Chandler J R
Ann Otol Rhinol Laryngol. 1977 Jul-Aug;86(4 Pt 1):417-28. doi: 10.1177/000348947708600401.
Malignant external otitis is an infection which begins in the external auditory canal. It is uniformly caused by the Gram negative Pseudomonas aeruginosa organism and mainly affects elderly diabetics. It spreads to the soft tissues beneath the temporal bone and, if not properly treated leads to facial nerve palsy, mastoiditis, sepsis, osteomyelitis of the base of the skull, sigmoid sinus thrombosis, multiple cranial nerve palsies and death. Experience with 72 patients in varying stages of the disease is summarized. Stressed are the diagnostic criteria of nonresponsiveness to the usual methods of treatment, continued suppuration, and the continuing reformation of granulation tissue in the floor of the external auditory canal. Medical treatment is recommended with hospitalization and intravenous carbenicillin and gentamicin. Minor surgical debridement is helpful. All patients should be treated medically for as long as improvement continues, reserving surgical intervention only in the event a plateau is reached or symptoms and signs become worse under treatment. With or without a major surgical procedure, it is imperative to continue treatment for at least seven days after apparent cure in order to avoid recurrent disease possibly at a site distant from the canal.
恶性外耳道炎是一种始于外耳道的感染。它均由革兰氏阴性铜绿假单胞菌引起，主要影响老年糖尿病患者。它会扩散至颞骨下方的软组织，若治疗不当会导致面神经麻痹、乳突炎、败血症、颅骨基部骨髓炎、乙状窦血栓形成、多组颅神经麻痹甚至死亡。本文总结了72例处于不同疾病阶段患者的治疗经验。强调了对常规治疗方法无反应、持续化脓以及外耳道底部肉芽组织持续再生的诊断标准。建议住院治疗并静脉注射羧苄青霉素和庆大霉素。轻微的外科清创术会有所帮助。只要病情持续改善，所有患者都应接受药物治疗，仅在病情达到平稳期或治疗过程中症状和体征恶化时才进行手术干预。无论是否进行大型外科手术，在明显治愈后必须继续治疗至少七天，以避免疾病可能在远离外耳道的部位复发。
