Diagnosis Of Tuberculous Otitis Media Research Articles

Clinical case of tuberculous otitis media in early childhood

Nowadays, the incidence of tuberculosis remains high all over the world, despite the vaccination, medical support, social policy. The main reasons for this are the high level of migration, the prevalence of bad habits, the prevalence of immunodeficiency conditions, the formation of resistance to antimicrobial drugs, the tendency to refuse vaccination. At the same time, great difficulties arise in the diagnosis of extrapulmonary forms of infection. The purpose of this publication is to remind about the peculiarities of the course and diagnosis of tuberculous otitis media. According to the literature, the main characteristic features of tuberculous of the middle ear are prolonged suppuration without pronounced pain syndrome, inefficiency of standard antibacterial therapy, the anamnestic data about contacts or violation of the vaccination schedule, multiple perforations and a pronounced granulation process during otoscopy, a pronounced destructive process in the temporal bone during X-ray examination. The article presents a clinical case of the development of tuberculous otitis media in a young child with delayed diagnostics and the development of mastoiditis with required emergency surgical treatment. Verification of the etiology of the disease and the specific treatment carried out made it possible to achieve complete relief of ear symptoms, restoration of the tympanic membrane and ventilation of the middle ear.

Clinical case of tuberculous otitis media in an adolescent with generalised tuberculosis

Since the incidence of tuberculosis (TB) of the middle ear is low, alertness to this condition among physicians is decreased. The absence of specific clinical signs of the disease results in the late diagnosis of tuberculous otitis media, the development of irreversible changes and extracranial or intracranial complications, which leads to patients' disabilities. The clinical example has demonstrated the development of tuberculous otitis media in the patient with chronic nonspecific inflammation in the middle ear and infiltrative pulmonary TB. The absence of pathognomonic signs led to the late diagnosis of tuberculous otitis media and, consequently, the development of bilateral mesotympanitis. Tuberculous etiology of the disease was suspected based on the case history analysis (drug-refractory chronic otitis media and exposure to TB), clinical and laboratory data (the absence of expressed pain syndrome and normal hemogram values along with expressed changes in the middle ear), active long-lasting pulmonary TB, positive immunological skin test results. The diagnosis was verified by microbiological detection of M. tuberculosis in the ear discharge. Complex treatment of the patient resulted in clinical cure of tuberculous otitis media after 18 months; infiltrative TB led to the development of a tuberculoma after 8 months. The late diagnosis of the disease resulted in surgical treatment (bilateral tympanoplasty, resection of two segments of the left lung).

Tuberculous otitis media in Vietnam: Clinical features and diagnostic difficulties

ObjectivesThe purpose of this article is to draw the attention of otorhinolaryngologists to tuberculous otitis media in the light of two cases illustrating the diagnostic difficulties of this rare form of extrapulmonary tuberculosis, which often presents as subacute otomastoiditis or apparently benign chronic otitis media. It is characterized by symptoms such as atonic tympanic membrane perforation with granulation tissue, absence of any history of otitis media, facial paralysis or severe otosclerosis, and failure to respond to the usual treatments. Case reportsThe first case was a 24-year-old man referred for right chronic otitis media present for 18 months despite topical treatment and tympanoplasty. The second case was a 21-year-old woman referred for right facial paralysis present for 8 days in a context of chronic otitis media, also treated medically for two years and by two tympanoplasties without success. ConclusionThe diagnosis of tuberculous otitis media is not based on histopathological examination, but bacteriological identification of Mycobacterium tuberculosis on an otorrhoea fluid sample collected according to the technique described here. A rigorous clinical approach should ensure early diagnosis and initiation of treatment to prevent complications and severe sequelae.

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

<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results:</strong> 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.</p><p><strong>Conclusions: </strong>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.</p>

Primary tuberculosis of the middle ear cleft: diagnostic and therapeutic considerations

Tuberculosis remains one of the most challenging infectious diseases, which rarely manifests in the middle ear cleft exclusively. Typical symptoms of tuberculosis have become more and more confusing due to the genetic evolution of different Mycobacterium species. In the diagnosis of tuberculous otitis media (TOM), clinical suspicion plays a fundamental role, when topical and/or systemic antibiotic treatment cannot lead to improvement in ear discharge and inflammation. If there is no other reason of persisting otorrhea, microbiological sampling and culturing are the subsequent steps of diagnosis. These investigations, however, have low sensitivity; therefore a canal wall-up mastoidectomy is recommended, which includes the removal of necrotic bone and multiple histological sampling from various locations. Currently, histopathological analysis is the most robust and reliable method in the diagnosis of TOM. Tuberculin skin test, Mycobacterium-specific PCR and interferon-gamma release assay cannot distinguish between active, inactive or post-infective conditions. According to these considerations, these methods may serve as supplementary assays for the final diagnosis. Having the appropriate diagnosis after surgical intervention and laboratory analysis, medical management should be continued by anti-tuberculosis chemotherapy. Hereby, we demonstrate two cases with primary TOM and provide an overview of the literature in the light of diagnostic and therapeutic guidelines in the management of TOM.

Complicated Coexisting Pyogenic and Tuberculous Otitis Media Affecting the Temporozygomatic, Infratemporal, and Parotid Areas: Report of a Rare Entity

We report an unusual case in which a 28-year-old woman presented with a long-standing history of ear discharge, hearing loss, facial weakness with ipsilateral facial swelling and cellulitis, a postauricular fistula, and an abscess of the temporozygomatic, infratemporal, and parotid areas. The pus stained positive for bacteria and acid-fast bacilli, and culture was positive for Proteus vulgaris and mycobacteria. Based on these findings, a diagnosis of tuberculous otitis media with complications was made. Computed tomography showed extensive destruction of the tympanic and mastoid part of the temporal bone, as well as lytic lesions in the skull. The patient was placed on antituberculosis drug therapy. Although her facial nerve palsy and hearing loss persisted, she otherwise responded well and did not require surgery.

Tuberculous otitis media without lung involvement and the risk of airborne transmission

Tuberculous otitis media (TOM)/mastoiditis is a rare disease in developed countries. A delayed diagnosis causes significant morbidities including hearing loss, facial palsy, vertigo, and an intracranial invasion. We present a previously healthy 28-year-old woman working as a respiratory therapist. She had suffered from chronic intermittent otorrhea since June 2006, refractory to medical therapy. Illustrated in Fig. 1A, high resolution of computed tomography of the temporal bone in Aug 2006 suggested right otitis media with mastoid involvement. Significant hearing loss and facial palsy complicated in November 2006. She underwent surgical intervention subsequently, which showed total perforation of the right eardrum and whitish granulation tissue over the right middle ear. The pathologic findings revealed necrotic debris and granuloma formation. The mycobacterium culture of debridement was negative. But, the similar symptoms still bothered her, even though she received antibiotics therapy and additional operation in July 2007. The diagnosis of tuberculous otitis media was confirmed by microbiologic evidence of ear discharge approximately 18 months after her initial presentations. Meanwhile, the

Challenges encountered in the diagnosis of tuberculous otitis media: case report and literature review

To report a rare case of tuberculous otitis media, and to highlight barriers to clinical and microbiological diagnosis. Case report and literature review. Tuberculous otitis media is a rare cause of chronic ear infection in the UK. Its symptoms may mimic a range of other otological conditions, including otitis media, chronic suppurative otitis media, cholesteatoma and necrotising otitis media. This case report highlights the challenges of obtaining a clinical diagnosis of tuberculous otitis media, and emphasises the fact that screening for acid-fast bacilli is not sufficient, in isolation, to rule out mycobacterial infection.

Tuberculous Otitis Media and Lupus Vulgaris of Face: An Unusual Association

Tuberculous otitis media is a rare extra-pulmonary presentation of tuberculosis. Tuberculous otitis media is usually associated with pulmonary tuberculosis or tuberculosis involving nasopharynx and oropharynx. Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. The disease often affects the face and may be associated with nasal or nasopharyngeal tuberculosis. Lupus vulgaris associated with tuberculous otitis media is not reported in English literature. We report a case of 40year old female patient who presented with symptoms of chronic suppurative otitis media and non-healing skin lesion of face. The biopsy of skin lesion showed granulomatous pathology and helped us to reach a diagnosis of tuberculous otitis media.

Tuberculose de l’oreille moyenne

Tuberculous otitis media is a rare disease. Its diagnosis is often made late. We report the case of a 13-year-old girl presenting with a right chronic otitis media and a massive and painful cervical adenitis. High resolution CT-scan revealed cervical and mediastinal adenitis associated with extensive lesions involving the middle ear, mastoid air cells, and sphenoidal bone. The diagnosis of tuberculous otitis media was made on a positive tuberculin skin test and on the identification of Mycobacterium tuberculosis in gastric juices. The young girl progressed well after 9 months of antituberculous chemotherapy.

결핵성 중이염에 대한 임상적 고찰

Background and Objectives: The diagnosis of tuberculous otitis media (TOM) is often delayed because of its rarity, the variable presentation, and the lack of highly sensitive and specific diagnostic methods. This delay may results in permanent morbidities such as hearing loss and other complications. This study was performed to evaluate clinical manifestation of TOM and methods of early diagnosis and treatment. Material and Methods: We reviewed the medical records of 26 patients with TOM treated at Presbytreian Medical Center. The diagnosis of TOM was made by AFB smear, culture, histologic analysis and PCR. Results: The results showed the average age of patients is 30.2 years and male outnumbers female. Most patients showed painless intractable otorrhea, mild to moderate hearing loss and perforated drum with granulation. But multiple perforations, facial palsy, and other complications were not observed. Most of the cases were confirmed pathologically by operative specimen. In only medication group, duration of time for diagnosis was relatively shorter and TM closure rate is 50% without surgical intervention. Conclusion: A high index of suspicion for TOM is required patients who do not respond to standard therapy for non tuberculous infections. Appropriate evaluation for TOM includes AFB smear, culture, PCR of otorrhea and operative biopsy. Early diagnosis and treatment of TOM are important to avoid irreversible complications, surgical intervention, and propagation of the disease. (J Clinical Otolaryngol 2007;18:184–189)

Tuberculous Otitis Media: A Clinical and Radiologic Analysis of 52 Patients

This retrospective study reports on the clinical and radiologic features and the treatment outcomes of patients with tuberculous otitis media (TOM). We reviewed the medical records of 52 patients (53 ears) with TOM between 1993 and 2005 and analyzed temporal bone computed tomography scans of 23 patients. The diagnosis of TOM was made if a specimen of the middle ear revealed the presence of acid fast bacilli (AFB), grew Mycobacterium tuberculosis (M. Tb) on a culture, revealed characteristic histology, and/or was positive for polymerase chain reaction (PCR) for M. Tb. The highest incidence of the disease was observed among patients in their 30s. The main symptom was otorrhea, and the duration of symptoms was shorter than with nonspecific chronic otitis media. Most patients demonstrated a moderate to severe hearing loss. Five patients (9.6%) demonstrated a peripheral-type facial palsy. Temporal bone CT scans demonstrated relatively well-pneumatized mastoids and occupation by soft tissue of the entire tympanum and mastoid air cells. Six patients demonstrated bone destruction that involved the cortex of the mastoid bone. In most patients, antituberculous medication was effective treatment. The patients who underwent chemotherapy after surgery achieved more rapid healing of the ear and more frequent closure of the tympanic membrane than those who did not receive surgery. Clinicians should have a high index of suspicion and be aware of the clinical and radiologic characteristics of TOM.

中耳結核例

We report a case of tuberculous otitis media in a 68-year-old man. The patient complained of left otorrhea, right otalgia and hearing loss. Chronic otitis media was suspected on his first visit, but Ziel-Neelsen staining of the aural discharge resulted in a diagnosis of tuberculous otitis media. Treatment with INH and RFP led to complete healing.In the diagnosis of middle ear infections, it is necessary to bear in mind the possibility of tuberculous and to carry out Ziel-Neelsen staining if there is massive otorrhea in the ear canal. Examination for tuberculous should be done before medication with the new quinolones, some of which are effective against tuberculous.

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.

Die Wertigkeit des mikroskopischen Nachweises säurefester Stäbchen bei der Mittelohrtuberkulose

The microscopic identification of acid-proof rod-shaped bacilli via smear is of great importance for the diagnosis of tuberculous otitis media, since it is performed quickly and easily, for it enables an early diagnosis and treatment. The importance of the staining method using auramine is discussed, and it is examined if contamination by apathogenic or atypic mycobacteriae can yield a wrong positive result.