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岁以上行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正常人的骨传导水平进行了比较。这项研究显示，在所有测试频率中，特别是在2KHz以上的频段，其水平都有所下降。这提示内耳窗腔内长期存在的炎症可能通过内耳窗膜向耳蜗扩散。组织学上粘附的鼓膜上皮下区表现为四种类型：(1)炎性肉芽肿；以鼓膜明显肥大、肉芽增生伴炎性细胞浸润、弹性纤维增生为特征；(2)瘢痕组织；成纤维细胞增生，弹性纤维增多；(3)非晶态衬底玻璃变性导致的透明化；(4)混合型：以上组织学变化的混合型。上皮多种多样，从由几层细胞组成的薄上皮到由于基底细胞的强烈增殖而形成的厚上皮，这些上皮形态与上皮下炎症的存在密切相关。在上皮肥大和角化增加的病例中，上皮碎片由于极性逆转而增殖；提示有可能转变为胆脂瘤。透明化型可被认为是炎症的稳定终末期。然而，由于感染等原因，疤痕组织类型可能会转变为炎性组织类型。粘连性中耳炎并不总是代表稳定的病理进展到胆脂瘤等，以响应耳内环境的变化。此外，长期存在的内耳窗腔病理改变提示感音神经性耳聋发展的可能性。

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.