Pattern of Ossicular Disruption after Head Trauma

Abstract

최근 3년 동안 두부외상 후 청력장애를 주소로 이비인후과 외래를 방문하여 전음성 난청을 보이고 수술로 확진된 이소골 탈구 환자 23례를 대상으로 문진 소견, 측두골전산화단층촬영 소견, 수술소견을 통하여 다음과 같은 결과를 얻었다. 1) 본 연구에서 두부외상 후 6 유형의 이소골 탈구 소견이 관찰되었고, 두부외상 후 이소골 탈구의 유형은 침골의 완전 탈구가 가장 많았으며, 전 23례 중 8례(34.8%)에서 는 측두골전산화단층촬영 상 측두골의 골절선이 관찰되지 않았다. 이 경우에는 침골등골관절의 탈구(8례 중 4례)가 가장 많았다. 2) 두부 외상의 가장 많은 원인은 교통사고가 가장 많았으며(70%), 보행 중 교통사고가 차안에서의 교통사고보다 침골의 전위가 더 심하였다. 3) 측두골전산화단층촬영을 통한 이소골 연쇄 상태의 세심한 관찰이 술전 이소골 탈구의 중요한 정보를 줄 수 있었다.

BACKGROUND AND OBJECTIVES: Mechanization and reliance on motorized transportation place everyone in our society at risk for head injury. Temporal bone trauma is usually the result of blunt head injury in patients suffering from multiple body injury. Hearing problems can be neglected initially, but many patients complain of hearing difficulties later after the head trauma. If hearing loss is conductive, there is the possibility of the ossicular disruption. The ossicular disruption after the head trauma can develop with or without the temporal bone fracture line. The aim of this study was to analyze the types of ossicular disruption and to review their pathophysiology. MATERIALS & METHODS: In the present study, we analyzed 23 cases of ossicular disruption following head trauma (mean age: 20.2 years, Male: female=14:9). The diagnosis was based on medical history, physical examination, findings of temporal bone CT and confirmed with operative findings. RESULTS: Among 6 types of ossicular disruption, we encounted 10 cases of complete incus dislocation, which was the most common type of ossicular disruption (43.5%). The most common cause of head injury was car accident. The fracture line of the temporal bone was found in 15 cases. In the 8 cases, we could not find any evidence of fracture. CONCLUSIONS: Incus dislocation is the most common type of ossicular disruption after head trauma and the I-S joint is the weakest point of ossicular chain because of its anatomical structure.