A rare presentation of Tuberculous otitis media in an immunocompetent adult: Case report and literature review

Background Tuberculous otitis media (TOM) is a rare form of chronic otitis media, which presents diagnostic challenges due to nonspecific symptoms. Aims/objectives To characterize the clinical features and identify strategies for early diagnosis. Materials and methods A retrospective analysis was conducted on 32 patients (40 ears) diagnosed with TOM between 2002 and 2024. Clinical, audiologic, radiologic, and laboratory findings were reviewed. Results Mean diagnostic delay was 28.9 months. Persistent otorrhea (90%) and hearing loss (HL) (100%) were predominant. Tympanic membrane findings varied: single perforation (70%), multiple (12.5%), and intact (17.5%). Granulations were universal. Age stratification revealed conductive HL and pneumatized mastoids predominated in patients <40 years, while mixed HL and mixed-type mastoid were more common in patients >40 years (p = 0.016, p = 0.005). Bone destruction was evident in 25% of the cases. Mastoid type correlated with HL patterns in non-destructive cases (p = 0.040). Interferon-gamma release assay (IGRA) and polymerase chain reaction (PCR) showed relatively high detection rates. Conclusions and significance Early suspicion of TOM in refractory/recurrent otitis media, combined with IGRA/PCR screening, prompt imaging, and consideration of age-specific patterns, facilitates timely diagnosis. Surgical biopsy remains critical for confirmation. Integration of age-stratified clinical, laboratory, and radiological findings improves detection accuracy and patient outcomes.

Introduction: Tuberculosis of the middle ear cleft is a rare extra-pulmonary manifestation. Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult. Material &amp; Methods: Here we present 14 years old, case of malnourished male with a history of poor immunisation and contact TB in neighbourhood was admitted in our hospital in December 2023 with right ear otorrhea, hearing loss, fever with Bezold’s abscess post aurally and peripheral facial nerve paralysis.Ear Discharge was from childhood, the recent episode of fever with post aural swelling developed over 1 week. Examination of right ear showed copious amount of mucopus which was cleaned to visualise granulation tissue with retracted tympanic membrane Conclusion: Tuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas. Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods. Keywords: tubercular, otitis media, facial paralysis, Bezold’s abscess, mastoidectomy

Tuberculous otitis media is a chronic granulomatous disease of the middle ear as well as temporal bone and a rare form of tuberculosis. Diagnosis is difficult due to its unspecific clinical features and a lack of reliable diagnostic tests including microbiological and histopathological examinations. Unfortunately, demonstration of microbiological positivity has been the exception rather than the rule. The polymerase chain reaction test has been recommended as the standard for suspected tuberculous otitis media. In our country, the “National Tuberculosis Elimination Project” has been reduced the numbers of newly-diagnosed tuberculosis since 2010. We recently experienced a case of tuberculous otitis media in young female. Despite the diagnosis was suspected early, it was not confirmed because tuberculosis studies of otorrhea were negative. The objective of this article is to make an awareness of tuberculous otitis media, to present the suggestion for its early diagnosis, and review its diagnostic criteria and treatment.

Abstract: Introduction: Tuberculous otitis media (TOM) is an infrequent ailment. As an uncommon form of extra-pulmonary Tuberculosis, it is often underestimated, leading to a delay in diagnosis and start of appropriate treatment. Case Series: We describe 3 cases of TOM diagnosed and treated in our institute. The typical presentation was prolonged ear discharge not responding to culture sensitive antibiotics, hard of hearing, perforation of tympanic membrane, pale whitish granulation tissue. Pure Tone Audiogram (PTA) done to evaluate the hearing loss. The granulation tissue from all the patients sent for Histopathology examination (HPE) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) examination. CBNAAT results were positive in all three patients. HPE reported as chronic inflammatory pathology. PTA revealed sensorineural hearing loss in 2 patients and conductive hearing loss in 1 patient. Treatment with regular ATT 4FDC (Anti Tubercular Treatment- Four Drug Combination) regimen was started as per weight band for 6 months. Each of them was on follow up and symptomatically improving. Discussion: TOM requires recognition in refractory chronic otitis media. Early diagnosis and intervention are essential to prevent complications and optimise outcomes. The delay in initiating therapy may lead to complications such as facial nerve palsy. This case series aims to highlight the clinical presentation, effective diagnostic modalities and treatment of tuberculous otitis media and stresses the importance of awareness among otorhinolaryngologists regarding TOM and its timely management.

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.

A case report due to atypical case of tuberculous Otitis media: Role of early indicated surgery for early diagnostic challenge

Туберкулезный средний отит является редкой локализацией внелегочных форм туберкулеза. Несмотря на научные достижения в области диагностики, лечения и профилактики заболеваний, вызванных микобактериями туберкулеза, данная проблема до сих пор остается актуальной для врачей различных специальностей. Диагностика туберкулезного поражения среднего уха всегда представляет большие трудности ввиду отсутствия патогномоничных признаков заболевания. Редкость встречаемости подчеркивает важность хирургического лечения с последующим культуральным и патологоанатомическим исследованием. В данной статье рассматривается случай туберкулезного среднего отита у ребенка женского пола в возрасте 3 лет 8 месяцев на момент хирургического лечения. Для диагностики использованы компьютерная томография (КТ), магнитно-резонансная томография (МРТ), патогистологическое, культуральное и бактериологическое исследования. Учитывая редкость встречаемости данного заболевания, мы полагаем, что описание этого клинического случая позволит врачам-оториноларингологам лучше ориентироваться в диагностике специфических форм среднего отита у детей. Tuberculous otitis media is a rare localization of extrapulmonary forms of tuberculosis. Despite scientific advances in the field of diagnosis and treatment, prevention of diseases caused by Mycobacterium tuberculosis, this problem still remains relevant for doctors of various specialties. Diagnosis of tuberculous lesions of the middle ear always presents great difficulties due to the absence of pathognomonic signs of the disease. The rarity of occurrence emphasizes the importance of surgical treatment followed by culture and pathological examination. This article discusses a case of tuberculous otitis media in 3 years 8 months at the time of surgical treatment. Computed tomography (CT), magnetic resonance imaging (MRI), pathohistological, cultural and bacteriological studies were used for diagnosis. Considering the rarity of occurrence of this disease, we believe that the description of this clinical case will allow otorhinolaryngologists to better navigate the diagnosis of specific forms of otitis media in children.

Objective:The purpose of this study was to analyze and summarize the clinical characteristics and diagnostic methods of tuberculous otitis media（TOM）, to enrich clinical experience in diagnosis and treatment of tuberculous otitis media, so as to reduce missed diagnosis and misdiagnosis, and facilitate timely and effective therapy for better prognosis. Methods:This study retrospectively analyzed the clinical data of patients with tuberculous otitis media who were hospitalized in the Ear ward of our hospital and received surgical treatment from 2008 to 2022. The data of patients' clinical characteristics, radiological examination, intraoperative findings and therapeutic strategies were recorded and summarized. Results:A total of 23 cases （26 ears） of tuberculous otitis media were included in this retrospective study. The most common clinical symptoms were otorrhea（thin odorless fluid）（100%） and conductive hearing loss（100%）, with a high incidence of facial paralysis（23.1%）. It was not sensitive to traditional antibiotic treatment, eg. Levofloxacin （50% effective rate only）, and relapsed soon after drug withdrawal. It was revealed that all the surgical views had gray and white tough granulation tissue hyperplasia（100%）, and 23.1% with caseous necrosis. The purpose of surgery was to clear the lesion, reduce the recurrence rate of suppurative infection, and repair the function （hearing reconstruction or facial nerve decompression） as appropriate. The paraffin pathology of granulation tissue were reported as typical granulomatous inflammation and caseous necrosis with positive acid-fast staining, which was consistent with tuberculosis. Conclusion:It was easily confused by the clinical manifestations of tuberculous otitis media and common chronic suppurative otitis media. When met with the following conditions, we should pay highly attention to suspect tuberculous otitis media: The severity of local manifestations did not match with the length of the disease; with poor tympanic membrane at the early stage with no obvious cholesteatomas, with facial paralysis or hearing loss early onset; insensitive to traditional antibiotic treatment; with extensive granulation appeared in the tympanum and or mastoid cavity, with or without caseous necrosis or dead bone in the early days. The diagnosis should be confirmed based on the acid-fast staining of the histopathological section to detect positive acid-fast bacilli. Meanwhile, multiple laboratory examination methods（such as T-spot and PCR） should be integrated synchronously to help support the diagnosis.

Tuberculosis (TB) constitutes 15-20% of TB cases in general practice among HIV-negative adults in India. The head and neck region provides an impressive field of research because of its varied presentations and different sites of involvement. TB may often mimic malignancy and is misdiagnosed, which leads to an unnecessary delay in diagnosis. Through this study, we aim to draw focus on the various ways in which isolated extrapulmonary TB manifests in today's clinical practice in the head and neck region. Prospective analysis of 60 patients diagnosed with TB in a simple random sampling over 1year. The period of study was from July 2022 to June 2023. All those patients who presented to the ENT OPD of Civil Hospital of Asarwa. Patients with complete clinical data were included in the study. In our study patients in the 3rd and 4th decade of life were most commonly affected and a male preponderance of the disease was seen. The most common presentation of EPTB in the head and neck region is cervical lymphadenitis, followed by tuberculous otitis media and laryngeal TB. Each of these has a characteristic clinical presentation that helps to identify this disease. Fine needle aspiration cytology is a very efficient cytopathological examination method that helps in the diagnosis of the disease. Special care should be taken in patients in whom other routine conventional medical and surgical therapy fail to show the desired outcome. Special care and a high degree of suspicion are needed to diagnose extrapulmonary TB. Once rightly diagnosed, it will prevent the progression of the disease and its complications.

Although tuberculosis has become more common in recent years, it still accounts for just a small percentage of cases of chronic otitis media. Common symptoms of tuberculous otitis media (TOM) include otorrhoea, hearing loss, and multiple tympanic membrane perforations. Due to its rarity, the illness is frequently misdiagnosed. When a patient does not improve with standard antibacterial and antifungal treatment, this may be a possible diagnosis to explore. Complete healing is possible if the illness is diagnosed and treated timely to prevent consequences.

Co-infection with Neisseria mucosa in a patient with tuberculous otitis media

To determine the initial clinical diagnoses of patients with tuberculous otitis media (TBOM), to determine the value of PCR test, biopsy, and ancillary diagnostic procedures in detecting middle ear TB infection, and to establish the differences in treatment outcomes. The clinical records of twenty-eight patients identified with middle ear TB infection by PCR test and biopsy, from January 2010 to December 2016, were reviewed to determine their initial clinical diagnoses. The positivity rates of PCR test and biopsy were compared. The records of 12 patients included in a previous publication were revisited and included in the present study population. The combined cases were classified according to clinical diagnosis to constitute a summary of demographic characteristics, clinical diagnoses, laboratory tests, and treatment outcomes. Results of diagnostic and surgical procedures were reviewed and analyzed. Clinical findings and hearing test results before and after treatment were compared. Of the 28 patients, eight different clinical diagnoses of patients confirmed with middle ear TB were determined. PCR test diagnosed most cases belonging to the early and chronic stages of the disease process. Biopsy diagnosed mostly the chronic cases but failed to diagnose acute cases and late cases with diagnosis of chronic suppurative otitis media with cholesteatoma. By including the twelve cases that were published in 2011, the range of clinical diagnoses was expanded and an outcome of eleven clinical diagnoses confirmed with TB infection was established. Analysis of treatment outcomes showed that the clinical and hearing outcomes were better for patients managed at the early stage of the disease than for those presenting at the late stages of the disease process who underwent more complicated surgical procedures. Our study supports the concept of tuberculous otitis media (TBOM) clinical spectrum, implying a paradigm shift in the established thinking that TBOM presents only as a chronic disease. The combined use of PCR and biopsy is a potential diagnostic tool to improve case detection rate, further broaden the scope of the clinical spectrum, and develop better control and preventive strategies for TBOM.

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).

Nontuberculous mycobacteria otomastoiditis with facial palsy.

Bilateral Tuberculous Otitis Media with Cerebellar Abscess in an Immunocompromised Child

BackgroundPrimary tuberculous otitis media is rare in the paediatric age group, and its neuro-otogenic complication of involvement of cerebellopontine angle in a child is very unusual. Tuberculosis should always be considered as a rare but possible aetiology for such neuro-otogenic lesions.Case presentationWe report a case of a 13-year-old female patient who presented with left ear discharge and mass-like lesion on otoscopy. High-resolution computed tomography (HRCT) temporal bone showed erosion of petrous temporal bone, external auditory canal and ossicles. Contrast-enhanced MRI (CEMRI) revealed peripherally enhancing hetero-intense lesion epicentred in the petrous and mastoid part of left temporal bone extending into the left cerebellopontine angle and external auditory canal. Homogenously enhancing soft tissue was seen in the left occipital condyle with sigmoid sinus thrombosis and cervical lymphadenopathy. There was also a single enhancing left temporal lobe lesion. Radiological and clinical assessment was suggestive of malignant aetiology. However, biopsy revealed tuberculosis and anti-tubercular therapy (ATT) was initiated. Interval imaging showed an adequate response to treatment.ConclusionsTuberculous otitis media often masquerades as malignancy on clinical and imaging assessment.

Tuberculous otitis media is not a common disease, especially in developed countries. Its low incidence and manifestation mimicking other diseases often results with delayed diagnosis and wrong treatment. A 29-year-old women presented to ENT department with history of bilateral acute otitis media not responding to regular treatment. Multiple tympanic membrane perforations noticed in the course of disease suggested tuberculosis. To confirm the diagnosis multiple examinations were performed: Quantiferon Test, traditional culture of Mycobacterium tuberculosis and genetic test. The patient responded well to anti-TBC treatment, however some of the damages done are irreversible and some requires adequate reconstructional treatment. This case emphasize that it is important to remain watchful, as tubercoulous otits media is often misdiagnosed. Proper early diagnosis may prevent further damage as chemotherapy is usually very effective and in most cases complete healing is achieved.

Tuberculous otitis media is a rare entity which requires high index of suspicion in an endemic country like India. A 38-year-old female with no prior history of tuberculosis or any predisposing factor presented to us with fever and altered sensorium. She was subsequently diagnosed to have disseminated tuberculosis with multiple cerebral tuberculomas. She complained of ear discharge which on further evaluation was established as smear positive tuberculous otitis media. This rare coexistence is seldom reported in literature.

The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP. Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18months with diagnosed EPTB of the otorhinolaryngeal regions. The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis. A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity.