最近の中耳結核の特徴と診断について

THE CLINICAL CHARACTERISTICS AND DIAGNOSIS OF THE MIDDLE EAR TUBERCULOSIS IN RECENT YEARS

　中耳結核は優れた抗結核剤療法により最近は激減したとはいえ日常診療からまつたく消滅したわけではなく，毎年2,3の症例報告がなされている。

　中耳結核の病像が往時に比べて変りつつあり，結核性病変を疑つた時には既に高度の感音難聴や顔面神経麻痺におちいつていることが多くなつている。早期に中耳結核と診断し，抗結核剤療法を施行すれば高度の感音難聴や顔面神経麻痺を残さずに治癒する可能性は十分にある。最近私どもが経験した両側性中耳結核症例を中心に1965年以後報告された中耳結核症例の病像を文献的に検討し，最近の中耳結核の診断基準を決めてみた。

　A case of tuberculous otitis media is reported. The patient was a 45-year-old male who had fistula symptom, bilateral facial paralysis and complete deafness in the course of this malady.

　The authors reviewed 25 cases (30 ears) of tuberculous otitis media reported in Japan since 1965. We noticed the remarkable transition of clinical pictures of tuberculous otitis media in recent years. A granulous type of tuberculous lesion was frequently found in the recent cases. Based on the characteristics of the recent cases, we established the new criteria of the diagnosis of tuberculous otitis media.

　1) chronic otitis media resistant to various antibiotics except for antituberculous agents

　2) a marked formation of granulation tissue in the tympanic cavity and its extension to the external ear canal

　3) disorder in hone conduction

　4) presence of active and/or cured lung tuberculosis

　5) accompanying of the periaural lymphadenitis in children

　6) positive intracutaneous tuberculin reaction

　7) facial paralysis

　Chronic otitis media presented with 3 out of 7 items should be suspected as tuberculous. Chronic middle ear disease presented with 5 out of 7 items can be clinically diagnosed as tuberculous otitis media. The final diagnosis should be established by biopsy of the lesion or by bacterial examination. The treatment consists of antituberculous agents and surgical removal of tuberculous regions.