Tuberculous Otitis Media – Revisited With 3 Interesting Case Reports

Abstract

Tuberculous otitis media is a rare disease that is clinically variable and nonspecific. Tuberculous otitis media can be difficult to diagnose because it can easily be confused with other acute or chronic middle ear conditions. The signs and symptoms are variable and nonspecific and often differ from classic descriptions. Furthermore, no two cases may not necessarily present itself clinically in the same manner. Cases of chronic otitis media that are unresponsive to the usual therapy or show unexpected postoperative evolution should be investigated for tuberculosis. Tuberculous otitis media should be suspected after failure of current antibiotics or persistent effusion after tympanoplasty or mastoidectomy. Because of these factors, the diagnosis is often made during surgery or postoperatively. Late diagnosis delays the start of treatment, thereby increasing the risk of complications. KEYWORDS: Tuberculous otitis media, chronic otitis media, mastoidectomy Key Messages: Tuberculous otitis media is a rare disease, which still persists in clinical practice despite effective antitubercular treatment. It may have varied modes of presentation making early diagnosis difficult. If left undiagnosed can cause significant damage to middle ear and other surrounding structures INTRODUCTION: Tuberculosis remains the leading cause of death secondary to infectious diseases worldwide in persons older than 5 years. Tuberculosis of middle ear is a comparatively rare entity usually seen in association with or secondary to pulmonary tuberculosis. Tuberculosis is one the major infectious disease with predominant involvement of lung and lymph nodes but tuberculosis of the middle ear is uncommon. Tuberculous otitis media is generally considered a disease of children and young adults, as patients <15 years of age account for 84% of all cases. Case report 1: A 19 year old female came to our institution with a history of right ear discharge since 4 yrs which was yellowish, scanty, continuous, foul smelling and non blood stained. She was treated with local and systemic antibiotics but her discharge did not reduce with medications. She also complained of decreased hearing on the right side. She had a history of abdominal Kochs 3yrs back for which she took AKT (anti Koch treatment) for 6 months. One year back she had a tubercular gluteal abscess which was drained under spinal anaesthesia. She took medications (AKT) for 9 months for the latter. Examination revealed a central perforation with granulations in middle ear. Ear swab for culture and sensitivity showed no bacterial growth. Her pure tone audiogram showed right sided severe mixed hearing loss. Schuler's view X-ray mastoid showed loss of pneumatization of right mastoid region. CBC, blood urea and electrolytes were insignificant. Chest x-ray was unremarkable.