感音難聴に対するステロイド療法の再検討

STEROID THERAPY IN SENSORI-NEURAL DEAFNESS

　I．はじめに

　原因不明の感音難聴，とりわけ突発性難聴に対する治療法として副腎皮質ステロイド療法（以下ステロイドと略）は，星状神経節ブロックと並んでもつとも広く行なわれており^1）〜4），われわれもこれまでしばしば用いてきた。

　ステロイドは多くのすぐれた薬理作用を有しているが，この作用が逆に副作用として有害に働く場合があることもよく知られている。

　Although the use of steroid for viral infections is still controversial, steroids are widely used for sensori-neural deafness suspected of viral origin. A 42-year-old woman recieving steroid therapy for a considerable period for the treatment of Wegener's granulomatosis, which was well suppressed, had developed a herpes zoster of the chest. The herpes disseminated unilaterally on the VIIth and VIIIth cranial nerves resulting in an unilateral facial paresisalong with bilateral severe sensori-neural deafness.

　In two other patients, men, aged 15 and 23, steroid administrations were carried out in the beginning of sudden deafness following the symptoms of a common cold with a marked impairment in their hearing capacity. However, in the former patient the hearing loss remained unchanged and the latter showed improvement after cessation of the steroids.

　It is, thus, in author's opinion that steroid therapy should be contraindicated in case of sudden deafness associated with symptoms of viral-like infections such as fever or nasal discharges.