Labyrinthectomy

The labyrinthectomy is mainly applied to patients with vertigo who cannot control the drug, accompanied by severe sensorineural hearing loss, speech frequency threshold is higher than 60dB, and language recognition rate is less than 70%. The principle of surgery is to completely remove all vestibular sensory epithelium. After the destruction of the vestibular terminal sensor, the bioelectrical activity of the vestibular nerve is eliminated, no pathological impulses, and the symptoms disappear completely. Currently commonly used labyrinthectomy has both tympanic and trans-emulsion processes. Treatment of diseases: neurological deafness Indication 1. Patients who have failed medical treatment still cannot control dizziness and progressive hearing loss after symptomatic treatment with diuretics, vestibular sedatives, vasodilators and other drugs. Generally, after more than one year of conservative treatment is invalid, surgery can be considered. 2. Late stage patients with complete loss of cochlear function, severe tinnitus. Severe hearing damage, still can not control the onset of vertigo, destructive surgery should be considered. 3. After the endolymphatic sac surgery, the vertigo is eliminated for more than 1 year. The symptoms of vertigo recurr and the hearing is still practical. The drainage port may be closed or blocked. The symptoms may disappear after re-draining or changing. If the symptoms recur and the hearing is very poor, destructive surgery is feasible. 4. After the endolymphatic sac surgery, the symptoms of vertigo continue to be unsatisfactory. If the patient's hearing is still at a practical level, consider transcranial fossa or vestibular neurotomy after labyrinth. If hearing has been severely degraded, it is feasible to have a destructive surgery. Contraindications 1. During acute exacerbation or acute infectious diseases, it is not suitable for surgery, and then consider surgery after remission. 2. Women's menstrual period is not suitable for surgery. 3. Cardiopulmonary function can not bear the operator. 4. Hyperglycemia, electrolyte imbalance, surgery can be corrected. 5. Patients with bilateral lesions generally do not undergo destructive surgery. If one ear hearing function is completely lost and the other ear has ear volatility and volatility hearing loss, non-destructive decompression should be considered first, and conservative endolymphatic sac decompression should be considered. Maybe you can save your hearing. Preoperative preparation The patient was supine, the head was biased to the opposite side, and the external ear canal and mastoid area were disinfected according to the mastoidectomy iodine, and the sterile towel was placed. Surgical procedure 1. Tympanic labyrinthectomy The incision was made by humeral surgery, and the tympanic ear canal flap was separated to expose the middle ear cavity. Separate the ankle joint to cut the iliac tendon, and use the crochet to remove the tibia from the vestibular window. If the long foot of the anvil affects the operation, the anvil can be removed and the tibia can be removed. When the tibial foot plate is removed, the inflated balloon can be seen in contact with the inner side of the foot plate, or there is a little fiber band adhesion, and the balloon-like tissue with the pigment can be taken out by a suction or crochet. Extend the crochet into the vestibular window, and move forward to the bottom of the cochlea. Upward from the deep surface of the facial nerve to the ampulla of the outer semicircular canal, and smear forward and downward to the ampulla of the posterior semicircular canal, thus achieving membrane destruction including the elliptical sac. organization. It is not possible to pass through the sieve area of the spheroidal crypt of the vestibular wall. Because it is very thin, cerebrospinal fluid leakage can occur once it is worn. In order to achieve more complete damage, the drum can be opened with a micro drill, first grinding a groove in the front of the round window, and then grinding the first tympanic step of the cochlea by the lower edge of the round window, followed by opening the vestibular step and In the second tympanic step, all the cochleas were removed except for the front end of the cochlea. The complete destruction of the cochlea is especially important for the treatment of tinnitus patients. It can be put into the vestibule with a small cotton ball, wipe the sensation epithelium of the ampulla, and the ellipse. The neuroepithelial vesicles and cystic plaques, which remove the tympanic bone, can be resected to neurofibroma in the cochlea. After the vestibular nerve sensory epithelium is completely excised, the ethanol can be dripped into the inner ear to achieve the purpose of completely destroying the sensory epithelium. The gelatin sponge of the imidamycin is used to fill the labyrinth, and the tympanic membrane of the external auditory canal is reset. Stuffing, incision suture, bandaging. 2. Transmural labyrinthectomy As with the tympanic cavity, the goal was to completely remove the neuroepithelial vestibular terminal. Surgery under general anesthesia, incision according to the mastoidectomy, expose the sinus, remove the mastoid air chamber, contour the semicircular canal shape, sigmoid sinus, jugular bulb and second abdominal tendon, retaining bone The integrity of the posterior wall of the external auditory canal. Use the small drill to open the upper, outer and rear three semicircular canals, expose the membrane to the labyrinth and remove or aspirate. After the three semicircular canals are all open, enter the vestibule deep in the facial nerve canal, remove the elliptic sac and balloon sac, and wait for three After the ampulla of the semicircular canal and the nerve endings of the two sacs are completely removed, the cochlear is removed according to the specific conditions. Finally, the free or pedicled iliac muscle flap is used to fill the vestibular and mastoid cavities to prevent the formation of traumatic neuroma in the vestibular nerve endings. After cleaning the operation cavity with antibiotic solution, the soft tissue was sutured in two layers, and the subcutaneous rubber piece was drained, bandaged, and the operation was terminated. complication Dizziness Although the semicircular canal has no function before operation, the vestibular nerve endings can still be discharged after the labyrinth is destroyed, so severe vertigo can occur and gradually recover after a few days. Because of the incomplete destruction of the vestibular peripheral receptor or the formation of traumatic neuroma, there is still postoperative vertigo. 2. Facial nerve injury When the ear canal approach is completely destructive, it is possible to damage the facial nerve in the tympanic cavity; the posterior approach through the ear may damage the knee between the tympanic segment and the facial nerve of the mastoid segment. Must be operated under the microscope, and familiar with the facial nerve signs, grinding the diamond near the facial nerve with a diamond bit to avoid facial nerve damage. 3. Cerebrospinal fluid leakage When the balloon is scraped off through the ear canal path, the spherical crypt of the inner wall of the vestibule is prevented from penetrating. If it is worn, cerebrospinal fluid leakage may occur. When the internal auditory canal is opened through the labyrinth cavity, a large amount of cerebrospinal fluid leakage may occur, and once cerebrospinal fluid leakage is formed, The fistula should be closed with connective tissue or muscle mass, filled with absorbable material, and the mastoid cavity filled with gauze. Postoperative diet Encourage patients to get enough nutrients to eat high-protein, high-vitamin, high-calorie, digestible diets.