摘要
惡性外耳炎（malignant external otitis）因在臨床上表現出對顱內重要組織的壞死性侵犯，造成不易控制且對生命具威脅性的感染而得”惡性”之名。此症幾乎都是綠膿桿菌感染，大多發生在年齡大的糖尿病人。惡性外耳炎初期症狀和緩，且常被誤診為一般外耳炎，一旦侵犯顳骨和顱底造成骨髓炎和多發性顱神經病變，即為第2期，1977年的文獻報告死亡率將由第1期的23%升高為67%。若向顱內進展造成腦膜炎、顱內膿瘍、敗血性血栓靜脈炎，即為第3期，死亡率高達80%。完整的治療期至少需要4至8週，否則復發率高且將更難控制。 本病例為38歲女性，門診主訴右耳疼痛和右側頭痛約有1 週。入院後經各項檢查證實為第1期惡性外耳炎和糖尿病。接受局部耳滴藥、抗生素合併療法、高壓氧輔助治療和局部擴創手術。本文將針對診斷之早期確立、治療方式之適當選擇、以及治療期長短的決定，作進一步的分析和討論。
並列摘要
Malignant external otitis, an invasive necrotizing pseudomonal infection of the external ear canal, is an uncommon but life-threatening disease. It occurs primarily in elderly diabetic patienrs. Without opti-mal treatment, the infection exclusively results in osteomyelitis of the skull base, multiple cranial neuropathy, and intracra-nial infection with high mortality. A case of 38 years old female suffered from right ear pain and right side headache for about one week . Marked swelling with whitish secretion was noted in the right external ear canal . After labo-ratory examination, malignant external otitis, stage I and diabetes mellitus was diagnosed. Her disease was recovered after treatment with ear drop, combined antibi-otics, hyperbaric oxygen and local debride-ment. The difficulties with early diagnosis, choice of treatment methods and when to terminate treatment were further discussed.
延伸閱讀
- Lin, C. C., Ho, K. Y., Wang, L. F., & Kuo, W. R. (2002). 異物性中耳炎 ─ 病例報告及文獻回顧. The Kaohsiung Journal of Medical Sciences, 18(11), 585-588. https://doi.org/10.6452/KJMS.200211.0585
- 邱泰茂、趙文元（1992）。惡性外耳炎。當代醫學，(227)，707-709。https://doi.org/10.29941/MT.199209.0006
- 莊碧焜、徐銘燦、李國森、陳一豪、林雲南、陳文炯（1993）。中耳惡性腫瘤－兩例報告。中華民國耳鼻喉科醫學會雜誌，28(6)，408-413。https://doi.org/10.6286/1993.28.6.408
- Pan, C. W., Yuan, C. H., & Chen, R. F. (2017). 外耳道多型性腺瘤－案例報告. 台灣耳鼻喉頭頸外科雜誌, 52(2), 83-86. https://doi.org/10.6286/2017.52.2.83
- 劉順枝、許紋銘（1988）。Microphthalmos with Cyst-Case Report。中華民國眼科醫學會雜誌，27(1)，443-446。https://doi.org/10.30048/ACTASOS.198805.0077