Clinical spectrum of Tuberculosis Otitis Media (TBOM) and management outcomes

Objectives@#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. @*Methods@#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. @*Results@#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. @*Conclusion@#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.

Aggressive tuberculous otitis media in a young child

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: The aim of this report is to describe an aggressive case of tuberculous otitis media in a young child and emphasize that surgical intervention and histopathologic studies can be employed to immediately arrive at a definitive diagnosis.</p><p style="text-align: justify;"><strong>METHODS:</strong></p><p style="text-align: justify;"><strong>          Design:</strong>           Case Report</p><p style="text-align: justify;"><strong>          Setting:           </strong>Tertiary Government Training Hospital</p><p style="text-align: justify;"><strong>          Participants:</strong>  One</p><p style="text-align: justify;"><strong>RESULTS</strong>: This is a case of a four-year-old boy who had refractory otitis media and erosive CT scan findings, mimicking aggressive CSOM manifestations. Due to unusual intraoperative granulation tissue characteristics, it was initially considered a malignancy, necessitating surgical intervention and biopsy that resulted in a definitive diagnosis of primary middle ear tuberculosis.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This case represents the more severe end of the spectrum of tuberculous otitis media and supports the recommendation that a high index of suspicion, early detection, and prompt initiation of treatment are imperative in its management, especially in children with refractory otitis media.</p><p><strong> </strong></p>

Tuberculosis en otorrinolaringología. Reporte de 3 casos / Tuberculosis in otolaryngology. Report of 3 cases / Tuberculose em otorrinolaringología. Relatório de 3 casos

La tuberculosis extrapulmonar suele ser una presentación poco frecuente. Aunque la vía respiratoria alta es la vía de entrada del Mycobacterium tuberculosis, su afectación es rara (menos del 2%), siendo la localización ótica, laríngea y nasofaríngea de carácter excepcional, pudiéndose presentar tanto de forma primaria como secundaria a una lesión pulmonar. Se describen tres formas de presentación de tuberculosis extrapulmonar, resaltando la importancia de su sospecha clínica; fundamental para el diagnóstico. Se reporta un caso de tuberculosis laríngea como presentación primaria; un caso de tuberculosis faríngea como presentación secundaria y un caso de presentación ótica en un paciente inmunocomprometido. Debido al aumento en los últimos años de esta enfermedad es necesario tenerla presente como diagnóstico diferencial. Se destacan las dificultades en su detección, ya que no existen características exclusivas de la tuberculosis. La importancia del diagnóstico precoz radica en que es una enfermedad con buena evolución si es tratada oportunamente.

Extrapulmonary tuberculosis is usually an uncommon presentation. Although the upper respiratory tract is the entry route of the Mycobacterium tuberculosis, its involvement is rare (less than 2%), being the otic, laryngeal and nasopharyngeal localization exceptional, being able to present both primary and secondary to a lung injury. Three forms of presentation of extrapulmonary tuberculosis are described highlighting the importance of their clinical suspicion; fundamental for the diagnosis. A case of laryngeal tuberculosis is reported as primary presentation; a case of pharyngeal tuberculosis as a secondary presentation and a case of otic presentation in an immunocompromised patient. Due to the increase in recent years of this disease it is necessary to keep it in mind as a differential diagnosis. The difficulties in its detection are highlighted, since there are no exclusive characteristics of tuberculosis. The importance of early diagnosis lies in the fact that it is a disease with good evolution if it is treated opportunely.

A tuberculose extrapulmonar é geralmente uma apresentação incomum. Embora a via aérea superior é o Mycobacterium tuberculosis porta de entrada, o seu envolvimento é rara (menos do que 2%), a localização ótica, da laringe e da nasofaringe excepcional, sendo possível que tanto na forma primária como secundária à lesão do pulmão. Três formas de apresentação da tuberculose extrapulmonar são descritas, destacando a importância de sua suspeita clínica; fundamental para o diagnóstico. Um caso de tuberculose laríngea é relatado como apresentação primária; um caso de tuberculose faríngea como apresentação secundária e um caso de apresentação ótica em paciente imunocomprometido. Devido ao aumento nos últimos anos desta doença é necessário ter isto em mente como um diagnóstico diferencial. As dificuldades em sua detecção são destacadas, uma vez que não existem características exclusivas da tuberculose. A importância do diagnóstico precoce reside no fato de ser uma doença com boa evolução se tratada oportunamente.

Development of attic cholesteatoma in acute otitis media with tuberculosis

@#<p style="text-align: justify;">Literature has reported the existence of cholesteatoma in chronic suppurative otitis media with tuberculosis. This report demonstrates that a cholesteatoma can be associated with an acute otitis media with tuberculosis. The importance of a high index of suspicion for tuberculous otitis media and its consequent meticulous management including diagnostic tests, medical and surgical procedures and monitoring are discussed.</p>

Tuberculous Otitis Media.

Considerable variation exists between the clinical presentation of tuberculous otitis media (TOM) seen nowadays and what was described earlier. Confusing clinical picture and subsequent delay in diagnosis of TOM permits it to progress unhindered and results in permanent disabling conditions like facial paralysis and profound hearing loss. Hence an early diagnosis of TOM and timely commencement of appropriate therapy remains a challenging task. A high index of suspicion is required on part of the clinician to diagnose this fabled entity.

Otomastoiditis tuberculosa: a propósito de un caso / Tuberculous Otomastoiditis: a clinical case

La tuberculosis (TBC), es una de las patologías infecciosas más estudiadas en medicina. En Chile, la incidencia de TBC en 2008 fue de 13,7 por 100,000 habitantes, situando al país en fase de eliminación y con la menor incidencia en América Latina. Las publicaciones internacionales consideran que la otitis media por TBC (OMT) es una forma de presentación clínica muy infrecuente de TBC con una incidencia que oscila entre un 0,05 y un 0,9 por ciento de las otitis media crónicas. La población más afectada es la menor de quince años, lo que constituye el 85 por ciento de los casos. En Chile no se cuenta con datos epidemiológicos de dicha patología. El objetivo de esta publicación es dar a conocer un caso clínico de OMT complicada con otomastoidistis, en un paciente del hospital de niños Dr. Roberto de Río de Santiago, Chile y revisar la información disponible en la literatura para concientizar a la población médica.

Tuberculosis (TB) has been one of the infectious diseases most studied in the history of medicine. In Chile, TB incidence was 13.7 per 100,000 inhabitants in 2008, being the country with the lowest incidence in Latin America. World-wide publications consider tuberculous otitis media (TOM) as a very rare form of TB presentation, constituting 0.05 to 0.9 percent of chronic otitis media. Population younger than 15 years old is the most vulnerable, 85 percent of the cases belongs to this range of age. Chile has not epidemiological data available on this pathology. The aims of this article are to show a clinical case of TOM and posterior otomastoiditis, in an infant hospitalized in Roberto del Rio Children's Hospital in Santiago de Chile and review the literature about this pathology, in order to raise awareness for doing an opportune diagnosis of this condition.

Tuberculous Otitis Media-Review of the Cases- / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of tuberculosis has decreased over the last decades because of antituberculous chemotherapy and this was not an exception in Korea where the tuberculous disorder was once the major problem of public health until 1980. The clinical features of tuberculous otitis media (OM) have a tendency to be changed so that it is different from the description in the textbook. The reports about tuberculuos OM have been very rare until recently. The purpose of this study is to analysis cases of tuberculous OM for 13 years and to be helpful to apply the early diagnosis and differential diagnosis of other OM. MATERIALS AND METHODS: Author reviewed retrospectively 23 patients who underwent middle ear surgery from 1986 to 1998 at Pusan National University Hospital and were comfirmed Tuberculous OM pathologically. RESULTS: The incidence of tuberculous OM was 0.61% of total 3801 cases of middle ear surgery and it was prevalent in age group below thirty. The local findings of tympanic membrane showed variable and multiple perforation was very rare. 56.5% of the cases showed findings suggesting bony destruction. AFB stain revealed no acid fast bacilli in all cases, but 61.6% showed mixed infection with other bacterial organisms. Mostly the tuberculous OM was primary tuberculosis (73.9%). The duration of antituberculous chemotherapy until dry-up state were within 5 months mostly. CONCLUSION: The importance of tuberculous OM as a part of general increase in the incidence and the variable clinical findings were reviewed.

A Clinical, Radiologic Study of Tuberculous Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tuberculous otitis media is not commonly found nowadays, and therefore, the index of suspicion is often low. However, once contracted, it can cause significant morbidities, such as profound hearing loss, labyrinthitis, facial nerve palsy and so on, if early diagnosis and treatment are not performed. MATERIALS AND METHODS: In the chronic otitis media patients who visited Masan Samsung Hospital from Jan. 1993 to Jan. 1996, 37 cases of pathologically proven tuberculous otitis media were retrospectively reviewed. And temporal bone computerized tomography (TBCT) of 14 cases of tuberculous otitis media were compared to those of chronic suppurative otitis media and choronic otitis media with cholesteatoma. RESULTS: 1) Classic clinical findings of the disease such as multiple perforation, painless otorrhea, young age are not consistent with the clinical findings reviewed here. 2) Unexpectedly severe hearing loss, facial paralysis, eroded malleus handle, polypoid granulation or necrotic debris in middle ear cavity were significant clinical features. 3) In TBCT findings, soft tissue density in the entire middle ear cavity, soft tissue density extension to superior external auditory canal, poor sclerotic change of mastoid air cell were more common than other types of chronic otitis media. 4) Most of cases were confirmed by operative specimen pathologically. 5) Delayed healing of postoperative wound and formation of granulation tissue suggested tuberculous otitis media. 6) Antituberculous chemotherapy provided effective means of treatment. CONCLUSION: Early diagnosis by pathologic examination of biopsied tissue obtained at OPD was mandatory to avoid complication and postoperative morbidity. Postoperative specimen obtained from middle ear surgery must be confirmed pathologically.

A Case of Primary Tuberculous Otitis Media with Lateral SinusThrombosis and Subperiosteal Abscess / 대한이비인후과학회지

Tuberculosis of the middle ear is a disease rarely encountered in recent years. Because what used to be the typical clinical signs of this disease have been changed in recent years and the index of suspicion being low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications. A case of tuberculous otitis media complicated with lateral sinus thrombosis and subperiosteal abscess is reported with review of the literature, emphasizing the fact that this entity must be considered in the differential diagnosis of persistent suppurative otitis media.