小児滲出性中耳炎例に対する治療と乳突蜂巣発育度
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概要
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It is generally believed that a cause and effect relationship exists between chronic middle ear inflammatory conditions and suppressed growth of the pneumatized cellulae. We already demonstrated the normal process of pneumatization and the suppressive process of pneumatization in experimental studies using pigs. In that study, the process of suppression of the pneumatization was caused by the continuous inflammatory changes of the epithelium of the middle ear cavity, and the degree of the suppression of the pneumatization was caused by the degree and duration of the air cavitys inflammatory condition at the growing stage of the mastoid process. We also carried out the histological study of the normal process of pneumatization using 100 sides of human fetuses between 16th and 36th week of pregnancy. In these studies the bone metabolisms which were found in the normal processes of pneumatization in pigs and human fetuses were same, and the normal pneumatization occurred at the growing stage of the mastoid process. This growing period of the mastoid is from 0 to 6 months after birth in pigs, and 0 to 15 years in humans. So in humans, we can infer that the suppression of the growth of the cellulae is closely related to a persistent state of otitic inflammation like an otitis media with effusion in the early stages of growth. From these studies, in children who have otitis media with effusion, it will be possible to realize the previous middle ear pathology by the degree of the suppression of pneumatization on x-ray film. According to this theory, two hundred forty-six children who had otitis media with effusion from the age of 3 years to the age of 15 years were separated to two groups by the degree of pneumatization on x-ray film, one group which had a large mastoid air cell system was treated with only a conservative treatment and the other group which had a small air cell system was operated mainly by insertion of a ventilation tube. After the start of this treatment, only twelve cases which were conservative treatment groups cases were changed to the operative treatment because of their difficulty to treat by conservative treatment. So it is clear that a large air cell systems group is basically good enough to treat only by conservative treatment, because the degree of pneumatization results from previous middle ear pathology.
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