癒着性中耳炎の後遺症(真珠腫ならびに感音難聴)の成立機転に関する研究

对69例1岁以上的粘连性中耳炎手术患者的骨传导水平与慢性中耳炎患者及健康人进行了比较。这项研究显示，所有测试频率的水平都有所下降，特别是在2 kHz以上的频段。这提示内耳窗腔中长期存在的炎症可能通过内耳窗膜扩散到耳蜗处。组织学上，粘连鼓膜上皮下区表现为四种类型：(1)炎性肉芽肿，以显著的鼓膜肥大和颗粒纤维增生为特征，伴有炎性细胞浸润和弹力纤维增生；(2)瘢痕组织；成纤维细胞增殖和弹力纤维增多；(3)玻璃体再生导致无定形基质玻璃化；(4)混合型：上述组织学改变的混合体。上皮细胞多种多样，由少量细胞层组成的薄上皮到基底层细胞大量增殖所致的厚上皮，这些上皮形态与上皮下炎症的存在密切相关。上皮性肥大和角质化增加的病例，由于其极性颠倒，上皮片层出现增殖，这提示有可能转变为胆脂瘤。玻璃化类型可以被认为是炎症的稳定晚期。然而，由于感染等原因，瘢痕组织类型可能会转变为炎性粘连类型。粘连性中耳炎并不总是代表着对耳朵环境变化的稳定的病理进展，如胆脂瘤等。此外，内耳窗腔的长期病变提示有可能发展为感音神经性耳聋。

The bone conduction level of 69 cases who were aged 1 years of more and who had been operated on for adhesive otitis media was compared with that in patients with chronic otitis media and healthy persons. This study revealed a decreased level in all frequencies tested, particularly in band above 2KHz. This suggested the possibility of spread of long-existing inflammation in the inner ear window cavities to the cochlea via the inner ear window membrane. Histologically, the subepithelial region of the adhered eardrums showed the following four types:(1) inflammatory granulation; characterized by marked eardrum hypertrophy and fibrous proliferation of granulations accompanied by inflammatory cell infiltration and elastic fiber proliferation;(2) scar tissue; fibroblast proliferation and an elastic fiber increase;(3) hyalinization of amorphous substrate due to glassy deneneration; and (4) mixed: mixture of the above histological changes. Epithelia were various ranging from thin epithelium comprising a few cell layers to thick epithelium due to vigorous proliferation of basal cells in general, these epithelial morphology had a close relationship with the presence of subepithelial inflammation. Cases with epithelial hypertrophy and increased keratinization showed proliferation if epithelial fragments due to reversal of their polarity; this suggested the possibility of change to cholesteatoma. The hyalinization type can be considered a stabilized terminal stage of inflammation. However, the scar tissue type may change to the inflammatory garanulation type due to infection etc. Adhesive otitis media does not always represent a stabilized pathological progress to cholesteatoma, etc. in response to environmental changes in the ear. In addition, long-term present of pathological changes in the inner ear window cavity indicates the possibility of development of sensorineural deafness.