肺結核から診断された結核性中耳炎の1例

A case of tuberculous otitis media diagnosed from lung tuberculous

はじめに

　結核性中耳炎の古典的特徴としては，耳介周囲リンパ節の腫脹，多発性鼓膜穿孔，一側性顔面神経麻痺，早期の高度難聴，骨壊死などの症状を示すとされているが^1），近年では肺結核の減少に伴い，血行性感染からこれらの症状を示す例も減少し，診断が困難となってきている。今回われわれは鼓膜穿孔を含む古典的特徴をまったく伴わずに発症し，中耳組織の病理検査では確定診断できなかったが，術後の咳嗽からの精査の結果肺結核と診断され，肺結核の治療とともに中耳病変も改善がみられた結核性中耳炎の1例を経験したので報告する。

　Clinical feature of tuberculous otitis media（TOM）is variable and it is difficult to diagnose TOM at the early stage, because clinical symptoms sometimes change rapidly. A 36-year-old female complained of earfullness in the left ear. A small mass lesion was observed in the middle ear and tympanic membrane was normal. We suspected congenital cholesteatom, but after 1 month, granulation was filled with the middle ear. TOM was suspected by pathohistological test, but Ziel-Nelsen staining was negative. In those days, she complained cough and lung tuberculous was diagnosed. Antitubercular chemotherapy yielded good results in both lung and middle ear.