小児滲出性中耳炎の病態と耳管通気療法の問題点

Pathology of Secretory Otitis Media (SOM) in Childhood and the Effectiveness of Tubal Inflation in its Treatment

I．はじめに

　耳管通気法は耳管狭窄の診断並びにその治療の面で広く臨床的に用いられているが，滲出性中耳炎の治療の効果については大きく意見が分かれている。

　内陥された鼓膜が換気により元の位置に戻ることから，滲出性中耳炎は換気障害によるとSade^7）は述べている。この意味では，通気法は換気と陰圧の正常化の両面で有効，簡便な方法であると考えられ，Gottshalkは滲出性中耳炎の大部分は治療できると報告している^4,5）。

　In an attempt to elucidate the pathology of secretory otitis media (SOM) in childhood, systematic clinical investigations were undertaken.

　The high resolution CT, tympanogram, and the comparison of the pre- and post- inflation tympanogram and the otoscopic findings strongly suggested that the primary pathology of SOM is an obstructive lesion somewhere in the tubotympanic cleft including the epitympanum and the mastoid, which in turn results in a negative pressure in the middle ear.

　The effectiveness and the limit of the tubal inflation in the treatment of SOM in childhood is discussed.