内耳窓破裂症の臨床像

抄録

Ten cases with labyrinthine window ruptures associated with hearing loss and vertigo are reported. Eight cases were treated surgically, and two conservatively. Surgical exploration revealed that the round window alone was ruptured in five cases, oval window alone in one, and both windows in two. The ruptures of the windows were closed with perichondrium or fascia. After surgical intervention, the attacks of vertigo subsided, while improvement of hearing was attained only in a few cases. In 7 of 10 patients, there was a definite history of head trauma prior to onset. In the other three patients, history of severe vomiting, cough, or physical exertion prior to the onset was proved. At the onset of the disease, the auditory and vestibular symptoms did not always developed simultaneously. In four cases, vertigo developed a few hours or a few days later following the onset of the hearing loss and tinnitus.
The vestibular findings of positional nystagmus, canal paresis, and fistula symptom, associated with sudden or fluctuating hearing loss, were of diagnostic value in labyrinthine window ruptures. Positional nystagmus was usually prominent especially in head hanging position or in supine position with the involved ear down, in which the flow of perilymph from the fistula increased. Positive fistula test in oval window rupture was important to determine the side of the involved windows. There was no specific type of hearing loss peculiar to labyrinthine window rupture.