真珠腫性中耳炎に関する臨床的観察—（その2）真珠腫性中耳炎のレ線所見について

CLINICAL STUDIES CHOLESTEATOMATOUS OTITIS MEDIA (2 ND REPORT) X-RAY STUDIES CHOLES-TE ATOMATOUS OTITIS MEDIA

Ⅰ．緒言

　耳科臨床上レ線所見は，治療方針を決定する場合に極めて重要な診断的価値を有することは周知の事実である。殊に真珠腫性中耳炎においては，今日なお手術的療法に依存せねばならぬ現状であるから術前に真珠腫の存在部位，範囲，骨破壊の程度，あるいは含気蜂窠の状態を充分識別しておくことが大切でレ線撮影は耳科診療上必要欠くべからざる役割を果している。

　著者らは，さきに本研究の前編において真珠腫性中耳炎の臨床所見と手術所見との関係について比較的詳細にわたり報告を行なつた。本編においては，真珠腫性中耳炎例に関して，真珠腫形成の状態をレ線学的に追求検討し，特にレ線所見と臨床所見および手術時所見との比較検討を行ない真珠腫形成におけるレ線所見の示す診断的意義について述べた。

　Eighty seven cases of cholesteatomatous otitis media are studied from the standpoint of x-ray, clinical and surgical observations. The results are as follow:

　1) In 61 cases of choelsteatomatous otitis media the x-ray observation was negative in 28 cases, 46%, and either doubtful or positive in 33 cases, 54%.

　2) In the 33 positive cases the mastoid region showed softening in 19 cases, broken down trabeculae in 12 cases and osteosclerosis in 2 cases.

　3) No definite relation could be established between the picture presented by appearance of tympanic membrane to cholesteatoma; in 2 cases cholesteatoma was found in whom tympanic membrane was not visible due to the prese nce of aural polyp.

　4) In 40 cases of the 61 the presence of cholesteatoma was shown in the x-ray picture by presenting a widened clear are in the tympanic cavity particularly the epitympanum.

　5) The diagnosis is easily made when cholesteatoma involvement is large in area ; but, when this area is small and deeply situated with presence of sclerosis the diagnosis is made with a great difficulty.

　6) In the 26 cases in whom choleateatoma occurred after the radical mastoid operation, 3 cases showed a positive x-ray picture, 10 cases were questionable and 13 cases were unknown.