内リンパ水腫に関する組織学的研究 (滋賀医科大学耳鼻咽喉科学教室開講3周年記念論文集<特集>)

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Perisaccular fibrosis of the endolymphatic sac was observed often in the autopsy case reports concerning endolymphatic hydrops examined in the present study. Therefore perisaccular fibrosis was determined to be one of the causes of malabsorption of endolymph in the sac, which results in endolymphatic hydrops. Perisaccular fibrosis was readily produced experimentaly by cauterizing the endolymphatic sac in guinea pig with 10% silver nitrate solution. This procedure resulted in endolymphatic hydrops in most cases. Some experiments were performed using these guinea pigs with experimentally produced endolymphatic hydrops.Results are as follows.1) Seventy autopsy case reports of Meniere's disease (1938-1980) were considered. All but five cases reported the finding of endolymphatic hydrops (93%).2) The condition of the endolymphatic sac was discussed in only 31 out of 70 cases. In 15 cases, perisaccular fibrosis was observed.3) Perisaccular fibrosis was readily produced in guinea pigs by cauterizing the endolymphatic sac through microinjection of 10% silver nitrate solution into the sac. In 53 guinea pigs out of 60, endolymphatic hydrops resulted (88%).4) The fine inner ear structure of guinea pigs with resultant endolymphatic hydrops was studied under the light microscope. Degeneration of Corti's organ was found in 5-10% of the original 60 guinea pigs. Atrophy of the stria vascularis was found in 41%. As perisaccular fibrosis increased, the endolymphatic hydrops became more marked.5) The cochlear structures were observed after administering diuretic drugs (glycerol, furosemide and iso-sorbide) to a sub-group of guinea pigs with experimental endolymphatic hydrops. Foldings in Reissner's membrane were seen very commonly in cases when glycerol was used, less often when iso-sorbide was used and rarely when furosemide was administered.6) After surgical opening of the endolymphatic ducts of a second sub-group of guinea pigs with experimental endolymphatic hydrops, Reissner's membranes appeared wrinkled, and when suction of the endolymphatic duct was performed, the membranes collapsed completely.7) A fine glass capillary was inserted into the scala media of the basal turn of normal guinea pigs through the stri.a vascularis and connected to an irrigator containing artificial endolymph. Then the pressure of the scala media was increased by raising the irrigator to three different positions and the cochlear structures were observed.i) H2O pressure at 50mm:Reissner's membrane acquired a wave-like appearance in several instances.ii) H2O pressure at 100mm:Reissner's membrane bulged and sometimes developed small ruptures.iii) H2O pressure at 300mm:Reissner's membrane ruptured outward and the torn edges were observed touching to the bony portion of scala vestibuli.
耳鼻咽喉科臨床学会の論文

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矢沢代四郎
滋賀医科大学耳鼻咽喉科

内リンパ水腫に関する組織学的研究 (滋賀医科大学耳鼻咽喉科学教室開講3周年記念論文集<特集>)

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