顔面神経麻ひ検査としての耳小骨筋反射の意義

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  • Midde Ear Muscle Reflex as a Test for Facial Nerve Paralysis
  • ガンメン シンケイ マヒ ケンサ トシテノ ジショウコツ キン ハンシャ ノ

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The middle ear muscle reflex of 50 patients with facial paralysis was compared with the results of other facial nerve tests, to determine its validity as an objective test for facial paralysis. An additional experiment was made in 3 cats to determine the time lag between the middle ear muscle reflex and the evoked electro-myogram. The middle ear muscle reflex was recorded through simultaneous summation of the pressure in the external ear canal and the impedance of tympanic membrane. At the same time, other tests for facial paralysis (EMG., evoked EMG., NET, and facial paralysis score) were carried out. It was found that the middle ear muscle reflex closely correlated with the score of facial paralysis and evoked EMG, but not with NET. The results indicated that the measurement of middle ear muscle reflex permit an objective evaluation of facial paralysis. The advantage of this test simplicity and objectivity. Disadvantages are involvement of the tensor tympani muscle in the reflex wave, and omission of weak reflex. The method of simultaneous summation of pressure and impedance contributed to minimize these disadvantages. The animal experiment disclosed that a time lag between the middle ear muscle reflex and the evoked EMG was 67.7hr, when the facial nerve was disected at the horizontal section. The middle ear muscle reflex seemed to be useful especially in early cases of facial paralysis, because the reflex is evoked by the stimulus to the central nervous system, while the evoked EMG is a test of a more peripheral facial nerve. In conclusion, the middle ear muscle reflex is useful in evaluating the degree of facial paralysis rather than topognosis.

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