小児滲出性中耳炎経過中における中耳真珠腫の発現

Development of Cholesteatoma from Otitis Media with Effusion

I．はじめに

　小児滲出性中耳炎の発症は大変緩慢で，疾患神過中の症状も大抵は穏やかであるため，医師や家族が本症に対して重症感をもつことは少ない。しかし，本症が慢性の神過を示しその中耳病態が変化に富むことから推して，本症が成人における耳疾患に多くの関わり合いをもつことが想像される。

　本症から中耳真珠腫が発現する危険性に関していくつかの記述があるが，実際に真珠腫が発症するとすればその発症の過程に関心がもたれる。

　From a longitudinal study of 230 cases with otitis media with effusion, the authors observed development of cholesteatoma in the middle ear.

　In a 7-year-old girl with otitis media with effusion, there was observed a sudden development of red, fragile and readily bleeding granulations in the posterior superior wall of the external auditory canal associated with purulent discharge. The destruction of the lateral wall of the attic was developed due to localized osteomyelitis with an invasion of the canal skin into the attic, which produced a cholesteatoma. The patient underwent radical mastoidectomy because of this extensive disease.

　In another girl of 6 years of age, a similar granulating tissue of the external auditory canal due to osteomyelitis of the lateral wall of the attic was successfully treated with a middle ear ventilation tube and intensive antibiotic therapy. Destruction of the lateral wall of the attic by cholesteatoma was successfully prevented in this case. The patient was suffered from a 40dB hearing loss due to ossicular disruption.

　These two cases indicate the process of development of cholesteatoma in otitis media with effusion, where osteomyelitis and destruction of the lateral wall of the attic play a cardinal role in the development of cholesteatoma. it is also suggested that the development of this type of cholesteatoma could be prevented by adequate treatment by middle ear ventilation tubes and antibiotics.