小児滲出性中耳炎におけるアデノイドの要因

アデノイドの細菌学的検索を中心に

抄録

The bacterial floras of the nasal cavity and adenoid were studied in 80 children. Among them 40 children were the cases of secretory otitis media (SOM) and the other 40 children were the cases of acute otitis media (AOM). Histological study of adenoid was also performed in SOM cases. In AOM cases, swab samples were obtained from the nasopharynx through the nasal cavity. In SOM cases, they were operated by adenoidectomy and insertion of ventilation tube and bacterial studies of adenoid were done directly. In the SOM group, Haemophilus influenzae was isolated in 24 cases (60.0%) and streptococcus pneumoniae was isolated in 11 cases (27.5%). Usually Haemophilus influenzae was found in the cases of acute inflammatory disease of epipharynx, but this result showed that the isolation rate of H. influenzae was significantly higher in the case of SOM which was the chronic inflammatory disease than in the case of AOM (p<0.05). This findings suggest that adenoid mass may play a role as chronic inflammatory focus which is caused by the frequent acute inflammatory stimulation.
On the other hand, histological study of the adenoid with SOM showed the hypertrophy of secondary lymphoid follicle and the changes of epithelium from ciliary epithelium tosquamous epithelium. This results also showed that the adenoid mass was exposed to frequent acute inflammation.
As the result, it is concluded that adenoid play an important role in the etiology of SOM. We consider the adenoid as bacterial flora, so SOM cases have to be operated not only by insertion of ventilation tube but also by adenoidectomy.