耳管通気により発症した外リンパ瘻確実症例

A case of perilymph fistula following eustachian tube insufflation

はじめに

　カテーテルによる耳管通気は耳鼻咽喉科で日常よく行われる処置であるが，時に咽頭粘膜下気腫などの副損傷をきたす^1,2）。耳管通気によって外リンパ瘻が起きることは稀であり，国内外で4例が報告されているに過ぎない。今回われわれは耳管通気後に難聴をきたし，中耳洗浄液からcochlin-tomoprotein（CTP：コクリントモ蛋白）が検出され外リンパ瘻確実例と診断できた症例を経験したので報告する。

　A 76-year-old male had presented to local E. N. T. clinic and had been undergone Eustachian tube insufflation. During the insufflation, the patient had heard pop sound in his left ear, then he had recognized hearing loss in left ear without dizziness or vertigo. The day after the Eustachian tube insufflation, he presented to our hospital. Otoscopic examination revealed small perforation in left tympanic membrane and audiogram showed sensory neural hearing loss in left. No vertigo or dizziness was complained and no nystagmus was observed. Cochlin-tomoprotein（CTP）detection test was performed since barotraumatic perilymph fistula（PLF）was suspected. After conservative observation for 2 weeks, hearing acuity was not improved. A perilymph fistula repair surgery was performed subsequently by transcanal endoscopic ear surgery technique. Positive result for the CTP detection test was reported after the operation and the pre-operative diagnosis was confirmed as definitive PLF. The left hearing acuity of the patient was improved satisfactorily after the operation.