小児悪性外耳炎の1例

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Malignant external otitis (necrotizing otitis) is caused by Pseudomonas aeruginosa and usually affects elder diabetics. But it is very rare in children. This is the fourth case report of child malignant external otitis in the world literature.The patient was a 2-year and 9-month-old girl who was admitted because of severe pain, redness and swelling of the periauricular area and purulent discharge of the right ear with high fever, paralysis of the VIIth nerve and trismus. She had a persistent cough for one and half month before her admission. Laboratory examination revealed anemia, leucocytosis and increased erythrocyte sedimentation rate. Blood sugar level and humoral and celltlar immune function were normal. The cartilaginous external auditory canal was necrotized exposing the cartilage and the cortex of the temporal bone. Pseudomonas was found evidently on the culture of bacteria. Gentamicin, sulbenicillin and human gamma-globulin therapy resulted in disappearance of the granulation tissue and subsequent epithelization of the ear canal without surgical treatment. The facial nerve paralysis and loss of the cartilaginous canal remained.The authors postulate that the most possible factor in the pathogenesis of this condition may be a virulent action by a specific stem of pseudomonas, which produces stronger toxin or enzyme than ordinary stems.
社団法人日本耳鼻咽喉科学会の論文