唯一聽耳之中耳手術

Middle Ear Surgery on Patients with Only One Hearing Ears

溫青彥(Chin-Yen Wen) ； 賴仁淙(Jen-Tsung Lai)

《台灣耳鼻喉頭頸外科雜誌》 42卷5期 (2007/10) Pp. 145-149

https://doi.org/10.6286/2007.42.5.145

摘要

背景：在唯一聽耳(only one hearing ear)實施鼓室成型術存在著許多風險及爭議，過去的文獻也不多見。本研究針對那些接受過中耳手術之唯一聽耳進行結果分析及研究，並回顧國內外發表過之相關研究報告。
方法：採回溯性分析，自1997年至2006年之間接受過中耳手術並排除掉對側保有部份聽力（純音聽力損失小於80 dB，語言辨識度大於50%）及追蹤時間不足6個月者，共有20名患者成為本研究之對象。將這20例依病因分為單純慢性中耳炎及中耳炎併膽脂瘤兩組，分析各組其術前及術後純音聽力氣導閥值、氣骨導差間距、語言辨識度、手術方式及術後併發症。
結果：20例中，男性7名、女性13名，皆無糖尿病、心、腎、肝等重大疾患，年齡分布由30歲到79歲，平均52.9歲。追蹤時間平均34個月。中耳炎併膽脂瘤這組有6耳，其中4耳接受修正乳突根除術，1耳鼓室上隱窩切除術，1耳階段性鼓室成型術；單純慢性中耳炎這組有14耳，其中7耳接受單純第一型鼓室成型術，另外7耳則為第三型鼓室成型術。慢性中耳炎這組術前平均氣導聽力為52.5 dB、術後為39.2 dB、進步13.3 dB。膽脂瘤術前平均氣導聽力為55.3 dB、術後為49.5 dB、進步5.8 dB。語言辨識度上兩組術前及術後並無明顯差異。術後併發症方面，只有膽脂瘤這組有1名(16.7%)為暫時性面神經麻痺。
結論：慢性中耳炎這組術後氣導明顯進步，進而也提升了患者的生活品質。膽脂瘤這組在去除病灶後平均氣導閥值雖進步有限，但患者流膿等症狀獲得控制，避免進一步傷害。在唯一聽耳進行手術不論是單純的鼓室成型術或複雜的乳突鑿開術，對施術者來說是一項壓力與挑戰，因此需要具備相當的手術經驗來篩選病患及評估危險，手術治療的方向與期待也因不同的病因而有個別差異，因此術前給予患者詳盡的資訊與溝通更是重要的工作。

關鍵字

唯一聽耳 ； 鼓室成形術 ； 氣骨導差間距

並列摘要

BACKGROUND: Middle ear surgery performed on patients with only one hearing ear holds the risk of bilateral total deafness and has been a controversial subject. In Taiwan, literature on this subject is relatively scarce, so we have collected and analyzed information on patients with only one hearing ear who have received middle ear surgery in our hospital and compared this with other relevant literature.
MATERIALS AND METHODS: We studied the hospital database for the years 1997 to 2006 and excluded cases without full follow-up. In total, only twenty cases were identified involving surgery on a patient with only one hearing ears and these could be divided into two groups, namely those with chronic otitis media and those with cholesteatoma. The surgical methods, pure-tone audiometry and speech discrimination score together with air bone gap pre- and post-operation were recorded as well as the outcome.
RESULTS: The patients were aged from 30 years to 79 years and were completely and unserviceable deaf in one ear. There group included seven males and thirteen females and the average duration of follow-up was 34 months. Among the six cholesteatoma cases, four received a Bondy-operation, one received an atticotomy and one received a staging operation with total ossicular replacement prosthesis. In the chronic otitis media group of 14 cases, seven received type I tympanoplasty, and others received type III tympanoplasty. The average hearing gain was 13.3 dB in the chronic otitis media group and 5.8 dB in the cholesteatoma group. There were no major complications except that one patient suffered from transient facial paralysis.
CONCLUSION: Middle ear surgery on patients with only one hearing ear incurs a greater risk and is more stressful than a normal operation and therefore process must be performed by an experienced surgeon. Explicit communication with the patient and their family about the goal of surgery is important because the aim of the surgery is to improve the patients' hearing and life quality.

並列關鍵字

only one hearing ear ； tympanoplasty ； air-bone gap