Tubercular otitis media: an under diagnosed entity

Abstract

<p class="abstract"><strong>Background:</strong> Tubercular otitis media (TOM) is a well described rare entity in literature. Its characteristic diagnostic delay leads to severe irreversible complications. Diagnosis is much more difficult when it co-exists with aural cholesteatoma. Its Actual incidence is thought to be much more, than what is reported in literature. This study was carried out to establish TOM as an under diagnosed entity and to study its various presentations<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> A prospective study was performed in 617 cases (both recurrence and new) of chronic otitis media who gave a fully informed consent, for being investigated for a probable diagnosis of TOM, based on history and clinical findings. Histopathological examination of the granulation tissue retrieved during biopsy/mastoid exploration surgery and mycobacterial culture of the aural discharge was performed in all cases. A final diagnosis was made with either of tests being reported as positive for mycobacterium tuberculosis infection. All confirmed cases were treated with a 6 month course of anti-tubercular therapy<span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> Diagnosis of TOM was confirmed in 12 cases. M:F ratio was 1:1.4. Cholesteatoma was found to co-exist in 4 cases (33.33%). A positive histopathology report was obtained in 11 cases (91.67%) while the mycobacterial culture yielded growth in 3 cases (25%) only. Canal wall down mastoidectomy was performed in 9 cases. In all cases, a follow-up with a 6 months course of anti-tubercular therapy gave satisfactory healing with no complications<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The incidence of TOM, a potentially dangerous entity is on a rise. Role of surgery is crucial in procuring tissue for histopathological and bacteriological examination. It is a curable disease if diagnosed in time with early institution of anti-tubercular therapy<span lang="EN-IN">.</span></p>

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“…Primary TOM is extremely rare. Majority are secondary to pulmonary etiology via several mechanisms like spread through the Eustachian tube usually the result of retrograde flow of hemoptysis, direct entry via the external auditory canal or perforated tympanic membrane (TM), contiguous involvement from adjacent intracranial or extracranial infected foci, hematogenous spread and rarely via transplacental transmission or infected birth canal [9,10].…”

“…Jean Louis Petit (18 th century) was the first to describe about tuberculous mastoiditis and Wilde (1853) enlightened the detailed clinical insights, Koch found tuberculous bacillus in 1882 and Esche demonstrated bacillus in middle ear secretions in 1883 [7,9]. The classical characteristics of TOM initially described by Wallmer in 1953 were painless otorrhea, multiple tympanic membrane perforations, pale granulation tissue, ipsilateral facial nerve paralysis, early severe hearing loss and bone necrosis.…”

“…Conductive deafness is noticeable in 90% of cases and mixed or sensorinerual type is also seen with the disease progression. Generally, TB of middle ear is unilateral however, bilateral involvement have been reported [7,9]. It is a challenging task to diagnose TOM as it requires a high level of suspicion and is based on pre and post-operative histological and bacteriological findings [9].…”

“…Surgery is done mainly for biopsy purpose in suspicious cases and in management of complications like facial palsy, postauricular fistula, subperiosteal abscess, labyrinthitis, removal of bony sequestrum and intracranial extension. Combined therapy with surgery and chemotherapy have a good chance of healing with dry ear and with better prognosis [9,10].…”

Clinical Finding, Diagnosis, and Management of Tuberculous Mastoiditis in 4 Cases

“…In many case reports, examination of geneXpert TB is used in detecting the presence of M. tuberculosis in pulmonary and extrapulmonary TB cases (8) . The administration of antituberculosis for tuberculous mastoiditis was in accordance with the treatment of extrapulmonary tuberculosis, namely category 1 antituberculosis for new cases of patients (9) . Based on the description above, we are interested in reporting a case of tuberculous mastoiditis.…”