外傷性耳小骨変位による瘻孔症状の1例

FISTULA SYMPTOM DUE TO TRAUMATIC OSSICULAR DISLOCATION

　I．はじめに

　耳鏡所見や側頭骨X線所見には異常がなく聴力もほぼ正常であるのに瘻孔症状を有する症例を経験した。原因探求のため試験的乳突洞鼓室開放術を施行したところキヌタ骨が変位し，ツチ・キヌタ関節は亜脱臼，キヌタ・アブミ関節は脱臼し擬関節をつくつていた。血清梅毒反応は陰性で他に中耳病変も認められず，連鎖の再建によつて瘻孔症状が消失したので，この耳小骨連鎖の変位が瘻孔症状の原因であると結論した。

　われわれの調査した限りでは類似の症例報告はみられず，きわめて稀な症例と考え，ここにその詳細を報告するとともに瘻孔症状の原因などについて考察した。

　A case with fistula symptom due to traumatic ossicular dislocation was reported. A 44-year-old male driver complained of transient vertigo in compression of his right ear and of abnormal aural sensation in driving his car into a tunnel.He had had a head injury 28 years ago but has no hearing disturbance. No abnormality was shown by otoscopic, audiological, radiological, and serological examinations. A fistula test was positive, but it was proved an atypical reaction of fistula symptom. A tympanometric study suggested an ossicular discontinuity. The exploratory tympanomastoidectomy revealed that themalleoincudal joint was subluxated, incudostapedial joint was disrupted, and the long process of the incus was shifted to the head of the stapes which was surrounded by granulation tissue. These ossicular dislocation seemed to be caused by head injury of 28 years ago. His complaints have disappeared after the reconstruction of the ossicular chain.