中耳壓力調控功能對第一型鼓室成型術的預後影響

Middle-Ear Pressure Regulation Functions to Predict the Outcome of Type 1 Tympanoplasty

林軼化(Yi-Hua Lin) ； 蔡明洲(Ming-Chou Tsai) ； 康焜泰(Kun-Tai Kang) ； 許權振(Chuan-Jen Hsu) ； 張維修(Wei-Hsiu Chang)

《台灣耳鼻喉頭頸外科雜誌》 49卷4期 (2014/12) Pp. 217-224

https://doi.org/10.6286/2014.49.4.217

摘要

背景：耳膜破損可藉由鼓室成型手術來改善聽力情況。一般認為歐氏管功能不良會影響中耳壓力調控功能，本研究將乳突氣化程度納入中耳壓力調控功能並分析對第一型鼓室成型手術的影響。方法：本研究收集臺大醫院耳鼻喉部在2006年1月到2011年1月間接受第一型鼓室成型手術的病例做病歷回顧。以灌氣—放氣測試（inflation-deflation test）來評估歐氏管正壓與負壓的調控功能。以乳突X光攝影檢查來評估乳突氣化程度，並取樣30名同時期於臺大醫院接受乳突X光攝影檢查的非中耳炎病人之乳突面積的平均值作為正常乳突氣化程度的面積。綜合分析中耳壓力調控功能對第一型鼓室成型手術結果的相關性。結果：共計111耳（109名，女70名，男39名）。年齡為45.83歲（從7歲到76歲）。接受第一型鼓室成型手術的成功率為81.1%（90/111）。3個影響中耳壓力調控功能的參數包括歐氏管正壓調控功能、歐氏管負壓調控功能、和乳突氣化程度都無法單獨顯著的影響第一型鼓室成型手術結果。但結果顯示在3個參數都不良的情況下將對手術結果產生顯著的不良影響（p=0.025）。結論：本研究發現中耳壓力調控功能不好，接受第一型鼓室成型手術後較易失敗。

關鍵字

中耳壓力調控功能 ； 第一型鼓室成型手術 ； 歐氏管功能 ； 乳突氣化程度

並列摘要

BACKGROUND: Restoration of sound-conducting mechanism of the perforated ear drum can be accomplished by tympanoplasty. Although it was well known that poor Eustachian tube function will have an impact on middle-ear pressure-regulation function. This study take mastoid aeration into consideration in middle-ear pressureregulation function and further analysis the influence of middle-ear pressure-regulation function on type I tympanoplasty. METHODS: We reviewed charts of patients who received type 1 tympanoplasty between the period of January 2006 and January 2011 in National Taiwan University Hospital. We use inflation-deflation test for evaluating Eustachian tube positivepressure-regulation function and negative-pressure-regulation function. Mastoid lateral projection x-rays were examined for evaluating the mastoid aeration. We collected data of 30 persons who received mastoid lateral projection x-ray in the mean time. The average mastoid aeration area of these 30 persons was used as the defined normal mastoid aeration area. We then analyzed the correlation about the middle-ear pressureregulation function and the outcome of type I tympanoplasty. RESULTS: There were 111 ears (109 patients, 70 female and 39 male). Average age were 45.83 years old, ranges from 7 years old to 76 years old. The successful rate of type I tympanoplasty was 81.1% (90/111). All three parameters that influenced the middle-ear pressure-regulation function, included Eustachian tube positive pressureregulation function and Eustachian tube negative pressure-regulation function and mastoid aeration, don't significant influenced the outcome of type I tympanoplasty. But significantly higher incidence of poor outcome was seen only when all the three parameters were poor (p=0.025). CONCLUSIONS: Our result showed that impairment of middle-ear pressure-regulation function was associated with poor outcome of type I tympanoplasty.

並列關鍵字

middle-ear pressure-regulation functions ； tympanoplasty type I ； eustachian tube function ； mastoid aeration