聴器と腎障害—病理学的研究

HISTOPATHOLOGICAL FINDINGS OF THE TEMPORAL BONES WITH RENALFAILURE

　聴器と腎臓は，解剖学的にも機能的にも別の器官で，医師にしても，そこに相関を求めることは困難である。しかも腎臓は排泄および分泌器官であり，耳で感覚器である。

　しかし，両器官にも一面，機能的に類似した点があることや，また，同時に障害されやすいことなどが耳鼻科医の常識となつていることも，また事実である。

Histopathological studies of the temporalbones of 7 patients with renal failure were performed referring to their audiograms in alive.

Case 1 ; A foruteen months old boy had 50~60 dB hearing loss with bilateral ear anomalies, micrognathia, hydronephrosis in the right kidney, and aplasia in left kidney. External and middle ear malformations were disclosed by histopatho-logical study.

Case 2 ; A fifteen years old boy had progres-sive, 20~50 dB gradual high tone hearing loss, and suffered chronic gromerulonephritis. His mother died from uremia after chronic nephri-tis. Histopathological studies revealed no remarka-ble pathological findings in hair cells, but shrunked slender tectorial membrane in the basal turn.

Case 3 ; A fifty-five years old male developed progressive renal failure with auriculo-ventricu-lar block in heart, and he died from ishemic heart disease. After hemodialysis of three years' duration, he developed a hearing loss of 50~80 dB, and recovered three month later to 10~70 dB gradual high tone loss. Histopathological studies revealed atrophy of the stria vascularis, inner hair cells, tectorial membrane in the basal turn and no remarkable pathological finding in the middle and apical turn.

Case 4 ; A thirty-five years old male had renal insufficiency after chronic nephritis, and treated peritoneal infusion, and developed serum hepa-titis. He developed complete hearing loss sudden-ly in the right ear and six days later in the left after he had high fever for a month. Thepertinent findings were loss of the outer and inner hair cells in each turn of the cochlea, and the tectorial membrane was curled in to the inner sulcus cells. Collapse of the vestibular membrane was observed in the middle turn and saccular wall in the right ear.

Case 5 ; A thirty years old male developed renal failure of six years' duration. He was treated with peritoneal infusion thirty times followed with hemodialysis. He was treated with kanamycin for two days, 1.0 g in each day, and he suddenly suffered from deafness in the both ears on next day. The most remarkable changes were loss of the outer and inner hair cells in all turns just like as the findings in animal experiment.

Case 6 ; A thirty-nine years old male suffered from renal insufficiency for ten years. He was treated with hemodialysis, and he had a transient slight hearing loss of 20~50 dB in the both ears, and his hearing was completely recovered two month later. Temporal bone studies revealed no remarkable pathological findings in the inner ear, but the carotid canal in the temporal bone was occluded by fungious mass.

Case 7 ; A thirty-two years old female de-veloped hyperparathyroidism after long term hemodialysis. She had a 30dB conductive hearing loss which was recovered completely. Temporal bone studies revealed decalcification of all layers of bone with many osteoclasts but no remarka-ble pathologic findings were observed in the inner ear.