DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20203220

Tuberculous otitis media: rare cause of recurrent facial nerve palsy

Vibhu Tiwari, Rohit Singh, V. Anand

Abstract


Tuberculous otitis media (TOM) is a rare form of tuberculosis, due to tubercular otitis media, thick caseous material and granulation tissue gets deposited in middle ear cleft causing bone erosion, sequestration, ossicular destruction, heading loss which can be conductive or mixed and rarely facial paralysis. In this case report we discuss tubercular otitis media as a cause of recurrent facial nerve paralysis. 54 year old male patient with no known previous comorbidities presented to ENT OPD on 12 October 19 with complaints of scanty, mucopurulent foul smelling occasionally blood stained continuous otorrhoea (R)×02 years, painless progressive and persistent hearing loss ×1 year and recurrent (R) sided facial nerve palsy, 03 episodes in last 2 years which were spontaneous and sudden in onset, showed gradual recovery with oral medication. Tubercular otitis media is not a very common diagnosis with which an otolaryngologist comes across. It generally presents with otorrhea and hearing loss which mimics more commoner ear disease. Typical findings of multiple tympanic membrane perforations are not necessarily seen. There can be involvement of facial nerve and presence of refractory otorrhoea with atypical features may be considered indicative of tubercular pathology. A clinician should have high index of suspicion whenever there are signs which outlies symptoms in form of severity. This case highlights the diagnostic challenge and high index of clinical suspicion required for diagnosis. Combination of appropriate diagnostic modality along with good clinical vigilance will aid in early diagnosis and start of early medication which reduces chances of any subsequent complications.

 


Keywords


Tubercular otitis media, Bony sequestrum, Facial nerve palsy, Chronic otitis media with complication

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References


Weiner GM, O'Connell JE, Pahor AL. The role of surgery in tuberculous mastoiditis: Appropriate chemotherapy is not always enough. J Laryngol Otol 1977;111:752-3

Myerson, M. C., & Gilbert, J. G. (1941). Tuberculosis of the middle ear and mastoid. Archives of Otolaryngology - Head and Neck Surgery, 33(2), 231–250

V. Vital, A. Printza, T. Zaraboukas, Tuberculous otitis media: a difficult diagnosis and report of four cases, Pathol. Res. Pract. 198 (2002) 31–35

B.G. McKibben, J.L. Sheehy, Tuberculosis of the middle ear and nasal passages, AMA Arch. Otolaryngol. 63 (3) (1956) 286–289

S. Davidson, D. Creter, G. Leventon, D. Katznelson, Tuberculosis of the middle ear in an infant, Arch. Otolaryngol. Head Neck Surg. 115 (1989) 876–877

Kirsch CM, Wehner JH, Jensen WA, Kagawa FT, Ampagna A, Tuberculous otitis media Southern Med J, 88 (3) (1995), pp. 363-366

Saunders NC, Albert DM. Tuberculous mastoiditis: when is surgery indicated? Int J Pediatr Otorhinolaryngol. 2002;65:59-63

Rajesh Gandham N, Sardar M, Jadhav SV, Vyawahare C, Misra R. Tuberculous Otitis with Proteus mirabilis Co-Infection: An Unsuspected Presentation Encountered in Clinical Practice. J Clin Diagn Res. 2014;8(5):01–03

Kasat S, Biradar M, Deshmukh A, Jadhav S, Deshmukh H. Effectiveness of CBNAAT in the diagnosis of extrapulmonary tuberculosis. Int J Res Med Sci 2018;6:3925-8

Sharma SK, Kohli M, Chaubey J, Yadav RN, Sharma R, Singh BK, et al. Evaluation of Xpert MTB/RIF assay performance in diagnosing extrapulmonary tuberculosis among adults in a tertiary care centre in India. Eur Respir J. 2014 Oct;44(4):1090-3

Chaudhary A, Barve K, Desai U, Joshi J. Utility of GeneXpert in diagnosis of multidrug-resistant extrapulmonary tuberculosis. Inter J Recent Surg Med Sci. 2017;3(2):85-7

World Health Organization. Global tuberculosis report 2019. Geneva, WHO, 2019. Available at: http://apps.who.int/iris/bitstream/handle/10665/329368/978924156 5714-eng.pdf?ua=1

Vaamonde P, Castro C, García-Soto N, Labella T, Lozano A. Tuberculous otitis media: a significant diagnostic challenge. Otolaryngology--Head and Neck Surgery. 2004 Jun;130(6):759-66

Farrugia EJ, Raza SA, Phillipps JJ. Tuberculous otitis media–a case report. The Journal of Laryngology & Otology. 1997 Jan;111(1):58-9

Dale OT, Clarke AR, Drysdale AJ. Challenges encountered in the diagnosis of tuberculous otitis media: case report and literature review. The Journal of Laryngology & Otology. 2011 Jul;125(7):738-40