文献摘要

單側和雙側人工耳蝸植入對耳鳴的影響:一項前瞻性研究
Effect of Unilateral and Simultaneous Bilateral Cochlear Implantation on Tinnitus: A Prospective Study

Volume 1, Issue 1

關鍵字 :
Tinnitus, cochlear implantation, bilateral cochlear implantation, Tinnitus Handicap Inventory, Tinnitus Questionnaire 耳鳴、人工耳蝸植入、雙側人工耳蝸植入、耳鳴障礙量表、耳鳴問卷

作者 :
Alice van Zon, MD; Yvette E. Smulders, MD; Geerte G. J. Ramakers, MD; Inge Stegeman, PhD;Adriana L. Smit, MD; Gijsbert A. Van Zanten, PhD; Robert J. Stokroos, MD, PhD; Nadia Hendrice; Rolien H. Free, MD, PhD; Bert Maat, PhD; Johan H. M. Frijns, MD, PhD;Emmanuel A. M. Mylanus, MD, PhD; Wendy J. Huinck, PhD; VedatTopsakal, MD, PhD;Rinze A. Tange, MD, PhD; Wilko Grolman, MD, PhD

譯者 :
高雄長庚紀念醫院 黃仲鋒醫師

摘要:


Objectives/Hypothesis: To determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation.


Study Design: Prospective study.


Methods: Thirty-eight adult patients were included in this prospective study, as part of a multicenter randomised controlled trial investigating the benefits of bilateral cochlear implantation versus unilateral cochlear implantation. Pre- and postoperative tinnitus perception scores were evaluated, before and 1 year after implantation on three tinnitus questionnaires; the Tinnitus Handicap Inventory (THI), the Tinnitus Questionnaire (TQ), and a visual analogue scale for tinnitus burden.


Results: Before implantation, the tinnitus prevalence was 42.1% (16 of 38) in the whole study group. One year after implantation, the tinnitus questionnaire scores had decreased in 71.4% according to the TQ and 80.0% according to the THI. Tinnitus was induced after cochlear implantation in six patients, five in the bilateral and one in the unilateral group.


Conclusions: Our study shows that cochlear implantation is effective in the reduction of tinnitus in patients with bilateral sensorineural hearing loss who suffered from preoperative tinnitus. Conversely, tinnitus may also increase or even be induced by the cochlear implantation itself. Cochlear implant candidates should be well informed about these possible consequences before undergoing surgery.

專家評論:


單側和雙側人工耳蝸植入對耳鳴的影響:一項前瞻性研究

高雄長庚紀念醫院  黃仲鋒醫師


耳鳴在成年人中的患病率較高,且隨著年齡的增加而增加,據統計在一般人群約6%到20%有慢性耳鳴症狀,這些病例的1%至3%其耳鳴會嚴重影響生活品質。已知耳鳴及感覺神經性聽損之間有很強的相關性,在極重度聽力障礙需要人工耳蝸植入的個案,其耳鳴的發病率高達67%至86%。1981年,House和Brackmann報告人工耳蝸植入對耳鳴有抑制作用,之後陸續報告顯示耳鳴的抑制率有很大的不同,範圍從8%至61%,其中對耳鳴感知的降低率更能達64%至100%,但相對的研究也顯示1.3%到24.5%的人植入之後產生新的耳鳴症狀。本篇文章是前瞻性研究,目的在於確定人工耳蝸植入術對重度感音神經性聽力損失患者術後對耳鳴感知效果,並且辨別單側和雙側人工耳蝸植入之間可能存在的差異。

 總共38名成人患者參與這次多中心隨機控制的前瞻性研究,探討雙側人工耳蝸植入與單側人工耳蝸植入的效果的比較。術前和術後耳鳴感知的評分,分別在術前和術後1年以三種耳鳴問卷評估;耳鳴障礙量表(Tinnitus Handicap Inventory, THI),耳鳴問卷(Tinnitus Questionnaire, TQ),和耳鳴困擾視覺類比量表(Visual Analogue Scale)。結果在植入前,整個研究組的耳鳴患病率為42.1%(16/38)。術後一年耳鳴問卷得分均下降71.4%,耳鳴障礙量表則減少80%,平均耳鳴困擾視覺類比量表由5分降到2分。但人工耳蝸植入術後引發新耳鳴症狀有6例,其中雙側5例(5/10),單側組1例(1/12)。

作者所有的患者都有使用柔軟的外科技術(soft surgery techniques)植入,希望術後引起耳鳴的比例能降低,但是仍然在有27.3%(6/22)產生新耳鳴。因此,即使人工耳蝸手術技術的不斷發展,似乎仍然無法避免部分患者會誘發新耳鳴。其實本研究是已發表論文中,術後誘發新耳鳴比率最高,雖然文章中沒有討論這問題,但是我們由作者資料可以得知,原因是雙側人工耳蝸植入術後誘發新耳鳴的比率高達50%(5/10)造成。現有的文獻就雙側植入對耳鳴的效果尚未定論。  Summerfield等報導在他們的第二耳植入之後患者增加耳鳴煩惱,而Olze等報告第一耳植入之後耳鳴煩惱降低,第二耳植入之後耳鳴又再額外減少。本文顯示誘發新耳鳴的在雙側組發病率較高於單側組(5/10 vs. 1/12),雖然此差異尚無統計學顯著(P =0.06),可能是由於樣本量較小。總結本論文發現人工耳蝸植入在術前感音神經性聽力損失合併有耳鳴患者的耳鳴症狀可有效的降低。相反,耳鳴也可能新增或甚至是由人工耳蝸植入引起的,特別是雙側植入者。所以植入人工耳蝸患者術前應充分瞭解這些可能的後果。


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