聽神經瘤之耳科學診斷及治療經驗

Otologic Experience in the Diagnosis and Management of Acoustic Neuromas

林凱南(Kai-Nan Lin) ； 杜永光(Yong-Kwang Tu) ； 徐茂銘(Mow-Ming Hsu)

《慈濟醫學雜誌》 5卷3期 (1993/09) Pp. 207-216

https://doi.org/10.6440/TZUCMJ.199309.0207

摘要

內聽道病變，尤其是聽神經瘤，經早期發現後，治療較為容易，且可維持較佳之聽覺機能，故吾人對單側之感音神經性聽力障礙應有警覺。本文報告在兩年內經歷之6例，包括男性4例，女性2例；年齡自29歲至58歲。聽力障礙時間自1個月至5年，有2例為突發性。所有病例經過聽力學檢查，包括純音聽力、語音辨別、聽覺反射及腦幹反應，加上放射線Stenvers法攝影，使我們懷疑耳蝸後病變，再施行充氣法電腦斷層腦池攝影而得到診斷。此6例中有4例為不超過內聽道口1公分之小型及聽道內之腫瘤性病變，應是早期診斷例。接受手術者有3例，均為聽神經瘤，其中2例使用經迷路法，1例由枕骨下進入，其腫瘤均長自下前庭神經。有2例為疑似聽道內腫瘤，尚在追蹤，其中1例已經三年，腫瘤無明顯變大。吾人期望核磁共振攝影有效的使用，俾能發現更多早期病例。

關鍵字

內聽道 ； 聽神經瘤

並列摘要

When treating lesions in the internal auditory canals, especially acoustic neuromas, usable hearing can be more possibly preserved if the tumors are diagnosed and excised at an early stage. Thus it is important for the otolaryngologist to identify such cases from from the large population of patients with unilateral progressive sensorineural hearing loss. In this paper, we reported the clinical courses of six cases who had been examined in two years.
They were four males and two females, with age ranging from 29 to 58. The duration of hearing impairment was from one month to five years. Unusually, in two cases, the onset of auditory symptoms was sudden; and in one of these two, the contralateral ear also experienced a later episode of sudden hearing loss, although CT scanning showed nothing on this side. We used tone audiometry, speech discrimination test, acoustic reflex test, auditory brain-stem evoked potential, plain x-ray study (Stenvers’ view), and then air CT cisternography for diagnosis.
Three cases had been operated, two through translabyrinthine and one via suboccipital approach. Tumors were all found originating from the inferior vestibular nerve. Two “watchful waiting” non-operated cases were of the intracanalicular type; one of them had been followed for three years without evidence of tumor growth.
On the condition that the otolaryngologists are with high alertness and MRI are properly applied to cases of unilateral or asymmetric sensorineural deafness, we anticipate that we can find out more small acoustic neuromas in the future.

並列關鍵字

internal auditory meatus ； acoustic neuroma