搏动性耳鸣的治疗研究进展

Treatment of pulsatile tinnitus: a literature review

摘要

搏动性耳鸣(pulsatile tinnitus, PT)是一种具有节律性的耳鸣,其发生机制尚不明确,病因涉及血管性病变或畸形、乙状窦壁缺损及憩室、副神经节瘤、上半规管裂综合征、腭肌及中耳肌阵挛等多种头颈部疾病。 PT 的治疗以外科治疗为主,内科治疗适用范围相对较小,临床常用的治疗方法包括以支架置入术、弹簧圈栓塞术等的血管内治疗与以表面重建术为代表的外科手术治疗,大部分 PT 经治症状均能明显减轻或完全消除,且长期疗效理想、不良事件率低,但由于发病机制不明确,目前尚无 PT 治疗方面的统一意见,如何分辨 PT 的具体病因并给予对应治疗以及部分治疗方法是否适用于 PT 等问题仍需进一步研究与讨论。 本文通过查阅近年与 PT 治疗相关的中、外文文献,总结与分析了目前临床常见的 PT 病因与对应治疗研究进展,以期为 PT 的临床诊疗工作提供参考。

Abstract

Pulsatile tinnitus (PT) is a type of rhythmic tinnitus symptom. The pathological mechanism of PT is still unclear, its causes include various diseases such as vascular malformation, sigmoid sinus wall dehiscence/ diverticulum, paraganglioma, superior canal dehiscence syndrome, and palatal/ middle ear myoclonus, etc. Surgical treatment is the main method of PT, the scope of medical treatment is smaller in comparison. Endovascular stenting, coil embolization and surgical treatment represented by surface reconstruction have been widely used in clinical management. Most of PAD can be significantly reduced or eliminated after treatment, with ideal long-term efficacy and low adverse event rate. However, because the pathogenesis of PT is still unclear, there is no unified opinion for the management of PT, how to clarify the specific cause and choose the corresponding treatment, and whether some treatment methods are suitable for PT still require further research and discussion. This article reviews the literatures related to the treatment of PT in recent years, summarizes the common clinical causes of PT and the research progress of corresponding treatments, aiming to provide reference for the clinical diagnosis and treatment of PT.

关键词

耳鸣 / 搏动性耳鸣 / 乙状窦壁缺损 / 表面重建术

Key words

Tinnitus / Pulsatile tinnitus / Sigmoid sinus wall anomalies / Reconstruction

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