- 期刊
以鐙骨小窗術治療耳硬化症－四年的經驗
Stapedotomy for Otoslerosis-Experience of Four Years
摘要
背景及目的：本研究旨在以鐙骨小窗術治療耳硬化症患者，比較國人治療的結果與盛行地區的結果是否有所不同，作為台灣治療耳硬化症的參考。 方法：針對從1992年1月到1995年12月間耳硬化症病人接受同一術者以相同材質之鐙骨取代物的鐙骨小窗術治療並經至少兩年半的追蹤，共33耳。以純音聽力檢查評估其術前及術後的聽力狀況並比較術前到術後聽力改善的情形。 結果：術前與術後純音聽力檢查聽力閾值（氣導差），除兩例無進步外，其餘皆有改善，占93.9%。另外，術後的氣骨導差（術後氣導減去術後骨導）在十分貝以內占84.8%，在十五分貝以內可達90.9%。其中除一例有輕微的耳蝸傷害（骨導喪失12.5分貝）外，所有患者並無外淋巴液漏、面神經麻痺或全聾之副作用。 結論：在鐙骨手術中，鐙骨小窗術的施行有增加的趨勢，而成為在治療耳硬化症中最常使用的術式。這是因為一般認為鐙骨小窗術對耳蝸的傷害較小，而且對於高頻率的聽力有較佳的改善程度。在本院施行的鐙骨小窗術，其術後聽力改善的情形並不亞於國外學者的結果，故將此結果提供國人參考。
並列摘要
Background and purpose: Stapedotomy was carried out in patients with otosclerosis. The efficacy of stapedotomy for treatment of otosclerosis still awaits durable clinical experience in Taiwan. Efficacy was therefore evaluated and compared in Taiwan and in an otosclerosis-prevalent area to serve as a reference for treatment of otosclerosis in Taiwan. Methods: From January 1992 to December 1995, 33 otosclerostic ears were treated with stapedotomy by the same ENT surgeon. Regular postoperative follow-up was arranged for at least 2.5 years. Preoperative and postoperative pure-tone hearing threshold was recorded and compared to evaluate the efficacy of stapedotomy. Results: The difference of air conduction hearing threshold between pre- and postoperative ears measured by pure tone audiometry was evaluated. About 93.9% of the postoperatively otosclerotic ears were improved. Most of the postoperative air-bone gaps, calculated as the difference between postoperative bone and air conduction values, were smaller. The rate of postoperative air-bone gap within 10 dB was 84.8%, and within 15 dB, 90.9%. Except for mild cochlear damage in one case (bone conduction hearing threshold lost 12.5 dB), there were no serious complications after operation, no perilymph leakage, facial palsy or total sensorineural hearing loss. Conclusion: Because stapedotomy is seen as less traumatic to the cochlea and as providing better outcomes (improvement of hearing in the high frequency range), the method has increasingly become the most used surgical technique for treatment of otosclerosis. The postoperative results of this operation were similar in Taiwan and in the reference otosclerosis-prevalent area.