36.3 🩺 內科專科考前版

36.3.0.1 📌 䞀頁重點

  • 22Ecochlear implant 適應 expanding、hearing aid 預防 dementia evidence 匷化
  • Sudden SNHL early steroid is standard
  • Taiwan 健保 cochlear implant 郚分

36.3.0.2 🧠 進階機蜉

  • Hair cells 䞍胜再生
  • Aminoglycoside 环積圚 endolymph → outer hair cell death
  • Genetic deafness: GJB2, SLC26A4 等 mutation

36.3.0.3 💊 進階治療

36.3.0.3.1 Sudden SNHL
  • Oral pred 1 mg/kg × 14 d → taper
  • Intratympanic dexamethasone 4-12 mg q week × 4
  • Salvage IT steroid for failure
36.3.0.3.2 Cochlear Implant
  • Adults profound bilateral
  • Children CI 越早越奜
  • Bilateral CI standard
36.3.0.3.3 Tinnitus
  • CBT
  • Sound therapy
  • Hearing aid for hearing loss with tinnitus
  • 沒 cure for chronic idiopathic

36.3.0.4 🌟 Pearls (8)

  1. Sudden SNHL 14 days window for steroid
  2. Unilateral SNHL → MRI acoustic neuroma rule out
  3. Aminoglycoside irreversible — TDM 必做
  4. Hearing aid + cognitive function: Lancet 2024 #1 prevention
  5. Cochlear implant 越早越奜pediatric
  6. NF2 = bilateral acoustic neuroma
  7. Otosclerosis = stapes fixation, conductive 挞進
  8. Tinnitus 倚 hearing loss 共病

36.3.0.5 📍 台灣 Context

  • 健保 cochlear implant 兒童
  • 聜力篩檢 newborn
  • 助聜噚補助
  • 老人聜力篩檢掚廣

36.3.0.6 🎓 內專重點

  1. 䞉類 loss + Weber/Rinne
  2. Sudden SNHL emergency
  3. Acoustic neuroma
  4. Ototoxic
  5. Cochlear implant + hearing aid
36.3.0.6.1 跚章節
  • Ch 24 Dizziness
  • Ch 31 Dementia (hearing aid prevention)

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