鼓室硬化症の臨床的ならびに病理組織学的観察

Clinical and Microscopic Observations on Tympanosclerosis

　はじめに

　鼓室硬化症は一般に慢性中耳炎の後遺症とみなされており，病理組織学的に極めて特異な像を示す。特徴となる硬化物質は耳小骨連鎖の可動性を制限し，伝音難聴を起こさせる厄介な疾患である。今まで経験した鼓室硬化症症例の病態について臨床的に検討を加え，併せて，一部の症例で手術時に採取した硬化病変組織を形態学的に観察する機会を得，若干の知見を得たのでここに報告する。

Tympanosclerosis was investigated clinically and microscopically in 23 ears of 22 patients. It is of interest to note that the majority of the patients were middle- aged females and possessed keloid and/or allergic dispositions. Clinical diagnosis was made by characteristic symptoms and findings, and confirmed by a direct observation of sclerotic lesions using a super-fine fiberscope through the eustachian tube or a perforated hole of the tympanic membrane.

The tympanoplasty type Ⅲ was almost successful compared with other types in present series.

Sclerotic lesions were mainly found around and adjacent to the body of incus in the attic.

They partly extended down to the incudosta-pedial joint area. Microscopically hyaline degenera-tion and calcification of collagen fibers were char-acteristic features of sclerotic lesions. By mi-croanalysis of sclerotic substances calcium and phosphorus were observed in almost the same distri-bution pattern, indicating that these electrolytes exist in a form of calcium phosphate in sclerotic lesions. One-thirds of the patients possessed keloid and/or allergic dispositions, suggesting that these dispositions may more or less relate to an occur-rence of tympanosclerosis.