中耳換気tubeの比較検討

COMPARATIVE STUDY OF MIDDLE EAR VENTILATING TUBES

　I．はじめに

　小児滲出性中耳炎は小児耳鼻咽喉科疾患の中で次第に重要な位置を占める傾向がみられるが，その主な理由は本症の頻度が急激に増加していることの他に，本症の主徴としての難聴が，耳からの知識の吸収が最も大切な小児期に惹起されることと，本症を放置した場合，将来伝音機構の障害をもたらす不可逆性の中耳病変をきたす懸念のあることにある。

　現在，本症に対する有効な治療法として，中耳に換気tubeを挿入する手術が広く行われている。この治療法に関して，まだ様々の議論があるが，小児滲出性中耳炎の直接の要因として耳管の排泄機能不全が関与することは十分考えられ，換気tubeの挿入は聴力の即時改善という臨床的効果のほかに，耳管に代わってtubeによって中耳のaerationを可能にするという意味において有用と思われる。

　The author has compared the clinical results of 3 different middle ear ventilating tubessimple tube, hard grommet and elastic grommetin a series of 154 ears with tympanostomy with tube that had been treated during the 7 years from 1972 to 1978.

　The results are summarized as follows;

　1) The most frequent cause of early failure of the tube function has been found to be occlusions of the tube with effusions or crusts. This tendency was most prominent with the simple tubes.

　2) Grommets have been found to function for longer periods than simple tubes and, at the same time, to have less chance of recurrence.

　3) Of the two grommets, elastic grommets (Paparella type) have functioned for longer periods than hard grommets (Shepard type) and showed a tendency of less susceptibility to recurrence.

　4) The longer the function periods of the tube the lesser the chance of recurrence.

　5) Use of tubes with longer functioning periods seems to be most important for a successful treatment of otitits media with effusion and also for prevention of recurrence of the disease.