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

粘连性中耳炎后遗症（胆脂瘤、感音神经性耳聋）形成机制的研究

基本信息

批准号：
03454409
负责人：
MORIYAMA Hiroshi
金额：
$ 2.11万
依托单位：
THE JIKEI UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1991
资助国家：
日本
起止时间：
1991 至 1992
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-03454409/
关键词：
ADHESIVE OTITIS MEDIA CHOLESTEATOMA SENSORY NEURAL HEARING LOSS HISTOLOGICAL STUDY 電顕的観察

项目摘要

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.

将69例1岁以上粘连性中耳炎手术患者的骨导水平与慢性中耳炎患者及健康人进行比较。这项研究表明，所有测试频率的水平均有所下降，特别是在 2KHz 以上的频段。这表明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。组织学上，粘连鼓膜上皮下区表现为以下四种类型：（1）炎性肉芽形成；其特点是鼓膜明显肥大，肉芽纤维增生，伴有炎性细胞浸润和弹力纤维增生；(2)疤痕组织；成纤维细胞增殖，弹性纤维增加；(3)玻璃质变性导致非晶质基质透明化； (4)混合型：上述组织学变化的混合体。上皮的形态多种多样，从由几个细胞层组成的薄上皮到由于基底细胞增殖旺盛而导致的厚上皮，这些上皮形态与上皮下炎症的存在密切相关。上皮肥厚且角化增加的病例，如果上皮碎片由于极性反转而出现增殖；这表明有可能转变为胆脂瘤。玻璃样变类型可以被认为是炎症的稳定末期。然而，由于感染等，疤痕组织类型可能会转变为炎性颗粒类型。粘连性中耳炎并不总是代表响应耳内环境变化而稳定地发展为胆脂瘤等的病理过程。此外，内耳窗腔长期出现病变，提示有可能发展为感音神经性耳聋。