Amorosa L, Modugno G C, Pirodda A
Department of Otorhinolaryngology, University of Bologna, Italy.
Acta Otolaryngol Suppl. 1996;521:3-16.
Malignant external otitis (MEO) is an infrequent but severe infective disorder, generally due to Pseudomonas aeruginosa, which most often affects elderly diabetics patients. The clinical features rarely permit exact diagnosis of MEO to be made promptly, and initially at least they are difficult to distinguish from those of external otitis. This explains the frequent delay in diagnosis with respect to the onset of symptoms. Physical examination almost always reveals the presence of aspecific granulation tissue in the external auditory canal, while the most common laboratory finding is raised erythrocyte sedimentation rate (ESR). Imaging has great diagnostic relevance: CT and MRI are very useful for spatial resolution, while radionuclide scanning and, in our experience, SPECT are superior for detecting early osteitis and monitoring response to therapy. We present an extensive review of the literature and our personal experience. In particular, we stress the relevance of immunological study of MEO patients: all our 4 patients had defective immune defences. As regards therapy, like other authors we underline the fundamental importance of long-term antibiotic treatment. The availability of quinolones and latest generation cephalosporins has greatly simplified the choice of antibiotic treatment, although clinicians should be aware of the possibility of drug-resistant bacterial strains.
恶性外耳道炎（MEO）是一种罕见但严重的感染性疾病，通常由铜绿假单胞菌引起，最常影响老年糖尿病患者。其临床特征很少能迅速做出MEO的准确诊断，至少在初期很难与外耳道炎的症状区分开来。这就解释了相对于症状出现而言诊断经常延迟的原因。体格检查几乎总能在外耳道发现非特异性肉芽组织，而最常见的实验室检查结果是红细胞沉降率（ESR）升高。影像学检查具有重要的诊断意义：CT和MRI对空间分辨率非常有用，而放射性核素扫描以及根据我们的经验，SPECT在检测早期骨炎和监测治疗反应方面更具优势。我们对文献和个人经验进行了广泛综述。特别是，我们强调了对MEO患者进行免疫学研究的相关性：我们所有4例患者的免疫防御功能均有缺陷。关于治疗，与其他作者一样，我们强调长期抗生素治疗的根本重要性。喹诺酮类药物和新一代头孢菌素的出现极大地简化了抗生素治疗的选择，尽管临床医生应意识到存在耐药菌株的可能性。
