悪性外耳炎の1例

A Case of Malignant External Otitis with Multiple Cranial Nerve Involvement

　I．はじめに

　悪性外耳炎は，高齢の糖尿病者におこる壊死性変化のつよい外耳道の緑膿菌感染症であり，周囲に波及して脳神経症状をおこし，時には死に至ることが知られている。筆者らは多発性の脳神経麻痺を伴った1例を経験し，手術と抗生物質療法により治療せしめることができたので，文献的考察とともに報告する。

　A 76 year-old male whose initial symptoms werepain and discharge of the left ear was hospitalized because of development of multiple cranial nerve paralysis (VII, IX,X, XI and XII) after systemic administration of ampicillin and local treatment. The bacteriological studies demonstrated Pseudomonas aeruginosa infection. GTT showed the borderline diabetic pattern. Extensive surgical debridement and carbenicillin with dibekacin were effective. He survived, and the cranial nerves recovered their functions.

　Malignant external otitis is a painful disease and sometimes fatal infection of the external auditory canal and surrounding tissue caused by Pseudomonas aeruginosa, usually occuring in elderly diabetic patients. Medical treatment is recommended with hospitalization, carbenicillin and gentamicin, and minor surgical debridcment. Cranial nerve involvement is still recognized as an ominous prognostic sign, and extensive operation is needed in such cases.