日本語フィールド
著者：首藤洋行, 中島俊之, 進 武幹題名：原著 ビスホスホネート製剤が原因と考えられた外耳道真珠腫症例の検討発表情報：耳鼻と臨床 巻: 67 号: 6 ページ: 352-360キーワード：Diphosphonates(治療的利用, 毒性・副作用), 骨粗鬆症(薬物療法), 耳疾患(化学的誘発, 診断, 治療), 真珠腫(化学的誘発, 診断, 治療), X線CT, 経口投与, 内視鏡法, 重症度指標, 真珠腫-外耳道(化学的誘発, 診断, 治療), 長期投与(有害作用), 頭部CT概要：ビスホスホネート製剤(以下、BP製剤)の重大な副作用として外耳道骨壊死・外耳道真珠腫が知られているが、症例報告数はいまだに少ない。BP製剤は強力な骨吸収抑制作用を有しており、骨粗鬆症や骨転移を有する癌患者に対する第一選択薬であるため、高齢化著しい本邦では今後ますますBP製剤使用者は増加すると予想される。今回、われわれはBP製剤が原因と考えられる外耳道真珠腫10例を経験した。また、本症例と渉猟し得た既報告19例との臨床的な進展度分類による比較検討を行ったが、両報告共に多くは高齢女性に発症し、いずれも長期間にわたりBP製剤を使用していた。進展度と投与期間は逆の相関を示しており、投与期間が長くても必ずしも病状が進行するとは限らないことが分かった。進展度に関係なく、片側発症例が多く、外耳道下壁から前下壁に好発する傾向があった。本症例は全例、局所処置のみで上皮化を得たが、既報告例では治療別や進展度別にみた治療後経過は一定ではなかった。今後、症例数の蓄積により診療方針が定まるのを期待したいが、現時点ではBP製剤使用の有無の確認を怠らずに、外耳道真珠腫・骨壊死の早期発見に努め、必要に応じて整形外科や内科と連携し治療方針を検討することが重要である。抄録：英語フィールド
Author：Hiroyuki SHUTO, Toshiyuki NAKASHIMA, Takemoto SHINTitle：Original Article A study of cases of bisphosphonate-induced cholesteatoma of the external auditory canalAnnouncement information:jibi to rinsho Vol: 67 Issue: 6 Page: 352-360An abstract：Although osteonecrosis of the external auditory canal has been known to be a serious side effect of bisphosphonates, there are still few case reports on this condition. Bisphosphonates, are bone resorption inhibitors that are a first-line drug for osteoporosis and metastatic bone cancer. In Japan, where the population is rapidly aging, the number of people taking bisphosphonates will probably continue to increase. We experienced 10 cases of bisphosphonate-induced cholesteatoma of the external auditory canal. In addition, we compared our cases to 19 previously reported cases according to the clinical progression classification. In both groups, the condition most frequently developed in elderly women who had been treated with bisphosphonates for a long time. The degree of progression and the duration of administration showed an inverse correlation, and it was found that even if the duration of administration was long, the condition did not necessarily progress. Regardless of the degree of progression, there were many cases of unilateral onset, and there was a tendency for the condition to frequently develop on the inferior and anterior inferior walls of the external auditory canal. Epithelialization was obtained in all cases with local treatment only; however, in the previously reported cases, the post-treatment course was not constant according to the treatment or degree of progression. It is expected that the accumulation of further cases of bisphosphonate-induced cholesteatoma of the external auditory canal will lead to the establishment of medical guidelines; however, at the present time, otolaryngologists should check whether patients take bisphosphonates, strive for early detection and discuss treatment strategies as needed in collaboration with orthopedic surgeons or physicians.