Tuberculous otitis media: a case presentation and review of the literature

Abstract

SummaryA 42-year-old farmer being treated for pulmonary tuberculosis was referred to our clinic after developing otorrhoea and hearing loss in his right ear. Examination revealed a large subtotal perforation in the right ear in addition to a purulent discharge with right facial nerve palsy. Audiometry indicated a 35 dB conductive hearing loss at 0.5, 1 and 2 kHz with air-bone gaps of 12, 15 and 10 dB, respectively. A middle ear biopsy was performed under direct visualisation, with a middle ear lavage which was positive for allergic fungal sinusitis (AFS). The final diagnosis was tuberculous otitis media (TOM).Clinical symptoms and signs should be reviewed in every case of chronic otitis media keeping the possibility of tuberculosis in mind. Otorrhoea in a patient with known or suspected active pulmonary tuberculosis should be assumed to be TOM until proven otherwise. BACKGROUND

Tuberculous Otitis Media—A Rare Entity or a Missed Diagnosis

“…There was no formation of post aural fistula or graft rejection. As observed by Aremu [17] in his study, our patients also complained of wet feeling of the ear (rather than discharge) in the initial post operative period-for three months. A mean follow up for one year was done and all patients were doing well except for the defaulters.…”

Agresyvi Abipusė Smilkinkaulių Tuberkuliozė. Klinikinis Atvejis

“…Probably, this was a consequence of the progressive osteitis, describied in such patients [8] with further sequestration. It should emphisized that the CT images obtained in the initial phase of the disease didn't show any destructive changes.…”

Tuberculosis de oído medio. Descripción de dos casos

“…Desde el punto de vista anatomoclínico se identifican 3 tipos de tuberculosis: miliar, granulomatosa y caseosa. El tipo miliar se asocia con infección superficial, el granulomatoso con afectación superficial del hueso y el caseoso con necrosis masiva y secuestros óseos [3]. La tuberculosis del oído medio (TOM) es rara, puede ocurrir a cualquier edad y sus hallazgos clínicos son similares a otros formas de otitis media crónica (OMC) [5].…”

“…Clásicamente la TOM es una afección unilateral vinculada a la tríada clínica otorrea no dolorosa, perforación timpánica múltiple, y parálisis facial, y asociada a la formación de tejido de granulación y necrosis ósea. (Wallmer, 1953) [3]. Esta presentación es excepcional hoy en día [7], ya que la parálisis facial sólo se da en aproximadamente el 16% de los adultos y el 35% de los niños [8].…”

“…Hasta en un 79% de los pacientes, la identificación del bacilo con tinciones no es posible y los cultivos son negativos [3]. Ante una TOM es obligado investigar la posibilidad de que existan otros focos tuberculosos realizando al menos una radiografía de tórax, aunque en un 40-50% de los pacientes afectos de TOM no se encuentra enfermedad en otras localizaciones [6,7].…”