日本耳鼻咽喉科学会会報
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
慢性側頭骨炎による高度難聴者の臨床並びに側頭骨の病理組織学的研究
安田 和秀
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ジャーナル フリー

1958 年 61 巻 11 号 p. 1971-2017

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The author reports clinical and histopathological studies in seven cases with chronic suppuration of the temporal bone accompanied with severe hearing loss. The specimens examined were taken from each part the temporal bone at the radical or conservative radical operation (S. Niho) for osteomyelitis of temporal bone.
(1) In recent years, since the advent of chemo-antibiotic therapy, the findings of the ear drum of patients with chronic suppuration of the temporal bone are less significant compared with histopathological findings of the specimens taken from the temporal bone. Of most importance are X-ray findings of the temporal bone especially in infants.'
(2) Among the many reported methods of X-ray study of the temporal bone, Stenver's position is the best, and films taken in this position revealed more or less manifest pathological changes in all of these seven cases.
(3) In prevention of chronic mastoiditis and petrositis it is necessary to eliminate disorders in the nose and throat, performing tonsillectomy and adenoidectomy even if the patients are only one or two years of age. It is also necessary to perform attico-mastoidectomy or conservative radical operation for osteomyelitis of temporal bone, even in infants.
(4) In such severe cases in young children, chronic pneumato-cellulitis, osteitis and osteomy-Pelitis are observed histopathologically. However, in. long standing cases especially these in whom more than twenty years .had elapsed, chronic pneumato-cellulitis is very rare and chronic osteitis and osteomyelitis are demonstrated.
In the soft tissue, thickening of the epithelium, edematous swelling of subepithelial -and periosteal layers, infiltration of polymorphnuclear leucocytes, histiocytes, plasma cells, round cells and sometimes eosinophile leucocytes, granulation tissue and its organization, etc. are observed.
As histopathological changes of the bony tsisue removed at the operation of the temporal.bone, the following, findings are revealed: marked degeneration, for example, pycnosis or. disappearance of the bone nuclei, indistinction or disappearance of bone lamellae, appearance of abnormal lamellae, chemical absorption of the bone (halisteresis), bone necrosis, absorption by osteoclasts (lacunar absorption), absorption by granulation tissue, widening of bone cavity, another type of porosis, widening of Haver's canaliculi and other bone canaliculi, increase of bone canalleuli in.a broad sense and of. the marrow tissue, osteoporosis, circulatory disturbance of fluid, .edema and fibrosis in the bone canaliculi in a broad sense or in, the marrow tissue, appearance of, osteoblasts, bone proliferation and appearance of osteoid-tissue, etc.
Summarizing the above mentioned findings, bony damages. may disturb the healing of soft tissue, and circulatory disturbances of fluid in soft tissue may disturb the healing of the bone tissue.
(5) As a result of existence of these pathological changes around the labyrinth for a long time, development of osteoporosis of the bony capsule of the semicircular canals with eventual labyrinthitis has been demonstrated. In the author's opinion similar pathological processes may occur sometimes in the cochlear capsule and in such incidences circulatory disturbances of fluid or inflammatory changes may have some influence on the cochlear function, which may become gradually less active and conductive deafness may become mixed deafness.
Accordingly, for restoration of the cochlear function, it is of importance to eliminate such damaged bone tissue around the cochlea by performing the radical operation for osteomyelitis of temporal bone recommended by S. Niho.

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