耳性ならびに鼻性頭蓋内合併症について—統計的観察

Otogenic and Rhinogenic Intracranial Complications: A Statistic Analysis

　I．はじめに

　かつて耳鼻科領域最大の危険症の1つとされた耳性，ならびに鼻性頭蓋内合併症は，戦後，抗生剤の登場により激減し，次第に耳鼻科医の意識から遠ざかっていったが，最近幾人かの報告者により，本症には近年抗生剤使用の結果として従来の激症型に代わり遷延型をみることが多く，その結果，誤診例，手術時期を逸した症例等が増え，また症例自体も最近再び増加の傾向にあるようだ等の指摘がなされている^{2,3,5,6,9,16,18,21,25,26）}。筆者らも同様の印象を得てきていたが，しかしその詳細は，ことに近年本邦で本症についての教室単位での統計的報告を欠くため不明である。

　そこで今回筆者らは，最近経験した本症の3症例を紹介し，併せて本症の臨床像の近年の変貌を知ることを主目的に，教室の最近20年間の症例につき統計的観察を試みた。ただし取り上げる症例としては，手術時たまたま発見される硬膜外炎，硬膜外膿瘍等は除外し，硬膜内感染が明らかな耳性，ならびに鼻性頭蓋内合併症に限った。

　Twenty-four cases of intracranial complications resulting from ear and paranasal sinus infections, hospitalized for emergency treatment in the ENT department of Gunma University Hospital during past 20 years (1960-1979), were investigated statistically. The results obtained were as follows :

　1. Recently, especially since 1975, there is a tendency of re-increase of the intracranial complications.

　2. The majority of the patients (21 cases out of 24) was otogenic.

　3. The primary lesion was predominated by chronic inflammation such as chronic otitis media and chronic frontal sinusitis (22 cases out of 24).

　4. The symptoms were initiated mainly by such general symptoms as cephalagia (80%), pyrexia (67%,) and vomiting (46%), while the localized symptoms such as otorrhea (38%), otalgia (29%), frontal tumefaction (4%), etc. were less complained.

　5. The examination at the time of hospitalization revealed a high incidence of positive signs of meningeal irritation (80%) and abnormality in cerebrospinal fluid (100%). On the other hand, pyrexia was subsided by antibiotics already administered in most patients with normal or slightly above normal body temperature (75%). Based on these findings, discussion was made on the early diagnosis in the post antibiotic era.