Zaky D A, Bentley D W, Lowy K, Betts R F, Douglas R G
Am J Med. 1976 Aug;61(2):298-302. doi: 10.1016/0002-9343(76)90181-9.
Two cases of malignant external otitis are presented and the literature is reviewed. The disease seems to occur exclusively in elderly diabetic patients. Diagnosis is mostly a clinical one, and requires a high index of suspicion. The characteristic clinical manifestations are pain and severe tenderness of the tissues around the ear and mastoid, persistent drainage and the presence of granulation tissue at the junction of the osseus and cartilagenous portions of the external ear. Roentgenographic findings are not helpful in the early stages. The pathogenesis of this disease depends on the presence of clefts in the cartilage forming the floor of the external auditory canal at its junction with the osseus portion through which infection can spread from the external ear to the deep soft tissues. Serious and often fatal complications may ensue. The most common and earliest symptom to appear if facial nerve palsy. Pseudomonas aeruginosa has been isolated uniformly, in pure or mixed cultures. This entity, therefore, should be borne in mind whenever an elderly diabetic patient presents with external otitis not amenable to the usual methods of therapy. Ps. aeruginosa should be strongly suspected, and its isolation should prompt vigorous systemic treatment with gentamicin and carbenicillin before extensive necrosis of cartilage and bone takes place. Any delay in diagnosis and management will lead to a serious and often fatal complications.
本文报告了2例恶性外耳道炎病例并复习了相关文献。该疾病似乎仅发生于老年糖尿病患者。诊断主要依靠临床判断，需要高度怀疑。其特征性临床表现为耳部及乳突周围组织疼痛和严重压痛、持续流脓以及外耳道骨部与软骨部交界处出现肉芽组织。X线检查结果在疾病早期并无帮助。本病的发病机制取决于外耳道底部与骨部交界处形成的软骨中存在裂隙，感染可通过此裂隙从外耳道蔓延至深部软组织。可能会随之出现严重且常为致命的并发症。最常见且最早出现的症状是面神经麻痹。均已从纯培养或混合培养物中一致分离出铜绿假单胞菌。因此，当老年糖尿病患者出现常规治疗方法无效的外耳道炎时，应牢记这一疾病。应高度怀疑铜绿假单胞菌感染，一旦分离出该菌，应在软骨和骨发生广泛坏死之前立即用庆大霉素和羧苄青霉素进行积极的全身治疗。诊断和治疗的任何延误都将导致严重且常为致命的并发症。
