• 期刊

黴菌鼻竇炎的診斷與治療

黴菌鼻竇炎可分為非侵犯性和侵犯性兩大類：非侵犯性包括過敏性黴菌鼻竇炎和黴菌球兩種；侵犯性黴菌鼻竇炎包括急性、慢性和肉芽型慢性三種。黴菌鼻竇炎的分類依據患者免疫狀況、臨床表現、影像學、病理和微生物檢查的結果判斷，各分類有其特徵，但也有共通的表現：過敏性黴菌鼻竇炎發生於過敏體質者；黴菌球發生在免疫力正常或稍有減弱者，常發生於單一鼻竇；侵犯性黴菌鼻竇炎常發生在免疫不全者，如嗜中性球不足、糖尿病、移植患者、長期使用類固醇者，除了感染鼻腔鼻竇，常有眼及中樞的侵犯，除造成功能損傷，亦可能發生致命性的感染。本文介紹黴菌鼻竇炎的分類和定義，並回顧國内外文獻，希望臨床醫師能熟悉黴菌鼻竇炎的診斷與治療。

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經口機械手臂治療睡眠呼吸中止症之術後味覺症狀追蹤

背景：手術治療睡眠呼吸中止症中，經口機械手臂舌根縮減術在軟組織手術上的效益逐漸備受肯定。然而對於術後長短期之症狀，如吞嚥、味覺的變化等觀察，缺乏系統性文獻探討，這代表患者的手術後品質可以進一步闡明，故提出本院味覺觀察結果。本研究呈現經口機械手臂治療睡眠呼吸中止症術後長短期之主觀味覺變化結果。方法：15名睡眠呼吸中止症個案接受懸壅垂顎咽成形術與側咽成形術，並以經口機械手臂執行3 cm寬度舌根縮減術之後，蒐集該15名患者味覺變化數據。使用視覺輔助味覺評估量表，於術後2週、3週、4週、3個月、5個月及2年定期追蹤並評估甜味、酸味、苦味、鹹味、鮮味及幻味之主觀感覺，並分析味覺障礙的種類與持續時間。結果：術後5個月結果顯示，73.3%個案甜味、酸味恢復正常，68.8%個案苦味、鹹味恢復正常，53.3%個案鮮味恢復正常，無患者表示有幻味（金屬味）；術後2年結果顯示，93.3%個案甜味恢復正常，86.7%個案酸味、鹹味與鮮味恢復正常，無患者表示有苦味與幻味。結論：研究結果顯示經口機械手臂治療睡眠呼吸中止症，患者術後的長短期味覺異常須留意。

• 期刊

The Multiparametric Acoustic Analysis of Benign Vocal Lesions

BACKGROUND: The objective of this study was to investigate the differences in acoustic parameters between the patients with benign vocal lesions (nodule/polyp) before and after laryngomicrosurgery. METHODS: Sixteen patients who received laryngomicrosurgery were recruited by retrospective cohort study from August 1, 2018, through August 1, 2019. The objective voice parameters were collected before and after laryngomicrosurgery. Patients' collected voice parameters were analyzed between the two groups with Wilcoxon signed ranks test. RESULTS: The variation of the fundamental frequency variation (vFo), The peak-amplitude variation(vAm) and the degree of voice breaks (DVB) were improved after laryngomicrosurgery. There was no significant improvement in the noise-to-harmonic ratio (NHR), the voice turbulence index (VTI), the soft phonation index (SPI) and the degree of subharmonics (DSH). CONCLUSIONS: This study shows that the laryngomicrosurgery can improve the voice parameters of vFo, vAm, and DVB. Due to the small number of patients, additional studies are warranted for better validate this result.

• 期刊

Button Battery as Foreign Body in Nasal Cavity-Case Series and Literature Review

BACKGROUND: Button batteries are very common. Unintentional placement of such a battery into the nasal cavity may cause irreversible problems if the battery is not immediately removed. This study discusses the clinical presentation and management of these foreign bodies and raises awareness regarding this hazard. METHODS: We retrospectively collected nine cases of button batteries as nasal foreign bodies from January 2010 to October 2019 in our department. The charts, laboratory examination results, and images were analyzed for each case. RESULTS: The average follow-up period was 4 weeks. The mean age was 3.29 years (range: 23-52 months). Most of the children (77.8%) had placed the button battery into the left nasal cavity. Four patients (44.4%) developed septal perforation. No other major complications were noted. CONCLUSIONS: Early diagnosis with prompt management is important for preventing lifelong sequela. For children presenting with brownish rusty-like nasal discharge or epistaxis, physicians should consider a nasal foreign body, especially a button battery.

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成骨不全引起的耳硬化症之人工耳蝸植入－病例報告

成骨不全（osteogenesis Imperfecta）是由第一型膠原蛋白製造缺陷所引起减少骨量及強度的遺傳疾病，發生率約為1/20,000。在臨床及組織學上除了肢體變形外，也發現耳硬化症等臨床表徵。患者在成年早期發生聽力損失時，可能是傳導性失聰，感覺神經性失聰或混合性失聰。1名53歲女性患者，於30歲時發現聽損，左耳於7、8年前聽力急遽下降至極重度聽損，1年前右耳聽力也急遽下降至極重度聽損，佩戴助聽器亦無法辨識語音與人溝通。純音聽力檢查：右耳90 dB／左耳105 dB。高解析度顳骨電腦斷層顯示雙耳都有Grade 2C的耳硬化症。病患接受右側人工耳蝸植入，植入時圓窗不明顯，吾等使用cochlear nucleus CI 24RE預彎電極以advance off-stylet方式植入。術後NRT 22個電極皆有反應。病人術後2週開頻，1週後調頻即可講電話，沒有面神經刺激等併發症。因病例罕見，特提出報告。

• 期刊

鼓室軟骨片置入術治療頑固性耳咽管開放症－病例報告

耳咽管開放症之病因為耳咽管功能異常，無法順利關閉，患者有耳悶、自聽增強等症狀，當患者彎腰低頭或平躺時症狀有所改善。目前常見的治療方法包括保守觀察、增加體重、使用鼻滴劑、中耳通氣管置放、耳咽管填塞及耳咽管重建等。本文報告1名64歲女性，因耳悶及自聽增強無法緩解，經診斷後為耳咽管開放症。病患曾接受中耳通氣管置放、鼻滴劑及兩次經鼻耳咽管填塞，治療後主觀症狀仍持續存在。我們將病人的耳珠軟骨裁切後，經鼓膜切開處置入耳咽管峽部，病患術後恢復良好，耳悶及自聽增強主觀症狀均有明顯改善，無耳部不適。

• 期刊

Lemierre's Syndrome－抗生素時代後罕見之急性咽喉炎併發症－病例報告

本篇個案報告討論1名60歲男性病患，上呼吸道感染1週後，以深頸部膿瘍為表現之Lemierre's syndrome。雖然此個案之血液細菌培養中無典型Fusobacterium Necrophorum，但病患之頸靜脈血栓及肺膿瘍之表現高度暗示Lemierre's syndrome之診斷。在抗生素發現及廣泛使用後，此診斷已不復常見，且其致死率也具變異性。因此，早期診斷及抗生素使用對此疾病之治療非常關鍵。此案例也強調在抗生素治療無效後，適時手術進行膿瘍引流，可避免併發症及降低致死率。我們也藉文獻回顧來探討抗凝血藥物在Lemierre's syndrome治療的適當性。

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Lymphangiomatous Polyp in the Nasopharynx-Case Report

Lymphangioma is a rare congenital tumor of the lymphatic system that is thought to result from the failure of the lymphatic system to communicate with the venous system. They are most often seen in children and are frequently located in the head and neck region. Nasopharynx that involves an isolated lymphangioma is extremely rare, with very few cases having been reported. This paper presents a rare case of nasopharynx lymphangiomatous polyp. It is the first case report in English in Eastern Asia.

• 期刊

Spindle Cell Carcinoma in Unknown Primary Head and Neck Cancer-Case Report

Spindle cell carcinoma, as defined by the National Institutes of Health, is also known as sarcomatoid carcinoma. It is a type of cancer that appears to be a mixture of carcinoma and sarcoma. The sarcoma-like cells are often spindle cells. The overlapping effects of both cancers mean that misdiagnosis and mortality rates are high for rare cases. This paper presents a rare case of a 70-year old male with neck mass, which was initially diagnosed as myeloid sarcoma, but later diagnosed as spindle cell carcinoma in unknown primary head and neck cancer. He then received concurrent chemoradiotherapy and eventually expired 6 months after the onset of symptoms. To the authors' best knowledge, this is the first case of spindle cell carcinoma in unknown primary head and neck cancer to be reported in English. So we presented how this rare case was diagnosed and treated, expecting those similar patients in the future could have better management.

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甲狀舌囊腫併喉部侵犯－病例報告

甲狀舌囊腫源自於甲狀舌管，是兒童最常見的先天性腫塊，腫塊通常表現於頸部中央。我們觀察到某些複雜性的甲狀舌囊腫會伴有喉部侵犯，臨床表現除了頸部腫塊之外，也會出現喉部症狀，包括咽喉異物感、聲音沙啞、吞嚥障礙、或是呼吸困難。理學檢查後常發現假聲帶隆起；影像學檢查顯示囊狀病灶經由甲狀舌骨膜進入會厭前間隙，呈現啞鈴狀。手術經由頸部將病灶移除，術後喉部功能逐漸回復正常。考量呼吸道風險，術後需考慮留置氣管內管觀察，除非插管困難，否則不需要實施氣管切開手術。