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題 名 | 先天性聽小骨異常的手術治療=Surgical Treatment of Congenital Ossicular Anomalies |
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作 者 | 黃鈞儒; 賴仁淙; | 書刊名 | 中華民國耳鼻喉科醫學雜誌 |
卷 期 | 36:3 民90.05-06 |
頁 次 | 頁155-159 |
分類號 | 416.821 |
關鍵詞 | 先天性聽小骨異常; 先天性鐙骨足板固定; Congenital ossicular anomaly; Congenital stapes footplate fixation; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:未伴隨耳郭及外耳道畸形之單純性先天性聽小骨異常,由於患者通常年紀小不易早期診斷且為罕見病例,國內對於此類患者聽力重建手術之報告不多,故特提出討論。材料與方法:自1995年1月至1999年12月,經鼓室探查術証實為此類先天性聽小骨異常患者,共22手術耳。整理並分析術中發現聽小骨異常類型,聽力重建術式,手術前後聽力變化等資料。結果:共蒐集21名病例,22手術耳,男性12名,女性9名,平均年齡19歲。術後聽力改善(>10 dB)的有16耳(佔73%),氣骨差間距由平均39 dB進步到21 dB。聽小骨異常類別以鐙骨足板固定最多(14耳,佔64%)。術式方面,鼓膜足板連結術2耳,鼓膜前庭連結術6耳,人工鐙骨置換術12耳。另2耳因合併先天性膽脂瘤而實施分期手術,尚未重建聽力。結論:1)重建一般慢性中耳炎患者聽力時,較常採用的是鼓室成型術第1、3型;而本系列類串者合併鐙骨足板固定或卵圓窗發育不良者佔18耳(82%),其需實施較危險之鐙骨足板造孔術或內取開窗術,故術前應更加謹慎準備。2)先天性鐙骨固定患者,其聽力重建可就聽小骨異常類型,選擇人工鐙骨置換術(piston-wire prosthesis)或使用全聽小骨置換物(TORP)來做鼓膜前庭連結術myringove- stibulopexy)。 |
英文摘要 | BACKGROUND:Congenital ossicular anomalies are rarely unaccompanied by abnormalites of the external ear. We review our surgical experience with such patients and the hearing outcomes described in the literature. METHODS:Between January 1995 and December 1999, exploratory tympanotomy was performed on 22 ears in 21 patients with conductive hearing loss but without external ear malformations. The following data were collected and analyzed: otological history, intraoperative findings, types of ossicular chain reconstruction and hearing results. RESULTS: Twelve men and nine women were recruited, with an average age of 19 years. Sixteen patients had (>10 dB) improvements in hearing postoperatively. The average airbone gap improved from 39 dB preoperatively to 21 dB postoperatively. Congenital stapes footplate fixation was the most common abnormality (14 ears). With the exception of two ears where staged operations were arranged to treat coexisting congenital cholesteatomas, ossicular chain reconstruction was performed with myringoplatinopexy in two ears, myringovestibulopexy in six ears and stapedotomy with a piston-wire prosthesis in 12 ears. CONCLUSIONS: Preoperative preparation is important due to the likelihood of stapes footplate surgery being required when repairing congenital ossicular anomalies. For treatment of congenital stapes footplate fixation, the effects of myringovestibulopexy with TORP and stapedotomy with a piston-wire prostheis should be equivalent. The method used should be based on the pattern of ossicular anomalies encountered during surgery. |
本系統中英文摘要資訊取自各篇刊載內容。