WordNet

an abnormal passage leading from a suppurating cavity to the body surface (同)sinus
the bodily fluid that fills the space between the bony labyrinth and the membranous labyrinth of the inner ear

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瘻(ろう)菅(長い菅状になった潰瘍)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/01/27 11:40:51」(JST)

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A labyrinthine fistula is an abnormal opening in the bony capsule of the inner ear, resulting in leakage of the perilymph from the semicircular canals into the middle ear.^[1] This includes specifically a perilymph fistula (PLF), an abnormal connection between the fluid of the inner ear and the air-filled middle ear. This connection is caused by a rupture of the oval window or round window that separate the inner and middle ear.^[1] Another type of l.f. is a semicircular canal dehiscence, which allows the inner ear to be influenced by the intracranial pressure directly.

These can be both congenital or develop over time with the thinning of the otic capsule by the persistent pulsations of the intracranial pressures against the bones of the skull. Finally, disease conditions—for example cholesteatoma—can result in a labyrinthine fistula.^[2] Traumatic events, with excessive pressure changes to the inner ear such as in deep-water diving, head trauma, or an extremely loud noise can lead to rupture and leakage.^[1]

PLF is a cause of dizziness, imbalance, and hearing loss—any or all of these symptoms can exist. Vertigo (an illusion of motion) is not common in this disorder. The most common cause of this fistula is head or ear trauma. Rapid increases of intracranial pressure can also result in a PLF. Rarely, these fistulas can be congenital, leading to progressive hearing loss and vertigo in childhood. It has also been a complication of a stapedectomy.

Unlike other vestibular systems that are treated well with physical therapy (BPPV), it is a contraindication for most patients with PLF. Patients are advised to treat with bed rest with the hopes of the membrane healing on their own.^[1]

When diagnosing, PLF should be differentiated from Ménière's disease. Tympanostomy has been reported to be a way to diagnose^[3] and cure PLF.

References

^ ^a ^b ^c ^d O'Sullivan, Susan B. (2007). Physical Rehabilitation (Fifth ed.). Philadelphia: Davis Company. pp. 1024.
^ Chen Z, Wu Y, Shi H, et al. (June 2009). "Surgical treatment of labyrinthine fistula caused by cholesteatoma with semicircular canal occlusion". Acta Otolaryngol.: 1–4. doi:10.1080/00016480902875083. PMID 19488888. http://www.informaworld.com/openurl?genre=article&doi=10.1080/00016480902875083&magic=pubmed%7C%7C1B69BA326FFE69C3F0A8F227DF8201D0.
^ Goto F, Ogawa K, Kunihiro T, Kurashima K, Kobayashi H, Kanzaki J (January 2001). "Perilymph fistula--45 case analysis". Auris Nasus Larynx 28 (1): 29–33. doi:10.1016/S0385-8146(00)00089-4. PMID 11137360. http://linkinghub.elsevier.com/retrieve/pii/S0385-8146(00)00089-4.

External links

http://www.dizziness-and-balance.com/disorders/unilat/fistula.html

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UpToDate Contents

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1. 回転性めまいの病態生理、病因、および鑑別診断 pathophysiology etiology and differential diagnosis of vertigo
2. 中耳外傷の評価およびマネージメント evaluation and management of middle ear trauma
3. 小児および思春期における浮動性めまいの評価 evaluation of dizziness in children and adolescents
4. 小児における聴覚障害：病因 hearing impairment in children etiology
5. Surgical resection of sporadic pancreatic neuroendocrine tumors

English Journal

Perilymph fistula presenting with contralateral symptoms.

Hermann M1, Coelho DH.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.Otol Neurotol.2014 Feb;35(2):301-4. doi: 10.1097/MAO.0b013e3182a43639.
OUTCOME OBJECTIVES: To report the case of a contralateral Tullio phenomenon, suggest possible pathophysiology, and give insight into normal vestibular physiology.PATIENTS: Twenty-year-old female subject who presented with 8-month symptoms of left-sided Tullio phenomenon after a motor vehicle collisi
PMID 24448290

Congenital perilymph fistula causing recurrent meningitis: lessons learnt from a single-institution case series.

Rupa V1, Agarwal I, Rajshekhar V.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.Otolaryngol Head Neck Surg.2014 Feb;150(2):285-91. doi: 10.1177/0194599813513716. Epub 2013 Dec 13.
OBJECTIVE: To study the steps involved in definitive evaluation and successful management of patients with congenital perilymph fistula presenting with recurrent meningitis.STUDY DESIGN: Case series with chart review.SETTING: Tertiary care center.SUBJECTS AND METHODS: The case records of 11 patients
PMID 24334961

Enhanced oval window and blocked round window passages for middle-inner ear transportation of gadolinium in guinea pigs with a perforated round window membrane.

Zou J1, Pyykkö I.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery.Eur Arch Otorhinolaryngol.2013 Dec 11. [Epub ahead of print]
To elucidate the communication between the middle and inner ear, and the fluid dynamics of the inner ear with the perilymphatic fistula (PLF) of the round window membrane (RWM). The PLF of the RWM was created in nine guinea pigs. Gadolinium diethylenetriamine pentaacetic acid bismethylamide (Gd-DTPA
PMID 24323165

Japanese Journal

当科における外リンパ瘻手術症例の臨床的検討

岸本逸平,内藤泰,藤原敬三,菊地正弘,山崎博司,金沢佑治,栗原理紗
Equilibrium Research 72(2), 107-111, 2013
… Perilymphatic fistula are difficult to diagnose, and the associated hearing loss is not easy to treat. … In 18 patients with perilymphatic fistula, who visited our department from April 2008 to December 2010 with a confirmed diagnosis by exploratory tympanotomy, 19 ears were retrospectively analyzed from chart review. …
NAID 130003372589

内視鏡を用いた経外耳道鼓膜中耳手術の手技と工夫

五十嵐良和
耳鼻咽喉科臨床. 補冊 = Practica otologica. Suppl. (134), 34-39, 2012-07-01
NAID 10030773815

難聴・めまいのバイオマーカーCTPの新展開

池園哲郎
Otology Japan 22(5), 911-917, 2012
内耳リンパ腔と周囲臓器のあいだに瘻孔が生じ、生理機能が障害される疾患が外リンパ瘻である。これまでは外リンパ瘻の診断は外リンパ漏出の有無を視覚的に判断していたが、これは主観的であると批判されてきた。そこで新たな診断マーカーを求めて内耳蛋白のプロテオーム解析を行った結果、遺伝性難聴の原因遺伝子COCHの蛋白産物のアイソフォームCTP (cochlin-tomoprotein) を見いだした。外リンパ瘻 …
NAID 130003373592

Related Pictures

★リンクテーブル★

リンク元

「外リンパ瘻」

Labyrinthine fistula
	Classification and external resources
	; Cross-section of cochlea. Perilymph is located in the scala tympani and scala vestibuli - the aqua regions at the top and bottom of the diagram.
ICD-10	H83.1
ICD-9	386.4
DiseasesDB	32218
eMedicine	emerg/414

　　[★]

英: perilymphatic fistula, perilymph fistula
関: 内耳窓破裂
関: 外リンパ液、内リンパ液

概念

外的・内的な圧力が内耳にかかり、前庭窓もしくは蝸牛窓の破綻を来たして内耳症状をきたしたもの

病因

explosive route：脊髄圧の急激な上昇(力む、咳き込む、鼻をかむなど)
implosive route：内耳圧の急激な上昇(Valsalva法、気圧性外傷など)

徴候

瘻孔現象
Tullio現象

症状

難聴、耳鳴、耳閉塞感、めまい、平衡感覚障害。

治療

ベットでの安静、頭部挙上、および力むことを回避する。数週間の保存療法で回復しなければ外科手術により瘻孔にパッチを当てる。(参考1)

予後

再発率は10%である。 (参考1)

参考

1. [charged] Pathophysiology, etiology, and differential diagnosis of vertigo - uptodate [1]

[O.27Sullivan_2007_1024-1] O'Sullivan, Susan B. (2007). Physical Rehabilitation (Fifth ed.). Philadelphia: Davis Company. pp. 1024.

[pmid19488888-2] Chen Z, Wu Y, Shi H, et al. (June 2009). "Surgical treatment of labyrinthine fistula caused by cholesteatoma with semicircular canal occlusion". Acta Otolaryngol.: 1–4. doi:10.1080/00016480902875083. PMID 19488888. http://www.informaworld.com/openurl?genre=article&doi=10.1080/00016480902875083&magic=pubmed%7C%7C1B69BA326FFE69C3F0A8F227DF8201D0.

[pmid11137360-3] Goto F, Ogawa K, Kunihiro T, Kurashima K, Kobayashi H, Kanzaki J (January 2001). "Perilymph fistula--45 case analysis". Auris Nasus Larynx 28 (1): 29–33. doi:10.1016/S0385-8146(00)00089-4. PMID 11137360. http://linkinghub.elsevier.com/retrieve/pii/S0385-8146(00)00089-4.

匿名

検索

案内

案内

perilymph fistula