Aural tuberculosis at the start of the 21st century. Literature review according to SWiM guidelines. Part 2: Treatment |
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| Institution: | 1. Université Paris Cité, service d’otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, Assistance Publique des hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France;2. Unité CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition Group, France;3. Institut Arthur Vernes, service d''Otorhinolaryngologie et de chirurgie cervico-faciale, 36 rue D''Assas, 75006, Paris, France;4. Université Paris Cité, bibliothèque universitaire Necker, 160 rue de Vaugirard, 75015, Paris, France;5. Clinique St-Vincent, 8, rue de Paris, CS 71027, Saint-Denis Cedex 97404, La Réunion, France;1. Service d’ORL et de chirurgie cervico-faciale, hôpitaux civils de Colmar, 68024 Colmar cedex, France;2. Service d’ORL et de chirurgie cervico-faciale, hôpitaux universitaires de Strasbourg, 67091 Strasbourg cedex, France;1. Division of Otolaryngology, Department of Surgery, Dentistry Pediatrics and Gynecology, University Hospital of Verona, Verona, Italy;2. Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy;1. Service d’oto-rhino-laryngologie et de chirurgie cervico-faciale, HEGP, Assistance publique–Hôpitaux de Paris, université Paris Centre, 20–40, rue Leblanc, 75015 Paris, France;2. European Annals of Otorhinolaryngology Head & Neck Diseases, Elsevier, 165, rue Camille-Desmoulins, 92130 Issy-les-Moulineaux, France;1. Service d’ORL et chirurgie cervico-faciale, université Lyon 1, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France;2. Service de cardiologie, université Lyon 1, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France;1. Service ORL et chirurgie cervico-faciale pédiatrique, CHU de Tours, boulevard Béranger, 37044 Tours, France;2. Inserm UMR 1253 I-Brain, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France;3. Service ORL et chirurgie cervico-faciale, CHU de Tours, boulevard Tonnellé, 37044 Tours, France;4. Faculté de médecine de Tours, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France;5. House Institute Foundation, 2100W 3rd Street, Suite 111, Los Angeles, CA 90057, USA;1. President of YO-IFOS. Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP–HM, Aix-Marseille université, Marseille, France;2. Vice-President of YO-IFOS. Department of Otolaryngology, Hafr Albaten Central Hospital, Hafr Albaten, Saudi Arabia;3. Vice secretary of YO-IFOS. College of Medicine, King Saud University, Riyadh, Saudi Arabia;4. President of IFOS. Service d’Otologie, Otoneurologie et ORL pédiatrique, hôpital Pierre-Paul Riquet, CHU Purpan, Toulouse, France;5. Vice President of IFOS. Department of Otorhinolaryngology, Dr. Sulaiman Al Habib Hospital, Dubai, United Arab Emirates;6. General Secretary of IFOS. Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital, Comenius University Bratislava, Bratislava, Slovakia;7. General Secretary of the French Society of Otorhinolaryngology (SFORL). Department of Paediatric Otolaryngology, hôpital Necker-Enfants Malades, AP–HP - université de Paris, Paris, France;8. General Secretary of YO-IFOS. Pediatric ENT Department, Robert-Debré Hospital, Paris 7 Denis Diderot University, 48, Boulevard Sérurier, 75019 Paris, France;9. Vice-chair of the YO-IFOS Education Committee. Department of Paediatric Otolaryngology, Hôpital Necker-Enfants Malades, AP-HP - Université de Paris, Paris, France |
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| Abstract: | ObjectivesSystematic review of the scientific literature dedicated to treatment modalities and results for aural tuberculosis published since the start of the 21st century.Material and methodsSearch of the Medline, Cochrane and Embase databases for the period 2000 - 2020. Selection of articles in English, French and Spanish devoted to clinical cases and series documenting treatment of auricular tuberculosis. Extraction of data on pre-established files documenting treatment modalities and results. Reading of articles by two authors. Analysis performed according to SWiM guidelines, evaluating cure, tuberculosis-related death, treatment-related complications, improvement in facial palsy, and hearing sequelae rates.ResultsOne hundred and twenty eight articles: 118 case reports (159 patients) and 10 cohorts (177 patients) from 42 countries were analyzed. Female/male sex ratio was 1.2 with ages ranging from 1 month to 87 years. Medical treatment consisted in 5 to 24 months’ antitubercular antibiotic treatment using 2 to 8 antibiotics. Mastoidectomy, tympanoplasty and facial nerve decompression were associated to medical treatment in 64.7%, 17.4% and 6.2% of cases, respectively. Overall rates of cure, death, treatment-related complications, facial sequelae and hearing sequelae were 96.8%, 2%, 9.5%, 35.8% and 75.5%. In case reports, BCG vaccination did not appear to protect against facial palsy and severe intracranial complications (P > 0.6). There was no significant correlation (P > 0.3) between death and the clinical variables tested, and facial nerve decompression did not appear to influence outcome for facial function (P = 0.4).ConclusionMedical treatment is very effective but not without risk of death, complications and sequelae. It is the same as for pulmonary tuberculosis. Indications for and benefit of major auricular surgery during medical treatment deserve further studies. |
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| Keywords: | Tuberculous otitis media Facial palsy Medical treatment Mastoidectomy |
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