小児滲出性中耳炎におけるアデノイドの位置づけ

THE ROLE OF ADENOIDS IN OTITIS MEDIA WITH EFFUSIONS

　I．はじめに

従来，小児滲出性中耳炎および反復性中耳炎（以下，中耳炎と略す）に対して治療の1つとして，アデノイド切除術が行われてきたが，その臨床的効果は必ずしも満足すべきものではなく，事実，アデノイド切除術後もなお，中耳炎に罹患する例が少なからず経験される。

　近年，Mawsonら^1）やDagooら^2）が，中耳炎に対するアデノイド切除術は，効果がないと報告して以来，その功罪が論じられるようになってきており，アデノイド切除術の意義に疑問が生じているのが現況ではないだろうか。

　The effect of adenoidectomy on otitis media with effusions (O.M.E.) is analysed to elucidate whether or not adenoids play a role in the etiology of O.M.E. From the questionnaires study, the majority of children with O.M.E. showed a benefit from adenoidectomy.

　Histological observation of the distribution of IgA-producing cells of adenoid tissues were also performed. Regardless to the presence of O.M.E., adenoids in children with sinusitis were more infected than those without it. Upper respiratory tract infection may produce a harbor of microorganisms in the upper airway and may result in enlarged or infected adenoids. Adenoids itself might not contribute to the etiology of O.M.E., but infection in the upper respiratry tract may play an important role.

　The present study suggested that adenoidectomy did not always improve O.M.E., and there was persisting or recurrent infection of the upper respiratory tract after adenoidectomy.

　In those cases, these infections should intensively he treated to reduce the incidence of O.M.E.