耳性髄膜炎の1例

OTOGENIC MENINGITIS

　I．はじめに

　耳性頭蓋内合併症は抗生剤出現以前は比較的高頻度に見られ，早期発見，早期手術が耳科医の診療技術としてかなり重要な役割をはたしていた。最近ではサルファ剤，抗生剤の出現により日常の臨床で遭遇する機会が比較的稀となつた。われわれは最近，肺炎双球菌に由来する耳性髄膜炎の1例を経験し，手術時期が遅れたにもかかわらず，幸い，救いえたので報告し，併せて最近，本邦10年間における文献的検討を加えた。

　A man, aged 60, was admitted to the hospital with complaints of a severe headache which began 3 days before this admission. He soon went into a coma with stiffness of the neck and Kernig's sign.

　The spinal fluid examination immediately after the admission showed the pressure at 230 mmH₂O, and cloudiness. With microscopic study gram negative diplococci, i. e. pneumococci were revealed.

　Otologic examination showed perforation of the left ear drum with a small amount aural discharge.

　With a tentative diagnosis of otogenic meningitis, radical mastoidectomy was performed. The antrum was well developed; the mastoid cells were filled with reddish viscous material but, there was no venous thrombosis nor any subdural involvements.

　Following the operation the patient rapidly recovered his consciousness. ⁹⁹Tc-scintiscanning procedure was performed twice after the operation; no abnormality was seen.

　Three mon hs after the operation the patient showed a complete epithelization of the middle ear.