Broken stray window
Introduction
Introduction to the broken window The rupture of the labyrinth membrane means that the annular ligament of the humerus foot plate and the rupture of the round window membrane cause the outer ear lymph of the inner ear to flow into the middle ear cavity to form the perilymphatic sputum, causing dizziness and deafness. In the rupture of the labyrinth window, the annular ligament (vestibular window membrane) is more broken than the round window membrane. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: tinnitus, deafness, nausea and vomiting, dizziness
Cause
Cause of rupture of lost window
According to Goodhill, injuries can be caused by two types of pressure transmission:
1 Explosive route (Explosive route): For the most common reason, the cerebrospinal fluid pressure is suddenly increased and transmitted to the inner ear, such as coughing, vomiting, and crying loudly. The cerebrospinal fluid conduction process is: cerebrospinal fluid cochlea Water pipe drum order basement membrane intermediate order vestibular membrane vestibular step humerus ligament middle ear; or cerebrospinal fluid inner auditory sieve plate balloon and elliptical capsule floor ligament middle ear.
2Inplosive route (Inplosive route): The sudden increase of pressure in the eustachian tube of the tympanic cavity is directly caused by the basement of the humerus and the round window pressing against the inner ear, such as flying, diving, blowing nose, playing musical instruments, hyperbaric chamber, gunshot wound, Boxing and sneezing, etc., the pressure in the nasopharyngeal cavity increases. The conduction process is: nasopharyngeal cavity eustachian tube bottom plate vestibular order cerebrospinal fluid; or by nasopharyngeal cavity eustachian tube round window membrane tympanic membrane cerebrospinal fluid.
3 direct injury: such as surgery and craniocerebral trauma.
4 congenital anomaly abnormalities: the cochlear aqueduct has a diameter of 0.02 mm in the inner mouth and a diameter of 2 to 3 mm in the outer port. If the diameter is abnormally wide, the circular window is sheared and loses its protective function. The lumen lacks choroid-like fibrous tissue, such as the tympanic lymph. If the pressure increases sharply, the window membrane can be ruptured. Generally, the left side catheter is larger than the right side, which can explain the phenomenon of more clinical left side disease. For example, the humerus floor is fixed in the oval window, and the ring ligament loses the buffering effect. It can also cause the round window membrane to rupture. According to animal experiments, the critical pressure of cerebrospinal fluid pressure to rupture the round window membrane is 2.67~4.00kPa. The simple round window membrane rupture only loses a few decibels, but the clinical findings are severe deafness. The rupture of the window membrane is accompanied by rupture of the membrane or cover membrane. It is caused by potassium poisoning of the cells produced by the mixing of internal and external lymph fluids. Stewart examined 68 cases of normal tibia specimens, 55% of which had round window aponeurosis, and the membrane was perforated. In the three forms of mesh and closure, Sando describes the round window film as two fan-shaped structures, not in one plane, the upper rear part is horizontal and the front lower part is relatively vertical, and the total area is 2.29±0.42 mm2. The third layer is 50-70m thick, and the edge is thick and thin at the center. The middle layer contains elastic fibers, blood vessels and nerves. There is a small tube opening on the inner side of the inner drum of 0.3mm drum. In humans, because the small tube is very thin, there is soft tissue filling. Therefore, intracranial hypertension has been significantly weakened when it reaches the perilymph, and it is not easy to cause membrane damage, but it can cause chronic progressive injury. On the contrary, infantile open cholangiocarcinoma and abnormal anatomy are prone to suffering.
Prevention
Lost window crack prevention
1. Rest in the bed, take the head high, avoid using force or nose.
2. Use antibiotics to prevent infection and use energy mixture as appropriate to promote rupture self-repair.
3. For patients who have been treated conservatively for 2 weeks, tympanic exploration should be performed as soon as possible, and the fascia of the temporalis or cartilage should be covered.
Complication
Lost window rupture complications Complications, tinnitus, deafness, nausea and vomiting
Some manifested as sudden severe tinnitus and deafness, accompanied by severe nausea, vomiting, etc., easily confused with irritability caused by other causes, and some only have dizziness, deafness occurs 1 to 2 years after the disease.
Symptom
Lost window rupture symptoms Common symptoms Nausea tinnitus movement disorders Deafness fatigue vertigo
Otological examination of the tympanic membrane is generally normal, occasionally congestion and turbidity and liquid level, there is a rotating nystagmus on the lower side of the ear, there is an incubation period, accompanied by dizziness, fatigue surrounding vestibular type, according to Singleton report, perilymphatic Positional nystagmus has a short incubation period and is not prone to fatigue. 26% to 60% of the fistula test is positive. Anyone with obvious head or ear pressure trauma or traumatic history, or flying, diving and exertion suddenly appear dizzy and deaf, and have fistula Those who have a positive test should think about this disease, should be hospitalized for observation, intracranial radiography, neurological examination, hearing and functional examination. Simmons (1979) proposed to perform hearing threshold examination from 400 to 1300 Hz for every 100 Hz. If there is a notch, it may indicate rupture of the endometrium. It should be differentiated from Meniere's disease, benign positional vertigo and other violent sputum. The value of acoustic impedance diagnosis is not great, and there is a risk of further damage. Not suitable for use.
Weisskopf et al. scraped all the guinea pig round window membranes and measured the postoperative hearing with a microphonic potential. Only 6dB of injury was detected. Simmosn speculated that the disease had severe deafness, and it must be complicated by other parts of the cochlea. Flint observed by scanning electron microscopy. Hair cells are damaged, limited to apical turn and basal turn, and are not proportional to hearing loss. Simmons has done a rat round window film puncture test, which can heal within one week after injury, and hearing can return to normal within 1 to 4 weeks. It is still difficult to explain the phenomenon of severe deafness in experiments.
Examine
Lost window rupture check
Otological examination of the tympanic membrane is generally normal, occasionally congestion and turbidity and liquid level, there is a rotating nystagmus on the lower side of the ear, there is an incubation period, accompanied by dizziness, fatigue surrounding vestibular type, should be hospitalized for observation, intracranial Tablets, neurological examination, hearing and functional examination, acoustic impedance diagnosis is of little value, and there is a risk of further damage to the lost, it should not be used.
Diagnosis
Lost window diagnosis diagnosis
Clinically, it should be differentiated from Meniere's disease, benign positional vertigo and other violent convulsions.
