イオン浸透法による滲出性中耳炎の治療

Treatment of Otitis Media with Effusion with Transtympanic Iontophoresis

I．はじめに

　滲出性中耳炎の治療は鼓膜切開，鼓室チューブ留置などの外科的処置が有効である。しかし小児では外科的処置の困難なことも多く，保存的治療を行うことが必要となる。薬剤による治療ではステロイド^1）や抗生剤^2）の経口投与の有効性の報告があるが，経口投与の場合にステロイドは全身的な副作用も考えられ，抗生剤は中耳への移行が悪いなどが問題となる。

　Passari^3）は小児滲出性中耳炎にcarbocisteineのイオン浸透法による治療の有効性を報告しており，今回われわれはステロイドおよび抗生剤のイオン浸透法による治療の効果を調べるため，モルモットによる基礎実験と小児滲出性中耳炎13例22耳に対する効果判定を行ったので報告する。

　Effect of transtympanic iontophoresis with steroid and antibiotics on otitis media with effusion (OME) was investigated clinically and experimentally. Using guinea pigs, transtympanic passage of dexamethasone and fosfomycin after application of galvanic current was examined. It was revealed that these drugs passed through the tympanic membrane to produce intratympanic value enough for anti-inflammatory and anti-microbial effect. Among 30 children with OME, 22 ears were treated with iontophoresis and 21 ears were untreated as control. Tympanogram and hearing test were performed after 1 month and 2 months respectively. The hearing gain for treated ears was 12.8±13.0 dB at 1 month, 16.8±13.3 dB at 2 months and for untreated ears, 3.9±10.3 dB, 3.0±11.8 dB (p<0.02, p<.0.01). As for treated ears, tympanogram type B was found in 36.4% at 1 month, 27.8% at 2 months and for untreated cars, 78.9%, 71.4% (p<0.05, p<0.05). These results indicated that iontophoresis of steroid and antibiotics was effective for treatment of OME.