- 期刊
Age and the Prognosis of Tympanoplasty TypeⅠ
年齡與鼓室成形術第一型的預後關係
摘要
處理慢性中耳炎而實施鼓室成形術時，很多因素可以決定手術的預後，包括中耳炎的範圍及嚴重度，耳咽管功能，實施的術者的技術等均有關聯。至於年齡的因素對於預後的影響，則有不同的看法。本研究收集4年內由同一位醫師所執行的100例鼓室成形術第一型，年齡由16歲至65歲，平均37.9歲。 依日本聽語協會的手術成功率標準來分析，術後氣導閾達到40分貝以內者，以16-25歲年齡層最多，有80%；56-65歲年齡層最少，有66.7%。術後聽力改善超過15分貝者，以36-45歲最多，有60.9%；年齡層最少，有26.7%。術後氣骨導差在20分貝以內者，以16-25歲最多，有70%；56-65歲最少，有40%。總體而言，手術成功率最好的是16-25歲年齡最好，達到80%；而56-65歲年齡層成功率最低，有66.7%。全體平均成功率為74%。 然而在將年齡與個人所獲得聽力做線性迴歸分析時，不同年齡間並沒有顯著的差異，平均達12.9分貝。另外術後質導閾值雖然隨年齡增加而增加，但是術前氣導閾值也隨年齡增加而增加，再加上所獲得的聽力沒有顯著的差異，顯示高年齡者術後聽力狀況較年紀輕者差的原因是根源於術前較惡化的聽力。對於年紀輕者患者，雖然術後所獲得的聽力沒有統計上的優勢，但是由於術前的聽力狀況較佳，所以術後氣導閾值也比較容易達到所謂的社會適應標準，在評估手術成功率時便佔有較大的優勢。年紀較大的患者，雖然術後的氣導閾值較高。但由於施行鼓室成形術第一型之後，可以獲得乾燥耳，若需要配戴助聽器時也較方便。所以對年紀較高者的患者，建議實施鼓室成形術是應該予以鼓勵的。
關鍵字
無資料並列摘要
The purpose of this study is to evaluate the influence of the age factor on the prognosis for tympanoplasty type I. One hundred subjects (41males, 59 females, 16-65years old, mean age 37.9 years old) who accepted tympanoplasty type I during a four-year period were reviewed. The success rate of the surgery was analyzed wuing the three criteria suggested by the Japan Clinical Otology Committee. In addition, linear regression was used to analyze the correlations between age and pre-operative hearing, post-operative hearing and hearing gain. Using the proportion of patients with a postoperative hearing threshold within 40 dB as the criterion, the 16-25 year-old group had the best results (80%) and the 56-65 year-old group had the worst results (66.7%). Using hearing gain exceeding 15 dB as the criterion, the best result was for the 36-45 year-old group (60.9%), and the worst result was for the 56-65 year-old group (26.7%). Using post-operativfe air-bone gap within 20 dB as the criterion, the best result was for the 16-25 vear-old group (70%), and the worst result was for the 56-65 year-old group (40%). The best total success rate was for the 16-25 year-old group (80%) and the worst was for the 56-65 year-old group (66.7%). The total average success rate was 74%. Linear regression analysis showed that the postoperative hearing thresholds increased significantly with advancing age. But there was no statistically significant difference in hearing gain between the various age groups and the preoperative hearing thresholds also increased with advancing age. In conclusion, although tympanoplasty type I offered the patients a similar hearing gain among the different age groups, from the point of view of social function, it offered younger people a better chance of social hearing than the elderly and a higher surgical success rate. The poor postoperative hearing of the elderly was a result of their poor preoperative hearing condition.