術後に遅発性の顔面神経麻痺・内耳障害を発症した中耳結核例

A case of primary middle ear tuberculosis with delayed facial palsy and profound sensorineural deafness after middle ear surgery

はじめに

　成人の難治性中耳炎の鑑別疾患としては，真珠腫性中耳炎，抗好中球細胞質抗体（anti-neutrophil cytoplasmic antibody：ANCA）関連血管炎性中耳炎，中耳結核（結核性中耳炎），好酸球性中耳炎，悪性腫瘍などがある。今日，中耳結核は稀ではあるが，一般細菌による慢性中耳炎との鑑別は時に困難である。その要因としては古典的な症状がみられにくくなったことやニューキノロン点耳薬に感受性を示す場合があることなどが挙げられる。側頭骨CTでも特異的な所見はなく，肺に病変を伴っていない例，結核菌への曝露歴が不明な例も挙げられる。今回われわれは鼓室形成術後に進行性の鼓膜壊死，顔面神経麻痺，内耳障害をきたし，最終的に中耳結核の診断に至った1例を経験したので報告する。

　A 60-year-old woman without significant past history underwent tympanoplasty for chronic otitis media. Post-operative course was uneventful until 8 months after surgery. Around 12 months after surgery, bullous pemphigoid was diagnosed. During steroid therapy, necrosis of the ear drum, sensorineural hearing loss, and facial palsy developed. Administration of Levofloxacin was partly effective. Smear, PCR, and culture revealed tuberculosis. No other tuberculotic foci, including lung, epipharynx, and kidney, were detected. After treatment, facial movement recovered, ear drum was restored spontaneously, but deafness persisted. Middle ear tuberculosis is rare, but should be considered as a differential diagnosis of intractable otitis media.