メニエ-ル病の反復性めまいに対する免疫アレルギ-学的考察
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The reality of allergic endolymphatic hydrops as a cause of recurrent episodes of Meniere's disease was suggested from results of the following studies:1) Clinical studiesa) The skin test using 34 sorts of food antigen extracts and the glycerol test were performed for 23 patients with Meniere's disease. A positive rate of the glycerol test was higher in the group of positive skin reaction than in the negative group (P=0.05).b) In some cases, whose episodes were provocated by the challenge feeding test, the improvement of hearing loss was found after doing Portmann's endolymphatic operation.2) Experimental studiesa) Labyrinthine reactions induced by challenging the antigen through the left foram, stylomastoideum were observed for 4 groups of rabbits as follows: (A) rabbits sensitized by hen's serum, (B) control rabbits, (C) rabbits inoculated with BCG vaccine and (D) control rabbits. Among these 4 groups, a character of positional nystagmus observed in group A bore a striking resemblance to that of Meniere's attack. Moreover, electrocochleograph of group A showed a pattern of cochlear impairment and histological study revealed endolymphatic hydrops in the challenged ear side. This endolymphatic hydrops was not found in the other group. From these findings, endolymphatic hydrops does not appear to be induced by cell-mediated immunity, but by humoral immunity.b) To determine the place of antigen-antibody reaction, the labyrinths of guinea pigs sensitized by horseradish peroxidase (HRP) were investigated by electronmicroscopy after challenge with this antigen through the perilymphatic space. Particles of HRP could pass through the Reissner's membrane by intra-cellular transportation and clung to the surface of dark cells in the stria vascularis. These findings were not observed in the control study and suggest that hyper-permeability of the Reissner's membrane and hypersecretion of the stria vascularis induced by the antigen-antibody reaction are probable causes of endolymphatic hydrops.
- 耳鼻咽喉科臨床学会の論文
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