悪性外耳道炎5症例の検討

Malignant external otitis

はじめに

　悪性外耳道炎（malignant external otitis）は耳漏・耳痛，外耳道肉芽，耳漏からの緑膿菌の検出，糖尿病の合併を特徴とする難治性の外耳道炎である^1）。下位脳神経麻痺，頭蓋底骨髄炎，さらには頭蓋内合併症をきたすこともあり，時に致死的となりうる疾患である^2）。しかし近年，緑膿菌に有効な抗菌薬の発達により緑膿菌による典型例は減少し，緑膿菌以外の菌による発症例や，AIDS患者や白血病患者に発症する例など，非典型的な症例も報告されている^3）。今回，われわれは当科にて入院し，加療を行った悪性外耳道炎の5例を経験したので若干の文献的考察を含めて報告する。

　Malignant external otitis is a severe and intractable external otitis accompanied by persistent otalgia, otorrhea, formation of granulation tissue and is typically caused by Pseudomonas aeruginosa infection in diabetic patients. We herein reported 5 cases, 3 men and 2 women aged 57-80 years. All had diabetes mellitus, and Pseudomonas aeruginosa was detected in 4 patients. Two patients developed facial nerve paralysis and the one brain abscess. In addition to the administration of antibiotics in all cases, 3 patients underwent surgery and 2 patients were treated with corticosteroids. One patient recovered completely, and the other 4 patients improved. This potentially life-threatening disease must be diagnosed correctly and treated appropriately.