Tuberculous Otitis Media Research Articles

鼓室形成術後に判明した結核性中耳炎例

Because the suspicion of tuberculous otitis media is low and clinicians are no longer encountering the typical classical features of the disease on a regular basis, there is frequently a considerable delay prior to diagnosis. For that reason, a description of modern features is needed. We report a case of postoperationally diagnosed tuberculous otitis media. The patient had not experienced any otalgia even though the left tympanic membrane had a central perforation. The observation of the tympanic membrane after tympanoplasty revealed that the painless perforation of the tympanic membrane could have been a sufficient feature to indicate tuberculous otitis media. The administration of oral antituberculous drugs can be effective therapy even if the diagnosis is made after tympanoplasty.

Temporal Bone CT Findings of Tuberculous Otitis Media: Comparison with Chronic Otitis Media

Purpose : To compare the differential findings of tuberculous otitis media(TOM) with those of chronic suppu-rative otitis media with or without cholesteatoma, as seen on high resolution temporal bone CT. Materials andMethods : We retrospectively reviewed 14 cases of TOM, 30 cases of chronic suppurative otitis media(CSOM), and 30cases of chronic otitis media with cholesteatoma(Chole). All had been pathologically confirmed. We evaluated thepreservation of mastoid cells without sclerotic change, the location and extension of soft tissue to the externalauditary canal, the erosion of ossicles, the tegmen tympani, scutum, bony labyr inth, facial nerve canal andsigmoid sinus, and the presence of intracranial co mplications. Results : Soft tissue in the mastoid antrum wasseen in all cases of TOM(100%), 29 cases of CSOM(96.7%), and 26 cases of Chole(86.7%). In contrast, the softtissue in the entire middle ear cavity was noted in 13 cases of TOM(92.8%), 7 cases of CSOM(23.3%), and 12 casesof Chole(40%). Soft tissue extended to the superior aspect of the external auditory canal in 4 cases of TOM(28.6%) and 5 cases of Chole (16.7%). Mastoid air cells were seen in 9 cases of TOM (64.3%), 4 cases of CSOM(13.3%), and 3 cases of Chole(10%). Ossicular erosion was noted in 6 cases of TOM (42.9%), 12 cases of CSOM (40%),and 26 cases of Chole(86.7%), while in one case of TOM (7.1%), 5 cases of CSOM (16.7%), and 15 cases of Chole(50%)there was erosion of the scutum. In one case of TOM, follow-up CT study after 9 months of antituberculousmedication without surgery revealed com-plete clearing of previously noted soft tissue in the middle ear cavity.Conclusion : Specific CT findings of TOM were not seen, but if there were findings of soft tissue in the entiremiddle ear cavity, soft tissue extension to the external auditory canal, preservation of mastoid air cells withoutsclerotic change, and intact scutum, TOM may be differentiated from other chronic otitis media.

Three Cases of Tuberculous Otitis Media

Three Cases of Tuberculous Otitis Media

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.

中耳結核例

The case of a 34-year-old man with tuberculous otitis media is reported. He presented with a first chief complaint of deafness in the left ear. A simple central perforation without transdate and without granulation tissue was noted. A tympanoplasty was carried out under the diagnosis of simple otitis media, and it revealed that the cavity from the attic to the mastoid antrum was occupied by a mass of granulation tissue. Since this characteristic finding was found during surgery, tuberculous otitis media was strongly suspected. A tuberculin test, a smear test of the bacterial specimen of the ear transdate and a histopathological examination of the granulation tissue by Zeel-Neelsen stain yielded negative results. However acid fast bacilli were cultured from the sputa and aural discharge. Pulmonary tuberculosis with tuberculous otitis media was finally diagnosed and the patient was treated with adequate antituberculous medication. Most of the tuberculous examination showed negative results in the patient. The only one positive finding was the granulation tissue in the middle ear cavity, which was detected by surgery. It is necessary to repeated lyexamine the ear, and to keep in mind tuberculous otitis media if massive granulation tissue is detected in the middle ear cavity during surgery.

Unusual features of osteoarticular tuberculosis in children

Three children with tuberculous arthritis, two of whom also had tuberculous otitis media, are described. Two of the children were atypical at presentation, with an acute onset of arthritis, an elevated erythrocyte sedimentation rate, and a predominance of polymorphonuclear cells in the joint fluid. Both had histories of recurrent otitis media with perforations. Recognition that Mycobacterium tuberculosis could be the cause of disease in all three cases was delayed. Placement of a tuberculin skin test ultimately led to the correct diagnosis. These cases illustrate that tuberculous arthritis is not always insidious in onset and underscore the need to maintain a high index of suspicion for tuberculosis infection in high-risk patient populations. Our experiences suggest that Mantoux skin tests might be considered part of the “routine” diagnostic study of children with arthritis or recurrent otitis media, especially in communities with high tuberculosis case rates. (J P EDIATR 1996;129:597-602)

Tuberculous Otitis Media

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear and mastoid. The increasing incidence of tuberculosis in the United States may be associated with more cases of TOM than recognized previously. Patients typically have a chronic tympanic membrane perforation and ear drainage associated with progressive and profound hearing loss. The correct diagnosis starts with consideration of the disease in a patient with a chronic middle ear infection that is unresponsive to routine therapy. TOM should be strongly considered in patients with known or suspected tuberculosis and a chronic ear infection; however, the lack of evidence of tuberculosis elsewhere does not exclude the possibility of TOM. Appropriate evaluation for TOM includes a chest film, purified protein derivative (PPD) skin testing, and smears or cultures of otic secretions for mycobacteria. Operative biopsy may be required. Facial nerve paralysis is highly suggestive of TOM. Medical therapy with antituberculous drugs is usually effective, and surgery is rarely needed.

Tuberculous Otitis Media in an HIV-Infected Patient

Tuberculous Otitis Media in an HIV-Infected Patient

Commentary: Tuberculous Otitis Media in AIDS

Commentary: Tuberculous Otitis Media in AIDS

Computed tomography of the temporal bone in tuberculous otitis media

Nine cases of tuberculous otitis media were treated by us over the past 10 years. Six patients presenting with large tympanic membrane perforations were treated for suppurative otitis media at various ENT clinics. The remaining three patients presented without perforation. Intractable otorrhoea, aggravation of hearing loss, dizziness, and in one case facial palsy, resulted in eventual referral to us. Histological examination revealed a tuberculous granulation, confirming the diagnosis in most cases. CT in four cases with profound sensorineural hearing loss showed bone destruction of the otic capsule around the oval window and the promontory. Changes noted included a notch in one case, disappearance of the bony contour around the hook in two cases, and a distinct fistula in the final case. A cochlear fistula seemed to be characteristic of advanced tuberculous otitis media.

원발성 결핵성 중이염 1례

Tuberculous otitis media is one of rare granulomatous disease caused by Mycobacterium tuberculosis and it has been reported to occur usually with tuberculosis of lung. Recently, we experienced a case of tuberculous otitis media without pulmonary tuberculosis in 39 years old male patient. This patient suffered right otorrhea and hearing loss for 4 months and was diagnosed as tuberculosis by biopsy. He had been treated by anti-tuberculosis drug with good result.

最近２年間に経験した耳鼻科領域の結核症例

We have treated 8 patients with tuberculosis in the Department of Otorhinolaryngology of Kimitsuchuo Hospital during the past 2 years.The patients ranged in age from 29 to 70 years (average 53.8 years). Anti-tuberculous chemotherapy was administered to all 8 patients. Seven were cured, but one died of pulmonary tuberculosis.Four of the 8 patients, including all of those with tuberculous otitis media, also had pulmonary tuberculosis, but most of those with tuberculous cervical lymphadenitis did not have pulmonary tuberculosis. Their painless cervical swelling made it difficult in some cases to differentiate tuberculosis from malignancy.A carefully taken personal history is important. The diagnosis should be confirmed with X-ray examination, but finally histopathological studies are required.Early diagnosis and treatment are mandatory.

Tuberculous otitis media: findings on high-resolution CT

We describe two cases of tuberculous otitis media studied with high-resolution computed tomography (CT). Findings included extensive soft tissue densities with fluid levels in the tympanic cavity, the antrum, the mastoid and petrous air cells. Multifocal bony erosions and reactive bone sclerosis were seen as well. CT proved valuable for planning therapy by accurately displaying the involvement of the various structures of the middle and inner ear. However, the specific nature of the disease could only be presumed.

Ein Beitrag zur Klinik und Histopathologie der Mittelohrtuberkulose*

During the past few decades the clinical features of middle ear tuberculosis have changed. Hence, clinical differentiation between tuberculous and non-specific proliferative otitis media and mastoiditis is now difficult. Between 1986 and 1992 five cases of tuberculous otitis media were treated surgically in the ENT-Dept. of the University of Hamburg, representing 0.2% of all performed middle ear operations. According to our experience the therapy of choice is the open mastoid cavity with subsequent chemotherapy to avoid recurrent infections. The advantages of this procedure are proven by actual histopathological findings as well as by the analysis of historical microsections of the Wittmaack temporal bone collection: according to these findings, two different types of histopathological alterations can be differentiated.

頭頚部領域の結核症

Eighteen cases of tuberculosis of the head and neck region are reported.1) Fourteen of the 18 patients had cervical lymphnode tuberculosis, 2 had tuberculous otitis media and 2 had tuberculosis of the larynx.2) Recently, cervical lymphnode tuberculosis has become uncommon, but it is important to differentiate it from malignancy by histopathological and bacteriological studies.3) Fine needle aspiration biopsy (FNA), performed in 9 cases, was positive in 7 cases (77.8%).We conclude that FNA is useful in the diagnosis of cervical lymphnode tuberculosis.

結核性中耳炎の８例について

Eight cases (10 ears) of tuberculous otitis media are reported. These patients visited our clinic between 1988 and 1989. Seven of the 8 cases were previously treated as chronic otitis media at some other E. N. T. clinics. As five of these 8 cases were once treated in a certain clinic, iatrogenic implanted infection at that clinic was strongly suspected. Characteristic features of the symptoms were remedy-resistant otorrhea, otalgia, progressive hearing loss and facial paralysis. Important local findings for diagnosis were pale granulation tissue covered with thick fibrinoid material and presence of bare bone on the promontory. Combined use of antituberculous medicines, such as isoniazid, ethambutol, rifampicin, was effective for treatment. Although facial paralysis and progressive hearing loss occurred during the use of these medicines in the non-operated group, none of these complications were seen in patients who had had surgery before the use of these medicines. Eradication of the infection by surgery may be preferable in some cases of tuberculous otitis, especially in cases with bone erosion on the CT images.

Tuberculous Otitis Media Presenting as Complications: Report of 18 Cases

Tuberculous otitis media is a rare but treatable disease; delay in its diagnosis usually leads to complications. In the last 15 years we have come across 18 cases of tuberculous otitis media, which presented various intra- and extracranial complications. In the past, tuberculous otitis media had always been considered a discrete disease, but it is possible that tuberculosis may coexist or secondarily affect an already discharging ear. The following discussion illustrates the complications and clinical problems encountered in tuberculous otitis media.

結核性中耳炎の一例

The patient was a 26-year-old male clinical laboratory technician who was admitted to our hospital complaining of right intractable otorrhea and hardness of hearing. After tympanoplasty under a diagnosis of chronic otitis media, tuberculous otitis media was diagnosed from the results of the histopathological examination. He was administered antituberculosis drugs (SM, RFP, INH) postoperatively and he is presently being treated as an out-patient with a favorable course. This case is considered to be of primary tuberculous otitis media in which infection with the tubercle bacillus occurred via the external auditory meatus while the patient was working in hospital.

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.

Tuberculous otitis: An underdiagnosed disease

A series of 31 cases (33 ears) of tuberculous otitis was reviewed. Classical findings of the disease, such as painless ottorhea and multiple perforations of the tympanic membrane, are not consistent with the clinical findings reported here. Severe conductive hearing loss, abundant pale granulations, and an eroded malleus handle occur consistently and appear to be important clinical features of the disease. In all cases suspected of tuberculosis, granulation tissue from the middle ear or mastoid was submitted for bacteriologic and histologic examination. As a result, tuberculous otitis was diagnosed in its early stages. In 10 patients (32%), pulmonary tuberculosis was found following confirmation of the tuberculous otitis media. Following 6 months of treatment with oral antituberculous therapy in conjunction with surgery, no evidence of active tuberculosis was present in any of the patients studied.