跳到主要內容

臺灣博碩士論文加值系統

(3.231.230.177) 您好!臺灣時間:2021/08/04 03:57
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:黃麒容
研究生(外文):Chi-Jung Hwang
論文名稱:先天感覺神經性聽損耳其內耳相關骨管與聽力功能的關聯性
論文名稱(外文):The Relationship between Inner Ear Bone Canals and Audition in Congenital Sensorineural Hearing Loss
指導教授:黃仲鋒
指導教授(外文):Chung-Feng Hwang
學位類別:碩士
校院名稱:國立高雄師範大學
系所名稱:聽力學與語言治療研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:122
中文關鍵詞:感音神經性聽損耳蝸神經骨管前庭神經面神經
外文關鍵詞:sensorineural hearing lossbony cochlear nerve canalvestibular nervefacial nerve
相關次數:
  • 被引用被引用:0
  • 點閱點閱:134
  • 評分評分:
  • 下載下載:16
  • 收藏至我的研究室書目清單書目收藏:0
背景與目的: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(如耳蝸神經骨管、前庭神經骨管、面神經骨管和內聽道等),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。

病人與方法:我們回溯分析共有 403 名病患(806耳)接受顳骨電腦斷層檢查,經過段篩選剩 253 人(506 耳)有詳細聽力檢查病患,依據病史即出生有無感音神經性聽損分為非先天 SNHL 耳組(293 耳,男 150 耳,女 143耳,平均年齡 40.9 歲)和先天 SNHL耳組(213 耳,男 134 耳,女 79 耳,平均年齡 6.9 歲),並測量比較兩組耳蝸神經骨管、前庭神經骨管、面神經骨管、內聽道和聽損程度等數值。

結果:先天SNHL耳組(共213耳,65.06 dB)多為中重聽障者,骨導聽損程度明顯大於非先天SNHL耳組(共293耳,20.76 dB)( p < 0.001)。而先天聽損組的耳蝸神經骨管寬度與長度以及前庭神經骨管寬度和內聽道寬度均明顯小於非先天聽損組(p < 0.001) ,至於面神經骨管在橫切及冠狀切寬度,兩組則無統計學上顯著差異(p = 0.695;p = 0.335)。我們也發現,先天SNHL耳組共213耳其平均骨導閾值與耳蝸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 = – 0.699 (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SNHL耳的內耳骨管多小於非SNHL耳組,特別是耳蝸神經骨管的平均長度和寬度以及前庭神經骨管,而且耳蝸神經骨管的寬度與平均骨導聽損程度呈現明顯負相關。
BACKGROUND AND PURPOSE: 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 and inner auditory canal (IAC)) under temporal bone computed tomography (CT) and try to find out the correlation of bony canal diameter and the degree of hearing loss.

PATIENTS AND METHODS: In our retrospective study, 253 patients (506 ears) were included and all received temporal bone CT scan and pure tone audiometry. We used CT scans to measure various bony canals of the inner ear in patients with or without SNHL (213 vs. 293 ears). The degree of hearing loss also was correlated with the diameters of these bony canals (IAC, cochlear nerve, vestibular nerve and facial nerve).

RESULTS: The SNHL is more severe in congenital SNHL group (213 ears, 65.06 dB) than non-congenital SNHL group (293 ears, 20.76 dB) (p < 0.001). The width and length of the BCNC was significantly wider and longer in non-congenital SNHL group than in congenital SNHL group (p < 0.001). Besides, the bony canal of vestibular nerve and IAC had the different width between these two groups (p < 0.001).The average hearing level of congenital hearing loss group revealed obvious negative correlation with the width of the BCNC (correlation coefficient: r = – 0.699, p < 0.001).

CONCLUSION: The result showed significantly smaller and shorter bony cochlear nerve canal, smaller vestibular nerve bony canal and IAC in the congenital hearing loss group. The width of BCNC had negative correlation with sensorineural hearing loss.
目 錄

第一章 緒論1
第一節 研究背景與動機1
第二節 研究目的4

第二章 文獻探討5
第一節 名詞解釋5
第二節 內耳相關骨管在有無先天SNHL耳的差異9
第三節 耳蝸神經的胚胎學與解剖學13
第四節 內聽道狹窄的機制和與耳蝸神經缺陷的相關性18
第五節 耳蝸神經管狹窄的機制和與耳蝸神經缺陷的相關性20
第六節 內耳相關骨管的解剖學23
第七節 SNHL耳其內耳相關骨管和聽力功能的關係39

第三章 研究方法42
第一節 研究對象42
第二節 研究工具與測量方法48
第三節 研究限制54
第四節 資料分析方法55
第五節 研究架構與流程65

第四章 實證分析與結果66
第一節 描述性統計66
第二節 差異性檢定71
第三節 相關分析79
第四節 迴歸分析83

第五章 結論與建議99
第一節 結論99
第二節 建議103

參考文獻105
中文部分105
英文部分107

附錄112
附錄一、李宗伊-1983言語接收閾值檢查語料112
附錄二、陳小娟-1999言語接收閾值檢查語料113
附錄三、林永松-1997言語接收閾值檢查語料114
附錄四、林永松-1994臺語言語接收閾值檢查語料118
附錄五、王老得-1979言語辨識度檢查語料119
附錄六、張人仁-2005言語辨識度檢查語料120
附錄七、蔡昆憲-2009言語辨識度檢查語料121


表目錄

表4-1-1、內耳相關骨管的統計量68
表4-1-2、聽力功能的統計量70
表4-2-1、內耳相關骨管在非先天SNHL耳組和先天SNHL耳組的獨立樣本 T 檢定結果73
表4-2-2、聽損程度分級的聽力分佈情形74
表4-2-3、聽損程度分組的聽力分佈情形75
表4-2-4、內耳相關骨管在聽損程度分組的統計量76
表4-2-5、內耳相關骨管在聽損程度分組的單因子變異數分析結果78
表4-3-1、內耳相關骨管和聽力功能的相關分析結果82
表4-4-1、應變數為四頻PTAs之迴歸參數估計表84
表4-4-2、先天 SNHL 耳組中,應變數為四頻PTAs之迴歸參數估計表85
表4-4-3、應變數為平均BC之迴歸參數估計表88
表4-4-4、先天 SNHL 耳組中,應變數為平均BC之迴歸參數估計表89
表4-4-5、應變數為SRT之迴歸參數估計表92
表4-4-6、先天 SNHL 耳組中,應變數為SRT之迴歸參數估計表93
表4-4-7、應變數為SDS之迴歸參數估計表96
表4-4-8、先天 SNHL 耳組中,應變數為SDS之迴歸參數估計表97


圖目錄

圖2-3-1、面聽神經之內聽道底部(右耳)解剖15
圖2-3-2、面聽神經之膜迷路(右耳)解剖16
圖2-6-1、內聽道的MRI斜矢狀面解剖24
圖2-6-2、內聽道的CT斜矢狀面解剖(近心端)25
圖2-6-3、內聽道的CT斜矢狀面解剖(遠心端)26
圖2-6-4、耳蝸神經骨管的MRI橫剖面解剖27
圖2-6-5、耳蝸神經骨管的CT橫剖面解剖28
圖2-6-6、耳蝸神經骨管的CT冠狀面解剖29
圖2-6-7、面神經骨管的MRI橫剖面解剖30
圖2-6-8、面神經骨管的CT橫剖面解剖31
圖2-6-9、面神經骨管的CT冠狀面解剖32
圖2-6-10、上前庭神經骨管的MRI橫剖面解剖33
圖2-6-11、上前庭神經骨管的CT橫剖面解剖34
圖2-6-12、上前庭神經骨管的CT冠狀面解剖35
圖2-6-13、下前庭神經骨管的MRI橫剖面解剖36
圖2-6-14、下前庭神經骨管的CT橫剖面解剖37
圖2-6-15、下前庭神經骨管的CT冠狀面解剖38
圖3-1-1、病患篩選和分類44
圖3-1-2、病患耳分類和分組46
圖3-2-1、橫剖面耳蝸神經骨管寬度50
圖3-2-2、橫剖面耳蝸神經骨管長度50
圖3-2-3、橫剖面面神經骨管寬度51
圖3-2-4、冠狀面面神經骨管寬度51
圖3-2-5、橫剖面前庭神經骨管寬度52
圖3-2-6、橫剖面內聽道寬度52
圖3-5-1、研究架構與流程63
圖4-4-1、先天SNHL耳組中,四頻PTAs和橫剖面BCNC 寬度的關係85
圖4-4-2、先天SNHL耳組中,平均BC和橫剖面BCNC 寬度的關係90
圖4-4-3、先天SNHL耳組中,SRT和橫剖面BCNC 寬度的關係95
圖4-4-4、先天SNHL耳組中,SDS和橫剖面BCNC 寬度的關係100


一、中文部分

王冰、鮮軍舫、牛延濤、趙波、王振常 (2008)。 健康成人内聽道底 CT 及 MRI 解剖。放射學實踐, 23(9),950-954。


王冰、鮮軍舫、王振常 (2006)。16 層螺旋 CT 内聽道底孔道多平面重建研究。實用放射學雜誌,22(2),162-165。


王老得、蘇富美 (1979)。中國語音均衡字彙表之編製研究。耳鼻喉科醫學會雜誌,14,87-95。


王輝兵(2004)。蝸神經異常的磁共振成像及臨床意義。國外醫學:耳鼻咽喉科學分冊,27(5),284-288。


李榮輝、楊志明、林昌平、呂鎮中、黃仲鋒 (2012)。高解析顳骨電腦斷層攝影在人工電子耳植入評估之應用。中華放射線技術學雜誌,36(2),83-88。


周正根、茹光騰、姚良忠、王啟華(2015)。成人内聽道底相關結構的多層螺旋 CT 解剖學觀察。中華解剖與臨床雜誌,20(1),27-31。


林永松、李正順、陳小娟、李國玲(1994)。台語語詞聽閾檢定的編制。中華民國耳鼻喉科醫學會雜誌,29(6),457-463。


林永松、沈美玲(1997)。中文揚揚格語詞聽閾檢定表。中華民國耳鼻喉科醫學會雜誌, 32(1),7-13。


邵柏源 (Ed.)(2008)。耳鼻喉科醫典。台北市:合記圖書出版社。


姜泗長 (Ed.)(1999)。耳解剖學與顳骨組織病理學。北京:人民軍醫出版社。


張人仁(2005)。PC-Based 助聽復健平台設計開發(碩士論文)。成功大學:臺南市。


莊克士(Ed.)(2012)。醫學影像物理學 (2nd ed.)。台北市:合記圖書出版社。


陳小娟、利文鳳(1999)。學齡前兒童國語語音閾語詞之編製。特殊教育與復健學報, 7,183-217。


劉鋋(Ed.)(2006)。内耳病。北京:人民衛生出版社。


蔡昆憲(2009)。華語語音聽辨測驗語料之設計與驗證(未出版之博士論文)。國立陽明大學:臺北市。


衛生福利部國民健康署(2012)。全面補助新生兒聽力篩檢。取自 http://www.hpa.gov.tw/BHPNet//Web/Service/Major_DecisionShow.aspx?No=201301220006


蕭雅文(2008)。聽力學導論。台北市:五南圖書出版股份有限公司。 



二、英文部分

Adunka, O. F., Jewells, V., & Buchman, C. A. (2007). Value of computed tomography in the evaluation of children with cochlear nerve deficiency. Otol Neurotol, 28(5), 597-604. doi: 10.1097/01.mao.0000281804.36574.72


Adunka, O. F., Roush, P. A., Teagle, H. F., Brown, C. J., Zdanski, C. J., Jewells, V., et al. (2006). Internal auditory canal morphology in children with cochlear nerve deficiency. Otol Neurotol, 27(6), 793-801. doi: 10.1097/01.mao.0000227895.34915.94


Association, A. S.-L.-H. (2005). Guidelines for manual pure-tone threshold audiometry[Guidelines]. doi: 10.1044/policy.GL2005-00014


Blaser, S., Propst, E. J., Martin, D., Feigenbaum, A., James, A. L., Shannon, P., et al. (2006). Inner ear dysplasia is common in children with Down syndrome (trisomy 21). Laryngoscope, 116(12), 2113-2119.


Buchman, C. A., Roush, P. A., Teagle, H. F., Brown, C. J., Zdanski, C. J., & Grose, J. H. (2006). Auditory neuropathy characteristics in children with cochlear nerve deficiency. Ear Hear, 27(4), 399-408. doi: 10.1097/01.aud.0000224100.30525.ab


Carner, M., Colletti, L., Shannon, R., Cerini, R., Barillari, M., Mucelli, R. P., et al. (2009). Imaging in 28 children with cochlear nerve aplasia. Acta Otolaryngol, 129(4), 458-461.


Chapple, C., Willis, S., & Frame, J. (2002). Effective dose in paediatric computed tomography. Physics in medicine and biology, 47(1), 107.


Fatterpekar, G. M., Doshi, A. H., Dugar, M., Delman, B. N., Naidich, T. P., & Som, P. M. (2006). Role of 3D CT in the Evaluation of the Temporal Bone. Radiographics, 26(suppl_1), S117-S132.


Fatterpekar, G. M., Mukherji, S. K., Alley, J., Lin, Y., & Castillo, M. (2000). Hypoplasia of the bony canal for the cochlear nerve in patients with congenital sensorineural hearing loss: initial observations. Radiology, 215(1), 243-246. doi: 10.1148/radiology.215.1.r00ap36243


Fatterpekar, G. M., Mukherji, S. K., Lin, Y., Alley, J. G., Stone, J. A., & Castillo, M. (1999). Normal canals at the fundus of the internal auditory canal: CT evaluation. J Comput Assist Tomogr, 23(5), 776-780.


Giesemann, A. M., Kontorinis, G., Jan, Z., Lenarz, T., Lanfermann, H., & Goetz, F. (2012). The vestibulocochlear nerve: aplasia and hypoplasia in combination with inner ear malformations. European radiology, 22(3), 519-524.


Glastonbury, C. M., Davidson, H. C., Harnsberger, H. R., Butler, J., Kertesz, T. R., & Shelton, C. (2002). Imaging findings of cochlear nerve deficiency. AJNR Am J Neuroradiol, 23(4), 635-643.


Jager, L., Bonell, H., Liebl, M., Srivastav, S., Arbusow, V., Hempel, M., et al. (2005). CT of the Normal Temporal Bone: Comparison of Multi–and Single–Detector Row CT. Radiology, 235(1), 133-141.


Jang, J. H., Kim, J. H., Yoo, J. C., Kim, C. H., Kim, M. S., Chang, S. O., et al. (2012). Implication of bony cochlear nerve canal on hearing in patients with congenital unilateral sensorineural hearing loss. Audiol Neurootol, 17(5), 282-289. doi: 10.1159/000338821


Jaryszak, E. M., Patel, N. A., Camp, M., Mancuso, A. A., & Antonelli, P. J. (2009). Cochlear nerve diameter in normal hearing ears using high‐resolution magnetic resonance imaging. Laryngoscope, 119(10), 2042-2045.


Joshi, V. M., Navlekar, S. K., Kishore, G. R., Reddy, K. J., & Kumar, E. V. (2012). CT and MR imaging of the inner ear and brain in children with congenital sensorineural hearing loss. Radiographics, 32(3), 683-698.


Kim, H.-S., Kim, D.-I., Chung, I.-H., Lee, W.-S., & Kim, K.-Y. (1998). Topographical relationship of the facial and vestibulocochlear nerves in the subarachnoid space and internal auditory canal. American Journal of Neuroradiology, 19(6), 1155-1161.


Komatsubara, S., Haruta, A., Nagano, Y., & Kodama, T. (2007). Evaluation of cochlear nerve imaging in severe congenital sensorineural hearing loss. ORL J Otorhinolaryngol Relat Spec, 69(3), 198-202. doi: 10.1159/000099231


Kono, T. (2008). Computed tomographic features of the bony canal of the cochlear nerve in pediatric patients with unilateral sensorineural hearing loss. Radiat Med, 26(3), 115-119.


Li, A., & Martin, F. (1983). Development of materials for determination of the speech reception threshold in Chinese. Chin Med J, 32, 282-288.


McClay, J. E., Tandy, R., Grundfast, K., Choi, S., Vezina, G., Zalzal, G., et al. (2002). Major and minor temporal bone abnormalities in children with and without congenital sensorineural hearing loss. Arch Otolaryngol Head Neck Surg, 128(6), 664-671.


Miyasaka, M., Nosaka, S., Morimoto, N., Taiji, H., & Masaki, H. (2010). CT and MR imaging for pediatric cochlear implantation: emphasis on the relationship between the cochlear nerve canal and the cochlear nerve. Pediatr Radiol, 40(9), 1509-1516. doi: 10.1007/s00247-010-1609-7


Morimoto, N., Miyasaka, M., Iigaya, N., Matsuda, A., & Taiji, H. (2009). Clinical aspects of unilateral hearing loss due to isolated cochlear nerve aplasia. Otol Jpn, 19, 41-48.


Organization, W. H. (2015). Deafness and hearing loss. Retrieved from http://www.who.int/mediacentre/factsheets/fs300/en/


Pagarkar, W., Gunny, R., Saunders, D. E., Yung, W., & Rajput, K. (2011). The bony cochlear nerve canal in children with absent or hypoplastic cochlear nerves. Int J Pediatr Otorhinolaryngol, 75(6), 764-773. doi: 10.1016/j.ijporl.2011.02.017


Rinaldo, F. C., & Paul, R. L. (2000) The ear: comprehensive otology (pp. 33-35). USA: Lippincott Williams & Wilkins, Philadelphia.


standardization, i. o. f. (1964). standard reference zero for the calibration of pure-tone audiometers (pp. R389).


Standring, S., Ellis, H., Healy, J., Jhonson, D., Williams, A., & Collins, P. (2005). Gray's anatomy: the anatomical basis of clinical practice. American Journal of Neuroradiology, 26(10), 2703.


Teissier, N., Van Den Abbeele, T., Sebag, G., & Elmaleh-Berges, M. (2010). Computed tomography measurements of the normal and the pathologic cochlea in children. Pediatr Radiol, 40(3), 275-283.


Thai-Van, H., Fraysse, B., DeGuine, O., Sevely, A., & Berges, C. (2001). Does cochlear nerve aplasia always occur in the presence of a narrow internal auditory canal. Annals of Otology Rhinology and Laryngology, 110(4), 388-392.


Walton, J., Gibson, W. P. R., Sanli, H., & Prelog, K. (2008). Predicting cochlear implant outcomes in children with auditory neuropathy. Otology & Neurotology, 29(3), 302-309.


Watanabe, Y. (2000). High-resolution computed tomography using multiplanar reconstruction for the facial nerve canal. Acta Otolaryngol, 120(542), 44-48.


Westerhof, J. P., Rademaker, J., Weber, B. P., & Becker, H. (2001). Congenital malformations of the inner ear and the vestibulocochlear nerve in children with sensorineural hearing loss: evaluation with CT and MRI. J Comput Assist Tomogr, 25(5), 719-726.


Wilkins, A., Prabhu, S. P., Huang, L., Ogando, P. B., & Kenna, M. A. (2012). Frequent association of cochlear nerve canal stenosis with pediatric sensorineural hearing loss. Archives of Otolaryngology–Head & Neck Surgery, 138(4), 383-388.


Yi, J. S., Lim, H. W., Kang, B. C., Park, S. Y., Park, H. J., & Lee, K. S. (2013). Proportion of bony cochlear nerve canal anomalies in unilateral sensorineural hearing loss in children. Int J Pediatr Otorhinolaryngol, 77(4), 530-533. doi: 10.1016/j.ijporl.2012.12.031

連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關點閱論文