Tuberculous Otitis Media: A Significant Diagnostic Challenge

Abstract

If there are strong clinical grounds for suspicion, standard laboratory tests for tuberculosis should be repeated even if initially negative.

Tuberculose de orelha, doença profissional?

“…4 Rather than pathognomonic features, there are specific findings, the most common of which are: 9 significant otalgia, probably due to pressure caused by granulation tissue within the mastoid; serous otorrhea (mostly), which may become purulent due to secondary bacterial contamination; 4,9,12 severe, early, sensorineural, mixed or conductive hearing loss in 90% of cases, which may persist after the infection has been completely treated, especially if therapy was initiated late. 1,4,11,12 Single or multiple tympanic perforation, denuded hammer of the ear, erosion of ossicles and even of the cortical bone of the mastoid, which may involve the bone capsule of the facial nerve, pallid granulation of the middle ear and mastoid cells, which may be mistaken for a cholesteatoma, and necrotic tissue, may all be seen on otoscopy. Granulation may eventually become hyperemic and friable.…”

“…3 Factors that have led to an increased incidence of tuberculosis in past decades include: the increased prevalence of HIV infection; an increased incidence of people living in poor social and economic conditions; increased resistance to anti-tuberculosis therapy; the development of resistant bacilli; drug dependency; diabetes; and alcoholism. [3][4][5][6][7][8] In the head and neck tuberculosis affects mostly the larynx, and to a lesser degree, the middle and external ear, the tonsils, neck lymph nodes, the pharynx, the mouth and salivary glands. 4,7,8 In the beginning of the 20th century, tuberculosis caused 3% to 5% of chronic suppurative otitis media cases; this rate decreased with the advent of anti-tuberculosis therapy.…”

“…[3][4][5][6][7][8] In the head and neck tuberculosis affects mostly the larynx, and to a lesser degree, the middle and external ear, the tonsils, neck lymph nodes, the pharynx, the mouth and salivary glands. 4,7,8 In the beginning of the 20th century, tuberculosis caused 3% to 5% of chronic suppurative otitis media cases; this rate decreased with the advent of anti-tuberculosis therapy. 8,9 Its current frequency in developed countries ranges from 0.05 to 0.9% of the causes of chronic middle ear infection.…”

“…8,9 Its current frequency in developed countries ranges from 0.05 to 0.9% of the causes of chronic middle ear infection. 4 This decreased incidence has meant that tuberculous otitis media is currently misdiagnosed, particularly in underdeveloped countries. This is due to lack of constitutional symptoms and the fact that signs and symptoms are frequently indistinguishable from nontuberculous chronic otitis media.…”

“…This is due to lack of constitutional symptoms and the fact that signs and symptoms are frequently indistinguishable from nontuberculous chronic otitis media. 4,5,10,11 The purpose of this paper was to review the literature on this theme, to report four cases of tuberculous otitis media, and to describe the predisposing factors, clinical features, the diagnosis, the progression, and therapy.…”