人工耳蝸使用者夜間輔具使用對耳鳴狀況緩解之探討：跨領域團隊照護與健康照護矩陣之應用個案報告

本個案為一位24歲女性，患有先天性雙耳大前庭導水管擴大症候群（large vestibular aqueduct syndrome, LVAS）合併蒙狄尼氏症（Mondini dysplasia）。考量配戴雙耳助聽器高頻效益不佳，個案於20歲時選擇於右耳植入人工耳蝸，術後穩定配戴亦有良好的聽理解表現。然而，術後第二年，個案反應語音聽辨表現不如以往，數次調頻皆未有改善，並出現有耳鳴情形。本報告探討夜間輔具使用下耳鳴的緩解，同時以跨領域團隊照護的方式，利用健康照護矩陣來檢視團隊在此個案的介入與處置上，可以改進之處，以提升醫療品質。

關鍵字

人工耳蝸；過度刺激；術後耳鳴；健康照護矩陣；跨領域團隊

並列摘要

This study reports a 24-year-old woman with congenital large vestibular aqueduct syndrome (LVAS) and Mondini dysplasia. Because the outcome of bilateral hearing aids was not helpful, she underwent right side cochlear implantation in 20-year-old. After surgery, the patient continuously wearing cochlear implant and had had good auditory comprehension performance. However, the situation deteriorated 2 years after the operation. It was not making much progress in programming. Furthermore, the patient had been bothered by tinnitus after surgery. This article discusses the use of cochlear implant during the night for tinnitus suppression, meanwhile using HealthCare Matrix by Interprofessional collaborative practice for medical review.

並列關鍵字

Cochlear implant ； Overstimulation ； Post-surgery tinnitus ； HealthCare Matrix ； Interprofessional collaborative practice

參考文獻

Baguley, D. M., & Atlas, M. D. (2007). Cochlear implants and tinnitus. Progress in Brain Research, 166, 347-355. doi:10.1016/S0079-6123(07)66033-6

Bingham, J. W., Quinn, D. C., Richardson, M. G., Miles, P. V., & Gabbe, S. G. (2005). Using a healthcare matrix to assess patient care in terms of aims for improvement and core competencies. The Joint Commission Journal on Quality and Patient Safety, 31, 98-105. doi:10.1016/s1553-7250(05)31014-2

Kennedy, V., Wilson, C., & Stephens D. (2004). Quality of life and tinnitus. Audiological Medicine, 2, 29-40. doi:10.1080/16513860410027349

Perreau, A., Tyler, R., & Mancini, P. C. (2020). Programming a cochlear implant for tinnitus suppression. Journal of the American Academy of Audiology, 31, 302-308. doi:10.3766/jaaa.18086

Thornton, A. R., & Raffin, M. J. (1978). Speech-discrimination scores modeled as a binomial variable. Journal of Speech and Hearing Research, 21, 507-518. doi:10.1044/jshr.2103.507

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