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陈 晓, 李 伟, 李 海, 戴 春. [Surgical management of 27 cases with temporal bone cerebrospinal fluid leakage]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:998-1003. [PMID: 34886603 PMCID: PMC10128364 DOI: 10.13201/j.issn.2096-7993.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Indexed: 06/13/2023]
Abstract
Objective:To study the clinical manifestations and surgical treatment of temporal bone cerebrospinal fluid leakage. Methods:The clinical data of twenty seven cases with temporal bone cerebrospinal fluid leakage were analyzed retrospectively. Different surgical procedures were adopted according to the location of the leak and the hearing status of the affected ear.If the leakage location was clear before surgery, direct repair was performed via mastoid path or middle cranial fossa path with or without mastoid abdominal fat packing.For patients with unclear leak, large lesion or intractable CEREBROspinal fluid leakage of temporal bone, subtotal petrosal resection and abdominal fat packing were performed.Subtotal temporal bone resection and abdominal fat packing were performed for patients with cochlear involvement. Results:In this study, cases of temporal bone CSF leakage including 13 cases of inner ear malformation; 5 cases secondary to head trauma or previous surgery,5 cases of idiopathic intracranial hypertension or meningocele, 2 cases of langerhans histiocytosis in the temporal bone and 2 cases of inner ear inflammation. High resolution CT (HRCT) of temporal bone showed bone defect of inner auditory canal with vestibular communication in 13 patients with inner ear malformation.The temporal bone HRCT of the remaining 14 patients showed bone defects in the middle cranial fossa or posterior cranial fossa, while MRI of the temporal bone showed meningeal continuity interruption with cerebrospinal fluid inflow into the temporal bone or meningoencephalocele in 12 patients. The 26 patients were followed up from 6 months to 6 years. 1 patient lost follow-up.Meningitis recurred in only 1 patient with inner ear malformation, and subtotal resection of rock bone plus abdominal fat packing was performed.Postoperative hearing was preserved or improved in 7 patients.None of the patients had serious complications, and only 1 patient developed HB Grade Ⅱ facial paralysis after vestibular obliteration, and the facial paralysis recovered within one week. Conclusion:Temporal bone cerebrospinal fluid leakage is relatively rare. Surgical intervention should be taken as early as possible when conservative treatment is failure. Preoperative HRCT and MRI examination are necessary for the localization of the leakage, and individualized surgical approaches can be adopted according to the location of the leakage and the features of the lesion.
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Affiliation(s)
- 晓红 陈
- 嘉兴市第二医院(嘉兴学院附属第二医院)耳鼻咽喉科(浙江嘉兴,314000)Department of Otorhinolaryngology, the Second Hospital of Jiaxing [ the Second Affiliated Hospital of Jiaxing University], Jiaxing, 314000, China
| | - 伟 李
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University
| | - 海同 李
- 嘉兴市第二医院(嘉兴学院附属第二医院)耳鼻咽喉科(浙江嘉兴,314000)Department of Otorhinolaryngology, the Second Hospital of Jiaxing [ the Second Affiliated Hospital of Jiaxing University], Jiaxing, 314000, China
| | - 春富 戴
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University
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Xu X, Chen W, Han X, Qiao R, Ma X, Ding Y, Zhang H. Peristapedial bulb: an indicator of spontaneous CSF leak in cochlear candidates with Mondini dysplasia. Acta Otolaryngol 2021; 141:476-481. [PMID: 33641594 DOI: 10.1080/00016489.2021.1887930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mondini dysplasia with spontaneous cerebrospinal fluid (CSF) leak is rare in cochlear implantation (CI) candidates but lethal. Detailed evaluation and surgical intervention are needed for these patients. AIM/OBJECTIVE To report our findings of the peristapedial bulb in computer tomography (CT) as diagnostic evidence of spontaneous CSF leak and discuss its clinical value to direct the surgical plan for patients with profound sensorineural hearing loss (SNHL) and meningitis. MATERIAL AND METHODS A retrospective review was conducted, including patients' demographic features, radiographic examination, operation records, auditory/speech evaluation. The patients presented with a peristapedial bulb were included. RESULTS In 2775 CI recipients, 7 out of 219 (3.2%) patients with Mondini anomaly had detectable peristapedial bulbs in HRCT, among whom 6 patients have a history of meningitis. Surgical exploration verified the radiographic findings in 6 out of 7 patients. All patients received CI and vestibular obliteration. Control of meningitis was acceptable. The threshold of hearing significantly decreased from 74.1 dB ± 6.9 dB to 37.1 ± 4.8 dB after CI and the word recognition score elevated from 21.4 ± 14.9% to 78.6 ± 9.3%. CONCLUSIONS AND SIGNIFICANCE Peristapedial bulb is an indicator of spontaneous CSF leak in patients with profound SHNL and Mondini anomaly. Patients will benefit from CI and surgical intervention.
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Affiliation(s)
- Xinbo Xu
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Otolaryngology, Chinese Ministry of Health, Jinan, China
| | - Weiliang Chen
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Otolaryngology, Chinese Ministry of Health, Jinan, China
| | - Xiao Han
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Otolaryngology, Chinese Ministry of Health, Jinan, China
| | - Ruru Qiao
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Otolaryngology, Chinese Ministry of Health, Jinan, China
| | - Xiaojie Ma
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Otolaryngology, Chinese Ministry of Health, Jinan, China
| | - Yuanping Ding
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Otolaryngology, Chinese Ministry of Health, Jinan, China
| | - Hanbing Zhang
- Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Otolaryngology, Chinese Ministry of Health, Jinan, China
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Yan Z, Hao P, Wen X, Liu J, Dai J, Cao K, Zhang J, Wang N. Pseudomonas aeruginosa meningitis following head injury after cochlear implantation: A case report. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220966479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bacterial meningitis is a rare event in children with cochlear implants. A 7-year-old child who underwent cochlear implantation (CI) for the right ear 6 years ago was admitted to our hospital with the chief complaint of intermittent fever and headache for 6 months. Cochlear implant infection was suspected. The right cochlear implant removal and middle ear exploration were performed. Postoperatively, the bacterial cultures of cerebrospinal fluid (CSF), cochlear implant and inserting electrodes all suggested Pseudomonas aeruginosa. The body temperature of the child was controlled within 2 weeks after the operation by using meropenem, and other symptoms like headache and abdominal pain disappeared. During 20-month follow-up visit, the child did not suffer any discomforts. In conclusion, we reported a child who developed Pseudomonas aeruginosa meningitis following head injury after CI. This case should serve as a reminder for clinical doctors.
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Affiliation(s)
- Zhanfeng Yan
- Department of Otorhinolaryngology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Pengpeng Hao
- Department of Otorhinolaryngology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohui Wen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jinfeng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jinsheng Dai
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Keli Cao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ningyu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Deng W, Liu J, Pang F, Zhang X. Diagnosis and management of pediatric cerebrospinal fluid leakage secondary to inner ear malformations: A report of 13 cases. Int J Pediatr Otorhinolaryngol 2020; 135:110049. [PMID: 32497907 DOI: 10.1016/j.ijporl.2020.110049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Inner ear malformations (IEM) with cerebrospinal fluid (CSF) leakage in children is a rare condition, nevertheless, it may lead to meningitis. Early diagnosis and treatment are crucial. The aims of the study were to summarize the clinical characteristic of pediatric CSF leakage secondary to IEM, and to recommend transcanal endoscopic ear surgery (TEES) as an effective surgical technique for the treatment of CSF leakage with IEM in children. METHODS This was a retrospective study. Thirteen children and fourteen ear surgery were included. Demographics, detail history, laboratory data, Audio test, and imageological examination results were recorded. All the pediatric patients underwent TEES. RESULTS Most (92.31%) of the children presented with a history of rhinorrhea. 69.23% (9/13) of the children had suffered from meningitis, and the other had presented with respiratory tract infections. The follow-up duration ranged from 0.75 years to 5.29 years. Transcanal endoscopic repair of CSF leakage secondary to IEM was the first surgery with a success rate of 92.86% (13 out of 14 cases). A fistula could be found in the stapes footplate in all pediatric patients. CONCLUSION Even if there has been no history of meningitis, the diagnosis of CSF leakage in children suffering from unilateral rhinorrhea and recurrent respiratory tract infection is considered. Auditory brainstem response (ABR) and Temporal bone computed tomography (CT) examinations are suggested to identify IEM. The TEES procedure is recommended in our study as the first choice that repairs CSF leakage secondary to IEM.
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Affiliation(s)
- Wenmin Deng
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Jie Liu
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Feng Pang
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Xiangmin Zhang
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
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Surgical Treatment for Cerebrospinal Fluid Leaks in Patients With Inner Ear Malformations. Otol Neurotol 2020; 41:1102-1107. [PMID: 32501937 DOI: 10.1097/mao.0000000000002734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study is to present our technique of surgical closure in a series of patients suffering from cerebrospinal fluid (CSF) leak due to inner ear malformations. STUDY DESIGN AND SETTING We conducted a retrospective study in our tertiary care academic department of pediatric otolaryngology. PATIENTS We did include all patients who presented a CSF leak or bacterial meningitis (one episode or recurrent) related to a malformation of the inner ear. INTERVENTION(S) Through a retro-auricular or endaural approach we performed a filling of the vestibule cavity with multiple fragments of cartilage with perichondrium introduced through the oval window, after stapedectomy until a near-complete sealing was obtained. After the surgery, all patients received a treatment with acetazolamide during 15 days. MAIN OUTCOME MEASURE(S) We did evaluate our technics with the recurrence of CSF leak. RESULTS Thirteen patients, from 1 to 14, were operated with our technics. With a follow-up of 4.4 ± 4.7 years, only one patient needed a second intervention. None had a novel episode of meningitis. We observed no complication. The leak was observed in the oval fossa in 11 cases. CONCLUSIONS Our "minimally invasive" technique of vestibular obliteration with cartilage inserted through the oval window after stapedectomy did demonstrate its safety and reliability.
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Chen B, Shi Y, Gong Y, Chen J, Li Y. Simultaneous repair of cerebrospinal fluid otorrhea and cochlear implantation in two patients with recurrent meningitis and severe inner ear malformation. Int J Pediatr Otorhinolaryngol 2019; 124:147-151. [PMID: 31195308 DOI: 10.1016/j.ijporl.2019.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the outcomes of simultaneous cochlear implantation and repair of a cerebrospinal fluid (CSF) leak in two patients with inner ear malformations following meningitis. METHODS In this retrospective study and review of the literature, two patients with recurrent meningitis and severe inner ear malformation underwent cochlear implantation via the round window, and repair of CSF otorrhea via a transmastoid lateral semicircular canal approach. Both patients were treated with antibiotics for 7 days after the surgery. RESULTS Neither patient has exhibited evidence of CSF otorrhea 1 year after surgical repair. Categorical Auditory Performance (CAP) scores and the Speech Intelligibility Ratings (SIRs) were obtained before and 1 year after surgery: the scores were 0 versus 4 and 0 versus 2, respectively. Vestibular function tests of both patients were reviewed and were normal. CONCLUSION Simultaneous repair of CSF otorrhea and cochlear implantation in patients with recurrent meningitis and severe inner ear malformation can be regarded as safe and effective.
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Affiliation(s)
- Biao Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, PR China
| | - Ying Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, PR China
| | - Yue Gong
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, PR China
| | - Jingyuan Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, PR China
| | - Yongxin Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, PR China.
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Wang B, Dai WJ, Cheng XT, Liuyang WY, Yuan YS, Dai CF, Shu YL, Chen B. Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases. J Zhejiang Univ Sci B 2019; 20:156-163. [PMID: 30666849 DOI: 10.1631/jzus.b1800224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the characteristics of the clinical presentation, diagnosis, surgical methods, and outcomes of patients with otogenic cerebrospinal fluid (CSF) leakage secondary to congenital inner ear dysplasia. METHODS A retrospective review was performed of 18 patients with otogenic CSF leakage secondary to inner ear dysplasia who underwent surgery in our group from 2007 to 2017 and had a follow-up of at least 4 months. The average length of follow-up was three years. The characteristics of the clinical presentations of all patients, such as self-reported symptoms, radiographic findings, surgical approaches and methods of repair, position of the leakage during surgery, and postoperative course, including the success rate of surgery, are presented. RESULTS The patients presented mostly with typical symptoms of meningitis, severe hearing impairment, and CSF otorrhea or rhinorrhea. All 18 patients had at least one previous episode of meningitis accompanied by a severe hearing impairment. The preoperative audiograms of 17 patients showed profound sensorineural hearing loss, and one patient had conductive hearing loss. Twelve patients presented with an initial onset of otorrhea, and two had accompanying rhinorrhea. Six patients complained of rhinorrhea, two of whom were misdiagnosed with CSF rhinorrhea and underwent transnasal endoscopy at another hospital. High-resolution computed tomography (HRCT) images can reveal developments in the inner ear, such as expansion of a vestibular cyst, unclear structure of the semicircular canal or cochlea, or signs of effusion in the middle ear or mastoid, which strongly suggest the possibility of CSF otorrhea. The children in the study suffered more severe dysplasia than adults. All 18 patients had CSF leakage identified during surgery. The most common defect sites were in the stapes footplates (55.6%), and 38.9% of patients had a leak around the oval window. One patient had a return of CSF otorrhea during the postoperative period, which did not re-occur following a second repair. CONCLUSIONS CSF otorrhea due to congenital inner ear dysplasia is more severe in children than in adults. The most common symptoms were meningitis, hearing impairment, and CSF otorrhea or rhinorrhea. HRCT has high diagnostic accuracy for this disease. The most common fistula site was around the oval window, including the stapes footplates and the annular ligament.
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Affiliation(s)
- Bing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China
| | - Wen-Jia Dai
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China
| | - Xiao-Ting Cheng
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China
| | - Wen-Yi Liuyang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China
| | - Ya-Sheng Yuan
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China
| | - Chun-Fu Dai
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China
| | - Yi-Lai Shu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China
| | - Bing Chen
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200030, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200030, China
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Men M, Li W, Chen H, Wu J, Feng Y, Guo H, Li J. Identification of a Novel CNV at 8q13 in a Family With Branchio‐Oto‐Renal Syndrome and Epilepsy. Laryngoscope 2019; 130:526-532. [DOI: 10.1002/lary.27941] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/06/2019] [Accepted: 03/01/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Meichao Men
- Health Management Center, Xiangya HospitalCentral South University Changsha Hunan People's Republic of China
- Hunan Key Laboratory of Medical GeneticsCentral South University Changsha Hunan People's Republic of China
| | - Wu Li
- Department of Otolaryngology, Xiangya HospitalCentral South University Changsha Hunan People's Republic of China
| | - Hongsheng Chen
- Department of Otolaryngology, Xiangya HospitalCentral South University Changsha Hunan People's Republic of China
| | - Jiayu Wu
- Hunan Key Laboratory of Medical GeneticsCentral South University Changsha Hunan People's Republic of China
- Hunan Key Laboratory of Animal Models for Human DiseasesCentral South University Changsha Hunan People's Republic of China
| | - Yong Feng
- Hunan Key Laboratory of Medical GeneticsCentral South University Changsha Hunan People's Republic of China
- Department of Otolaryngology, Xiangya HospitalCentral South University Changsha Hunan People's Republic of China
| | - Hui Guo
- Hunan Key Laboratory of Medical GeneticsCentral South University Changsha Hunan People's Republic of China
- Hunan Key Laboratory of Animal Models for Human DiseasesCentral South University Changsha Hunan People's Republic of China
| | - Jia‐Da Li
- Hunan Key Laboratory of Medical GeneticsCentral South University Changsha Hunan People's Republic of China
- Hunan Key Laboratory of Animal Models for Human DiseasesCentral South University Changsha Hunan People's Republic of China
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Xu J, Yi H, Li X, Chen W, Xu J. Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases. Acta Otolaryngol 2017; 137:131-135. [PMID: 27577755 DOI: 10.1080/00016489.2016.1222551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the surgical treatment and related experience of lateral skull base lesions. METHODS In a retrospective, clinical data analysis of 20 patients with lateral skull base diseases, 11 cases with temporal bone space-occupying lesions and intracranial invasion were treated by translabyrinthine surgery, mastoid cavity drainage, or transmastoid surgery to remove the lesion; two cases of cholesteatoma with destruction of tympanic cavity and tympanic sinus canopy with intracranial invasion were treated by extended radical mastoidectomy; seven cases with lateral skull base bone destruction with cerebrospinal fluid otorrhea caused by trauma and deformity were treated by translabyrinth and transmastoid repair. RESULTS Eleven cases with temporal bone space occupying lesions were resected completely and were without recurrence after surgery. Two cases with intracranial infection secondary to cholesteatoma were rapidly relieved of symptoms without recurrence after radical mastoidectomy. The remaining seven cases of CSF otorrhea included two cases of Mondini malformation and five cases of temporal bone fracture. The leak was stemmed in all seven cases after surgery. CONCLUSION Surgery is the main therapeutic option for the treatment of lateral skull base diseases. The surgical approach and the type of skull base reconstruction should be selected on an individual case-by-case basis.
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Affiliation(s)
- Jia Xu
- Department of Otolaryngology, Head & Neck Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, Beijing, PR China
| | - Haijin Yi
- Department of Otolaryngology, Head & Neck Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, Beijing, PR China
- Department of Otolaryngology, Head & Neck Surgery, Military General Hospital of Beijing PLA, Beijing, Beijing, PR China
| | - Xin Li
- Department of Otolaryngology, Head & Neck Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, Beijing, PR China
| | - Wenjing Chen
- Department of Otolaryngology, Head & Neck Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, Beijing, PR China
| | - Jinkun Xu
- Department of Otolaryngology, Head & Neck Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, Beijing, PR China
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Wang J, Li Y, Chen S, Hao X. Long-term outcomes of a transmastoid lateral semicircular canal approach to congenital CSF otorrhea in children associated with recurrent meningitis and severe inner ear malformation. Int J Pediatr Otorhinolaryngol 2016; 87:185-9. [PMID: 27368469 DOI: 10.1016/j.ijporl.2016.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the long-term effectiveness of transmastoid lateral semicircular canal approach (TMLSCCA) to repair cerebrospinal fluid (CSF) leakage in children associated with recurrent meningitis and severe congenital inner malformation. METHOD A retrospective study was conducted in a university hospital, academic medical center. Fifteen children with recurrent meningitis, secondary to severe congenital inner ear malformation, were included in the study. All of them had CSF associated otorrhea and treated using TLSCCA to repair CSF otorrhea by packing the vestibule with muscle and fascia. Observation of the status of postoperative CSF leakage, recurrence of meningitis and complication were conducted. RESULTS None of the cases had recurrent meningitis and CSF leakage after their TLSCCA procedure in the follow-up period of 1-8.5 years. One case presented with transient facial nerve paralysis and completely recovered 3 months later. CONCLUSION TLSCCA for CSF otorrhea in children with recurrent meningitis secondary to congenital inner ear malformation is an alternative approach that offers some advantages.
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Affiliation(s)
- Jie Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China; Beijing Engineering Research Center of Audiology Technology, Beijing, 100730, China
| | - Yongxin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China.
| | - Shubin Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China
| | - Xinping Hao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China
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Life-threatening unilateral hearing impairments. Review of the literature on the association between inner ear malformations and meningitis. Int J Pediatr Otorhinolaryngol 2015; 79:1969-74. [PMID: 26453271 DOI: 10.1016/j.ijporl.2015.09.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bacterial meningitis is a life threatening disease that can be triggered by a CSF leak through an inner ear malformation. Early identification of the specific type of cochleovestibular dysplasia and the associated risk of meningitis is of vital importance. OBJECTIVES The objective of this review is to collect and discuss available data on the association between inner ear malformations and meningitis in children. METHODS Electronic databases were crosschecked for obtaining relevant papers published in the last 20 years, and further cases were identified by hand searching through the references. Demographic data were extracted from full texts, together with information on the severity of hearing impairment, the type of inner ear anomaly, the site of cerebrospinal fluid leak, the number of recurrent meningitis episodes. RESULTS Sixty-seven cases of meningitis related to inner ear malformation have been identified among 45 papers. Mean age at presentation is 3.60±3.00 (range 0.1-14) years. Average diagnostic delay from the first episode of meningitis is 3.44±3.41 (range 0.00-10.00) years. The number of meningitis episodes that occurred before the correct diagnosis and definitive surgical treatment is 3.27±1.81 (range 1.00-10.00). Unilateral hearing impairment affects 70% of patients. Six patients had normal hearing at presentation. Two children are dead from inner-ear-malformation-related meningitis among reviewed reports. CONCLUSION A high number of paediatric patients carrying inner ear malformations, especially when associated with unilateral hearing impairment, could be at risk to develop recurrent bacterial meningitis. Universal newborn hearing screening programs should prompt a diagnostic work-up even in the case of unilateral hearing impairment, in order to prevent inner ear malformation-related meningitis.
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Hernandez RN, Changa AR, Bassani L, Jyung RW, Liu JK. Cerebrospinal fluid otorrhea and pseudomonal meningitis in a child with Mondini dysplasia: case report. Childs Nerv Syst 2015. [PMID: 26201554 DOI: 10.1007/s00381-015-2836-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Mondini dysplasia is a rare congenital inner ear malformation that presents with abnormal cochlear development with accompanied vestibular dilation and vestibular aqueduct enlargement. This dysfunctional anatomy provides the potential for sensorineural hearing deficits, cerebrospinal fluid leaks, and severe cases of recurrent meningitis. METHODS We present the case of a child with Mondini dysplasia who presented with unilateral hearing loss and cerebrospinal fluid (CSF) otorrhea that was surgically repaired through a combined middle fossa/transmeatal middle ear approach to alleviate any recurrence of infection and cerebrospinal fluid otorrhea. RESULTS Postoperatively, the patient remained neurologically stable without any further CSF leakage. CSF cultures revealed a Pseudomonas aeruginosa infection, a rare occurrence within the context of Mondini dysplasia. Retrograde bacterial spread from the external ear canal into the CSF space has been theorized as the possible pathogenesis of the resulting meningitis. The patient was successfully treated with intravenous antibiotics without any neurologic complications. CONCLUSIONS Although Mondini dysplasia is a rare malformation, the life-threatening sequelae of meningitis that can result from the dysfunctional anatomy makes it a condition that requires elevated clinical vigilance, especially when considering children with hearing loss associated with recurrent meningitis, otorrhea, or rhinorrhea.
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Affiliation(s)
- R Nick Hernandez
- Department of Neurological Surgery, New Jersey Medical School, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
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