温熱による鼓膜穿孔とその治療法

THE PERFORATION OF TYMPANIC MEMBRANE CAUSED BY THERMAL INJURY AND IT'S TREATMENT

　I．いとぐち

　臨床第一線の実地医家にとつて，もつともありふれた疾患について十分な深い知識が必要なことはいうまでもないが，一方，稀にしか遭遇しない疾患についてもどのように対処すべきか，その知識が必要なわけである。最近私は比較的稀な，湯傷による鼓膜穿孔およびそれに続発した中耳炎の症例を相いついで経験し，鼓膜成形術によつて鼓膜を閉鎖せしめたのみでなく，聴力をもほぼ正常にまで回復せしめ得たので，上述の意味においてその概要を報告するとともに，温熱による鼓膜穿孔の治療方針，特に湯傷の場合の鼓膜成形術について私見を述べたい。

　Perforation of the tympanic membrane caused by thermal injury seldom occurs, as the tympanic membrane is situated in the deep part of the auditory canal. Myringoplasty without mastoidectomy was performed to a nine-year-old boy and a five-year-old boy who had perforation of the tympanic membrane caused by scalding. By a few weeks later their perforations had completely closed, and their hearing recovered to the almost normal level. In performance of myringoplasty in such cases a wide vascular bed for transplantation of the temporal fascia must be provided, because scalding tends to induce cicatrization and undernourishment.

　Through the literature and the author's experience were drawn the following conclusions : The treatment for perforation by scalding is different from the treatment for perforation by burns or welding sparks. As the perforation byburns is usually not infected, conservative treatment is effective, for example, a piece of steristrip can be used to close the perforation. However, for the perforation by scalding there is no other treatment than myringoplasty which should be done cautiously to avoid failure.