いわゆる「蝸牛性耳鳴」の治療 : 粘膜麻酔剤の中耳腔注入による内耳ブロック療法の試み

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Tinnitus is an otological symptom which is often encountered and is as yet difficult to treat.If tinnitus is of cochlear origin, then it seems reasonable that a total depression of cochlear function should abolish cochlear tinnitus. To achieve this depression, transtympanic injections of a local anesthetic (4% Lidocaine) to anesthetize the inner ear were attempted in patients suffering from tinnitus.Forty eight patients (58 ears) who had suffered from relatively long-term (3 to 360 months) tinnitus were included in this study. In almost all of the cases the clinical symptoms and the laboratory finding (i.e., the audiogram and caloric test) indicated that the underlying lesion was probably located within the end organ.The anesthetic solution was applied to the middle ear cavity by a transtympanic injection. Patients were either sitting erect with the head tilted toward the side contralateral to the injection or lying on their side on the examining table with the injected ear upper-most. Immediately after lidocaine instillation u severe and transient spontaneous nystagmus developed toward the injected side. This nystagmus persisted less than one minute, and was accomcanied by a subjective symptom of vertigo. Then the patient was asked to lie for five to six hours. The onset of nausea and vertigo, accompanied by a spontaneous paralytic nystagmus of several hours duration, appeared within thirty minutes after the treatment. These signs were considerably ameliorated with the aid of antiemetic.The patients condition in the morning following his first injection generally provides a reliable index for further therapy. If the tinnitus is reduced at this time, further relief can be expected by additional instillations of lidocaine repeated two or three times at intervals of 5 days.On the contrary, if no improvement is observed, this therapy will be ineffective. In some cases this treatment brought a transient (for a few days) slight neuro-sensorial deafness in low frequencies. This auditory disorder, however, was completely restored without sequelae.Our results were summarized as follows:1) in 20 ears, tinnitus was completel abolished.2) in 22 ear, tinnitus was considerably ameliorated.3) 6 ears, tinnitus was a slightly ameliorated4) in 10 ears, there was no effect.
社団法人日本耳鼻咽喉科学会の論文

いわゆる「蝸牛性耳鳴」の治療 : 粘膜麻酔剤の中耳腔注入による内耳ブロック療法の試み

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