結核性中耳炎の1症例

A case of tuberculous otitis media

Ⅰ　はじめに

　結核性中耳炎は，一般細菌による慢性中耳炎との鑑別がしばしば困難であり，医師が診断に至るまでの期間（doctor's delay）が遷延する傾向がある^1）。このため結核の感染拡大という公衆衛生上の重大な問題を招く危険性があり，早期診断と治療がきわめて重要となる。しかし発症初期においては結核性中耳炎に特徴的な所見は乏しく，診断に苦慮することも少なくない^1～7）。今回われわれは，難治性慢性中耳炎の臨床経過を呈したものの，比較的早期に診断に至った結核性中耳炎症例を経験したので，文献的考察を加えて報告する。

　We reported a case of tuberculous otitis media with an intractable middle ear infection caused by Mycobacterium tuberculosis. An 18-year-old man was referred to our department with a one-month history of left-sided hearing loss. Otoscopic examinations showed a central perforation with granulation tissue and purulent otorrhea of the affected ear. Computed tomography revealed diffuse soft tissue shadow throughout the left middle ear without bone destruction. Topical and systemic antimicrobial drugs were ineffective. Histopathological examination of the granulation tissue showed nonspecific findings,but PCR assay and mycobacterial culture test proved the presence of Mycobacterium tuberculosis in his otorrhea. He received anti-tuberculosis chemotherapy,and the disease gradually subsided. Clinical characteristics,diagnosis and treatment of tuberculous otitis media were bibliographically reviewed.