Tuberculous otitis media – a case report

Abstract

Tuberculosis of the middle ear is a rare disease. Due to a change in the typical clinical signs in recent years and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications. A case of tuberculous otitis media is reported, re-emphasising the fact that this entity must be considered in the differential diagnosis of persistent suppurative otitis media.

A Case of Tuberculous Otitis Media

“…4,5,[9][10][11][12][13][14][15][16] Several sources also include peripheral facial ner ve paralysis among the classic symptoms. 9,12,13,15,17 Depending on the duration of the disease, the hearing deficit may progress to either a mixed or sen- 3,16 and granulation tissue in the ear canal or middle ear cleft. 9,10,12,13,15,20 Since the original description of "classic" TB otitis media, it has become clear that the presentation of TB otitis varies widely.…”

“…9,12,13,15,17 Depending on the duration of the disease, the hearing deficit may progress to either a mixed or sen- 3,16 and granulation tissue in the ear canal or middle ear cleft. 9,10,12,13,15,20 Since the original description of "classic" TB otitis media, it has become clear that the presentation of TB otitis varies widely. A significant proportion of the patients do experience otalgia as opposed to the classic painless presentation.…”

“…9,12,13,17,21 It has also been noted that otorrhea may be highly variable, being acute or chronic, constant or intermittent, light or profuse, and either serous or purulent. 4,9,15,22,23 A single perforation in the TM appears to be more common than the previously reported multiple defects, 4,9,[12][13][14]20,21,24,25 although there is some evidence that multiple perforations may form early in the course and coalesce into larger defects. 16 Granulation tissue usually is present in the ear canal, but is more frequently pale than beefy red.…”

“…16 Granulation tissue usually is present in the ear canal, but is more frequently pale than beefy red. 7,9,10,12,13,15,20,26 Occasionally the presenting symptoms are more similar to, and may be mistaken for, a sinusitis or nasopharyngitis. 9,14,24 In addition, although more than 75% of patients have a positive tuberculin skin test, 4,8,11,14,15,20,21 only about half have abnormal chest radiographs 4,5,9,24 and 40% have no other evidence of tuberculosis.…”

“…9,14,24 In addition, although more than 75% of patients have a positive tuberculin skin test, 4,8,11,14,15,20,21 only about half have abnormal chest radiographs 4,5,9,24 and 40% have no other evidence of tuberculosis. 4,7,9,15,19 Complications of TB otitis media include facial ner ve palsy, 8,9,[11][12][13]15,17,24,26 necrosis of the ossicles, 4,7,17,21,23,26 bony destruction of the mastoid, 4,6,15,21,27 and bony destruction of the petrous bones. 20 Periauricular fistulas, 9,10,15,26 lymphadenopathy, 15,19,27 and intracranial tuberculomas or abscesses 9 are rare complications.…”