Early diagnosis of tuberculous otitis media

In an area endemic for pulmonary tuberculosis, 23 of 192 histological specimens from chronic suppurative otitis media proved to be tuberculous. A personal or family history of tuberculosis was present in 75 per cent of the patients. A pre-operative diagnosis was made in six out of 23 patients, but middle ear mucosal biopsy and aural polypectomy provided a histological diagnosis in 30 and 35 per cent respectively. It is suggested that, when tuberculosis of the middle ear is a possibility, initial surgery for chronic suppurative otitis media should be minimal and directed towards obtaining a tissue diagnosis.     

Middle ear tuberculosis

OBJECTIVES: The aim of this study was to emphasize the difficulties of diagnosing middle ear tuberculosis because of its nonspecific symptoms and to incite the physician to seek it more frequently. MATERIAL AND METHOD: Six cases of middle ear tuberculosis were diagnosed within a 4-year period and included in a retrospective study. RESULTS: We listed two men and four women with an average age of 41 years. Two patients had a mastoidectomy with a histologic examination that enabled us to rectify the diagnosis. The medical treatment was based on a bactericidal chemotherapy. In all cases, the long-term evolution was favourable, with 11 months an average passing. CONCLUSION: The symptoms of middle ear tuberculosis are misleading. Pathologic findings are increasingly taking a more important place in the diagnosis, which the new techniques of serologic tests will surely improve.     

Tuberculous otitis media as a secondary infection to chronic otitis media with cholesteatoma

A series of six cases of tuberculous otitis media is reviewed. All patients had a history of chronic otorrhea and were operated on with a presumptive diagnosis of chronic otitis media with cholesteatoma. Postoperatively the diagnosis of tuberculosis was established by histologic examination of the granulation tissue from the middle ear and mastoid. We believe that any patient with a long history of discharging ears needs histologic examination, as tuberculous otitis might be the cause of infection. We report our findings in these patients and discuss the possibility of penetration of tuberculous mycobacteria into the ear and mastoid. In our opinion, the tuberculosis is secondary to established ear infection.     

Synchronous tuberculous involvement of both ears and the larynx in a patient with active pulmonary disease.

Since the incidence of pulmonary tuberculosis in the United States has declined dramatically, this diagnosis is often overlooked in the differential diagnosis of puzzling extrapulmonary disease. Recent publications emphasize that tuberculosis still needs to be considered in patients with chronic ear, nose, and throat complaints. A patient with tuberculosis involving both middle ears, the larynx, and the lung was correctly diagnosed only after a prolonged delay and several visits for chronically draining ears. As a result of the infection, subtotal bilateral tympanic membrane perforations and a profound hearing loss in both ears occurred. This case emphasizes the importance of a high index of suspicion in the evaluation and treatment of patients with symptoms of chronic disease who fail to respond to conventional therapy.     

Tuberculous Otitis media - a rare differential diagnosis in Germany

A 28-year-old female patient with a migrant background presented for surgery with a suspected cholesteatoma in the left ear. The patient reported having had an aural discharge for several months; otoscopic examination revealed a runny ear, and discrete granulation tissue was seen. Pure-tone audiometry showed conduction hearing loss of 30-40 dB across all frequencies in the left ear; high-resolution computed tomography of the temporal bone revealed that the mastoid and tympanic cavity were completely obscured. The intraoperative finding showed a caseous space-occupying mass that completely filled the tympanic cavity. The suspected diagnosis of tuberculosis was corroborated by pathohistological, microbiological and molecular biological tests. Tuberculostatic therapy was initiated at a different location. Although tuberculosis of the middle ear is a rare condition in Germany, it should nevertheless be considered when making a differential diagnosis, especially in high-risk patients where cholesteatoma is suspected on clinical and radiological evidence or in patients with a chronic middle ear process.     

Reversible inner ear hearing loss in middle ear tuberculosis

Middle ear tuberculosis in a female teacher aged 29 is reported. White necrotic areas were found on the skin of the remaining tympanic membrane and the auditory meatus, that stood out clearly against the healthy skin of the auditory meatus. The patient also had inner ear deafness. The function of the inner ear returned to normal after antituberculous therapy: a comparable course of this disease could not be found in the literature.     

Diagnosis of miliary tuberculosis by examination of middle ear discharge

Extrapulmonary foci of tuberculosis appear more frequently than in previous years, while the incidence of tuberculous otitis, a neglected and often difficult to diagnose entity, is unknown. We describe a case of an adult with miliary tuberculosis not initially suspected on clinical criteria, in whom the diagnosis of miliary tuberculosis was made by inspection of a modified Kinyoun stain of occult ear discharge. The significance and diagnostic problems associated with tuberculous otitis are briefly reviewed.     

Unilateral tuberculosis of middle ear in patient previously treated for rhabdomyosarcoma embryonal in the contralateral middle ear--case report

Authors present a case of a female patient surgically treated for chronic otitis media (radical middle ear surgery) in which basing on postoperative pathology report a specific inflammatory process (tuberculosis) has been diagnosed. It is pointed out that in this patient there is a history of malignant neoplastic process (rhabdomyosarcoma embryonal) treated previously at the contralateral middle ear.     

Tuberculosis of the head, neck and ear--a rare disease?

Between 1980 and 1984 we treated 9 patients with tuberculosis of the lymph nodes, middle ear, parotid gland, larynx and sphenoid sinus. Diagnosis is difficult because of the unusual courses of the disease, the special pathways of infection and because tuberculosis is rarely suspected as the diagnosis. The importance of a combined conservative-surgical therapy is stressed.     

Tuberculosis of the middle ear in an infant

Tuberculosis of the middle ear is currently a rare disease. As most physicians are unfamiliar with the typical presenting features, the diagnosis is made too late, with resulting complications, such as irreversible hearing loss and facial nerve paralysis. A case report and review of the literature are presented, emphasizing that tuberculosis should be considered in the differential diagnosis of chronic ear infection.     

Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess

A 70-year-old Asian man with noninsulin-dependent diabetes presented with a 4-month history of left-sided otitis externa and right-sided facial palsy. Physical examination of the left ear revealed a punched-out ulcerative lesion on the tragus, an edematous and inflamed external auditory canal, and a purulent nonmucoid discharge. Computed tomography of the brain and neck demonstrated a large retropharyngeal abscess, an abscess in the left parapharyngeal space, and a small collection adjacent to the right carotid sheath at the level of C4; the cervical vertebrae and lungs were normal. Microscopy of drained pus and histology of left ear and neck node biopsies identified tuberculosis. The patient was started on antituberculosis drug therapy, but he died within 2 weeks of treatment. We discuss the characteristics of this unusual presentation of tuberculosis infection.     

Coexistent acute pyogenic and tubercular petrous apicitis: a diagnostic dilemma

We report the case of a 16-year-old boy who presented to us with acute otitis media, facial weakness and retro-orbital pain. Computed tomography and magnetic resonance imaging (MRI) scans of the head and temporal bone revealed otitis media with petrous apicitis. The patient responded to broad-spectrum, parenteral antibiotics, with disappearance of facial weakness and reduction in pain. One month following the completion of treatment, the patient continued to have dull retro-orbital pain and developed ear discharge. A repeat MRI of the temporal bone revealed a persistent inflammatory lesion in the petrous apex, with a nodular, ring-enhancing lesion in the cerebellum, strongly suggestive of tuberculosis. The ear discharge stained positive for acid-fast bacilli and the patient's serum enzyme-linked immunosorbent assay for tuberculosis was reactive. The patient responded well to anti-tubercular treatment and was disease free eight months following the completion of treatment.     

Ear tuberculosis: clinical and surgical treatment

Two main points are discussed in this paper: First, the changing picture of the clinical process of tuberculosis, and second, various diagnostic problems caused by extra-pulmonary forms.We have analysed a case of ear tuberculosis in a child, and drawn the following conclusions: Directed chemotherapy is the primary method of treatment, and surgical methods should be used to provide tissue for bacteriological and histopathological analysis, to enable an early diagnosis during the first stage of the disease, and in other atypical cases.     

Diagnosis of middle ear tuberculosis

Middle ear tuberculosis is underdiagnosed. Clinical suspicion requires extensive diagnostic and therapeutic procedures. Due to a high degree of error in bacteriological and histological examination they must often be repeated. Indications for tentative diagnosis are given.     

Epidemiological considerations and clinical features of ENT tuberculosis

Between 1 April 1996 and 30 June 1997, 1003 ear, nose and throat (ENT) outpatients and 340 inpatients diagnosed as having pulmonary tuberculosis were analysed for ENT manifestations of tuberculosis to determine the relationship to sputum positivity, whether any high risk factors exist for the ENT manifestations as compared to other pulmonary tuberculosis patients, and the response to anti-tubercular treatment. The commonest ENT manifestation was found to be laryngitis (seven cases), which was more common in pulmonary tuberculosis patients (five out of seven), all except one of whom were sputum negative. All of these patients were defaulters from anti-tuberculosis treatment or relapse cases, and vocal cords were the commonest site of involvement. One case of tuberculous tonsillitis and one case of tuberculous mastoiditis were also noted. The practical implications of an awareness of ENT tuberculosis is a benefit of anti-tubercular therapy and hence conservative management usually suffices.     

Tympanoplasty and tuberculosis of the middle ear*

This report concerns 6 cases of middle ear tuberculosis. Typical clinical signs for this infection nowadays consist in a pale-coloured mucosa, spontaneous facial paresis, pneumatization of the mastoid and in a changing performation of the tympanic membrane. These signs can occur single or in combination. Under a specific chemotherapeutic treatment even in tuberculous infection of the middle ear tympanoplasty can be performed without danger for the newly transplanted tympanic membrane. One should consider tuberculous infection especially in cases when for apparently inexplicable reasons necrosis of the transplant occurs postoperatively.     

Tuberculous otitis: An underdiagnosed disease

A series of 31 cases (33 ears) of tuberculous otitis was reviewed. Classical findings of the disease, such as painless ottorhea and multiple perforations of the tympanic membrane, are not consistent with the clinical findings reported here. Severe conductive hearing loss, abundant pale granulations, and an eroded malleus handle occur consistently and appear to be important clinical features of the disease. In all cases suspected of tuberculosis, granulation tissue from the middle ear or mastoid was submitted for bacteriologic and histologic examination. As a result, tuberculous otitis was diagnosed in its early stages. In 10 patients (32%), pulmonary tuberculosis was found following confirmation of the tuberculous otitis media. Following 6 months of treatment with oral antituberculous therapy in conjunction with surgery, no evidence of active tuberculosis was present in any of the patients studied.     

中耳乳突结核7例临床分析

我科自1990～1998年共收治7例（8耳）中耳乳突结核患者,临床表现为耳漏,中耳胶粘膜苍白肉芽。术前明确诊断结核2耳,术前诊断为急性中耳乳突炎2耳,慢性化脓性中耳炎3耳,乳突根治术后感染1耳,此6耳经术后病理证实为结核病变。8耳均行乳突根治术清除病灶结合抗痨治疗,随访2月～2年,局部病变无复发。文中对中耳乳突结核的病因、诊断、鉴别诊断及治疗方法进行了讨论。     

结核性中耳乳突炎的临床特征及疗效分析

目的 探讨结核性中耳乳突炎的临床特点以及手术疗效.方法 回顾性分析经病理学证实的16例(18耳)结核性中耳乳突炎的临床表现、影像学特征以及治疗方法,并随访其预后.结果 16例(18耳)患者均表现为耳流脓、听力下降,并发重度感音神经性聋患者3例(4耳),并发周围性面神经麻痹患者3例.16例颞骨高分辨率CT均表现为鼓室、乳突充满软组织密度影,其中骨质破坏11例(12耳),颞骨内存在死骨7例(7耳).16例患者中伴发肺结核7例.15例患者接受了手术治疗去除病灶并联合抗结核治疗.除2例患者术前经穿孔的鼓膜取活检明确诊断为结核性中耳乳突炎外,其余14例患者均为术中或者术后确诊.除1例患者失访外其余15例患者均随访1年以上,中耳乳突结核无复发,3例面神经麻痹患者基本恢复正常.结论 对于顽固性耳流脓,影像学提示鼓室、乳突充满软组织密度影且存在骨质破坏或者死骨者,应仔细询问是否有结核病史,以便鉴别结核性中耳乳突炎.手术去除病灶并结合抗结核治疗对该病有较高的治愈率.     

Aural tuberculosis: a series of 25 patients

Twenty-five patients with thirty ears affected by tuberculosis of the middle ear cleft were diagnosed and treated at Groote Schuur Hospital, Cape Town, during the years 1972 to 1983. This series is a sequel to the series of 1967 to 1971 and reported by Sellars and Seid (1973). The classical disease presentation will be reviewed and compared to that found in our patients. The modern trends in diagnosis and management will be discussed. The emphasis is on early diagnosis and treatment in an eminently curable disease.