罕見兒童脈動性耳鳴使用心導管螺旋線圈栓塞術治療成功－病例報告

Rare Pulsatile Tinnitus in Children Treated with Transcatheter Coil Embolization: A Case Report

我們發表一個四歲的女生，初始的症狀表現出少見的夜間睡眠時右耳單側耳鳴，耳鳴怪異白天清醒時消失，持續了一年之久，導致病患失眠與夜間驚恐不安。經頭頸部磁振血管攝影與心導管攝影檢查後，證實其患有先天性右外頸動脈瘻管，瘻管連接右側外頸與內頸靜脈。此先天頸部動靜脈瘻管經由心導管螺旋線圈方式栓塞，術後狀況良好，病患夜間症狀痊癒，無併發症發生。耳鳴是個症狀，不是疾病，每個人在某個時間或情況下都曾感覺，目前缺乏全球耳鳴發生率的統計，在一些報告裡耳鳴在聽力正常小孩發生率約6~36%，而在聽力障礙的小孩上有超過一半的人感到耳鳴。若耳鳴出現規律、且跟自己的心跳一致的話稱為脈動性耳鳴(pulsatile tinnitus)。 脈動性耳鳴形成原因很多，大多與頭頸部靠近聽覺器官的血管或血流異常有關，它罕見在小孩身上，只佔所有耳鳴的百分之3。因病患的單側耳鳴僅出現在深夜睡眠時，導致驚恐失眠，經過反覆耳鼻喉科與神經科檢查並無發現相關的腦神經與聽覺器官的障礙缺陷, 因而被誤認為身心症候群而受精神科藥物治療。經診斷後，確定是一罕見的兒童先天性右側外頸動脈瘻管導致此夜間耳鳴，完成了心導管的螺旋線圈栓塞治療，術後長期症狀痊癒。過去的文獻裡，僅有少數報告發表兒童脈動性耳鳴導因於先天性外頸動脈瘻管，並成功藉由栓塞治療，對符合適應症的病人，栓塞治療具有良好的治療效果，提供了傳統外科手術治療瘻管之外的另一項選擇。

Tinnitus is the perception of abnormal ear or head noises without any external sounds. The noises might be high pitched or comprise ringing, clicking, or buzzing. Pulsatile tinnitus is a kind of rhythmical tinnitus that usually occurs at the same rate as the heartbeat and is rare in children. Herein, we present a 4-year-old girl who had an abnormal audible sound in the right ear during sleep for a year. We confirmed a simple congenital right external carotid artery to jugular vein fistula that produced pulsatile tinnitus and was successfully treated with coil embolization. Pulsatile tinnitus resulting from a congenital external carotid arteriovenous fistula in children is rare and deserves precise evaluation, as it can be effectively treated with transcatheter coil embolization.