DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20205630

Tubercular otitis media: demystifying its nuances and an update on the tenets of emerging perspectives

Apoorva Kumar Pandey, Aparna Bhardwaj, Tripti Maithani, Madhuri Kaintura, Fatma Anjum, Akanksha Bisht

Abstract


Background: Tuberculous otitis media (TOM), a rare cause of chronic otitis media, is easily confused with nonspecific chronic otitis media owing to its unexpectedly changing and variable presentation, low suspicion and low prevalence which causes difficulty in its early diagnosis. The purpose of this study was to analyze its changing clinical pattern and to formulate an acceptable management protocol.

Methods: This retrospective observational, descriptive study included 457 cases of Chronic otitis media who were operated between January 2017 to July 2020 in a tertiary care center. Histo-pathological examination of tissue from the middle ear and mastoid were sent and positive results were corroborated retrospectively to the clinical findings.

Results: Diagnosis of TOM was established post-operatively in five cases (1.09%) with a positive histopathology report in four out of five cases and by polymerase chain reaction (PCR) in one case. Three cases (60%) presented with facial palsy and one with profound hearing loss (20%). All cases received 6 months course of anti-tubercular therapy postoperatively and were in regular follow up.

Conclusions: Tuberculosis of the middle ear can present unexpectedly either as a complication or completely as a non-specific chronic otitis media. The extent of pathological findings might not be in commensuration with the clinical features. In operated chronic otitis media cases, specimen for histopathological examination must be sent in all cases and further specific microbiological investigations may as well be advised accordingly.


Keywords


Tuberculous otitis media, Otomastoiditis, anti-tubercular therapy, facial nerve palsy, tympanic membrane, acid fast bacilli

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References


Helb D, Jones M, Story E, Boehme C, Wallace E, Ho K et al. Rapid detection of mycobacterium tuberculosis and rifampicin resistance by use of on-demand, near-patient technology. J Clin Microbiol. 2010;48:229-37.

Kameswaran M, Natarajan K, Parthiban M, Krishnan PV, Raghunandhan S. Tuberculous otitis media: a resurgence? J Laryngol Otol. 2017;131(9):785-92.

Grewal DS, Baser B, Shahani RN, Khanna S. Tuberculous otitis media presenting as complications; report of 18 cases. Auris Nasus larynx. 1991:18;199-208.

Saltzman SJ, Feigin RD. Tuberculous otitis media and mastoiditis. J Pediatr. 1971;79:1004-6.

Birrel JF. Aural tuberculosis in children. Proc R Soc Med. 1973;66:331-8.

Wallner LJ. Tuberculous otitis media. Laryngoscope. 1953;63:1058-77.

Singh B. Role of surgery in tuberculous mastoiditis. J Laryngol Otol. 1991;105:907-15.

Ng PC, Hiu J, Fok TF, Nelson EAS, Cheung KL, Wong W. Isolated congenital tuberculosis otitis in a preterm infant. Acta Paediatr. 1995;84(8):955-6.

Plester D, Pusalkar A, Steinbach E. Middle ear tuberculosis. J Laryngol Otol. 1980;94:1415-21.

Lucente FE, Tobias GW, Parisier SC, Som PM. Tuberculous otitis media. Laryngoscope. 1978;88:11071-6.

Jesic S, Stosic S, Milenkovic B, Nesic V, Dudvarski Z, Jotic A et al. Middle ear tuberculosis: Diagnosic criteria. Srp Arch Celok Lek. 2009;137(7-8):346-50.

Kimonoyo K, Levi C, Krishnan J, Garro J, Lucey D. Tuberculous otitis media and mastoiditis (instructive cases). Inf Dis Clin Prac 2001;10:491-92.

Chirch LM, Ahmad K, Spinner W, Jimenez VE, Donelan SV et al. Tuberculous otitis media: report of 2 cases on Long Island, NY, and a review of all cases reported in the United States since 1990 Through 2003. Ear Nose Throat J. 2005;84(8):488-97.

Rho MH, Kim DW, Kim SS, Sung YS, Kwon JS, Lee SW. Tuberculous otomastoiditis on high-resolution temporal bone CT: comparison with nontuberculous otomastoiditis with and without cholesteatoma. AJNR Am J Neuroradiol. 2007;28(3):493-6.

Awan MS, Salahuddin I. Tuberculous otitis media: two case reports and literature review. Ear Nose Throat J. 2002;81(11):792-4.

Hand JM, Pankey GA. Tuberculous otomastoiditis. Microbiol Spectrum. 2016;4(6):TNM17-0020-2016.

Pinho MM, Kos AO. Otite média tuberculosa. Rev. Bras. Otorrinolaringol. 2003;69:829-37.

Diplan R, Johanna M, Díaz MP, Vales O, Hinojosa R, Del Angel JM et al. Neuro-otologic manifestations of tuberculosis. The great imitator. Am J Otolaryngol. 2015;36:467-71.

Rice DH. Tuberculosis. Pathological quiz case 2. Arch Otolaryngol. 1977;103:112-5.

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

Kwon M, Choi SH, Chung JW. Roles of an anti-tuberculosis medication and surgery in patients with tuberculous otitis media. Acta Otolaryngol. 2010;130:679-86.