摘要
背景：聽小骨成形手術的目的是清除病灶及改善聽力，手術是否能成功與很多因素有關。本研究的目的是針對部分中耳腔疾病所導致的傳導性聽障患者，藉由施行聽小骨成形手術來重建聽力，並分析其聽力重建的結果。 方法：本研究採回溯性研究方式，自2003年7月至2005年7月間，共有408人次接受中耳腔手術，其中有84人次接受同一位醫師施行聽小骨成形手術，並追蹤術後聽力大於6個月以上，病患依先天性聽小骨異常、中耳炎、膽脂瘤者分組，分析各組疾病狀況、手術方式、手術前後聽力的情形以及併發症。聽力分析採0.5K、1K、2KHz之平均值。 結果：在84耳的中耳腔手術中，包含34個男性耳及50個女性耳，平均年齡為44.3歲，平均聽力追蹤為13個月。依先天性聽小骨異常、中耳炎、膽脂瘤分組，分別佔8、44、32耳，而術後氣骨導差(air-bone gap, ABG)關至20dB以內分別占62.5%、54.5%、21.9%。術後的追蹤情形，因人工聽小骨沾黏而再一次手術者，分別為1、1及3名；此外中耳炎組有1名穿孔未癒合，膽脂瘤組有1名術後發生迷路炎。 結論：藉由施行聽小骨成形手術，來重建中耳腔疾病所導致的傳導性聽障，在臨床的預後方面，對於非膽脂瘤的患者在熟練的手術技巧下，可以增進病患的聽力；而膽脂瘤患者在根除腫瘤外，可以在聽小骨拆除後來重建聽力。但對於影響聽小骨成形術長期預後的各別因素，我們仍須依賴更多的病例追蹤與持續的觀察。
並列摘要
BACKGROUND: The goal of ossiculoplasty is to eradicate disease in the middle ear and to reconstruct the hearing mechanism. The success rate is influenced by many factors. The aim of the current study is to analyze the hearing results after ossiculoplasty among patients with conductive hearing loss induced by middle ear disease. METHODS: Retrospective analysis was performed on 408 cases undergoing middle ear surgery between July 2003 and July 2005. There were 84 patients who had ossiculoplasty performed by the same senior doctor. After the surgery, all of their hearing results were followed up for more than 6 months. Patients were grouped into congenital ossicular anomalies, chronic otitis media and cholesteatoma, and then analyzed for present disease conditions, surgery methods, hearing status and complications. The three-tone average of 0.5, 1 and 2 kHz was used for hearing analysis. RESULTS: Of 84 ossiculoplasty cases, 34 were male and 50 were female. The average age was 44.3 years and average follow-up period was 13 months. The cases were divided into 3 groups: congenital ossicular anomalies, COM and cholesteatoma with case numbers of 8, 44 and 32, respectively. In the present series, 62.5%, 54.5% and 21.9% of each group had an air-bone gap of 20 dB or better. However, 4 cases received repeat surgery due to adhesion of ossicular replacement prostheses. Further, 1 case with COM had a non-healing perforation and 1 case with cholesteatoma had the complication of labyrinthitis. CONCLUSION: The overall outcome of non-cholesteatoma cases showed efficient improvement of hearing by skillfully performed ossiculoplasty. Of the cholesteatoma cases, hearing was reconstructed after removing ossicles for disease eradication. To recognize individual unfavorable factors influencing the long-term outcome of ossiculoplasty, we need more cases to follow up and further inspection.