- 期刊
上半規管裂損症候群－二例報告
Superior Canal Dehiscence Syndrome - Report of Two Cases
摘要
上半規管裂損症候群，最早由Minor於1998年提出8例，至今已有27例報告。這些病患可因大的聲音、中耳腔壓力或顱內壓力的變化所引起的眩暈、振動幻視（oscillopsia），或不穩定感。一些患者有長期持續性的不穩定感，有些會聽到自己眼球在動的聲音，尤其當眼球向患側移動時。此處裂損可經由顳骨部高解析度電腦斷層攝影證實。臨床症狀表現方面，可以由裂損處對內耳迷路生理方面的影響來解釋。在此，我們報告1例54歲女性與1例48歲男性，前者患有反覆性頭暈約3年，聽到大的聲音時，右耳會感到耳鳴和耳漲感，以及有迴音感，尤其是最近1個月。此外，最近也有1次的眩暈發作；而後者患有反覆性頭暈與不穩定感約2年，水份攝取少時會加重症狀，並且頭暈前常常會先有頸部酸痛的現象，此外，患者有單側耳鳴和耳脹感，並有因外耳道壓力變化所引起的短暫眩暈現象。顳骨部高解析度電腦斷層攝影，前者顯示右側上半規管裂損，而後者疑似兩側上半規管有裂損的現象。治療方面，避開大的聲音和壓力變化，可免於眩暈或振動幻視的困擾，但是，長期頭暈和不穩定感對藥物的反應則不甚理想。因病例少見，特提出報告。
並列摘要
Superior canal dehiscence syndrome was first reported by Minor in 1998. Some twenty-seven cases have been described to date. Affected patients develop vertigo or oscillopsia in response to loud sound or maneuvers that change middle ear or intracranial pressure. They may also experience constant and often disabling disequilibrium and unsteadiness. This clinical entity has been confirmed by high-resolution computed tomography (HRCT) imaginge of the temporal bones. The clinical presentation and findings can be understood by the effect of dehiscence one the physiology of the labyrinth. A 54-year-old woman and a 48-year-old man are described. The first patient case presented with a three year history of recurrent dizziness. Tinnitus, fullness, and recruitment sensations of the right ear were noted, especially in one month during which, she had listened to loud noise. There was also a short, recent episode of vertigo. The second patient presented with a two year history of fluctuating dysequilibium, high-pitched tinnitus, and a sensation of fullness in the left ear. His symptoms were aggravated by reduced fluid intake, and were always followed by left occipital tightness and headache. A high fluid intake afforded significant relief. Short episodes of about 4 seconds of vertigo and oscillopsia were also noted, when finger were placed deeply into the left ear canal. HRCT of the temporal bone showed dehiscence of the bone overlying the right superior semicircular canal in the first case, and a suspicious dehiscence bilaterally in the second case. In terms of treatment, avoidance of provocative stimuli has been sufficient to prevent symptoms from becoming debilitating. Unfortunately, chronic dysequilibium and unsteadiness do not response well to medical treatment.