Extrapulmonary Tuberculosis in Otorhinolar¬yngology: A Case Series Describing the Challenges in their Management

Abstract

Background: In Otorhinolaryngology, tuberculosis (TB) though uncommon is not a rare clinical problem. HIV-TB co-infection, multidrug resistant tuberculosis (MDR TB), and Extrapulmonary tuberculosis (EPTB) continue to be major public health threats. The success of the WHO, “END TB” strategy requires their effective management. In this article we look into the challenges while dealing with cases of EPTB in otorhinolaryngology. Case Series: The clinical presentations & epidemiology of patients with extra pulmonary tuberculosis in otorhinolaryngology highlight the challenges in their management. Patients with laryngeal TB and TB of oral cavity and oropharynx are cases where the diagnosis can be easily delayed owing to lack of awareness and the need to exclude the other commoner lesions. The early diagnosis can be challenging with symptoms that mimic malignancy with subsequent hurdle being obtaining the histopathology report and confirmation of diagnosis. As elimination of this disease is the target which needs to be met there is need to ascertain features that will help accomplish the goal. Discussion: Laryngeal tuberculosis is an area that demands high index of suspicion with technical expertise in obtaining positive yield on histopathology which can at times be challenging. Dysphagia is a symptom where the diagnosis of tuberculosis in our patient came as a surprise rather than the norm which required the histopathological report to retrospectively think on the likely pathology. Conclusion: Extrapulmonary tuberculosis in otorhinolaryngology can have varied and atypical presentations responsible for delay in diagnosis. Awareness of this entity especially when the clinical signs are out of proportion to the symptoms among patients presenting to ENT OPD and emergency is necessary for prompt treatment. The features of carcinoma co-existing and confusing the diagnosis; along with paucibacillary nature of the specimens resulting in negative cultures makes histopathological examination mandatory, which is one among the challenges to be addressed for early diagnosis of EPTB cases in ENT. The timely initiation of anti tubercular treatment (ATT) can help avoid unnecessary surgery and morbidity