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はじめに
悪性外耳道炎は,外耳道の細菌感染が側頭骨や周囲軟部組織から頭蓋底に波及して髄膜炎や脳神経麻痺を合併し,時に致命的になりうる壊死性外耳道炎である。明確な診断基準はなく,耳痛,頭痛,耳漏などの症状,肉芽形成,骨破壊などの局所所見,画像所見,全身の炎症反応などを総合して診断する。起炎菌は緑膿菌が多いが,メチシリン耐性黄色ブドウ球菌(MRSA)を含むブドウ球菌,Proteus属,真菌なども報告されている1)。今回われわれは,診断に難渋した非定型の悪性外耳道炎の2例を経験したため,その治療経過を報告するとともに文献的考察を行った。
Malignant external otitis, also known as necrotizing external otitis, is an aggressive infection of the external auditory canal and skull base. We report two cases of atypical malignant external otitis. Pseudomonas aeruginosa was grown in one case, and aspergillus fumigatus in the other case. Both patients presented with otalgia, and were hospitalized longer than 30 days for a course of antibiotics treatment. The case of aspergillus infection with facial paralysis and received surgical intervention. The other case of pseudomonas aeruginosa had a history of nasopharyngeal lymphoma and radiation treatments, and died because of relapsed lymphoma 21 months after treatment.
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