左耳仍持续流液，生化检查确诊为脑脊液漏，颅底CT及颞骨MRI发现左侧颅底局部骨质缺损。经乳突径路探查见乳突天盖局部缺损，采用耳廓软骨膜及脂肪填塞法修补成功。病例2表现为右耳闷伴听力下降，经耳内镜检查发现右耳鼓室积液，曾有数次鼓室抽液史，颞骨CT平扫发现右鼓室天盖可疑缺损，积液生化检查确诊为脑脊液，该病例经耳道鼓室入路探查发现，漏口位于鼓室天盖，予以耳屏软骨膜填塞及生物胶封堵，修补成功。病例1随访2年，病例2随访6个月，均无复发。结论 SCSFO在成人中罕见，易被误诊为分泌性中耳炎，中耳积液的实验室检查可辅助诊断，颅底CT和MRI对于SCSFO的诊断、漏口位置的判断及手术方式的选择具有重要价值，手术是最有效的治疗方法。

Abstract:

Objective To explore the early clinical manifestations, diagnosis, and treatment methods of spontanneous cerebrospinal fluid otorrhea (SCSFO) in adults.Methods Based on literature reviews, this analyzed the clinical manifestations, audiologic and imaging findings, surgical approaches, and prognosis of two SCSFO patients: a 61-year-old adult (Case 1) and a 58-year-old adult (Case 2).Results Case 1 presented with long-term bilateral hearing loss, ear fullness, nasal congestion, and rhinorrhea. Endoscopic examination revealed bilateral middle ear effusion, hypertrophy of the inferior turbinate, and purulent discharge from the nasopharynx. Despite treatment with bilateral eustachian tube balloon dilation, bilateral tympanic membrane ventilation tube placement under endoscopic guidance, and endoscopic plasma radiofrequency ablation of the bilateral inferior turbinates, left ear continued to have persistent drainage. Cerebrospinal fluid (CSF) biochemical tests confirmed CSF leakage. Cranial base CT and temporal bone MRI revealed a localized bone defect at the left skull base. Exploratory surgery via the mastoid approach revealed a partial defect in the mastoid tegmen, which was successfully repaired using auricular cartilage perichondrium and fat grafting. Case 2 exhibited right ear fullness accompanied by hearing loss. Endoscopic otologic examination revealed fluid accumulation in the right tympanic cavity, with a history of multiple tympanocentesis procedures. Temporal bone CT scan detected suspected defects in the right tympanic tegmen. Biochemical analysis of the fluid confirmed CSF leakage. Exploratory surgery via the ear canal approach identified a fistula located in the tympanic tegmen. The defect was successfully repaired with auricular cartilage perichondrium grafting and biological glue sealing. Case 1 was followed up for 2 years, and Case 2 for 6 months. Neither case experienced recurrence.Conclusions SCSFO is rare in adults and is often misdiagnosed as secretory otitis media. Laboratory tests for middle ear effusion can aid in diagnosis, while cranial base CT and MRI are crucial for diagnosing and determining the fistula location as well as selecting the surgical approach. Surgery remains the most effective treatment.