- 期刊
唇顎裂病患接受正顎手術後之聽力變化
Audiotory Change after Orthognathic Surgery in Patient with Cleft Lip and Palate
摘要
背景：正顎手術已被廣泛用於先天及後天顏面齒槽錯位的病患上，雖然正顎手術導致咽部肌肉改變及術後的腫脹，進而造成中耳腔功能失調及中耳炎，但是顎骨畸形可經由此手術矯正過來，過去文獻多在探討唇顎裂病患的聽力變化，較少討論唇顎裂病患成年後接受正顎手術後的聽力變化，故這也是本篇研究的目的。方法：從2014年6月到2015年1月，共有25名唇顎裂的病患接受正顎手術。臨床聽力檢查包括純音聽力檢查、語音聽力檢査、鼓室圖檢查，分成術前、術後1週、術後3個月。結果：在鼓室圖方面其結果顯示術前皆呈現type A圖形，在手術後1週，有42％的個案（n=21）爲type C，即中耳壓力（middle ear pressure, MEP）由正常轉爲負壓（p ＜.001），並有2％（n = 1）爲type B呈現中耳積液（middle ear effusion）的情形。剩餘5690個案（n = 28）鼓室圖仍維持type A；手術後3個月type C類型的個案下降爲16％（n = 8），而type A的個案已由56％提升爲82％（n = 41）。但仍然有2％耳朵（n = 1）鼓室圖為type B的情形。在純音聽力檢查方面，術後1週發現左右兩耳在0.25K Hz部分的聽力閾値相較術前皆有相當顯著地增加（p ＜0.001）。而左側在整體中低頻率（0.5K, 1K Hz）部分的閾值上也有顯著性的增加（p ＜0.05），右側則較不明顯。至手術後3個月，發現相較於術後1週時的檢查結果，左右兩耳在中低頻部分的閾值都有下降，在0.25K Hz部分閾値的改變甚至有達顯著差異。結論：本研究顯示：正顎手術可能會導致一些聽力系統損傷。然而，大多數的損傷多爲短暫且輕微。
並列摘要
BACKGROUND: Orthognathic surgery (OGS) is widely used to correct congenital and acquired dento-facial deformities. Jaw deformities can be corrected by well-designed OGS despite the resulting changes in pharyngeal muscles and the postoperative swelling which usually results in dysfunction of the middle ear and otitis media. In the past, many articles reporting about the changes in auditory function of cleft palate patient had been published, but few article discussed this topic about the hearing trend of cleft palate patient who had received OGS at adulthood. Therefore, this is also the purpose of this article. METHOD: From June, 2014 to January, 2015, we enrolled 25 patients who underwent OGS and arranged hearing exams including pure tone audiometry, speech discrimination and tympanometry at the time of pre-operation and one week and three months after surgery. RESULTS: In tympanometry, all patients were type A before the operation. One week after surgery, 21 (42%) were type C as middle ear pressure (MEP) shifted from normal to negative, one (2%) was type B, meaning of middle ear effusion, and the others (56%) were normal. On pure tone audiometry, the hearing threshhold showed significant increase in 0.25 K Hz bilaterally one week after surgery. The hearing threshhold showed significant increase in 0.5 K Hz and 1 K Hz in the left ear, and was not remarkable in the right. Three months after surgery, the hearing threshhold decreased in the middle and lower frequencies compared with the results one week after surgery, especially in 0.25 K Hz where it was statistically significant. CONCLUSION: OGS may result in hearing impairment; however, most of the injuries are temporary and minor.