言語障害にて来院した外耳道異物による側頭葉膿瘍例

抄録

The subject was a 63-year-old female patient who visited the neurosurgery outpatient clinic with the chief complaint of speech impairment. As she also had a fever and earache, she was referred to the otorhinolaryngology clinic. Examination at that department revealed several cotton-like foreign bodies from the left external auditory meatus to the tympanic cavity, and when they were removed, the patient exhibited malodorous otorrhea. CT of the temporal bone showed soft-tissue densities from the left external auditory meatus to the middle ear and a defect in the tegmen of the temporal bone from the left tympanic cavity to the mastoid antrum. Head MRI showed high-intensity signals in the mastoid air cells of the left middle ear to the temporal lobe and in the ventricles, and signal abnormalities with low values of the apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI). On contrast-enhanced MR imaging, mass shadow containing a region with a low signal intensity in the central area with peripheral enhancement was observed in the left temporal lobe. The patient was diagnosed as having otitis media and cerebral abscess caused by foreign bodies in the external auditory meatus. Drainage of the brain abscess was performed and antibiotic therapy was initiated. The speech impairment gradually improved. Several bone defects in the tegmen of the left temporal bone were observed during the left tympanoplasty. No exacerbation has been observed during the three years since the surgery.