感覺神經性聽損：高解析電腦斷層攝影在內耳管道的分析

Sensorineural Hearing Impairment: High Resolution Computed Tomographic Analysis of Inner Ear Canalicular Structures

楊志明(Chih-Ming Yang) ； 李榮輝(Jung-Hui Li) ； 呂鎮中(Chun-Chung Lui)

《中華放射線技術學雜誌》 40卷3期 (2016/09) Pp. 162-168

摘要

多切層電腦斷層檢查在臨床上可以取得較多的細層影像，對於顳骨的解析能力也更加的細緻，內耳膜性迷路的構造也可以得到較佳的診斷。我們利用高解析電腦斷層（computer tomography, CT）針對內耳做檢查應用後，除發現部分先天聽損（sensorineural hearing loss, SNHL）的病患有骨性迷路的變異，也提供SNHL 的影像佐證。本研究利用64 切層電腦斷層檢查儀分析內耳各個骨性管道（如耳蝸神經管、前庭神經管、面神經管和內聽道等），並與病患聽力受損的程度進行分析比對以找出其相關性。我們回溯分析258名病患（516 耳）接受顳骨電腦斷層檢查，經過篩選剩108 人（216 耳）有詳細聽力檢查的病患。依據病史，以出生時有無感覺神經性聽損分為非先天SNHL耳組（133耳，男65耳，女68耳，平均年齡39.84歲）和先天SNHL耳組（83耳，男59耳，女24耳，平均年齡6.72歲），並測量比較兩組耳蝸神經管、前庭神經管、面神經管和內聽道管道距離等數值。先天SNHL 耳組（共83 耳，64.56 dB）多為中重聽障者，骨導聽損程度明顯大於非先天SNHL 耳組（共133 耳，21.15 dB）（p ＜ 0.001）。而先天聽損組的耳蝸神經管寬度與長度均明顯小於非先天聽損組（p ＜ 0.001）。

關鍵字

電腦斷層 ； 神經性聽力損失 ； 耳蝸神經

並列摘要

In the past, most patients with congenital sensorineural hearing loss (SNHL) were believed to have abnormalities of the membranous labyrinth and cannot be detected by conventional computed tomography. Taking the advantage of the evolution on multi-slice CT in recent years, the thinnest slice thickness comes up to 0.5 millimeter. Some authors discovered the bony labyrinth abnormalities of the inner ear in part of congenital SNHL patients by high resolution CT (HRCT), such as hypoplasia of the bony cochlear nerve canal (BCNC). We retrospectively reviewed the bony canal in the inner ear of SNHL patients who received 64-slice HRCT scanning for temporal bone to evaluate the bony canal for cochlear, vestibular and facial nerves, and inner ear canal (IAC). We measured the caliber of these bony canals and IAC, and correlated with the severity of hearing loss. There were 108 patients with SNHL (216 ears) got enrolled, and all of them had 64-slice HRCT scanning for temporal bone and pure tone audiometry. All patients were divided into two groups under their personal history of hearing impairment, one was congenital SNHL group (83 ears, M:F = 59:24, mean age 6.72 years old), and the other was acquired SNHL group (133 ears, M:F = 65:68, mean age 39.84 years old). The congenital SNHL group is significantly more severe than the acquired SNHL group (64.56 dB vs. 21.15 dB, p ＜ 0.001). The width and length of bony canals for cochlear in congenital SNHL group are significantly smaller than the acquired SNHL group.

並列關鍵字

computed tomography ； sensorineural hearing loss ； cochlear nerve