電腦斷層下先天及非先天聽損病患之內耳神經骨管分析

High Resolution Computed Tomographic of the Nerve Bony Canal of the Inner Ear in Congenital Hearing Loss

曾士誠(Shih-Cheng Tseng) ； 李榮輝(Jung-Hui Li) ； 呂鎮中(Chun-Chung Lui) ； 彭治平(Jyh-Ping Peng) ； 黃仲鋒(Chung-Feng Hwang)

《台灣耳鼻喉頭頸外科雜誌》 50卷3期 (2015/09) Pp. 145-152

https://doi.org/10.6286/2015.50.3.145

摘要

背景：先天性神經性聽損病患於臨床並不少見，以往認為可能是膜性迷路構造異常，但受限於測量儀器而無法測量，近年來，有國外學者發現在顳骨電腦斷層下，部分先天聽損病患存在骨性迷路的變異，國內目前尚無類似研究，本次研究目的在於利用電腦斷層分析內耳各個骨性管道（如耳蝸神經管、前庭神經管、面神經管等），並與病患聽力受損的程度進行分析比對，以期找出他們的相關性。材料與方法：我們回溯分析2011年3月至2014年4月期間共63名接受顳骨電腦斷層檢查及純音聽力檢查病患（分為先天聽損及非先天聽損兩組），並測量比較兩組耳蝸神經管、前庭神經管、面神經管和聽損程度等數值。結果：先天聽損組（34名共68耳）多為嚴重聽障者，骨導聽損程度明顯大於非先天聽損組（29名膽脂瘤患者共58耳）（p ＜ 0.001）。而先天聽損組的耳蝸神經管寬度與長度以及前庭神經管寬度均明顯小於非先天聽損組（p ＜ 0.001; p=0.011; p ＜ 0.001），至於面神經管寬度，兩組則無統計學上顯著差異（p=0.843）。我們也發現，兩組共106耳（排除後天性聽損的20耳）其平均骨導閾值與耳蝸神經骨管的寬長及前庭神經骨管的寬度呈現明顯負相關，其相關係數及p值分別為r=-0.495 (p ＜ 0.001); r=-0.245 (p=0.011); r=-0.368 (p ＜ 0.001)。結論：本研究證實本土患者與國外研究有相類似結果，先天聽損病患的耳蝸神經骨管的平均長度和寬度以及前庭神經骨管均明顯小於非先天聽力障礙組，而且與兩組綜合平均骨導聽損程度呈現明顯負相關。

關鍵字

神經性聽損 ； 耳蝸神經骨管 ； 前庭神經 ； 面神經

並列摘要

BACKGROUND: Most patients with sensorineural hearing loss (SNHL) are believed to have abnormalities of the membranous labyrinth that cannot be detected by conventional imaging techniques. Recently, some authors have reported previously unrecognized bony abnormalities of the inner ear in SNHL patients without cochlear malformation, such as hypoplasia of the bony cochlear nerve canal (BCNC). The aim of this study was to evaluate the diameters of the various bony canals of the inner ear (cochlear nerve, vestibular nerve, facial nerve) under temporal bone computed tomography (CT) and try to find out the correlation of bony canal diameter and the degree of hearing loss. METHOD: In our retrospective study, 63 patients were included and all received temporal bone CT scan and pure tone audiometry between Mar 2011 and April 2014. We used CT scans to measure various bony canals of the inner ear and also correlated the degree of hearing loss with the diameters of these bony canals. RESULTS: The SNHL is more severe in congenital hearing loss group (34 patients with 68 ears) than non-congenital hearing loss group (29 cholesteatoma patients with 58 ears) (p ＜ 0.001). The width and length of the BCNC was significantly wider and longer in non-congenital hearing loss group than in congenital hearing loss group (p ＜ 0.001; p=0.011). Besides, the bony canal of vestibular nerve had the different width between these two groups (p ＜ 0.001).The average hearing level of both groups revealed obvious negative correlation with the width and length of the BCNC , the width of vestibular nerve bony canal (correlation coefficient: r=-0.495 (p ＜ 0.001); r=-0.245 (p=0.011); r=-0.368 (p ＜ 0.001)). CONCLUSIONS: The result showed significantly smaller and shorter bony cochlear nerve canal, smaller vestibular nerve bony canal in the congenital hearing loss group and had negative correlation with sensorineural hearing loss.

並列關鍵字

sensorineural hearing loss ； bony cochlear nerve canal ； vestibular nerve ； facial nerve