Lin Hung-Che, Shih Cheng-Ping, Chen Hsin-Chien, Cheng Chun-An, Huang Yuahn-Sieh, Lin Chen-Shien, Chung Chi-Hsian, Huang Bor-Rong, Lee Jih-Chin, Shangkuan Wei-Chuan, Chien Wu-Chien, Chu Chi-Ming
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan.
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
Int J Environ Res Public Health. 2020 Sep 11;17(18):6624. doi: 10.3390/ijerph17186624.
The aim of study is to investigate the risk of developing acquired cholesteatoma and external auditory canal (EAC) stenosis after traumatic brain injury (TBI) from the Taiwan National Health Insurance Research Database (NHIRD). Each subject was individually traced from their index date to identify those who received a diagnosis of acquired cholesteatoma and EAC stenosis. Cox regression analyses were applied to determine the risk of TBI-related acquired cholesteatoma and EAC stenosis. The follow-up data collected over 10 years were obtained from the TBI and comparison cohorts, of 455,834 and 911,668 patients, respectively. Multivariate analysis demonstrated that TBI significantly increased the risk of cholesteatoma (adjusted hazard ratio (HR), 1.777; 95% confidence interval (CI), 1.494-2.114, < 0.001) and EAC stenosis (adjusted (HR), 3.549; 95% (CI), 2.713-4.644, < 0.001). In our subgroup injury analysis, falls had the highest associated risk (4.308 times), followed by traffic injuries (66.73%; 3.718 times that of the control group). Otolaryngologists should not neglect the clinical importance and carefully investigate the possibility of subsequent cholesteatoma and EAC stenosis, which leads to hearing impairment in patients with TBI. Our research also shows the important role in preventing TBI, especially as a result of traffic injuries and falls.
本研究旨在利用台湾国民健康保险研究数据库（NHIRD）调查创伤性脑损伤（TBI）后发生获得性胆脂瘤和外耳道（EAC）狭窄的风险。从索引日期开始对每个受试者进行单独追踪，以确定那些被诊断为获得性胆脂瘤和EAC狭窄的患者。应用Cox回归分析来确定TBI相关的获得性胆脂瘤和EAC狭窄的风险。从TBI队列和对照组分别收集的超过10年的随访数据，TBI队列有455,834名患者，对照组有911,668名患者。多变量分析表明，TBI显著增加了胆脂瘤的风险（调整后风险比（HR）为1.777；95%置信区间（CI）为1.494 - 2.114，<0.001）和EAC狭窄的风险（调整后HR为3.549；95%CI为2.713 - 4.644，<0.001）。在我们的亚组损伤分析中，跌倒的相关风险最高（4.308倍），其次是交通伤（66.73%；是对照组的3.718倍）。耳鼻喉科医生不应忽视其临床重要性，应仔细调查TBI患者后续发生胆脂瘤和EAC狭窄的可能性，这可能导致听力障碍。我们的研究还表明预防TBI具有重要作用，特别是预防交通伤和跌倒导致的TBI。
