두부손상후 청력장애에 관한 연구

Abstract

Recently head trauma more increased according to industrial and traffic development, and otologic problems including hearing impairment noted after head trauma. The purpose of this study is analysis and follow-up about hearing impairment and other otologic symptoms after head trauma, and provide good diagnostic and therapeutic guidance. We studied 45 patients among the 380 patients of head trauma who had been admitted to Dept. of otolaryngology and neurosurgery, Ewha Womans University Hospital from Jan. 1982 to Dec. 1982. Forty five cases, 19 with temporal bone fracture, 16 with other part of skull fracture except temporal bone, and 10 with head trauma without skull fracture, were sampled, who had no history of ear trouble and noise exposure. All the patients underwent a through E.N.T examination and puretone audiogram. The results were as follows ; 1. Of the 380 head trauma patients, 71 patients (19%) were skull fracture. And 27 patients of 71 skull fracture patients were temporal bone fracture. So the percentage of temporal bone fracture to skull fracture was 38%. 2. Male to female ratio was 3.5 : 1. 3. Most common cause of head trauma was automobile accident. 4. On otologic symptom and signs ; Of the 380 head trauma patients, 45 patients had clinical otologic findings. Of these 45 cases, the most common symptom was hearing impairment which was 39 cases (87%), ear bleeding in 19 cases (42%), tinnitus in 18 cases (40%), vertigo and dizziness in 8 cases (18%), hemotymanum in 7 cases (15%), and facial palsy in 3 cases (6%). And these otologic finding freequetly noted in temporal bone fracture. Un the type of hearing loss of 39 cases, unilateral hearing loss was 19 cases (49%), bilateral hearing loss was 14 cases (36%) and 6 cases (15%) were within normal speech range. 5. Audiogram finding ; Audiologic study was performed for 78 ears and hearing loss above 25 dB was observed in 47 ears. Conductive type hearing loss was 19 ears (40%), mixed type hearing loss in 16 ears (14%), and sensorineural type hearing loss in 12 ears (26%). Most common degree of hearing loss was mild degree which was 20 ears (43%), and most common audiogram curve type was flat type in 12 ears (26%). 6. Follow-up audiogram finding ; Fllow-up of 23 cases of hearing loss, 11 cases were improved, 11 cases no improved, and 1 case was malingering. And on the type of audiogram, the most improved type was descending type and least was flat type. 7. 2 cases of 18 tinnitus were spontaneously improved during 1 month, but remaining 16 cases were no improved. 8. 8 cases of vertigo and dizziness were all improved and 26 cases ear bleeding or hemotympanum also absorbed. In follow-up 2 cases of facial palsy, all were improved.;산업 및 교통수단의 발달에 따라 최근 두부손상 환자가 날로 증가하고 있다. 손상후 난청·이명·전정장애등 여러 이과적 증상이 나타나게 되며, 이러한 증상은 측두골 골절이 동반되는 경우에 빈발하다. 이에 저자는 두부손상후 청력장애등을 포함한 이과적 문제를 분석 연구하여 진단과 치료에 도움이 되고자 외상성 두부순상 환자 380예를 대상으로 하여 이비인후과적 검사 및 순음청력경사를 실시하여 다음과 같은 결과를 얻었다. 1. 외상성 두부손상 환자 380예중 두개골 골절 환자는 71예(19%)였으며 이중 27예가 측두골 골절로 두개골 골절의 38%였다. 2. 남녀의 비는 3.5 : 1로 남자에서 높았다. 3. 원인은 교통사고가 가장 많았다. 4. 이과적 임상소견 두부손상 환자 380예중 이과적 임상소견을 보였던 45예에서 난청이 39예(87%)로 가장 많았으며, 이출혈 19예(42%), 이명 18예(40%), 현훈 8예(18%), 고실혈종 7예(15%), 안면신경마비 3예(6%) 순이었으며, 이러한 임상소견은 측두골 골절에 의한 경우가 가장 많았다. 난청을 호소하는 39예중 청력검사상 편측 난청이 19예(49%)로 가장 많았으며 양측 난청을 호소한 예가 14예(36%)였고, 6예(15%)는 회화에 지장이 없는 범위였다. 5. 청력검사 소견 난청을 호소하는 39예(78耳)에 대한 청력검사 결과 25dB 이상의 난청이 있는 47耳 중에서 전음성 난청이 19耳(40%)로 가장 많았고, 혼합성 난청이 16耳(34%), 감음신경성 난청이 12耳(26%) 순이었다. 난청의 정도는 경도 난청이 20耳(43%)로 가장 많았고, 난청형은 수평형이 14耳(30%)로 가장 많았다. 6. 청력검사에 대한 추적소견 난청을 호소한 39예중 추적검사가 가능한 23예에서 11예는 난청의 호전을 보였다. 호전된 11예에서 7예는 측두골 골절로 고실혈종 및 이출혈이 있었고 2예는 감음신경성 난청, 2예는 혼합성난청이었다. 청력검사상 난청형은 하강형에서 호전도가 높았고 수평형에서의 호전도는 낮았다. 7. 이명을 호소하는 18예중 1개월 이내에 회복된 2예 이외에는 호전되지 않았다. 8. 현훈을 호소하는 8예는 모두 회복되었으며 이출혈 및 고실혈종을 보인 26예는 전부 흡수되었고 안면신경마비는 추적이 가능했던 2예에서 회복되었다.