長期観察中に突然進展した高齢者後天性真珠腫性中耳炎例

A case of acquired cholesteatoma in an elderly with sudden progression during long-term follow-up

はじめに

　高齢者における後天性真珠腫は長期間ほとんど進展のない症例もあり，保存的に経過をみることも少なくない。しかし手術を行わない場合には脱落する場合が多いため，同一施設において長期間保存的に観察できる例は思いのほか少ないと考えられ，さらに観察中に急速な進展に遭遇した症例の報告は稀である。今回われわれは，7年間の長期にわたる経過観察中に，突然の進展をみた高齢者の後天性真珠腫例を経験したので，文献的考察を加えて報告する。

　A 71-year-old woman was diagnosed as having asymptomatic attic-type cholesteatoma in her right ear with a slight hearing loss. CT demonstrated a lesion limited to attic and antrum with mild ossicular destruction. Since the patient refused surgery, the lesion was followed up by repeated local cleansing and imaging（CT）. The findings were unchanged until 7 years ago from initial diagnosis, when the cholesteatoma progressed abruptly with vertigo, destructing the middle fossa tegmentum and lateral semicircular canal. Finally, she underwent surgery and the post-operative course was uneventful. This is an instructive case demonstrating difficulty in managing less advanced cholesteatoma in the elderly.