以銣雅克雷射鼓膜切開術治療積液性中耳炎

Nd-YAG Laser Myringotomy for Otitis Media with Effusion

張晉源(Chin-Yuan Chang) ； 袁本治(Ben-Chih Yuan)

《中華民國耳鼻喉科醫學雜誌》 36卷1期 (2001/02) Pp. 22-28

https://doi.org/10.6286/2001.36.1.22

摘要

背景：積液性中耳炎是小孩中最常見造成聽力喪失的疾病，大多數的小孩經過藥物的保守療法大多能痊癒。一旦中耳腔積液持續數個月以上，考慮外科手術以保持中耳腔的通氣及引流積液，被認為是治療積液性中耳炎的有效方法之一。我們認為運用銣雅克雷射造孔術來治療大多數的積液性中耳炎病患是有效的，不但可使耳膜保持通氣至少3星期，而且可避免耳膜產生過多疤痕。因此，本研究的目的是評估積液性中耳炎，經由雷射耳膜造孔後，其臨床症狀改善的情形並分析耳膜打開的大小與癒合時間的關係。
方法：1999年3月起至2000年3月止，蒐集非內縮型之一般積液性中耳炎之病患20名共25病耳實施此方法，我們用的是Sharplan 3060銣雅克雷射配上600µm光纖，單次作用燒灼直徑為0.8mm，視耳膜大小給予1–4次雷射。術前及術後均以純音聽力檢查及鼓室圖來評估，並以STORZ 1215A 0度的耳內視鏡觀察術後追蹤結果。
結果：20名病患共25耳，年齡分布從4至18歲，平均8.2歲。雷射能量設定15w，造孔直徑小於1mm有1耳，約1.6mm有3耳，約2.4mm有10耳，約3.2mm有11耳。造孔大小與癒合時間成正比，小於1mm癒合時間為16天，1.6mm為21天，2.4mm為28天，大於3.2mm為31.5天。術後1週追蹤聽力，15耳中有11耳聽力進步至少10dB，其聽障改善率為73%，而鼓室圖於耳膜癒合後1週追蹤，25耳中恢復為A型有60%。
結論：傳統治療積液性中耳炎常使用通氣管置放術，但有些病患會有耳膜萎縮變形、耳膜硬化及永久耳膜穿孔等併發症出現。另外，耳膜切開術常疾病未完全痊癒，切開的洞就已經癒合起來。以銣雅克雷射耳膜造孔術在耳內視鏡輔助下治療積液性中耳炎，可改善上述的缺點，除術後耳膜疤痕較少外，其中耳通氣時間可達3星期以上。

關鍵字

積液性中耳炎 ； 銣雅克雷射 ； 鼓膜切開術

並列摘要

BACKGOUND: Otitis media with effusion (OME) accounts for the majority of hearing loss in children. Conservative treatment without surgery can resolve most infections. If, however, the effusion persists for several months then surgery should by undertaken to aerate the middle ear and allow the liquid to drain. Consequently, surgery can be considered an effective treatment for OME. We have found it effective to treat most patients suffering OME with a myringotomy, safely made with a Nd-YAG laser. The procedure not only keeps the eardrum aerated for at least three weeks but also prevents excessive scarring. The present study was conducted to correlate perforation size and healing time in patients with OME treated by laser myringotomy.
METHODS: Between March 1999 and March 2000, a total of 25 eardrums in 20 patients with OME underwent therapy. A Sharplan 3060 Nd-YAG laser in combination with 600µm optic fiber was used. The diameter of the perforation produced by a single shot was 0.8mm, and every eardrum received between one and four applications of the laser depending on the size of the eardrum. Pure tone audiometry and tympanograms were used for both pre-operative and post-operative hearing evaluation, and an otoscope (STORZ 1215A 0°) was used for post-operative follow-up.
RESULTS: The 20 patients were between 4 and 18 years of age, averaging 8.2 years of age. The laser's power was set to 15W. Of the 25 treated eardrums, one had a perforation less than 1mm in diameter, three had perforations about 1.6mm in diameter, 10 had perforations about 2.4mm in diameter, and 11 had perforations about 3.2mm in diameter. It was found that the healing time was in proportion to the size of the perforation. It took 16 days for a perforation less than 1mm in diameter to heal, three weeks for a perforation of 1.6mm in diameter to heal, 28 days for a perforation of 2.4mm in diameter to heal, and 31.5 days for a perforation larger than 3.2mm in diameter to heal. Hearing was measured after one week of surgery. Of the 25 eardrums, 11 improved to at least 10dB, which equated to a 73% improvement in hearing. Follow-up tympanograms one week after the membranes had healed indicated that 60% of the 25 infected eardrums had recovered to type A.
CONCLUSION: Ventilation tube insertion has been widely used for the treatment of OME, but the technique has some disadvantages, including atrophy of the tympanic membrane, tympanosclerosis, and persistent perforation. Additionally, following myringotomies the perforation often closes before the middle ear disease has completely resolved. These shortcomings can be safely overcome by a Nd-YAG laser myringotomy performed during ear endoscopy. The technique prevents excessive post-operative scarring and allows the infected middle ear to be aerated for at least three weeks.

並列關鍵字

otitis media with effusion ； OME ； Nd-YAG laser ； myringotomy