悪性外耳炎

A MALIGNANT EXTERNAL OTITIS

　I．はじめに

　糖尿病の患者で緑膿菌による壊死性変化の強い耳性感染症についての報告がある。Chandler^8）はmalignant external otitisと呼び自験の38例について検討した。外耳炎症状（耳痛，耳漏，外耳道の腫脹など）のほかに，耳周囲の軟部組織炎，骨軟骨炎を併い，さらには側頭骨や顕蓋底骨ならびにその周辺軟部組織へ炎症は進展し顔面神経麻痺などを合併しやすい。高齢の糖尿病患者に多くみられ原因菌として緑膿菌が証明される。

　通常の外耳炎の治療に抵抗を示し進行性で壊死性病変の強い死亡率の高い疾患である。

　A case of malignant external otitis is reported. A man affected with diabetes, aged 43, complained of otalgia and greenish otorrhea. Pseudomonas aeruginosa was isolated from this otorrhea in a pure culture. Surgical procedure showed a severe necrotizing lesion in the temporal bone and its surrounding soft tissues.

　Malignant external otitis in a severe form in an elderly diabetic patient was shown to be caused by pseudomonas aeruginosa infection. In its management, a rigid control of the diabetes, meticulous debridement of the external auditory canal, topical and systemic antibiotic therapy, use of local antiinflammatory agents, and extensive surgical debridement of the involved tissues, were the critical factors to influence the cure.