胆脂瘤型中耳炎并发半规管瘘的临床分析及诊疗策略OA

OBJECTIVE To investigate the clinical characteristics of semicircular canal fistula(SCF)secondary to cholesteatomatous otitis media,including preoperative assessment,intraoperative management strategies,and postoperative outcomes.METHODS We retrospectively reviewed 37 patients(38 ears)with SCF treated at Shandong Provincial Hospital Affiliated to Shandong First Medical University between November 2019 and April 2025.Data on clinical symptoms,audiological assessments(pure-tone audiometry and tympanometry),vestibular function tests(caloric test,video head impulse test,and vestibular-evoked myogenic potentials),and temporal bone high-resolution computed tomography(HRCT)were collected.All patients underwent standardized cholesteatoma removal with fistula repair.Postoperative follow-up evaluated hearing outcomes,vestibular symptoms,and complications,aiming to improve diagnostic accuracy and summarize surgical principles and selection of repair materials.RESULTS The overall abnormal rate of preoperative vestibular testing was 92.1％(35/38),with abnormal rates of 89.5％for vHIT and 81.6％for VEMP,which were higher than the positive rate of temporal bone HRCT(71.1％,27/38).Intraoperatively,fistulas were predominantly located in the lateral semicircular canal(78.9％)and were mainly Dornhoffer type I(73.7％).After cholesteatoma removal and fistula repair,the air-bone gap(ABG)decreased from(28.41±11.99)dB HL preoperatively to(22.16±10.83)dB HL postoperatively,with a statistically significant difference(P<0.05).Transient postoperative vertigo occurred in 73.7％of cases and generally resolved within 1 month.No severe inner-ear injury or intracranial infection was observed.CONCLUSION Preoperative diagnosis of SCF should integrate imaging and vestibular function testing,which are highly complementary and,when combined,can effectively reduce missed diagnoses.Meticulous surgical technique,complete disease eradication,and individualized selection of repair materials can preserve hearing,control vertigo,and reduce recurrence,with overall safe and reliable outcomes.