耳鼻咽喉头颈外科学教学 2017刘绮明耳聋眩晕课件.pptVIP

Definition定义 Idiopathic endolymphatic hydrops of inner ear characterized by spontaneous attacks of vertigo, with associated fluctuating sensorineural hearing loss, tinnitus and aural fullness. 一种特发性膜迷路积水的内耳病，表现为反复发作性眩晕，波动性感音神经性听力损失，耳鸣和（或）耳胀闷感。 History历史 1861 – Prosper Meniere described classic symptoms and attributed to labyrinth法国医生首先报道此病 1871 – Knappin theorized dilatation of membranous Labyrinth 1938 – Hallpike and Portman confirmed endolymphatic hydrops via temporal bone histology 1972 – AAO defined the disease criteria，1985 – AAO-HNS revised the definition and establishes reporting protocols，1995 – AAO-HNS revised the definition and reporting protocols again.美国耳鼻咽喉-头颈外科协会制定的梅尼埃病诊断治疗指南. 2015-Barany Society make the disease criteia.巴拉尼协会制定了梅尼埃病的诊治标准。（中国--2006年贵阳标准） Incidence发病率 15/100,000, 4~90Y, 40~50Y Male/Female 1:1-1:1.3 Unilateral 单侧first, 41.5% bilateral involvement双侧受累 occurs (Kitahara) Etiology病因 Idiopathic自发性(the cause is unkrown) Congenital abnormality 先天性解剖结构异常（Endolymphatic duct obstruction and endolymph malabsorption内淋巴管阻塞与内淋巴吸收障碍） Immunological-immune complex deposition免疫反应学说 Inner ear ischemia 内耳缺血学说 Inflammation and trauma炎症与外伤 Endocrine and autonomic nerves disorder内分泌障碍自主神经功能紊乱 Genetic factors遗传学说 Pathophysiology病理生理 endolymphatic hydrops 膜迷路积水 Normal membranous labyrinth 正常的膜迷路 Dilated membranous labyrinth in Menieres disease (Hydrops) 肿胀的膜迷路 Pathophysiology病理生理 Endolymphatic hydrops leads to distortion of membranous labyrinth内淋巴积水导致膜迷路变形 Reisner’s membrane can be seen bulging into the scala vestibuli in some histologic studies前庭膜推向前庭阶 Microruptures -- endolymph and perilymph mix—ions imbalance—biochemical disorder--may lead to episodic attacks膜迷路破裂导致症状出现 Clinical presentation临床表现 typical symptoms典型症状(4 features特征) Recurrent attacks of spontaneous vertigo(96.2%)反复自发性眩晕发作 :several minutes or hours Fluctuating and progressive hearing loss(87.7%)波动性、渐进性听力下降: diplacusis复听 Tinnitus(91.1%) 耳鸣 Aural fullness耳胀闷感