Tuberculose de orelha, doença profissional?

Abstract

Tubercul osis is a rare cause of chronic suppurative otitis media and mastoiditis; the predisposing factors of this association, however, are not commonly described. There has been an alarming increase in the incidence of tuberculosis in Brazil, including tuberculous otitis media. These patients typically present multiple perforations of the tympanic membrane, an ear discharge, and progressive hearing loss. This diagnosis should be taken into account in patients that do not respond to routine therapy for fungal external otitis or bacterial otitis media. In this retrospective study, the authors describe four cases of patients with tuberculous otitis media. This sample consisted of two physicians, a chemical engineer and an underage child in whose family there were cases of active tuberculosis. Predisposing factors for tuberculous otitis were contact with family members that had tuberculosis, professional contact with patients and exposure to pathogenic microorganisms in airways.

ENT Manifestations in Tuberculosis

“…In the region of the head and neck, TB manifests itself predominantly in the larynx; less frequently, it is found in the middle and external ear, tonsils, cervical lymph nodes, pharynx, oral cavity, and salivary glands [9].…”

“…TB located in the middle ear as the primary focus is uncommon. Classically it affects children more than adults [9].…”

“…Several theories attempt to explain the infection of the middle ear by TB, but its pathogenesis is still controversial. It is suggested that routes may be through the bloodstream by direct extension from the nasopharynx through the Eustachian tube via the lymphatic system; externally, by perforation of the tympanic membrane; by direct extension from adjacent structures, the central nervous system, congenital infection (via the placenta) or during passage through the birth canal [9].…”

“…Classically it is presented as the triad: painless otorrhea, multiple perforation of the tympanic membrane, and peripheral facial palsy; but currently its presentation has become polymorphic. Among its complications are the following: peripheral facial paralysis, retro-auricular fistula, labyrinthitis, meningitis, tuberculous osteomyelitis of the petrous pyramid, subperiosteal, cerebral or cerebellar abscess, acute mastoiditis and cellulites [9].…”

“…In laryngeal TB, differential diagnosis with inflammatory diseases and with laryngeal carcinoma should be conducted [7]. Similarly, in TB which affects the ear, differential diagnosis may reveal other diseases with chronic suppuration which do not improve with conventional treatment, such as cholesteatoma, syphilis, Wegener's granulomatosis, fungal infection, eosinophilic granulomatosis and sarcoidosis [9].…”