メニエール病に対する鼓索神経切断術の効果2,3の疑問点

RESECTION OF THE CHORDA TYMPANI NERVE FOR TREATMENT OF MÉNIÈRE'S DISEASE AND A NEW QUESTIONABLE POINTS

　Ⅰ．緒言

　Rosenによつて始められた鼓索神経切断術は，本邦でもここ10数年来多くの症例について行なわれ，手技が簡単でしかも合併症のほとんどない方法として，一時代を画したことは事実である。すでにメニエール病に対する外科的療法の1つとして一応の評価もなされ，この手術をきつかけとしてメマイ発作が鎮つて行くというのが大方の意見であつたが，近年，その効果に疑問が持たれ，余り行なわれなくなつているようである。

　従来の報告では，この方法の効果の有無とか，Rosenの言う鼓索神経とⅧ神経の吻合における前庭系への関与という意味づけの下に検討されることが多かつたが，肝腎の術後の味覚とメマイの経過の関連などについてはほとんど検討されていない。そこで，教室で行なつた術後2年以上経過した4症例を振返り，それらの遠隔成績および諸検査成績とメマイの経過の関係から見た，この方法に対する2,3の疑問点について検討したい。

　Section of the chorda tympani nerve performed in 4 cases for the treatment of Ménière's disease with prognosis of the procedure and a few other questionable points are discussed. The patients were women, aged 24 to 41, on whom the operation was performed from 2 to 5 years ago. The treatment was definitely effective in all cases in allaying the dizziness. However, there was no effect upon the tests of hearing, tinnitus and of caloric nystagmus.

　Subjective sense of taste showed recovery in 3 cases out of the 4, in 3 to 6 months after the operation and by electrogustometry 2 cases out of this group were completely recovered. But there seemed to be no relation between the recovery of the taste with that of the dizziness.

　The progress of the spontaneous nystagmus was examined during preoperative, during operation and postoperatively, but there seemed to no effect due to the section of the chorda tympani nerve. Consequently, it seemed that the effect ofthe nerve section was unrelated to the recovery of dizziness which implies that there is no relation between the dizziness and the vestibular system. The authors believe that the dizzinessmay the result of psychological disturbance and the relief of the tension of the autonomic nervous system appeared to be more appropriate.